This article explores the Nuffield Council on Bioethics’ recent report about non-invasive prenatal testing. Given that such testing is likely to become the norm, it is important to question whether there should be some ethical parameters regarding its use. The article engages with the viewpoints of Jeff McMahan, Julian Savulescu, Stephen Wilkinson and other commentators on prenatal ethics. The authors argue that there are a variety of moral considerations that legitimately play a significant role with regard to (prospective) parental decision-making (...) in the context of NIPT, for example, views on the morality of abortion and understandings of the impact of disability on quality of life. The variable nature of such considerations, both singularly and combined, suggests that any approach to NIPT should be sensitive to and understanding of similarly variable parental assessments and decisions. The implications of the approach developed for current and future policies in this area are explored, along with the impact of such arguments on ideas about procreative beneficence. (shrink)
This paper examines the doctrine of double effect as it is typically applied. The difficulty of distinguishing between what we intend and what we foresee is highlighted. In particular, Warren Quinn's articulation of that distinction is examined and criticised. It is then proposed that the only credible way that we can be said to foresee that a harm will result and mean something other than that we intend it to result, is if we are not certain that that harm will (...) result. The ramifications of this are explored. The paper concludes with a moral evaluation of a variety of cases that have harmful outcomes. It is recommended both that we abandon the doctrine of double effect and that we cease to describe cases with harmful outcomes in a dishonest way. (shrink)
The rule that a patient should give a free, fully-informed consent to any therapeutic intervention is traditionally thought to express merely a right of the patient against the physician, and a duty of the physician towards the patient. On this view, the patient may waive that right with impugnity, a fact sometimes expressed in the notion of a right not to know. This paper argues that the rule also expresses a duty of the patient towards the physician and a right (...) of the physician against the patient. The argument turns, first, on the truism that a physician has no obligation to commit a battery, or unauthorized touching, and, second, on the thesis that a patient necessarily cannot consent to something that is unknown to him. The conclusion is drawn that a patient is not free to receive treatment voluntarily without knowledgeably authorizing it. CiteULike Connotea Del.icio.us What's this? (shrink)
ABSTRACT This paper investigates the concept of wrongful disability. That concept suggests that parents are morally obligated to prevent the genetic transmission of certain conditions and so, if they do not, any resulting disability is ‘wrongful’. In their book From Chance to Choice, Buchanan, Brock, Daniels and Wikler defend the concept of wrongful disability using the principle of avoidability via substitution. That principle is scrutinised here. It is argued that the idea of avoidability via substitution is both conceptually problematic and (...) rather insensitive. Instead, it is suggested that the question of whether or not bringing a particular disability about is wrongful does not simply hinge on whether or not substitution takes place. Rather, it involves an evaluation of parental aspirations and responsibilities. It is argued that the desire not to be responsible for creating challenges for others that lie outside what is perceived to be an acceptable range provides a justification for termination of pregnancy on the grounds of projected disability that neither commits one to a wrongful life claim, nor requires that one substitute a non‐disabled child instead. The ramifications of such an approach are explored. The paper concludes by suggesting that the question of what is considered to be an acceptable range of human capability is an increasingly important one. It is argued that, when addressing that question, we should be acutely aware of the social context that may go some way to define what we consider to be an acceptable range. (shrink)
_Deprivation and Freedom _investigates the key issue of social deprivation. It looks at how serious that issue is, what we should do about it and how we might motivate people to respond to it. It covers core areas in moral and political philosophy in new and interesting ways, presents the topical example of disability as a form of social deprivation, shows that we are not doing nearly enough for certain sections of our communities and encourages that we think differently about (...) how we should best organize our societies in the future. The book develops a comprehensive yet accessible account of human freedom, which shows how the ability to realise our freedom is partly definitive of freedom itself. That account conclusively illustrates how many deprivations represent remediable inequalities of important and very basic human freedoms, posing the question as to why societies continue to do so little about them. In answering that question, Richard J. Hull shows how the idea of social exclusion is misleading and, instead, tackles the far more pertinent and challenging issue of societies' failure to include. The moral seriousness of non-inclusion, the failure to provide for freedom, is evaluated via critical discussion of a variety of central themes and distinctions in ethical and political theory. The author shows how such themes and distinctions comprise a framework for evaluating a raft of social issues, in turn providing a unique resource for students of moral, political and applied philosophy. The book concludes with an innovative, challenging and effective combination of analytic and continental styles, so to address the critical question of how we might actually motivate constructive social change. In doing so, it shows how a variety of approaches can work successfully together to provide an emphatic case for greater social inclusion. _Deprivation and Freedom _shows how even fairly modest claims about social provision illustrate that we should be doing a lot more about social deprivation than we are now. It should be of interest to anyone who is concerned with questions about the type of society in which they live, what it says about us to continue as we are – and how we might motivate realistically achievable social change. (shrink)
When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.
This book treats practical and political reasoning as an active engagement with the world and other people; it cannot be understood as exclusively cognitive and this is seen as a virtue rather than a deficiency. Informal, emotional, characterological, aesthetic and interactional aspects of thought can be constituents of reasonable arguing. The work examines key capacities connected with argumentation, in a variety of fields from professional and medical ethics to work organization and the practice of art.
This volume contains all of the presidential addresses given before the American Society for Value Inquiry since its first meeting in 1970. Contributions are by Richard Brandt*, Virgil Aldrich*, John W. Davis*, the late Robert S. Hartman*, James B. Wilbur*, the late William H. Werkmeister, Robert E. Carter, the late William T. Blackstone, Gene James, Eva Hauel Cadwallader, Richard T. Hull, Norman Bowie*, Stephen White*, Burton Leiser+, Abraham Edel, Sidney Axinn, Robert Ginsberg, Patricia Werhane, Lisa M. Newton, Thomas Magnell, Sander (...) Lee, John M. Abbarno, Ruth Miller Lucier, and Tom Regan*. Autobiographical sketches* by all of the living contributors and one recently deceased, biographical statements of the remainder, together with photographic portraits of all the contributors*, make this volume a unique record of value inquiry during the past quarter century. __. (shrink)
This work is a publication of a manuscript left unfinished at his death by the author. From the time of their conversations in 1936, William Henry Werkmeister has studied the phenomenon of Martin Heidegger's thought and the critical literature commenting on it. During a period spanning 36 years, Werkmeister wrote some nine articles and reviews about his findings. He turned to other interests, but the Heidegger phenomenon continued to reside at the back of his mind. At age ninety, Werkmeister set (...) out once again to write a work that would unify Heidegger's thought, clarify a number of its essential features, place Heidegger's chief works in an order that corresponds to the time line of his thought, critically appraise the development of his thought against the work of other German philosophers, and assess the question of Heidegger's alleged Nazi sympathies. (shrink)
My assigned task in today’s colloquium is to review philosophers’ perspectives on the broad question of whether health care rationing ought to target the elderly. This is a revolutionary question, particularly in a society that is so sensitive to apparent discrimination, and the question must be approached carefully if it is to be successfully dealt with. Three subordinate questions attend this one and must be addressed in the course of answering it. The first such question has to do with the (...) issue of justice: how is it fair to target the elderly in achieving reductions in health care costs? Isn’t the proposal, or for that matter, isn’t targeting any age group, morally objectionable as a species of ageism, just as targeting members of a particular race or sex would be racist or sexist? The second subordinate question has to do with the issue of fittingness. Given that we can show in some way that targeting the elderly is not inherently unjust, why would limiting health care to them be a fitting thing for medicine to do? How would it fit, for example, with the traditional commitments of medicine, to sustain life, to relieve suffering, to heal and cure and restore function? And in particular, if medicine has the ability to save and relieve and restore the elderly, why should it replace that set of commitments with a different set for this particular population? The third subordinate question seems political, an arena reserved for one of my speaker colleagues today. There are, I believe, some underlying philosophical dimensions to its answer, and so I will say something about it. The philosophical/political questions is, Given that rationing health care to the elderly is not patently unjust, and given that a case can be made out that the ends of medicine are not violated by such limitation, shy should the elderly, as a group, assent to such a limitation? I want to address these subordinate questions, for I believe them to be the chief stumbling blocks for the possibility of an affirmative answer to our... (shrink)
I bring you greetings from the United States, where its citizens have been closely following the events of the past three weeks. There has been a great change in the feelings of common American people towards the Russian people. Many have expressed their sense of identity and solidarity with the people of Moscow and St. Petersburg as they witnessed the resistance for the attempted coup. Americans have enormous respect for constitutional government as well as for democracy, and they saw the (...) coup as unconstitutional from the start. A major factor was the television news service. The major American broadcast networks NBCD, CBS, ABC and the cable networks, especially CNN provided often live coverage throughout the days and nights of events in the streets and squares of Moscow, and later in the halls of the Soviet and Russian Parliaments. We witnessed press conferences, from one with the committee of 8 to one 3 nights ago in which Boris Yeltsin and Mikhail Gorbachev spoke with the American people. We made our individual judgments about events, often listening to debates between experts and scholars on Soviet affairs some Russian, some Ukrainian, some from the Baltic states and we spoke frequently and freely with one another even some of discussions with our friends were televised. We experienced fear and dread as it seemed great military forces were being brought to bear on your White House. We wept with grief and rage as the deaths of Russians confronting tanks were reported. We cheered to see Russian women scolding soldiers in the streets. In the aftermath, there has been much discussion of Russia’s needs and how Americans might help. In that curious mixture of avarice and beneficence that is the way of American business, discussions were held on starting a restaurant, and import service, on how to use rubles to pay for local expenses and hard currency for profit-taking. (shrink)
Three ethical principles currently determine both law and practice with respect to starting and stopping dialysis in end stage renal disease cases: Medical Futility, Respect for Life, and Patient Sel-determination. Even where dialysis is not medically futile, patients possessing capacity, and patients lacking capacity but with valid, functioning proxy decision-makers, self-determination is the dominant principle, in that efforts to prolong and preserve life may be set aside or not initiated at the request of the adequately informed patient or the patient’s (...) proxy, both presumed conclusively to be acting in the patient’s own “best interests.” Where the patient lacks capacity and there is no proxy, Respect for Life dominates, and we are required to initiate and continue dialysis that is not medically futile, except where there is available clear and compelling evidence that the patient would not want life prolonged with dialysis, as in an advance directed or documented conversation. This category of patients — those lacking capacity who have given neither advance directives nor designated proxies — constitutes a continuum of cases. “At one extreme is the patient who will actually be harmed by dialysis — that is, the effects of dialysis will cause damage to other functions, or will cause significant increase in pain and suffering that would not occur absent the dialysis. In such situations, it can be said that [initiation of] continuation of dialysis is not medically reasonable,”i or is medically futile. The middle portion is the range of “difficult cases . . . where the therapeutic value of dialysis is.. (shrink)
On October 26, 1984, Dr. Leonard Bailey and the transplant team of Loma Linda University Medical Center in California operated on a five-pound baby girl born a few weeks earlier with hypoplastic left heart syndrome. In babies born with this defect the left side of the heart is much smaller than the right and is unable to pump sufficient blood to sustain life for more than a few weeks. This rare defect occurs about once in every 12,000 live births; it (...) accounts for about a quarter of all cardiac deaths of newborns. In an operation known as a xenograft, involving cross-species transplantation of an organ, Dr. Bailey removed the defective heart from the baby and replaced it with the heart of a baboon. (shrink)
There are two fundamental types of ethical theory: those based on the notion of choosing one’s actions so as to maximize the value or values to be expected as consequences of those actions (called consequentialist or teleological theories [from the Greek telos, meaning aim or purpose]; and those based on the notion of choosing one’s actions according to standards of duty or obligation that refer not to consequences but to the nature oaf actions and the motives that are held by (...) those performing them (called deontological theories [from the Greek deon, meaning that which is necessary or binding]). We will consider each type more fully and give specific instances of each type as illustrations. (shrink)
Robert Almeder has argued1 that three “fourth conditions” for nondefectiveness of knowledge justification claims, proposed in the recent literature,2 are essentially similar, require modification in order to eliminate the possibility of an unknowable defeater, and, so modified, render attainment of non-basic factual knowledge impossible. Although I believe there are objections to be raised against his exposition and reduction of the three proposed fourth conditions, I wish only to raise some doubts about the supposed necessity of the modifications and then to (...) argue against his claim that, so modified, the result is too stringent. (shrink)
I come before you today at the invitation of your Colloquium Chair, Professor Claes Lundgren. It was his thought that a colloquium session devoted to some of the foundational questions, or presuppositions, of animal might prove interesting. Such an examination may have several aims. 1) It provides an opportunity to reflect on and review together a common activity that, in the perceptions of some concerned fellow citizens and in the history of the discipline of physiology, has had some highly questionable (...) periods and prima facie objectionable practices. 2) It allows us to become more articulate about what we do, that we may speak effectively on its behalf to our critics. 3) Similarly, it enables us to speak to the concerns of our students, both of medicine and of physiology, whom we may initiate into the uses of animals without clarifying to them our perceptions of those uses and their rationale and justification. 4) Finally, such a stock-taking may occasion our own self-evaluation of our practices, with a possible result being the improvement of those practices from a moral point of view. And I suppose that Professor Lundgren asked me to speak with some of those aims in mind. (shrink)
Second, let me offer an apology for not having a handout for this talk. I do have a website that contains most of my talks and published papers, as well as various other ravings collected over thirty-plus years of ruminating, and you are each welcome to visit it and acquire for your own reading pleasure or other legitimate purposes (such as composing refutations of my foolish views) such copies as you may require. Just don’t steal my ideas and misrepresent them (...) as your own! The address is http://www.richard-t-hull.com. This paper should be posted there within the month. (shrink)
In this age of interdisciplinary interaction, we probably owe one another disclosures of our qualifications for commenting on each other’s profession. And you might well wonder why a philosopher would be asked to address this distinguished society of professiona l geologists. So, let me give what information I can about my qualifications to talk this evening about, of all things, the ethics of water geology.
Good Morning! When I was asked to talk on the subject of Dying in America at a breakfast meeting, It occurred to me that I might get to make some wisecracks about how we eat, at a breakfast where we would be served croissants, butter, sausage and eggs, and berries served with Devonshire cream: certainly the most tasteful form of dying in America! Nor have we been disappointed: quiche and ham should do quite nicely. Then, after last Tuesday’s election, someone (...) approached me and asked if my talk was gong to be on Democratic Party politics. I suppose the title “Dying in America: might fit that subject very nicely! Another wag asked whether I was going to discuss the Buffalo Bills’ current football season . . . . All of these possible applications of the phrase “Dying in America” point to the enormous importance we attach to the idea of dying, and the ways we use that idea in our very metaphorical language. That kind of richness of language is a sure sign, as Joseph Campbell would remind us, that culturally pervasive myths are constructed around the idea of dying. Now, I don’t intend to talk about Campbell’s views at all today, and I will avoid a short course on myths. But I will make just one or two observations about myths so that you are not uncomfortable with my later use of the term. For one of our myths about myths is that, in this educated and scientifically literate society, we don’t have any myths; myths are supposed to be the glue of fictional beliefs that holds primitive societies together, and we certainly are not primitive. Well, let me explain how I intend to use the idea of myth to illuminate some of our values and practices associated with the idea of dying in America. First, by a myth I mean a culturally pervasive set of beliefs and values that tends to center on a single, simple archetypal image or scenario. And second, by calling something mythic I mean to invoke perhaps a number of myths operating as a cluster of culturally important determinants of attitudes and behaviors.. (shrink)
In the May, 1960, issue of the American Bar Association Journal (vol. 499), Morton Birnbaum, a lawyer and physician, argued for a legal right to psychiatric treatment of the involuntarily committed mentally ill person. In the 18 years since his article appeared,, there have been several key court cases in which this concept of a right to psychiatric treatment has figured prominently and decisively. It is important to note that the language of the decisions have had at least an indirect (...) effect in the recently enacted mental Hygiene Law of the State of New York. While I shall not seek to establish the historical thesis that Birnbaum’s article has been efficacious in bringing about both these court decisions and changes in statutory laws, I do want to examine Birnbaum’s article and some of the opinions for three cases: Wyatt v. Stickney (1972), Wyatt v. Aderholt (1974), and O’Connor v. Donaldson (422 US 563, 1975), in an effort to understand both the significance of these changes in our laws and the underlying philosophical and ethical notions of which they are an expression. Birnbaum observed that the notable feature of the legal situation at the time was that there had not been recognized a constitutional requirement that one who had been institutionalized for mental illness according to due process must receive treatment. Birnbaum argued that the effects of an omission of such a requirement to treat were that mental institutions typically offered only custodial care, that patients who were held only under custodial care typically did not improve, and that the result was that involuntary incarceration in a mental institution was, at least from the point of view of the patient, functionally no different than would be imprisonment for an unspecified period of time. Birnbaum argued for a recognition and enforcement in the courts of the right to treatment “...as a necessary and overdue development of our present concept of due process of law,” i.e., as required by the 14th Amendment to the U.S.. (shrink)