The purpose of this paper is to propose a model of clinical-ethical decision making which will assist the health care professional to arrive at an ethically defensible judgment. The model highlights the integration between ethics and decision making, whereby ethics as a systematic analytic tool bring to bear the positive aspects of the decision making process. The model is composed of three major elements. The ethical component, the decision making component and the contextual component. The latter incorporates the relational aspects (...) between the provider and the patient and the organizational structure. The model suggests that in order to arrive at an ethically, justifiable sound decision one make reference to those three elements. (shrink)

This paper suggests that medical education should redirect resources to values education, specifically developing new strategies to improve the process of clarification of values. The author suggests using the values journal method which is based on a systematic record of students' personal value systems reflected in their stories and life experience; and on their responses to case presentation. Generating a personal values journal helps students define who they are, what their social and professional roles are, what their expectations are and (...) where they are going. Keeping values journals promotes students' decision-making capacity, and equips them with the necessary skills to teach their future patients how to generate their own value systems. The development of a well defined values journal is a preparatory stage for active participation in clinical conferences or group discussion, and for effective communal dialogue among the group's members. (shrink)

The moral justification of intellectual property is often called into question when placed in the context of pharmaceutical patents and global health concerns. The theoretical accounts of both John Rawls and Robert Nozick provide an excellent ethical framework from which such questions can be clarified. While Nozick upholds an individuals right to intellectual property, based upon its conformation with Lockean notions of property and Nozicks ideas of just acquisition and transfer, Rawls emphasizes the importance of basic liberties, such as an (...) individuals right to health, superceding such secondary rights as intellectual property rights. From a policy perspective, patent protection for pharmaceutical products necessarily entails the balancing of corporate intellectual property interests and public interests in healthcare. The moral dilemma that occurs when these two interests clash is not easily resolved. Aside from corporate and public interests, the state maintains an interest in creating and preserving policies that regulate the moral dilemma itself. This paper analyzes the economic and ethical factors surrounding the production and distribution of the anti-HIV medication, AZT. Potential policy implications and recommendations are also discussed. (shrink)

Having children is probably as old as the first successful organism. It is often done thoughtlessly. This book is an argument for giving procreating some serious thought, and a theory of how, when, and why procreation may be permissible.Rivka Weinberg begins with an analysis of the kind of act procreativity is and why we might be justifiably motivated to engage in it. She then proceeds to argue that, by virtue of our ownership and control of the hazardous material that (...) is our gametes, we are parentally responsible for the risks we take with our gametes and for the persons that develop when we engage in activity that allows our gametes to unite with others and develop into persons. Further argument establishes that when done respectfully, and in cases where the child's chances of leading a life of human flourishing are high, procreation may be permissible. Along the way, Weinberg argues that the non-identity problem is a curiously common mistake. Arguments intending to show that procreation is impermissible because life is bad for people and imposed on them without their consent are shown to have serious flaws. Yet because they leave us with lingering concerns, Weinberg argues that although procreation is permissible under certain conditions, it is not only a welfare risk but also a moral risk. Still, it is a risk that is often permissible for us to take and impose, given our high level of legitimate interest in procreativity. In order to ascertain when the procreative risk is permissible to impose, contractualist principles are proposed to fairly attend to the interests prospective parents have in procreating and the interests future people have in a life of human flourishing. The principles are assessed on their own merits and in comparison with rival principles. They are then applied to a wide variety of procreative cases. (shrink)

Life is pointless. That’s not okay. I show that. I argue that a point is a valued end and that, as agents, it makes sense for us to want our efforts and enterprises to have a point. Valued ends provide justifying reasons for our acts, efforts, and projects. I further argue that ends lie separate from the acts and enterprises for which they provide a point. Since there can be no end external to one’s entire life since one’s life includes (...) all of one’s ends, leading and living one’s life as a whole cannot have a point. Finally, I argue that since we live our lives and structure our living­a­human­life efforts both in parts and as a whole, it is fitting to be sad to recognize that leading and living a life is pointless. My discussion helps make sense of the literature that frequently talks around this topic but often does so vaguely and indirectly. (shrink)

Sperm donation is a widely accepted and increasingly common practice. In the standard case, a sperm donor sells sperm to an agency, waives his parental rights, and is absolved of parental responsibility. We tend to assume that this involves no problematic abandonment of parental responsibility. If we regard the donor as having parental responsibilities at all, we may think that his parental responsibilities are transferred to the sperm recipients. But, if a man creates a child accidentally, via contraception failure, we (...) tend to assume that the man does indeed have parental responsibilities. Assessing these contrasting conclusions requires a theory of parental responsibility. I analyze prevalent theories of what makes someone parentally responsible and show that none of these theories can withstand scrutiny. I propose a new theory of parental responsibility, which, I argue, is more plausible than the alternatives. My theory of parental responsibility is based on our ownership and control over hazardous materials, namely, our gametes. I show that neither my theory, nor the theories I reject, can support our contrasting intuitions. I conclude that sperm donors are fathers, with parental responsibility. I argue that the alternative conclusion, that neither sperm donors nor accidental fathers are parentally responsible for their resulting offspring, is less plausible. I then consider whether parental responsibility can be transferred and argue that it is far from clear that it can. Finally, I address objections and consider some practical implications of these views. (shrink)

Philosophers concerned with procreative ethics have long been puzzled by Parfit’s Non-Identity Problem (NIP). Various solutions have been proposed, but I argue that we have not solved the problem on its own narrow person-affecting terms, i.e., in terms of the identified individuals affected by procreative decisions and acts, especially future children. Thus, the core problem remains unsolved. This is a nagging concern for all who hold the common intuition that actions that harm no one are permissible. I argue against Harmon’s (...) and Woodward’s direct, narrow person-affecting solutions, and in favor of a new solution to the NIP. My solution, or, rather, dissolution, is based on the argument that merely possible people, i.e., hypothetical people who could possibly, but will not actually, exist, are morally irrelevant. I show that the NIP only arises when we concern ourselves with merely possible people. Once we are careful to restrict our concerns to only those that do or will exist, the NIP is dissolved. (shrink)

This article responds to the two replies, published in this issue, to my article “Ultimate Meaning: We Don’t Have It, We Can’t Get It, and We Should Be Very, Very Sad,” published in the first issue of this journal. In the first reply, Turp, Hollinshead, and Rowe present an internalist challenge to my account of value, and a relational conception of the self as a challenge to my premise that leading a life includes everything you do and aim at within (...) the project, effort, or enterprise of living and leading a life. I respond to the internalist challenge by showing it does not succeed in inserting values into acts. I respond to the relational conception of the self by noting that, regardless of the nature of the self, the project of leading a life includes all the things you do and aim at within that project, effort, or enterprise. Thus, we can accept a relational account of the self and allow for other-regarding values but that does not change the location of our pursuit of those values: they remain located within the meta-project of leading a life, leaving the meta-project of leading and living a life with nowhere to reach for a point. In the second reply, Cowan argues against feeling sad about life’s pointlessness. In response, I argue that sad facts warrant sadness. I further argue that there are reasons other than happiness to value truth, including the very, very sad truth about the ultimate pointlessness of our lives. (shrink)

Teleological theories of reason and value, upon which all reasons are fundamentally reasons to realize states of affairs that are in some respect best, cannot account for the intuition that victims in non-identity cases have been wronged. Many philosophers, however, reject such theories in favor of alternatives that recognize fundamentally non-teleological reasons, second-personal reasons that reflect a moral significance each person has that is not grounded in the teleologist’s appeal to outcomes. Such deontological accounts appear to be better positioned to (...) identify the wrong committed against non-identity victims because a person wrongs another on such accounts if she violates his second-personal claims -- overall benefit to victims presents no obstacle to the identification of second-personal wrongdoing. Derek Parfit argues that non-identity is a problem for these deontological theories as well because the alleged victims are properly understood as consenting to the action in question, thereby waiving any such second-personal claim. But his arguments misrepresent the role of consent on such theories by articulating it through appeal to the very teleological theory of reasons that their advocates dismiss as inadequate. Properly understood, Parfit’s appeal to consent understood as retroactive endorsement only provides the answer on such deontological accounts to the question of whether, given that the non-identity victim is second-personally wronged, he is nonetheless better off existing. Indeed, it becomes clear that it is teleological theories for which non-identity poses a particular problem: they cannot -- while their deontological counterparts can – account for the intuition that non-identity victims have been wronged. (shrink)

Life stinks. Mel Brooks knew it, David Benatar knows it,1 and so do I. Even when life does not stink so badly, there’s always the chance that it will begin to do so. Nonexistence, on the other hand, is odor free. Whereas being brought into existence can be harmful, or at least bad, nonexistence cannot be harmful or bad. Even if life is not clearly bad, it is at the very least extremely risky. David Benatar argues, somewhat notoriously, that since (...) it is better never to exist, one is harmed by being brought into existence and, therefore, procreation is likely always wrong and certainly always morally problematic. (shrink)

This paper suggests that there are three kinds of meaning: Everyday, Cosmic, and Ultimate. Everyday meaning refers to the value and significance in our everyday lives, including values such as beauty, morality, and truth, and the significance of engagement with them. Cosmic meaning refers to our meaningful role in the cosmos: to the significance and value of our cosmic niche, to the purposes of the cosmos and our place in it. Ultimate meaning is the end-regarding justifying reason, the valued end, (...) or the point of leading a life at all. It is here argued that procreating can be a deep source of Everyday meaning, and perhaps Cosmic meaning. But nothing can provide us with Ultimate meaning. The implications this may have for procreative ethics is considered. (shrink)

One might think that parental obligation to children ends with the end of childhood. I argue that if we consider why parents are obligated to their children, we will see that this view is false. Creating children exposes them to life’s risks. When we expose others to risks, we are often obligated to minimize damages and compensate for harms. Life’s risks last a lifetime, therefore parental obligation to one’s children does too. Grown children’s autonomy, and grown children’s independent responsibility for (...) some of their own problems, can sometimes limit what parental responsibility demands of parents but it doesn’t do away with the responsibility. I argue that my conclusions are not as counterintuitive as they might initially seem. I also consider the implications that parental obligation to grown children might have on the oft assumed obligation that grown children have to care for their parents. (shrink)

In formulating procreative principles, it makes sense to begin by thinking about whose interests ought to matter to us. Obviously, we care about those who exist. Less obviously, but still uncontroversially, we care about those who will exist. Ought we to care about those who might possibly, but will not actually, exist? Recently, unusual positions have been taken regarding merely possible people and the non-identity problem. David Velleman argues that what might have happened to you – an existent person – (...) often doesn't merit moral consideration since the alternative person one would have been had what might have happened actually happened is a merely possible person about whom one has no reason to care. He argues that his way of thinking can eliminate the non-identity problem. Caspar Hare argues that merely possible people have interests and are morally relevant. He argues that we can solve the non-identity problem by rejecting the view that merely possible people are morally irrelevant. Both Hare and Velleman argue that focusing on one's de dicto rather than on one's de re children can help us avoid the non-identity problem. I analyze the role that merely possible, nonexistent hypothetical entities ought to play in our moral reasoning, especially with regard to procreation. I refute both Velleman's and Hare's views and demonstrate the difficulties we encounter when we try to apply their views to common non-identity cases. I conclude with the common-sense view regarding who matters, morally: only those who do, did, or will exist. (shrink)

The author argues for a theory of responsibility for outcomes of imposed risk, based on whether it was permissible to impose the risk. When one tries to apply this persuasive model of responsibility for outcomes of risk imposition to procreation, which is a risk imposing act, one finds that it doesn’t match one’s intuitions about responsibility for outcomes of procreative risk. This mismatch exposes a justificatory gap for procreativity, namely, that procreation cannot avail itself of the shared vulnerability to risks (...) and their constraints—to the balance one is forced to strike between one’s interest in being free to impose risks on others and one’s interest in being safe from harm resulting from the risk imposed by others—which serves to justify risk imposition, generally. Whereas most risk impositions involve trade-offs of liberty and security among people who share the vulnerabilities associated with the taking, imposing, or being constrained from imposing risks, procreation involves the introduction of people into that position of vulnerability in the first place. Thus, when one procreates, one imposes risks in the absence of the shared vulnerability that usually serves as a justification for risk imposition. Procreative risks may not be wrongfully imposed, but they aren’t permissibly imposed in a manner fully comparable to other permissibly imposed risks. This makes procreation a unique form of risk imposition, with unique implications for its justification and for one’s responsibility for its outcomes. This insight can help explain several puzzling procreative asymmetries. (shrink)

Cet exercice historiographique se propose de suivre le cheminement du thème des femmes - femmes nobles aux XIe et XIIe siècles : - dans l’œuvre de Georges Duby, plus précisément dans son cours, son séminaire et ses publications. Trois phases peuvent être identifiées entre 1953 (année de la parution de sa thèse sur le Mâconnais) et 1996 (année de la publication de la trilogie Dames du XIIe siècle, année de sa mort). 1) 1953-1973 : les questions liées à la condition (...) féminine ont d’abord existé à l’état de questions éparses formulées dans les écrits sur l’aristocratie. 2) 1973-1980 : elles se dessinent plus fermement, avec l’enquête sur les structures familiales et le mariage. 3) 1980-1996 : elles se dégagent du thème de la parenté pour occuper la place centrale, et sont étudiées dans deux directions : la condition des femmes et la sainteté féminine. (shrink)

This survey of metaphysics covers the historical or classical aspects of the subject as well as those currently in the post-Wittgensteinian limelight--principally materialism, platonism, essentialism, and anti-realism. Benardete sees contemporary metaphysical preoccupations as more or less thinly disguised revisitings of those of the past, and explains how metaphysics and mathematical logic are interrelated and how metaphysical studies can illuminate both scinece and the humanities.

Parmi les séminaires que Georges Duby dirigea toute sa vie, ceux de Sénanque occupent une place particulière. Pendant trois ans, entre 1981 et 1983, il réunit des universitaires et des chercheurs autour de questions spécifiquement liées à l’histoire de la vie privée. L’Association des Amis de Sénanque (et en son sein le Cercle d’Etudes Médiévales) assurait la bonne organisation matérielle. Son directeur, Emmanuel Muheim, accueillait dans l’abbaye cistercienne provençale, pendant quelques jour..

This paper investigates connections between procreative ethics and the ethics of suicide and euthanasia. While there are good reasons for distinguishing between lives worth starting and lives worth continuing, I argue that those reasons provide no reason for denying that there is a relationship between procreative and end of life ethics. Regarding euthanasia/assisted suicide, we might think it too demanding to ask parents to help euthanize their terminally ill, suffering child, but had the parents not procreated, thereby exposing their child (...) to life's risks, their child wouldn't need euthanizing. If you need help killing yourself, shouldn't your parents, who got you into life in the first place – without your consent – help you out of it? Yet knowing that your parents would help you kill yourself may increase your desire to die. A conundrum. Regarding suicide, the fact that we are forced into life should bolster the right to suicide, even for reasons that others might find wanting. The ways in which we are brought into life have moral implications for the ways in which we are entitled to get out of it. (shrink)