In recent years, the notion of a reason has come to occupy a central place in both metaethics and normative theory more broadly. Indeed, many philosophers have come to view reasons as providing the basis of normativity itself . The common conception is that reasons are facts that count in favor of some act or attitude. More recently, philosophers have begun to appreciate a distinction between objective and subjective reasons, where (roughly) objective reasons are determined by the facts, while subjective (...) reasons are determined by one's beliefs. My goal in this paper is to offer a plausible theory of subjective reasons. Although much attention has been focused on theories of objective reasons, very little has been offered in the literature regarding what sort of account of subjective reasons we should adopt; and what has been offered is rather perfunctory, and requires filling-out. Taking what has been said thus far as a starting point, I will consider several putative theories of subjective reasons, offering objections and amendments along the way, will settle on what I take to be a highly plausible account, and will defend that account against objections. (shrink)
Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based. The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is “yes.” I argue that a patient’s autonomy is not (...) respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient’s previous values must be in that patient’s best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. (shrink)
Don Marquis’s “future-like-ours” argument against the moral permissibility of abortion is widely considered the strongest anti-abortion argument in the philosophical literature. In this paper, I address the issue of whether the argument relies upon controversial metaphysical premises. It is widely thought that future-like-ours argument indeed relies upon controversial metaphysics, in that it must reject the psychological theory of personal identity. I argue that that thought is mistaken—the future-like-ours argument does not depend upon the rejection of such a theory. I suggest, (...) however, that given a widely-accepted view about contraception and abstinence, the argument is committed to contentious metaphysics after all, as it relies upon a highly controversial assumption about mereology. This commitment is not only relevant for those who are inclined to endorse the argument but reject the mereological view in question, but in addition entails dialectical and epistemological liabilities for the argument, which on some views will be fatal to the argument’s overall success. (shrink)
In this article, I argue that professional healthcare organizations such as the AMA and ANA ought not to take controversial stances on professional ethics. I address the best putative arguments in favor of taking such stances, and argue that none are convincing. I then argue that the sort of stance-taking at issue has pernicious consequences: it stands to curb critical thought in social, political, and legal debates, increase moral distress among clinicians, and alienate clinicians from their professional societies. Thus, because (...) there are no good arguments in favor of stance-taking and at least some risks in doing so, professional organizations should refrain from adopting the sort of ethically controversial positions at issue. (shrink)
Morality is commonly thought to be normative in a robust and important way. This is commonly cashed out in terms of normative reasons. It is also commonly thought that morality is necessarily and universally normative, i.e., that moral reasons are reasons for any possible moral agent. Taking these commonplaces for granted, I argue for a novel view of moral normativity. I challenge the standard view that moral reasons are reasons to act. I suggest that moral reasons are reasons for having (...) sentiments—in particular, compassion and respect—and I argue that this view has important advantages over the standard view of moral normativity. (shrink)
It is a platitude that morality is normative, but a substantive and interesting question whether morality is normative in a robust and important way; and although it is often assumed that morality is indeed robustly normative, that view is by no means uncontroversial, and a compelling argument for it is conspicuously lacking. In this paper, I provide such an argument. I argue, based on plausible claims about the relationship between moral wrongs and moral criticizability, and the relationship between criticizability and (...) normative reasons, that moral facts necessarily confer normative reasons upon moral agents. (shrink)
This chapter discusses the moral framework for surrogate decision-making for incompetent medical patients. The chapter focuses on the question of how we can respect the autonomy of those who are no longer competent to make such decisions. The standard counterfactual account of how to respect the autonomy of the incompetent is evaluated, along with accounts that ground respect for autonomy on the patient’s most recent desires and values (regardless of whether the patient still possesses those desires and values) as well (...) as accounts according to which only the current desires and values of the patient matter. Other issues discussed include whether questions of personal identity should affect decision-making for incompetent patients, whether a patient’s former desires and values factor in to the patient’s current well-being, and whether an incompetent patient’s “investment interests” should guide decisions on the patient’s behalf. (shrink)
This paper aims to refute a common line of argument that it is immoral for physicians to engage in medical assistance in death (MAiD), i.e., the practices of euthanasia and physician-assisted suicide. The argument in question is based on the notion that participating in MAiD is contrary to the professional-role obligations of physicians, due to MAiD’s putative inconsistency with the ends of medicine. The paper describes several major flaws from which that argument suffers.
This paper argues for a novel sentimentalist realist metaethical theory, according to which moral wrongness is analyzed in terms of the sentiments one has most reason to have. As opposed to standard sentimentalist views, the theory does not employ sentiments that are had in response to morally wrong action, but rather sentiments that antecedently dispose people to refrain from immoral behavior, specifically the sentiments of compassion and respect.
Since the onset of the COVID-19 pandemic, a controversial criterion for allocating scarce medical treatment has been defended and incorporated into policy: the criterion of equity. Equity-included allocation schemes prioritize, to some degree, patients from marginalized or historically disadvantaged racial/ethnic groups, or patients with low socioeconomic status, for scarce treatment. The use of such criteria has been most prominently defended in two ways: (1) as reflecting a risk factor for severe COVID-19, and thus as a way of tracking medical need, (...) and (2) as a form of remedial justice, viz. a way of redressing disparities in COVID outcomes that are caused by underlying unjust social conditions. Here, we delineate and critique those arguments. We argue that not only are such arguments unconvincing but also that there are compelling moral reasons to reject the sort of equity-included allocation schemes at issue. (shrink)
It is nearly universally thought that the kind of decision-making competence that gives one a strong prima facie right to make one's own medical decisions essentially involves having an ability (or abilities) of some sort, or having a certain level or degree of ability (or abilities). When put under philosophical scrutiny, however, this kind of theory does not hold up. I will argue that being competent does not essentially involve abilities, and I will propose and defend a theory of decision-making (...) competence according to which one is competent only if one possesses a certain kind of rationality in making treatment decisions. (shrink)
Matthew Tedesco has argued that Alvin Plantinga’s argument that belief in naturalistic evolution is self-defeating entails, according to a parallel argument, that theistic belief is self-defeating for the same reasons. I defend Plantinga against this charge by arguing that the parallel argument is unsound.
In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision-making and policy-formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non-bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view (...) that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error. (shrink)
This paper proposes and employs a framework for determining whether life-saving treatment at birth is in the best interests of extremely preterm infants, given uncertainty about the outcome of such a choice. It argues that given relevant data and plausible assumptions about the well-being of babies with various outcomes, it is typically in the best interests of even the youngest preterm infants—those born at 22 weeks gestational age—to receive life-saving treatment at birth.