Physician-Assisted Death is the eleventh volume of Biomedical Ethics Reviews. We, the editors, are pleased with the response to the series over the years and, as a result, are happy to continue into a second decade with the same general purpose and zeal. As in the past, contributors to projected volumes have been asked to summarize the nature of the literature, the prevailing attitudes and arguments, and then to advance the discussion in some way by staking out and arguing forcefully (...) for some basic position on the topic targeted for discussion. For the present volume on Physician-Assisted Death, we felt it wise to enlist the services of a guest editor, Dr. Gregg A. Kasting, a practicing physician with extensive clinical knowledge of the various problems and issues encountered in discussing physician assisted death. Dr. Kasting is also our student and just completing a graduate degree in philosophy with a specialty in biomedical ethics here at Georgia State University. Apart from a keen interest in the topic, Dr. Kasting has published good work in the area and has, in our opinion, done an excellent job in taking on the lion's share of editing this well-balanced and probing set of essays. We hope you will agree that this volume significantly advances the level of discussion on physician-assisted euthanasia. Incidentally, we wish to note that the essays in this volume were all finished and committed to press by January 1993. (shrink)

Critics of international trade agreements often cast them as threats to human health, and they can point to some sobering warnings from world history. Infectious diseases have swept across political boundaries, carried by traders, colonists, and other agents of globalization. Transnational epidemics have laid economies low, undermining political stability. The spread of viruses and bacteria to peoples previously unexposed and therefore lacking immunity has decimated populations and changed the political course of continents. Trade, exploration, and warfare have repeatedly produced encounters (...) between peoples at different levels of agricultural and technological development. Often, the results have been devastating for the disadvantaged group — economic marginalization, loss of sovereignty and culture, and collapse of public health. Yet the rise of civilization — plant and animal domestication, division of labor, technology, and resulting prosperity — was powered in large part by movement of products and knowledge along routes of trade and migration. (shrink)

Critics of international trade agreements often cast them as threats to human health, and they can point to some sobering warnings from world history. Infectious diseases have swept across political boundaries, carried by traders, colonists, and other agents of globalization. Transnational epidemics have laid economies low, undermining political stability. The spread of viruses and bacteria to peoples previously unexposed and therefore lacking immunity has decimated populations and changed the political course of continents. Trade, exploration, and warfare have repeatedly produced encounters (...) between peoples at different levels of agricultural and technological development. Often, the results have been devastating for the disadvantaged group — economic marginalization, loss of sovereignty and culture, and collapse of public health. Yet the rise of civilization — plant and animal domestication, division of labor, technology, and resulting prosperity — was powered in large part by movement of products and knowledge along routes of trade and migration. (shrink)

Taking notice of race is both risky and inevitable, in medicine no less than in other endeavors. The literature on race as a classifying tool in clinical research poses this core dilemma: On the one hand, race can be a useful stand-in for unstudied genetic and environmental factors that yield differences in disease expression and therapeutic response. On the other hand, racial distinctions have social meanings that are often pejorative or worse, especially when these distinctions are cast as culturally or (...) biologically fixed. Our country's troubled past in this regard and the persistence of race-related disadvantage should keep us on notice about this hazard. Yet paying attention to race in order to ameliorate past wrongs sometimes supports the quest for social justice, as Dorothy Roberts points out in this issue. And at times, as Jay Cohn and Raj Bhopal note, attention to race can make a therapeutic difference, to the point of saving lives. (shrink)

Some of the commentators on Intricate Ethics complain of my method. One finds the main ideas ‘Kammouflaged’ because the relevant causal distinctions are so fine-grained and the cases that illustrate them so numerous. Some say that they do not have the intuitions about many cases that I have, that I concoct dubious and ad hoc distinctions and invest them with moral significance; I am Ptolemaic in that new crystalline spheres and epicycles are constantly being added in an attempt to fix (...) the appearances. (shrink)

Taking notice of race is both risky and inevitable, in medicine no less than in other endeavors. On the one hand, race can be a useful stand-in for unstudied genetic and environmental factors that yield differences in disease expression and therapeutic response. Attention to race can make a therapeutic difference, to the point of saving lives. On the other hand, racial distinctions have social meanings that are often pejorative or worse, especially when these distinctions are cast as culturally or biologically (...) fixed. I argue in this essay that we should start with a presumption against racial categories in medicine, but permit their use when it might prolong lives or meaningfully improve health. Use of racial categories should be understood as an interim step; follow-up inquiry into the factors that underlie race-correlated clinical differences is important both to improve the efficacy of clinical care and to prevent race in itself from being misunderstood as a biological determinant. If we pursue such inquiry with vigor, the pernicious effects of racial categories on public understanding can be managed. But perverse market and regulatory incentives create the danger that use of race will be “locked-in,” once drugs or other therapies are approved. These incentives should be revisited. (shrink)

A chilling subplot in the twentieth-century saga of state-sponsored mass murder, torture, and other atrocities was the widespread incidence of medical complicity. Nazi doctors' human and assistance in genocidal killing are the most oft-cited exemplar, but wartime Japanese physicians' human vivisection and other grotesque practices rivaled the Nazi medical horrors. Measured by these standards, Soviet psychiatrists' role in repressing dissent, Latin American and Turkish military doctors' complicity in torture, and even the South African medical profession's systematic involvement in apartheid may (...) seem, to some, almost prosaic. Yet these and other reported cases of medical complicity in human rights abuse compel an inquiry into medicine's vulnerability to becoming an adjunct to illicit state purposes. (shrink)

Bioethical Prescriptions collects F.M. Kamm's articles on bioethics -- revised for publication in book form -- which have appeared over the last 25 years and which have made her among the most widely-respected philosophers working in this field.

Ethics for Enemies comprises three original philosophical essays on torture, terrorism, and war. F. M. Kamm deploys ethical theory in her challenging new treatments of these most controversial practical issues. First she considers the nature of torture and the various occasions on which it could occur, in order to determine why it might be wrong to torture a wrongdoer held captive, even if this were necessary to save his victims. In the second essay she considers what makes terrorism wrong--whether it (...) is the intention to harm civilians, rather than harm to them being 'collateral damage,' or something else--and whether terrorism is always wrong. The third essay discusses whether having a right reason, in the sense of a right intention, is necessary in order for a war to be just. Kamm then examines ways in which the harms of war can be proportional to the achievement of the just cause and other goods that war can bring about, so as to make the declaration of war permissible. (shrink)

I begin by reconsidering the arguments of John Taurek and Elizabeth Anscombe on whether the number of people we can help counts morally. I then consider arguments that numbers should count given by F. M. Kamm and Thomas Scanlon, and criticism of them by Michael Otsuka. I examine how different conceptions of the moral method known as pairwise comparison are at work in these different arguments and what the ideas of balancing and tie-breaking signify for decision-making in various types of (...) cases. I conclude by considering how another moral method that I call virtual divisibility functions and what it helps reveal about an argument by Otsuka against those who do not think numbers count. (shrink)

This book is a philosophical discussion of moral, legal, and medical issues related to aging, dying, and death. One of its aims is to decide whether and when it might make sense to not resist or bring about the end of one's life. To answer this question it considers views about meaning in life and what makes life worth living. It also evaluates recent attempts to help the general public plan in advance for the end of life. It also considers (...) whether or not physician-assisted suicide is morally permissible and if it should be legalized. (shrink)

Zeller argued that the ‘innumerable worlds’ mentioned in accounts of Anaximander's system must be an endless succession of single worlds, not an unlimited number of coexistent worlds scattered through infinite space, some always coming into being while others are passing away. Zeller pointed out that a succession of single worlds is grounded in the principles of the system. ‘Things perish into that from which they had their birth… according to the order of Time,’ a cycle of birth, existence, and destruction. (...) A world ends, and the living divine stuff begets a new world to take its place. On the other hand, there is much in the system to contradict the idea of coexistent worlds. Anaximander's successors, Anaximenes, Anaxagoras, and Diogenes, show that this idea is not a necessary consequence of the unlimitedness of the original world-stuff. Nothing in the appearances of Nature suggests it. Anaximander is a monistic hylozoist, whereas Democritus is a pluralist with his innumerable independent atoms producing, by similar processes, independent world-systems in different parts of an infinite void. (shrink)

Zeller argued that the ‘innumerable worlds’ mentioned in accounts of Anaximander's system must be an endless succession of single worlds, not an unlimited number of coexistent worlds scattered through infinite space, some always coming into being while others are passing away. Zeller pointed out that a succession of single worlds is grounded in the principles of the system. ‘Things perish into that from which they had their birth… according to the order of Time,’ a cycle of birth, existence, and destruction. (...) A world ends, and the living divine stuff begets a new world to take its place. On the other hand, there is much in the system to contradict the idea of coexistent worlds. Anaximander's successors, Anaximenes, Anaxagoras, and Diogenes, show that this idea is not a necessary consequence of the unlimitedness of the original world-stuff. Nothing in the appearances of Nature suggests it. Anaximander is a monistic hylozoist, whereas Democritus is a pluralist with his innumerable independent atoms producing, by similar processes, independent world-systems in different parts of an infinite void. (shrink)