In their account of passive euthanasia, Garrard and Wilkinson present arguments that might lead one to overlook significant moral differences between killing and letting die. To kill is not the same as to let die. Similarly, there are significant differences between active and passive euthanasia. Our moral duties differ with regard to them. We are, in general, obliged to refrain from killing each and everyone. We do not have a similar obligation to try to prevent each and everyone from dying. (...) In any case, to be morally obliged to persist in trying to prevent their deaths would be different from being morally obliged to refrain from killing all other people even if we had both obligations. (shrink)

It is often maintained that, since the buying and selling of organs—particularly the kidneys—of living people supposedly constitutes exploitation of the living vendors while the so-called “altruistic” donation of them does not, the former, unlike the latter, should be a crime. This paper challenges and rejects this view. A novel account of exploitation, influenced by but different from those of Zwolinski and Wertheimer and of Wilkinson, is developed. Exploitation is seen as a sort of injustice. A distinction is made between (...) justice and fairness. To exploit someone is to take advantage of him or her unjustly. Exploitation pertains to the nature of actions, interactions, and transaction rather than to their outcomes or to how they are perceived by exploitees. Desperation on the part of one or other of the parties to a transaction does not preclude the giving of valid consent to the transaction. Disparities of power or wealth between the parties to a transaction do not indicate or entail that the transaction will be exploitative. A disparity in the benefits that arise from a transaction between the parties does not indicate or entail that exploitation has taken place. (shrink)

The current UK policy for the distribution of scarce vaccination in an influenza pandemic is ethically dubious. It is based on the planned outcome of the maximum health benefit in terms of the saving of lives and the reduction of illness. To that end, the population is classified in terms of particular priority groups. An alternative policy with a non-consequentialist rationale is proposed in the present work. The state should give the vaccination, in the first instance, to those who are (...) at risk of catching the pandemic flu in the line of their duties of public employment. Thereafter, if there is not sufficient vaccine to give all citizens equally an effective dose, the state should give all citizens an equal chance of receiving an effective dose. This would be the just thing to do because the state has a duty to treat each and all of its citizens impartially and they have a corresponding right to such impartial treatment. Although this article specifically refers to the UK, it is considered that the suggested alternative policy would be applicable generally. The duty to act justly is not merely a local one. (shrink)

David Shaw presents a new argument to support the old claim that there is not a significant moral difference between killing and letting die and, by implication, between active and passive euthanasia. He concludes that doctors should not make a distinction between them. However, whether or not killing and letting die are morally equivalent is not as important a question as he suggests. One can justify legal distinctions on non-moral grounds. One might oppose physician- assisted suicide and active euthanasia when (...) performed by doctors on patients whether or not one is in favour of the legalisation of assisted suicide and active euthanasia. Furthermore, one can consider particular actions to be contrary to appropriate professional conduct even in the absence of legal and ethical objections to them. Someone who wants to die might want only a doctor to kill him or to help him to kill himself. However, we are not entitled to everything that we want in life or death. A doctor cannot always fittingly provide all that a patient wants or needs. It is appropriate that doctors provide their expert advice with regard to the performance of active euthanasia but they can and should do so while, qua doctors, they remain hors de combat. (shrink)

Hugh V. Mclachlan Cet article est une réponse à la critique de Saunders de ma proposition de politique non conséquentialiste publiée précédemment concernant l’utilisation d’une loterie pour la distribution de vaccins rares par l’État face à une pandémie de grippe. J’y ai soutenu que, pour des raisons de justice, l’État devrait distribuer une partie du vaccin rare qu’il pourrait détenir à certains de ses employés de la santé et le reste aux citoyens de manière aléatoire et égale sur le principe (...) d’une loterie. Au coeur de la critique de Saunders se trouve l’affirmation selon laquelle j’ai omis à tort de prendre en compte les différences moralement pertinentes dans les besoins et la capacité de production entre les receveurs potentiels du vaccin. Le point central de ma réponse ici est que le fait que le besoin et la capacité de production soient ou non des facteurs moralement pertinents dépend de qui ou de quoi distribue le vaccin, à qui ils le distribuent et pourquoi ils le font. Par exemple, la discrimination entre les personnes dans la distribution de vaccins publics distribués à titre prophylactique sur la base de leur âge est injuste, qu’elle soit ou non moralement justifiable pour d’autres motifs. (shrink)

Marquis’s account of the ethics of abortion is unsatisfactory but not as Christensen implies baseless. It requires to be amended rather than abandoned. It is true, as Marquis asserts that murder and abortion both might deprive people of something of value to them, in particular, the life of a sort that might have been to them worth living. However, it is mistaken to conclude, as Marquis does, that murder and abortion are thereby morally equivalent. Not all deprivation is wrongful. Not (...) all that is wrongful is wrongful because it deprives someone of something. Contrary to what Christensen asserts, and Marquis seems to accept, it is not solely those discernible people who currently exist who might be deprived by our current actions. It is not only towards and concerning such living discernible people that we can have moral duties. It is not only such living discernible people who can be the beneficiaries of our generosity. Hence, contraception and the emission of greenhouse gases are, like abortion, issues that raise significant moral questions; however, they might each be properly answered. Nonetheless, it does not follow that is morally equivalent to each other far less than they are all morally equivalent to murder. If and when they are morally wrong, they can be different wrongs. (shrink)

Coggon’s remarks on a previous paper on active and passive euthanasia elicit a clarification and an elaboration of the argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not the same (...) as to let die is based upon a rejection of consequentialism. (shrink)

Wardrope argues against my proposed non-consequentialist policy for the distribution of scarce influenza vaccine in the face of a pandemic. According to him, even if one accepts what he calls my deontological ethical theory, it does not follow that we are required to agree with my proposed randomised allocation of doses of vaccine by means of a lottery. He argues in particular that I fail to consider fully the prophylactic role of vaccination whereby it serves to protect from infection more (...) people than are vaccinated. He concludes that: ‘The benefits and burdens of vaccination are provided impartially and far more effectively by targeted vaccination than impartial lotteries.’ He has shown convincingly that this conclusion can be established in the case of his particular envisaged scenario. However, Wardrope gives no reason to suppose that, in the circumstances that we actually face, targeted vaccination would constitute impartial treatment of citizens in the UK. I readily agree with Wardrope that if it should treat its citizens justly and impartially, it does not necessarily follow that the state should distribute vaccinations of the basis of a lottery. That will be a reasonable thing to do only if certain assumptions are made. These assumptions will not always be reasonable. However, they are reasonable ones to make in the actual circumstances that currently apply. (shrink)

In line with article 3.4 of EC directive 89/381, Keown has presented an ethical case in support of the policy of voluntary, unpaid donation of blood. Although no doubt is cast on the desirability of the policy, that part of Keown's argument which pertains to the suggested laudability of altruism and of its encouragment by social policy is examined and shown to be dubious.

David Shaw's response to Hugh McLachlan's criticism of his proposed new perspective on euthanasia is ineffectual, mistaken and unfair. It is false to say that the latter does not present an argument to support his claim that there is a moral difference between killing and letting die. It is not the consequences alone of actions that constitute their moral worth. It can matter too what duties are breached or fulfilled by the particular moral agents who are involved.

This is a continuation of and a development of a debate between John Keown and me. The issue discussed is whether, in Britain, an unpaid system of blood donation promotes and is justified by its promotion of altruism. Doubt is cast on the notions that public policies can, and, if they can, that they should, be aimed at the promotion and expression of altruism rather than of self-interest, especially that of a mercenary sort. Reflections upon President Kennedy's proposition, introduced into (...) the debate by Keown, that we should ask not what our country can do for us but what we can do for our country is pivotal to this casting of doubt. A case is made for suggesting that advocacy along the lines which Keown presents of an exclusive reliance on a voluntary, unpaid system of blood donation encourages inappropriate attitudes towards the provision of health care. Perhaps, it is suggested, and the suggestion represents, on my part, a change of mind as a consequence of the debate, a dual system of blood provision might be preferable. (shrink)

Julian Le Grand's case for saying that it would be equitable if smokers and smokers alone were to pay the costs of smoking-related health care is considered and found to be deficient.

The arguments of Van Niekerk and Van Zyl that, on the grounds that it involves an inappropriate commodification and alienation of women's labour, commercial surrogate motherhood (CSM) is morally suspect are discussed and considered to be defective. In addition, doubt is cast on the notion that CSM should be illegal.

The nature and significance of equity and equality in relation to health and healthcare policy is discussed in the light of a recent article by Culyer. Culyer makes the following claims: the importance of equity in relation to the provision of health care derives from the human need for health in order to flourish; and for the sake of equity, equality of health among the members of particular political jurisdictions should be the aim of health policy. Both these claims are (...) challenged in this paper.The argument put forward is that it is only when needs arise and are met in particular contexts that need and equity are fused. The state and its agents and agencies should distribute what it distributes impartially, whatever it distributes. Whether or not equity applies to the distribution of healthcare services depends on how they are provided and not on their nature as “primary goods”. Contrary to what Culyer suggests, a policy of trying to produce the outcome of health equality would be inequitable. It would not be impartial and it would fail to treat persons as persons ought to be treated. (shrink)

In his discussion of ethics and abortion, Prof. Richard Dawkins makes the provocative claim that: ‘The Great Beethoven Fallacy is a typ ical example of the kind of logical mess we get into when our minds are befuddled by religiously inspired absolutism.’ (Dawkins, p. 339) This supposed fallacy is presented as if it exemplified not only a particular view of abortion held, for instance, by certain fundamentalist Christians but as if it revealed some flaw that is characteristic of the thinking (...) of theists. I shall examine his claim. (shrink)

In a recent article, Shaw contrasts his own supposed good behaviour, as that of a self-proclaimed “social distance warrior” with the alleged rude behaviour of one of his relatives, Jack, at social events in the former’s house in Scotland in the early stages of the COVID-19 pandemic. He does so to illustrate and support his claims that it was wrong and rude to fail to comply with the governmental advice regarding social distancing because we had a responsibility “to minimize risk” (...) and not wrong nor rude to challenge and cajole those people who failed to do so. This article shows that his claims are contestable. It suggests that his own behaviour was no better than Jack’s. (shrink)

Various authors, for instance Elizabeth Anderson, Rosemary Tong, Mary Warnock and Margaret Brazier have argued that commercial surrogate motherhood is exploitative and that it should be prohibited. Their arguments are unconvincing. Exploitation is a more complex notion than it is usually presented as being. Unequal bargaining power can be a cause of exploitation but the exercise of unequal bargaining power is not inevitably or inherently exploitative. Exploitation concerns unfair and/or unjust strategies - rather than the exercise of power as such. (...) Commercial surrogate motherhood is not necessarily exploitative. Furthermore, not all transactions which are exploitative should be made illegal. (shrink)

Le Grand describes a situation where a drunk driver, who has medical insurance, is the cause of an accident in which he and a sober pedestrian, who has no medical insurance, are both equally and seriously injured. At the private hospital to which they are both taken, there is available emergency treatment for one of them only. Who should receive it? The issues raised by Le Grand's example are shown to be more interesting, more complex and less clearcut than Le (...) Grand suggests and implies. In particular, it is not the case that, unequivocally, the drunkenness of the driver establishes that the pedestrian rather than he should be treated nor that, unequivocally, the driver's possession of health insurance is morally irrelevant. (shrink)

The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral (...) entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies. (shrink)

Rather than to focus upon a particular ‘right to life’, we should consider what rights there are pertaining to our lives and to our living. There are different sorts. There are, for instance, rights that constitute absences of particular duties and rights that correspond to the duties of other agents or agencies. There are also natural and non-natural rights and duties. Different people in different contexts can have different moral duties and different moral rights including rights to life. The question (...) of the moral rights there are to and pertaining to life is considered with reference to James Griffin’s account of human rights. Also considered is the question of who or what can be a bearer of them. (shrink)

The literature concerning the possibility and desirability of using new pharmacological and possible future genetic techniques to enhance human characteristics is well-established and the debates follow some well-known argumentative patterns. However, one argument in particular stands out and demands attention. This is the attempt to tie the moral necessity of moral enhancement to the hypothesised risks that allowing cognitive enhancement will bring. According to Persson and Savulescu, cognitive enhancement should occur only if the risks they think it to poses are (...) mitigated by moral enhancement. By this they mean the compulsory and universal amplification of the disposition of altruism and the inflation of our sense of fairness, by chemical and/or genetic means. Their claim is important, intriguing and unsettling. This paper focuses on three central, but relatively neglected, features of their argument. First, there is a pernicious ambiguity in the language of ‘risk’ used by Persson and Savulescu where they tend to conflate ‘risk’ and ‘uncertainty’. Second, their use of the lottery analogy to render their position more plausible is unconvincing. It tends to distort rather than illuminate the relevant considerations. Third, Persson and Savulescu do not adequately take into account the social and individual benefits that enhancing cognition could have. If they did, it would be apparent that those benefits alone would outweigh the considerations used to justify accompanying CE with ME. (shrink)

In this paper we investigate the legal arrangements involved in UK surrogate motherhood from a transaction-cost perspective. We outline the specific forms the transaction costs take and critically comment on the way in which the UK institutional and organisational arrangements at present adversely influence transaction costs. We then focus specifically on the potential role of surrogacy agencies and look at UK and US evidence on commercial and voluntary agencies. Policy implications follow.

The author defends himself against an attack by Smith and Bopp on his views on smoking and taxation. The theory that, on the grounds of equity and/or fairness, smokers should pay via taxation on tobacco for the health care costs of treating smoking-related medical conditions is discussed and shown to be defective. It is argued that the fundamental mistake that Smith and Bopp make is to confuse and conflate the separate issues of whether particular taxes are fair and whether they (...) are justifiable. The conclusion is reached that an excise duty on tobacco is a good tax. It is a non-fair or even an unfair tax but it is justified on grounds other than fairness. (shrink)

In his paper , Culyer talks about “values” and “value judgments” in relation to equity.1 He says: “The focus is on equity in the allocation of health care resources .... These are value laden questions because any idea of “equity” must embody value judgments about what it is that makes for a good society”. He says too: “Equity in health care policy, as in other arenas of policy, is a question of ethics and therefore of values”.I disagree with this way (...) of talking: it suggests a sort of “postmodernist” moral relativism. It sounds as if there might be, say, socialist beliefs which were vouched for by socialist values while …. (shrink)

It has recently been suggested by Brassington that, when students in classes in medical ethics announce that some view that they wish to express is related to their religious convictions, the teacher is obliged to question them explicitly about the suggested link. Here, a different conclusion is reached. The view is upheld that, although the stratagem recommended by Brassington is permissible and might sometimes be desirable, it is not obligatory nor is it, in general, likely to be optimal.