Recent discussions of the doctrine of double effect have contained improved versions of the doctrine not subject to some of the difficulties of earlier versions. There is no longer one doctrine of double effect. This essay evaluates four versions of the doctrine: two formulations of the traditional Catholic doctrine, Joseph Boyle's revision of that doctrine, and Warren Quinn's version of the doctrine. I conclude that all of these versions are flawed. Keywords: double effect, intention, Joseph Boyle, medical ethics, Warren Quinn (...) CiteULike Connotea Del.icio.us What's this? (shrink)
Opponents of human embryonic stem cell (hESC) research claim that such research is incompatible with the moral principle that it is always wrong intentionally to end a human life. In this essay, I discuss how that principle might be revised so that it is subject to as few difﬁculties as possible. I then argue that even the most defensible version of the principle is compatible with the moral permissibility of hESC research.
According to Carson Strong, the future of value account of the wrongness of killing is subject to counterexamples. Ezio Di Nucci has disagreed. Their disagreement turns on whether the concepts of a future of value and a future like ours are equivalent. Unfortunately, both concepts are fuzzy, which explains, at least in part, the disagreement. I suggest that both concepts can be clarified in ways that seem plausible and that makes them equivalent. Strong claims that better accounts of the wrongness (...) of killing exist. I show that those alternative accounts are unsatisfactory. (shrink)
The doctrine that it is wrong to end the existence of something because it is a human life I call “the standard view.” I argue that attempts by proponents of abortion choice to avoid the implications of the standard view by suggesting that we don't know when life begins or by suggesting that fetuses are only potential lives fail. Nevertheless, opponents of abortion choice should not base their arguments on the standard view, for the standard view is false. I propose (...) a substitute for the standard view that avoids the difficulties with it, that explains why most people believe that the standard view is true and that also underwrites opposition to abortion choice. (shrink)
The three major classical accounts of the morality of abortion are all subject to at least one major problem. Can we do better? This article aims to discuss three accounts that purport to be superior to the classical accounts. First, it discusses the future of value argument for the immorality of abortion. It defends the claim that the future of value argument is superior to all three of the classical accounts. It then goes on to discuss Warren's attempt to fix (...) up her personhood account and David Boonin's attempt to fix up Tooley's desire account. Warren claims that her updated version of a personhood account is superior to any potentiality account, such as the future of value account. The article evaluates her claim. Boonin argues that his improved desire view both deals adequately with the apparent counterexamples to Tooley's original account and also is superior to the future of value account. The article evaluates his views as well. (shrink)
The surgical treatment of breast cancer has changed in recent years. Analysis of the research that led to these changes yields apparently good arguments for all of the following: (1) The research yielded very great benefits for women. (2) There was no other way of obtaining these benefits. (3) This research violated the fundamental rights of the women who were research subjects. This sets a problem for ethics at many levels.
Conversion of slowly accruing conventionally randomized studies to a prerandomized design has apparently been successful in increasing accrual enough so that some of these studies can be completed. Ellenberg (1984) has pointed out some of the ethical dangers of prerandomization. This paper argues that prerandomization must be either unsuccessful or unethical: either conversion to prerandomization will result in no significant increase in the rate of completion of the study or a significant increase in accrual rate will be achieved either at (...) the price of an inadequate attempt to obtain informed consent, at the price of the deceit of patients, or at the price of violations of patient autonomy. The argument of the paper can be sketched as follows: For any given randomized study, either patients prefer one treatment arm to the other or they do not. On the one hand, if they do, then conventional randomization fails. But prerandomization, if done ethically, will fail also. Hence, if prerandomization succeeds in this sort of case, then the trial has been conducted unethically. On the other hand, if patients do not prefer One arm to the other, then prerandomization will succeed. So will conventional randomization. Hence, prerandomization is either unnecessary or unethical. Ellenberg's concerns count as good moral reasons for not prerandomizing if prerandomization is unnecessary. It follows that prerandomization is always wrong. (shrink)
An apparent ethical dilemma arises when physicians consider enrolling their patients in randomized clinical trials. Suppose that a randomized clinical trial comparing two treatments is in progress, and a physician has an opinion about which treatment is better. The physician has a duty to promote the patient's best medical interests and therefore seems to be obliged to advise the patient to receive the treatment that the physician prefers. This duty creates a barrier to the enrollment of patients in randomized clinical (...) trials.1-10 Two strategies are often used to resolve the dilemma in favor of enrolling patients in clinical trials. (shrink)