This chapter contains sections titled: Introduction Procurement From the Dead Procurement From the Living The Transition from Life to Death Conclusion References.

Morality, Mortality as a whole deals with certain aspects of ethical theory and with moral problems that arise primarily in contexts involving life‐and‐death decisions. The importance of the theoretical issues is not limited to their relevance to these decisions; however, they are, rather, issues at the heart of basic moral and political theory. This first volume comprises three parts. Part I, Death: From Bad to Worse, has with four chapters, and an appendix, discussing death and why it (...) is bad for the person who dies. Part II, Saving Lives: General Issues, has six chapters, and explores a cluster of moral problems that arise in saving lives. The general question raised is whether we should always, in aiding life, act so as to save the greater number of lives or to produce the greatest amount of good. Part III, Scarce Resources: Theoretical Issues, Specific Recommendations, and Organ Transplants, has five chapters, and deals with the problem of the acquisition and distribution of organs for transplantation. It allows us to apply the theoretical discussion of saving lives and relevant/irrelevant utilities presented in the previous parts. However, the discussion can be understood independently of the first two parts, and the conceptual issues and procedures on which it focuses are relevant to dealing with any scarce resource, including money and time, which are needed to use other plentiful resources. Although the book contains much theoretical and methodological argument, it is firmly grounded in practical ethical issues, and is illustrated throughout by examples. (shrink)

Organ transplantation has given hope when formerly death was inevitable. But the replacement of vital organs highlights major moral and philosophical problems in medicine concerning the role of physicians and nurses, patient autonomy, and respect for the dying and the dead. These include the morality of excising organs from a healthy donor, and related problems regarding an individual’s consent to have organs removed for the benefit of others. These problems are not restricted to live organ (...) donation: cadaveric organ removal raises problems over the definition of death, and raises further questions of fundamental moral and philosophical concern over the procurement and distribution of organs. Guiding decisions in these areas is a mass of empirical knowledge, scientific theory, and philosophical beliefs concerning what it means to say that someone is dead or alive, or whether given persons are competent to make a decision, or whether other considerations should override a competent decision. These questions call for investigation of conceptual matters and moral principles, and are by no means exclusively determined by medical expertise. (shrink)

Transplantation is a medically successful and cost-effective way to treat people whose organs have failed--but not enough organs are available to meet demand. T. M. Wilkinson explores the major ethical problems raised by policies for acquiring organs. Key topics include the rights of the dead, the role of the family, and the sale of organs.

In lieu of an abstract, here is a brief excerpt of the content:The Institute of Medicine’s Report on Non-Heart-Beating Organ TransplantationRoger Herdman (bio), Tom L. Beauchamp (bio), and John T. Potts Jr. (bio)In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis of the IOM (...) report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.Transplantation BackgroundAs a first step, some background in the relevant aspects of organ transplantation will prove useful. For the purposes of this analysis, “transplantation” involves the transfer of cells, tissues, or solid organs from one human to another to replace the structure or function of comparable body components that, through injury or disease, are defective or of inadequate function. The IOM report deals with solid organs, primarily kidneys and livers, whose blood supply is reconnected in the organ recipient, in contrast to cells, like bone marrow, and tissues, like corneas. A variety of donor types exists for organ transplantation, each with particular medical and scientific conditions.Living donors are healthy (and usually genetically related) individuals who volunteer to provide either a whole, paired organ such as a kidney or a section of an organ such as a liver. Cadaver donors are individuals who have died and from whom a full array of organs can be taken. “Heart-beating” cadaver donors are individuals who have suffered “brain death,” that is, irreversible cessation of function of the whole brain including the brain stem; and “non-heart-beating” donors (NHBDs) are individuals who are ill or injured, but not “brain dead,” and who have suffered cardiopulmonary death, that is, irreversible cessation of cardiac and respiratory function. NHBDs can be “controlled,” which means that [End Page 83] they can be sustained by artificial life support systems until a medical and family decision is made to terminate futile life support. This can be done at a scheduled time and in a controlled manner, and organs can then be recovered for transplantation. NHBDs can also be “uncontrolled,” which means that their hearts and breathing have stopped through disease or injury at an unexpected time or in an uncontrolled manner, and they cannot be resuscitated; the organs of some individuals of this description can be recovered for transplantation. The IOM report focused on both controlled and uncontrolled NHBDs and on problems specific to them.The questions that were asked and addressed in the IOM report became current and salient beginning in 1992 with the establishment of the University of Pittsburgh “Policy for the Management of Terminally Ill Patients Who May Become Organ Donors After Death.” This policy addressed controlled NHBDs and the ethical questions raised by their use; much of the discussion was reported in the June 1993 special issue of the Kennedy Institute of Ethics Journal. Public notice and anxiety about some of these concerns were sharpened and refocused by national and local media allegations of improper treatment of donors at the Cleveland Clinic in 1997, specifically premature—i.e., antemortem—recovery of organs and administration of drugs that allegedly might hasten donor death.The DHHS Request for StudyIt is not surprising that several federal actions would be taken in response to these events. Some, such as the results of a transplantation task force, remain largely internal to DHHS at this writing. Others are public, such as the IOM study of the NHBD situation. In May 1997, the DHHS initiated contacts with the IOM with the goal of exploring federal concerns about the medical and ethical treatment of NHBDs, in particular the allegations directed at the Cleveland Clinic.The DHHS response should be understood in at least three contexts. First, living donors and uncontrolled NHBDs were essentially the only donor types in the early days of transplantation in the United States. The technologies, ethics, and social acceptance of controlling and terminating life support for... (shrink)

Many of the philosophical questions raised by Latin American thinkers are problems that have concerned philosophers at different times and in different places throughout the Western tradition. But in fact the issues are not altogether the same-- for they have been adapted to capture problems presented by new circumstances, and Latin Americans have sought resolutions in ways that are indeed novel. This book explains how well-established philosophical traditions gave rise in the "New World" to a distinctive manner (...) of thinking. There was no clean sweep of the past and an attempt to start over: rather, Latin American thinkers mostly welcomed European ideas at whatever pace such traditions happened to arrive. It is then no surprise that, for instance, Scholasticism became the accepted view under Spanish rule, and began to lose its grip only when the rulers did.But what does seem surprising is the radical way in which those traditions were transformed to account for problems that, though familiar, were now seen intake light of new circumstances. A distinctive Latin American way of thinking about such problems emerged from the project of "recycling" European philosophical traditions, some of which were already obsolete in Europe at the time their transplant took place. Thus theories commonly taken to be incompatible within Western traditions in philosophy were absorbed by Latin American thought-- and, in their newly acquired forms, such theories are even now at the basis of proposed solutions to many practical and philosophical problems.The book explores that recycling process. Above all, it aims to determine whether the various cultures that met in the "New World" could now be said to have come to share a common identity. This is in fact an issue which has preoccupied Latin Americans since at least the beginning of the 19th century, when their countries won their independence. But, in connection with this, it is also important to ask how Latin Americans have thought about the relationship between philosophy and rationality, and about other issues belonging to the major areas of philosophy such as epistemology, moral philosophy, and political philosophy, as well their application to vital social issues, including education and the emancipation of women. These are all taken up by the author, who pays special attention to questions of gender discrimination, justice, human rights, reparation for historically dispossessed peoples, and the role of education-- all matters of continuing concern in Latin American thought, from its earliest stirrings to the present day. (shrink)

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as uterine (...) transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure. (shrink)

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as uterine (...) transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure. (shrink)

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as uterine (...) transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure. (shrink)

Moral Problems in Higher Education brings together key essays that explore ethical issues in academia. The editor and contributors-all noted philosophers and educators-consider such topics as academic freedom and tenure, free speech on campus, sexual harassment, preferential student admissions, affirmative action in faculty appointments, and the ideal of a politically neutral university. Chapters address possible restrictions on research because of moral concerns, the structure of peer review, telling the truth to colleagues and students, and concerns raised (...) by intercollegiate athletics. Cahn selects two key readings in each area to offer a readable introductory guide to these critical subjects for students studying academic ethics and higher education policy. In addition to the selections and a general introduction, Cahn provides study questions for use in the classroom. Contributors include Scott F. Aikin, Derek Bok, William G. Bowen, Myles Brand, Richard T. DeGeorge, Paul D. Eisenberg, Leslie Pickering Francis, Martin P. Golding, Philip Kitcher, Charles R. Lawrence III, David Lewis, Paul J. Olscamp, Nancy Tuana, David Shatz, George Sher, Robert L. Simon, Robert B. Talisse, Stephan Thernstrom, Abigail Thernstrom, Laurence Thomas, Robert Paul Wolff, and the editor. (shrink)

Moral Problems in Medicine is based on Michael Palmer's earlier, well-received, book, Moral Problems. The new book retains much of the structure of the earlier volume and the majority of its philosophical component. But whereas the earlier text was a course in applied philosophy covering such topics as warfare, crime and punishment and civil disobedience in addition to topics in medical ethics such as abortion and euthanasia, Moral Problems in Medicine focuses entirely on medicine. (...) The text is primarily intended to be of interest to health care professionals, medical students and to those who teach them but is also aimed at the newcomer to medical ethics and would be suitable too for the general reader with an interest in the ethical issues raised by modern medicine. Following an introductory chapter on “What …. (shrink)

The priority that Tessman’s argument gives to phenomenological and neuropsychological explanations of moral requirements entails a fundamental shift in our understanding of these. Two central problems of normative theory come together in Tessman’s account. The first arises when an agent’s sense of requirement clashes with what a systematic theory prescribes. The second arises when neuropsychological accounts fail to fit the prescription. Tessman argues that no account successfully resolves moral dilemmas such that ought always implies can, and she (...) argues that neuropsychology explains our sense of impossible requirements. This explanation eliminates the role of a prescriptive theory in explaining an agent’s sense of requirement. (shrink)

This article gives an overview of the moral problems experienced and described by nurses working in a dialysis unit in the Netherlands. The nurses raised a wide variety of issues that they considered were moral problems, which were grouped into seven topics. A selection of cases are described, one of which is analysed using the Nijmegen method of ethical case deliberation. This method facilitates practical approaches to the different types of moral problems encountered. (...) The argument is made that, owing to their specific moral position and responsibility, nurses' contribution to ethical reflection in ward discussions should be valued more. All caregivers involved are indispensable in developing a basis for well-reasoned decisions when deliberating about moral problems. (shrink)

Discussion of real cases encountered by medical students has been advocated as a component of medical ethics education. Suggested benefits include: a focus on the actual problems that medical students confront; active learner involvement; and facilitation of an exploration of the meaning of their own values in relation to professional behaviour. However, the approach may also carry risks: students may focus too narrowly on particular clinical topics or show a preference for discussing legal problems that may appear to (...) have clearer solutions. Teaching may therefore omit areas generally considered to be important components of the curriculum. In this paper, the authors present an analysis of the moral problems raised by medical students in response to a request to describe ethically problematic cases they had encountered during two clinical attachments, for the purpose of educational discussion at case-based seminars. We discuss the problems raised and compare the content of the cases to the UK Consensus Statement on core content of learning. The authors also describe the approaches that the students used to undertake an initial analysis of the problems raised, and consider possible implications for the development of medical ethics education. (shrink)

According to the worm theory, persons are (maximal) aggregates of person-stages existing at different times. Personites, on the other hand, are non-maximal aggregates of stages that are very much like persons. Their existence appears to make instances of prudential self-sacrifice morally problematic: the personites that exist at the time of the sacrifice but not at the time of the reward seem not to receive future compensation for their sacrifice. Instances of punishment appear to give rise to a similar problem. We (...) argue that these impressions arise from a mistaken assumption about the primary bearers of properties such as suffering, receiving compensation (in the future) and having (previously) committed a crime. According to the worm theory, stages, rather than persons or personites, possess these properties. Persons and personites have these properties only derivatively. As we show, once this clarification and related ones are made, the apparent moral problems raised by the existence of personites dissolve. (shrink)

The question of whether an artificial moral agent (AMA) is possible implies discussion of a whole range of problems raised by Kant within the framework of practical philosophy that have not exhausted their heuris­tic potential to this day. First, I show the significance of the correlation between moral law and freedom. Since a rational being believes that his/her will is independent of external influences, the will turns out to be governed by the moral law and (...) is autonomous. Morality and freedom are correlated through independence from the external. Accordingly, if the actions of artificial intelligence (AI) are determined by something or someone external to it (by a human), then it does not act morally and freely, but heteronomously. As a consequence of AI’s lack of autonomy, and thus lack of access to the moral law, it does not and cannot have a moral understanding that proceeds from the moral law. Another consequence is that it has no sense of duty, which would follow from the moral law. Thus, moral action becomes impossible for the AMA because it lacks autonomy and moral law, moral understanding and sense of duty. It is concluded that, first, AMA not only cannot be moral, but should not be that, since the inclusion of any moral principle would imply the necessity for the individual to choose it, making the choice of the principle itself immoral. Second, although AI has no will as such, which prima facie makes not only moral but also legal action impossible, it can still act legally in the sense of conforming to legal law, since AI carries a quasi-human will. Thus, it is necessary that the creation of AI should be based not on moral principles, but on legal law that prioritises human freedom and rights. (shrink)

During the last two decades a broad and intensive discussion has taken place in the field of medical ethics. Especially in the English-speaking countries, “Biomedical Ethics” have developed as a part of secular, philosophical moral theory. Two ethical problems in organ transplantation – living organ donation and organ allocation – illustrate that this transition reflects both the complex ethical questions raised by rapid changes in the biological sciences and in health care, and the fact that traditional (...) Hippocratic ethics have proven to be inadequate in several respects. (shrink)

We examine the philosophical and ethical issues associated with conjoined twins and their surgical separation. In cases in which there is an extensive sharing of organs, but nevertheless two distinguishable functioning brains, there are a number of philosophical and ethical challenges. This is because such conjoined twins: 1. give rise to puzzles concerning our identity, about whether we are identical to something psychological or biological;2. force us to decide whether what matters from an ethical point of view is the biological (...) life of our organisms or the existence of our consciousness or mind; 3. raise questions concerning when, if ever, it is morally acceptable to sacrifice one of us to save another;4. force us to reflect on the conditions for ownership of organs and the justification of removal of organs for transplantation which causes the death of the donor; 5. raise questions about who should take decisions about life-risking treatments when this cannot be decided by patients themselves.We examine and suggest answers to these questions. (shrink)

Post-war Japan has seen profound and rapid social change and transformation. One of the most visible areas of change in Japan has been medicine, and particularly the ethical practices and policies that guide medical decision-making. The formal discipline of bioethics, Seimei Rinri in Japanese, has grown by leaps and bounds since the late 1970s, when it began to appear in the curriculum and professional activities of Japanese medical schools and philosophy departments. The introduction of bioethics to Japan was timely, as (...) innovation in medicine and technology was evolving in ways that revealed that the intersection of medicine, traditional Japanese values, and new cultural trends was an area of great moral complexity. In its infancy, bioethics in Japan was more or less an import from the United States, where the discipline took its roots. Quickly, however, it became clear that Japan's history and tradition would call for a different approach, and the engagement of slightly different ethical issues. Organ transplantation, for example, sparked much greater controversy in Japan than it ever did in the United States. Today, Japan has one of the most dynamic bioethics programs in the world, and it is one that reflects both traditional Japanese culture and the need for inter-cultural engagement in an increasingly global world. Through a series of original chapters written by bioethicists and covering a range of ethical issues, this anthology shows that, in contrast to previous assumptions, Japanese bioethics has, in fact, taken on an identity that is undoubtedly separate from its American origins. Rich philosophical questions raised by medicine, human subjects research, and psychiatric care are being posed by scholars in a way that reflect Japanese tradition and is no longer simply reflective of, or shaped by, American traditions and philosophical problems. The book highlights and showcases these trends through a series of chapters written by some of the leading scholars in contemporary Japanese bioethics, many of whom were pioneers of the field when it began and are now nearing retirement. (shrink)

Today's international community may well view covert action and democracy as mutually exclusive policies. This article examines the practice of covert action in American foreign policy in light of events of the mid-1970s and 1980s, focusing on the scandalous misuse of executive authority and lack of accountability associated with covert means. Often manipulative and sometimes anonymous, covert operations raise critical morality concerns in a democratic society. Whether "any form of accountability is likely to be sufficient to bring the unauthorized use (...) of executive power under control" is the crucial issue to be addressed when examining the practicality of covert actions by the executive branch. (shrink)

Due to the worldwide shortage of organs for transplantation, there has been an increased use of organs obtained after circulatory death alone. A protocol for this procedure has recently been approved by a major transplant consortium. This development raises serious moral and ethical concerns. Two renowned theologians of the previous generation, Paul Ramsey and Moshe Feinstein, wrote extensively on the ethical issues relating to transplantation, and their work has much relevance to current moral dilemmas. Their writings (...) relating to definition of death, organ transplantation and the care of the terminally ill are briefly presented, and their potential application to the moral problem of organ donation after circulatory death is discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Back to the Future:Obtaining Organs from Non-Heart-Beating CadaversRobert M. Arnold (bio) and Stuart J. Youngner (bio)Organ Transplantation requires viable donor organs. This simple fact has become the Achilles' heel of transplantation programs. Progress in immunology and transplant surgery has outstripped the supply of available organs. Between 1988 and 1991, for example, the number of transplant candidates on waiting lists increased by about 55 percent, while the number (...) of donors increased only about 16 percent.1 By the end of March 1993, more than 30,000 potential recipients awaited transplantation (United Network for Organ Sharing Database (UNOS) 1993). Every day six of these patients die prior to receiving a heart or liver transplant, while patients needing kidney transplants must tolerate a lower quality of life on dialysis (Grenvik 1992; Evans, Orians, and Ascher 1992).This scarcity is likely to get worse. As transplantation becomes more successful, it is being offered to sicker and older patients. Attempts to transplant other solid organs, such as small bowel and pancreas, will only fuel the demand for donors. However, the current source of organs is unlikely to grow. Most organs come from patients who have been declared dead by neurologic criteria (commonly referred to as "brain dead" or heart-beating cadaver donors (HBCDs) because their hearts are beating at the time of procurement). Estimates of the potential pool of HBCDs have been revised downward from 20,000-27,000 to roughly 10,000-12,000 (Nathan et al. 1991). Improvements in automobile safety and handgun legislation will likely lead to further reductions. Moreover, the rate of procurement from HBCDs has remained relatively flat despite extensive public awareness campaigns and legislation requiring hospitals to routinely request donation from families of dead patients (Caplan et al. 1992).If organ transplantation is going to continue to flourish, alternative [End Page 103] sources of organs must be found. Recently the University of Pittsburgh Medical Center (UPMC) proposed procuring organs from patients who have been declared dead by traditional cardiopulmonary rather than brain-oriented criteria after they or their families have decided to forgo life-sustaining treatment—hereafter referred to as the Pittsburgh protocol (UPMC Policy 1993). These patients are typically referred to as non-heart-beating cadaver donors (NHBCDs) because their hearts are no longer beating at the time of organ procurement.Although NHBCDs were a major source of transplantable kidneys prior to the institution of death by neurologic criteria, their usefulness was limited by "warm ischemia time." This term refers to the injury to tissues that occurs when the blood supply is interrupted and before the organs are cooled and reperfused. Under the Pittsburgh protocol, therapy is withdrawn in the operating room where a waiting surgical team removes organs immediately after death is declared. By controlling the place and time of death, it has been possible to minimize warm ischemia time and thus solve the technical problems previously associated with procurement from NHBCDs.The potential contribution of NHBCD organs is significant. Nathan (1992), using data from Delaware Valley Transplant Program, concludes that the use of severely brain injured, but not "brain dead" patients, would increase the donor pool by 20-25 percent. Moreover, unpublished data from the Pittsburgh organ procurement organization, the Center for Organ Recovery and Education (CORE), suggests that these organs, particularly kidneys, function as well as those procured from HBCDs (Broznick 1993).This volume is devoted to the ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors after a discussion to forgo life-sustaining treatment. The genesis of this volume was a project in which we invited leading experts in transplantation, ethics, and public policy to use the Pittsburgh protocol as a starting point for exploring a broad range of issues associated with attempts to procure organs from NHBCDs. The issues raised by NHBCDs turned out to have important implications about the fundamental conceptual and moral assumptions underlying organ procurement.Although each of the papers in this volume can be read separately, we intend the volume to be read as a whole. Many of the latter pieces on the ethical implications of the policy are best understood in light of the earlier background papers... (shrink)

This article reports on moral problems that were raised by medical students as the basis for an ethical case-conference in an obstetrics and gynaecology clerkship. After introducing the issue of teaching clinical ethics, the method of our case-conference is explained. Next, the variety of topics and related moral problems are presented. The article continues with a discussion of three distinct and challenging aspects that characterise obstetrics and gynaecology as a domain for teaching clinical ethics. The (...) conclusion puts forward three significant points our review raises. (shrink)

This dissertation argues for a metaethical theory I call "Expressive-Assertivism." Expressive-Assertivism is a distinctive, substantial refinement of dual-use metaethical theories traditionally associated with R. M. Hare, C. L. Stevenson, and, more recently, with David Copp. If true, Expressive-Assertivism clarifies, resolves, or dissolves---without, in turn, raising additional difficulties---a number of philosophical problems, including what Michael Smith calls "The Moral Problem," which many consider to be the central organizing problem in contemporary metaethics. The following are the three most important features (...) of Expressive-Assertivism. ;1. The central tenet. The proper, literal use of an ethical sentence, such as 'Donating to charity is right', is the performance of a direct expressive illocutionary act and a direct assertive illocutionary act. Recognizing that ethical sentences can be used to both directly express a speaker's attitude and directly assert something about the world captures what is intuitively compelling about "expressivist" theories---namely, that there is some strong connection between a speaker's sincere moral utterance and his or her motivations to act---and what is intuitively compelling about "descriptivist" theories---namely, that moral utterances appear to have descriptive or cognitive content and, therefore, are truth-evaluable. The Central Tenet is the feature of Expressive-Assertivism that dissolves The Moral Problem. ;2. The generality principle. The proper, literal use of an ethical sentence directly expresses an attitude, not toward the subject of the sentence, but toward things of a more general kind, namely, things that have the property picked out by the ethical predicate . ;3. The extensionality principle. A speaker directly expresses an attitude toward things that have the property picked out by an ethical predicate whenever that predicate appears in any extensional context. Together, the Extensionality and Generality Principles shield Expressive-Assertivism from many objections to traditional expressivist theories, including "The Embedding Objection," which many consider to be the most difficult problem faced by expressivists. (shrink)

Organ transplantation is at once a technology that raises new ethical problems and a good testing ground for various moral principles. It has become a common procedure in some countries and, at least in the United States, promises to become even more so. It poses questions about costs and benefits as well as the very large question of whether we should try to renew human life indefinitely and, if so, at what cost. It raises the problem of (...) whether organs are the property of their possessors – at least when the possessors are competent adults. It raises issues of organ sales, of what might be called donor recruitment, of informed consent, of reparations when transplant fails, of eligibility for transplant, and of competition for medical time and expertise between transplantation and other, less dramatic kinds of medical care. This essay touches on all of these topics, with the aim of identifying the broad dimensions of the ethical problems of organ transplantation and some of the moral principles that may help us solve them. (shrink)

This essay explores some moral problems raised by experimentation involving the human fetus. In the first part of the essay three examples of fetal experimentation from the medical literature are described in some detail. Next, the ethical and legal arguments employed in the two major existing public policy-documents on fetal experimentation are analyzed. Finally, the author seeks to identify four fundamental presuppositions which underlie divergent normative positions on the problem of fetal experimentation.

Most of the essays collected here are essaysinmetaethics seeking in exacting and interesting ways to resolve problems raised by the familiar options in metaethics we outlined in our Introduction. Richard Brandt, for example, forcefully argues, going much against the at least modestly holistic grain of our time, for a foundationalism (noncognitivist though it be) which would be foundational in both metaethics and normative ethics. R.M. Hare makes a brief but systematic defense, which is both spirited and clear, of (...) his prescriptivism (a species of what we, following tradition, have called ‘noncognitivism,’ but which he argues should instead be called ‘nondescriptivism’). His arguments here for his position - call it nondescriptivism or noncognitivism- are directed forcefully against ethical naturalism (descriptivism) and specifically against the naturalism of Philippa Foot. Nicholas Sturgeon and David Copp contribute elaborate and rigorously argued defenses of ethical naturalism, or, as they might prefer to call it, ‘moral realism.’. (shrink)

What should we do when we are not certain about what we morally should do? There is a long history of theorizing about decision-making under empirical uncertainty, but surprisingly little has been written about the moral uncertainty expressed by this question. Only very recently have philosophers started to systematically address the nature of such uncertainty and its impacts on decision-making. This paper addresses the main problems raised by moral uncertainty and critically examines some proposed solutions.

The ethical and social issues raised by transplants are so interrelated that the thread of any problem eventually leads to the whole tangled ball. This article, however, limits discussion to topics involving living donors in the United States. This restriction is not dictated solely by space constraints. Rather, the rise in the number of living donors gives a particular urgency to questions about informed consent, donor protection, and recipient needs. How we resolve conflicts of interest, address issues of consent, (...) and define the scope of autonomy will shape the policies and practices that determine whether donors are protected and whether lives are lost or saved. (shrink)

Philosophers, particularly moral philosophers, are increasingly being involved in public decision‐making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the ‘Committee of Inquiry into Human Fertilization and Embryology’ in the UK in 1982–4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only (...) are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential.The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision‐making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper. (shrink)

Philosophers, particularly moral philosophers, are increasingly being involved in public decision‐making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the ‘Committee of Inquiry into Human Fertilization and Embryology’ in the UK in 1982–4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only (...) are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential.The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision‐making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

. E. O. Wilson writes that the “choice between transcendentalism and empiricism” is this century's “version of the struggle for men's soul” . The transcendentalist argues for theism—that there is a God, a creator of the world. The empiricist instead makes the point that the notion of God, including morality and ethics, are adaptive structures of human evolution. Before entering the debate of the transcendentalist/empiricist controversy I analyze how things exist and suggest that all that is exists as united diversity, (...) as identity in difference. I argue that oneness by itself is intangible because wholes are concrete only through their tangible parts. I briefly discuss this understanding of existence in the realm of art to show that transcendence and immanence are not mutually exclusive but constitute each other. I conclude that existence, the hypostasis of unity in diversity, might be seen as a gift from absolute existence. In this view, the world might reveal itself as a gift that reflects the trinitarian existence of the Giver. (shrink)

Philosophers, particularly moral philosophers, are increasingly being involved in public decision‐making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the ‘Committee of Inquiry into Human Fertilization and Embryology’ in the UK in 1982–4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only (...) are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential.The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision‐making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper. (shrink)

Research into moral decision-making has been dominated by sacrificial dilemmas where, in order to save several lives, it is necessary to sacrifice the life of another person. It is widely assumed that these dilemmas draw a sharp contrast between utilitarian and deontological approaches to morality, and thereby enable us to study the psychological and neural basis of utilitarian judgment. However, it has been previously shown that some sacrificial dilemmas fail to present a genuine contrast between utilitarian and deontological options. (...) Here, I raise deeper problems for this research paradigm. Even when sacrificial dilemmas present a contrast between utilitarian and deontological options at a philosophical level, it is misleading to interpret the responses of ordinary folk in these terms. What is currently classified as “utilitarian judgment” does not in fact share essential features of a genuine utilitarian outlook, and is better explained in terms of commonsensical moral notions. When subjects deliberate about such dilemmas, they are not deciding between opposing utilitarian and deontological solutions, but engaging in a richer process of weighing opposing moral reasons. Sacrificial dilemmas therefore tell us little about utilitarian decision-making. An alternative approach to studying proto-utilitarian tendencies in everyday moral thinking is proposed. (shrink)

As a first step, the arguments for and against the use of animals for medical purposes in general were reviewed. These arguments are summarized briefly in the first part of the article; Secondly, even if people accept in principle the use of animals in medicine and medical research, their use in xenotransplantation mayraise particular difficulties. There are three key issues in the debate over the use of animals in xenotransplantation. The first is whether as a matter of principle, it is (...) considered to be morally acceptable to use animals as organ or tissue source; the second is the ethical acceptability of the use of primates to supply transplant material; the third is the ethical issues raised by the use of genetically modified animals to provide organs for xenotransplantation. If it is agreed to be acceptable in principle, there are then questions to address regarding the welfare of animals within any xenotransplantation program. Finally, the author makes an attempt to discuss these ethical issues in Chinese cultural context. (shrink)

According to Michael Zimmerman, no interpretation of the idea that moral responsibility is essentially interpersonal captures a significant truth. He raises several worries about the Strawsonian view that moral responsibility consists in susceptibility to the reactive attitudes and claims that this view at best supports only an etiolated interpretation of the idea that moral responsibility is essentially interpersonal. He outlines three problems. First, the existence of self-reactive attitudes may be incompatible with the interpersonal nature of (...) class='Hi'>moral responsibility. Secondly, Zimmerman questions the significance of the interpersonal nature of moral responsibility, according to the Strawsonian view. Thirdly, he argues that that view may be taken to suggest the wrong kind of priority relation between ‘P is morally responsible’ and ‘it is appropriate to adopt some reactive attitude toward P’. I discuss each of these problems in turn and conclude that Strawsonians can respond to all three problems raised by Zimmerman. The Strawsonian view supports a significant interpretation of the idea that moral responsibility is essentially interpersonal. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

This paper discusses a central idea of our everyday life—human actions and the role of luck in the moral life. The aim of this paper is to formulate and discuss the problem of moral luck, thereby dealing with the question: ‘what is the status or role of luck in the moral life of an individual?’ Bernard Williams and Thomas Nagel highlight the juxtaposition of the two contradictory terms: ‘Luck’ and ‘Morality’ and used the term ‘moral luck’ (...) which inculcates the view that the factor of luck or fortune can affect the moral worth of an individual. In this context, the paper is specifically concerned with the philosophical problem of moral luck which raises a conceptual tension between morality and responsibility by emphasizing that moral assessment, evaluation and justification of human actions are all subjected to luck. Further, in the light of this philosophical problem, the paper also attempts to postulate a possible moral framework with an aim to analyse and conceptually map the status of the juxtaposition of luck and morality. (shrink)

This chapter examines Dewey’s view of moral knowledge developed in Chapter 14 of the Ethics. I focus more specifically on the role played by sympathy in moral inquiry. While Dewey claims that sympathy is “the general principle of moral knowledge” as well as “the surest way to attain objectivity of moral knowledge,” it has not been the object of any extensive discussion by commentators on Dewey’s ethics. I emphasize the originality of Dewey’s position by contrasting it (...) with that of David Hume, Adam Smith, and John Stuart Mill, who all stressed the fundamental role of sympathy in making moral judgments. Accordingly, I examine their respective answers to the moral problem raised by natural sympathy: how can such a biased and partial psychological mechanism play a beneficial role in the formation of moral judgments, which specifically aim at impartiality and objectivity? I will argue that while Hume, Smith, and Mill choose to simply extend the scope of natural sympathy, Dewey argues in favor of a deeper transformation of natural sympathy: (1) the spontaneous emotional reaction becomes intentional perspective-taking; (2) it loses its function of direct approval or disapproval, and takes on an epistemic function of data-gathering subordinated to moral reasoning. (shrink)

John Dewey (1859-1952) lived from the Civil War to the Cold War, a period of extraordinary social, economic, demographic, political and technological change. During his lifetime the United States changed from a rural to an urban society, from an agricultural to an industrial economy, from a regional to a world power. It emancipated its slaves, but subjected them to white supremacy. It absorbed millions of immigrants from Europe and Asia, but faced wrenching conflicts between capital and labor as they were (...) integrated into the urban industrial economy. It granted women the vote, but resisted their full integration into educational and economic institutions. As the face-to-face communal life of small villages and towns waned, it confronted the need to create new forms of community life capable of sustaining democracy on urban and national scales. Dewey believed that neither traditional moral norms nor traditional philosophical ethics were up to the task of coping with the problems raised by these dramatic transformations. Traditional morality was adapted to conditions that no longer existed. Hidebound and unreflective, it was incapable of changing so as to effectively address the problems raised by new circumstances. Traditional philosophical ethics sought to discover and justify fixed moral goals and principles by dogmatic methods. Its preoccupation with reducing the diverse sources of moral insight to a single fixed principle subordinated practical service to ordinary people to the futile search for certainty, stability, and simplicity. In practice, both traditional morality and philosophical ethics served the interests of elites at the expense of most people. To address the problems raised by social change, moral practice needed to be thoroughly reconstructed, so that it contained within itself the disposition to respond intelligently to new circumstances. Dewey saw his reconstruction of philosophical ethics as a means to effect this practical reconstruction. (shrink)

Moral disagreement is widely held to pose a threat for metaethical realism and objectivity. In this paper I attempt to understand how it is that moral disagreement is supposed to present a problem for metaethical realism. I do this by going through several distinct (though often related) arguments from disagreement, carefully distinguishing between them, and critically evaluating their merits. My conclusions are rather skeptical: Some of the arguments I discuss fail rather clearly. Others supply with a challenge to (...) realism, but not one we have any reason to believe realism cannot address successfully. Others beg the question against the moral realist, and yet others raise serious objections to realism, but ones that—when carefully stated—can be seen not to be essentially related to moral disagreement. Arguments based on moral disagreement itself have almost no weight, I conclude, against moral realism. (shrink)

This article is a review of the literature on the subject of how nurses who provide palliative care are affected by ethical issues. Few publications focus directly on the moral experience of palliative care nurses, so the review was expanded to include the moral problems experienced by nurses in the care of the terminally ill patients. The concepts are first defined, and then the moral attitudes of nurses, the threats to their moral integrity, the (...) class='Hi'>moral problems that are perceived by nurses, and the emotional consequences of these moral problems are considered in turn. The results show that the moral behaviour of nurses, which is theoretically grounded in commitment to care and to the patient, appears to be shaped by specific processes that lead to engagement or to mental and behavioural disengagement in morally difficult situations. Nurses often appear to fail to recognize the moral dimensions of the problems they experience and also to lack the skills they need to resolve moral problems adequately. Although the findings show that several elements that are beyond the control of nurses, owing to their lack of autonomy and authority, influence their moral experience, intrinsic factors such as feelings of insecurity and powerlessness have a profound effect on nurses’ perceptions and attitudes in the face of moral problems. The moral problems perceived by these nurses are related to end-of-life issues, communication with patients, the suffering of patients, and the appropriateness of the medical treatment. (shrink)

ABSTRACT This article deals with a cluster of moral problems raised by the new techniques of human fertilisation. It is concerned primarily with the putative rights of embryos brought into being as a by‐product of the practice of in vitro fertilisation. In this connection it investigates the basis for the ascription of rights to entities and asserts the view that consciousness is a pre‐requisite for the possession of rights. It draws attention to the speciesism implicit in attitudes (...) of some of those who have contributed to the debate. It also examines other issues briefly, raising, for example, the question whether children by AID (or by in vitro fertilisation by donor) must be denied access to information about their genetic fathers; and looking at objections to the new techniques based on the so‐called unnaturalness of the procedures involved. (shrink)

According to Westermarck’s widely accepted explanation of the incest taboo, cultural prohibitions on sibling sex are rooted in an evolved biological disposition to feel sexual aversion toward our childhood coresidents. Bernard Williams posed the “representation problem” for Westermarck’s theory: the content of the hypothesized instinct is different from the content of the incest taboo —thus the former cannot be causally responsible for the latter. Arthur Wolf posed the related “moralization problem”: the instinct concerns personal behavior whereas the prohibition concerns everyone. (...) This paper reviews possible ways of defending Westermarck’s theory from the representation and moralization problems, and concludes that the theory is untenable. A recent study purports to support Westermarck’s account by showing that unrelated children raised in the same peer groups on kibbutzim feel sexual aversion toward each other and morally oppose third-party intra-peer-group sex, but this study has been misinterpreted. I argue that the representation and moralization problems are general problems that could potentially undermine many popular evolutionary explanations of social/moral norms. The cultural evolution of morality is not tightly constrained by our biological endowment in the way some philosophers and evolutionary psychologists believe. (shrink)

ABSTRACT:Does effective moral judgment in business ethics rely upon the identification of a suitable set of moral principles? We address this question by examining a number of criticisms of the role that principles can play in moral judgment. Critics claim that reliance on principles requires moral agents to abstract themselves from actual circumstances, relationships and personal commitments in answering moral questions. This is said to enforce an artificial uniformity in moral judgment. We challenge these (...) critics by developing an account of principle-based moral judgment that has been widely discussed by contemporary Kantian scholars. In so doing we respond to some basic problems raised by so-called “moral particularists” who voice theoretical objections to the role of principles as well as to contemporary business ethicists who have criticized principle-based moral judgment along similar lines. We conclude with some future areas of research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Menkiti's Moral Man by Oritsegbubemi Anthony OyowePolycarp IkuenobeOYOWE, Oritsegbubemi Anthony. Menkiti's Moral Man. Lanham, Md.: Lexington Books, 2022. xii + 221 pp. Cloth, $100.00Oyowe critically examines the various threads in, issues raised by, and implications of Menkiti's maximal conception of personhood, against the backdrop of various criticisms, including his own. He indicates that, as "a repentant critic," he does "not deny the merits of these (...) criticisms," but he is "convinced that there are resources in Menkiti's general account for tackling them."In chapter 1, Oyowe examines how Menkiti uses the idea of community to foreground his normative view of personhood, in order to illuminate the African idea that one is a person because of, and through relationships with, other persons in a community. This indicates that one's existence or [End Page 356] identity has necessary external elements of cultural belonging, in addition to internal intrinsic elements. These cultural elements require ontological progression that involves a process of social-moral incorporation into communal practices and norms. Oyowe argues that while this conception is plausible, it raises questions regarding oppressive cultures and their effects on individuals. He indicates that the kind of person that emerges from this conception is a "soft" social entity.Chapter 2 examines the issue of the nature of the relationship between persons (as soft social entities) and community, and the implications for individual autonomy, practical reasoning, and moral agency. Oyowe argues that the pertinent issue is not whether the individual should have moral or ontological priority over the community or vice versa, but the aspect of individuality that is conducive to what we cherish about the community. This is because Menkiti presupposes that in order to be a maximal person, one must have intrinsic capacities for moral agency to take on communal functions and duties. But the community creates the conditions for individuals to express individuality and autonomy, engage in practical reasoning, and make the choice to conform with communal norms in order to be recognized as persons.So, the maximal conception of personhood raises issues about the nature of entities that deserve a moral status. Chapter 3 examines the moral status of infants, people with cognitive impairment, the senile, nonhuman animals, and the moral duties that people have toward these entities. If we understand personhood as failing to extend moral status to these entities, such a view might be charged with speciesism and anthropocentrism. Oyowe argues that a plausible interpretation of personhood, in the context of the communal priority of duties, suggests that people have certain responsibilities toward human and nonhuman nonpersons. This interpretation is grounded in Menkiti's distinction between "deserving justice"—which is not based on having certain intrinsic properties, moral capacities, or cognitive abilities—and "being a person." Because Menkiti insists that persons ought to be able to use their capacities to perform requisite communal duties, personhood must involve an obligation to consider the interests of nonpersons and a community of respect for those who deserve justice.Chapter 4 examines the dilemma created by the social architecture of a community's cultural traditions, institutions, expectations, norms, and practices that are necessary for personhood and social identity. While such architecture is capable of supporting the achievement of personhood, it could also be restrictive. He uses Chinua Achebe's novel, Things Fall Apart, to illuminate how the structures for recognizing persons that are oppressive of and biased against women could be disguised. Although Menkiti does not address this issue, his conception of personhood highlights the problem of social justice for women because relevant social architecture may exclude women from equal and full communal recognition and participation. An appreciation of this problem [End Page 357] introduces an alternative way of understanding social justice in terms of communal recognition or lack thereof.In chapter 5, Oyowe uses the intuitions underlying Locke's distinction between "person" and "human being" to illuminate Menkiti's account of personhood. Person and human being are not identical because they have different persistent conditions. Persons persist by virtue of mental capacities and practical relevance that are developed after one is identified as a human organism. This raises the issues of (a) whether being a... (shrink)

The research described here contributes to the extant empirical research on business ethics education by examining outcomes drawn from the literature on positive organizational scholarship (POS). The general research question explored is whether a course on ethical decision-making in business could positively influence students’ confidence in their abilities to handle ethical problems at work (i.e., moral efficacy), boost the relative importance of ethics in their work lives (i.e., moral meaningfulness), and encourage them to be more courageous in (...) raising ethical problems at work even if it is unpopular (i.e., moral courage). Specifically, the study used a rigorous quasi-experimental pretest–posttest research design with a treatment (N = 30) and control group (N = 30) to investigate whether a graduate-level course in business ethics could influence students’ levels of moral efficacy, meaningfulness, and courage. Findings revealed that participants in the business ethics treatment course experienced significant positive increases in each of the three outcome variables as compared to the control group. The largest increase was in moral efficacy, followed by moral courage, and finally, moral meaningfulness. These findings are discussed in the context of the current research on business ethics education and POS. Implications for future research are discussed. (shrink)

The stipulation of living organ transplantation policy and practice in Bangladesh is family-oriented, with relatives being the only people legally eligible to donate organs. There have been very few transplantations of bone marrows, liver lobes, and kidneys from related-living donors in Bangladesh. The major question addressed in this study is why Bangladesh is not getting adequate organs for transplantation. In this study, I examin the stipulations of the policy and practice of living organ donation through the lens of (...) 32 key stakeholders including physicians and nurses, a health administrator, organ donors and recipients, and their family members, as they can shed light on the realities and problems of organ donation for transplantation in Bangladesh. My ethnography reveals that the family members are always encouraged to donate organs for transplantation, and saving the lives of relatives through organ donation is seen as a moral obligation. Many view saving the life of a relative by donating one’s organs as equivalent to saving one’s own life. An assessment of the dynamics of biomedicine, religion, and culture leads to the conclusion that the family-oriented organ donation policy and practice have been widely endorsed and accepted in Bangladesh, and Islamic ethical principles and collective family ethos undergird that policy and practice. However, the unavailability of medical resources, lack of post-operative coverage for organ donors, religious misconceptions and unawareness of the general public, and the absence of posthumously donated vital organs for transplantation are perceived to be the most common barriers to a successful living donor-recipient pair organ transplantation. By overcoming these obstacles, Bangladesh can develop a successful living donor-recipient pair organ transplantation program that will ensure improved healthcare outcomes, promote altruism and solidarity among Bangladeshi families, and protect the poor from having their organs sold to wealthy patients. (shrink)

Can addiction be credibly invoked as an excuse for moral harms secondary to particular decisions to use drugs? This question raises two distinct sets of issues. First, there is the question of whether addiction is the sort of consideration that could, given suitable assumptions about the details of the case, excuse or mitigate moral blameworthiness. Most discussions of addiction and moral responsibility have focused on this question, and many have argued that addiction excuses. Here I articulate what (...) I take to be the best argument for this view, based on the substantial difficulty that people with severe addiction experience in controlling drug-related behavior. This, I argue, may in some cases be sufficient to ground a mitigating excuse, given the way in which addiction undermines agents’ responsiveness to relevant moral reasons to do otherwise. Much less attention has been devoted to a second set of issues that critically affect the possibility of applying this mitigating excuse in particular cases, derived from the ambivalent nature of agential control in addiction. In order to find a fitting response to moral harm, the person with the right standing to blame must make a judgment about the extent to which the agent possessed certain morally relevant capacities at the time of the act. In practice, this will often prove tremendously difficult to assess. The ethical challenge for the person with the right standing to blame is fundamentally one of making a judgment about matters that seem underdetermined by the available evidence. (shrink)