Ethics

Published by University of Chicago Press
Online ISSN: 1539-297X
Print ISSN: 0014-1704
Publications
Analyse de l'objection de la responsabilite opposee a l'argumentation en faveur de l'avortement developpee par J. J. Thomson dans son article intitule «A defense of abortion» (in «Philosophy and public affairs», 1, 1971, 47-66). L'A. mesure la possibilite d'une dys-analogie morale entre le cas du partage involontaire d'un rein avec un violoniste celebre et celui d'une grossesse involontaire a la suite d'un viol
 
KIE Tushnet and Seidman attempt to show that, even if Michael Tooley is correct that fetuses have no right to life, others may have a right to their continued existence. Rights-bearing third parties with an interest in the fetus might be biological fathers, prospective adoptive parents, or even society as a whole. Criteria for assessing the legitimacy of claims of interest must be developed and then balanced against the claims of those who support abortion. The authors also discuss principles of bodily autonomy, the destruction as well as the removal of the fetus, and the question of whether legislation prohibiting abortion is mandatory, permissible, or optional.
 
KIE Reynolds argues that the nonconsequentialist moral theory proposed by Alan Donagan in his book The Theory of Morality (University of Chicago Press; 1977) does not resolve the cases in which craniotomy or removal of a cancerous uterus appears necessary to save the life of a pregnant woman. Donagan's absolute prohibition against the murder of the innocent and his rejection of the principle of double effect have led him to view the fetus as a pursuer or assailant or to assert the theory of proleptic agreement--that in risk taking ventures the parties may agree that killing one person to save the lives of the others will be accepted. Reynolds holds these arguments to be inapplicable in therapeutic abortions involving craniotomy or hysterectomy and concludes that Donagan's absolutist theory must be reexamined.
 
One of the aims of this article is to contribute to the identification of the empirical criteria governing the use of the concepts of killing and letting die. I will not attempt a comprehensive analysis of the concepts but will limit the inquiry to certain problematic cases -- namely, cases involving the removal or withdrawal of life-supporting aid or protection. The analysis of these cases will, however, shed light on the criteria for distinguishing killing and letting die in other cases as well. My overall aims in the article are partly constructive and partly skeptical. I hope to advance our understanding of the nature of the distinction between killing and letting die. This, I believe, will enable us to defend the moral relevance of the distinction against certain objections -- in particular, objections that claim that the distinction fails to coincide with commonsense moral intuitions. Yet I will suggest that, as we get clearer about the nature of the distinction and the sources of its intuitive appeal, it may seem that the intuitions it supports are not so well grounded as one could wish.
 
KIE Churchill reviews Norman Daniels' Am I My Parents' Keeper (Oxford University Press; 1988) and Daniel Callahan's Setting Limits (Simon & Schuster; 1987). Both books present their authors' reflections on one of the most pressing problems of social ethics, how to allocate health care resources to the elderly in a climate of scarcity. Churchill first analyzes Daniels' response to the problem, the "prudential lifespan account," by which health care rights might give persons legitimate claims to services at one stage of their lives but not at another. This approach is contrasted with Callahan's "return to virtue" argument, which rests upon two major claims, one about the appropriate ends of medicine and the other about the meaning of old age. Churchill discusses both works within the context of the problematic relation in the United States between private and public goods, and between individual and social well-being.
 
KIE In his monograph, The Case for Animal Rights (University of California Press; 1983), Tom Regan seeks to develop an alternative moral theory to utilitarianism, and to apply it to the question of animal rights, including animal experimentation. Here Jamieson presents an overview of Regan's theory and critically examines areas in which he, Jamieson, believes it to be most problematic. He argues that Regan's theory encounters difficulties in its account of our duties to render assistance and its principles for overriding rights. Jamieson concludes that Regan has failed to develop a "compelling and dramatic alternative to utilitarian theories" and that most plausible revisions of his theory lead back in the direction of utilitarianism.
 
KIE Various criticisms of bioethics are reported and evaluated in an effort to determine what it is reasonable to expect of this rapidly developing field and what should be its future directions. Specific charges by Renée Fox, Judith Swazey, and William Bennett are explored. Fox and Swazey contend that bioethics champions individualism and pays little attention to social relationships, that bioethicists distance themselves from the human settings where ethical issues are experienced, and that bioethics pretends to a false validity. Bennett indicts bioethics on the grounds that it promotes ethical relativism and moral indifference. Gorovitz argues the case against these contentions but urges ethicists systematically to assess their critics' statements.
 
KIE Stevens critiques what he calls the "conceptual possession requirement" as defined by Michael Tooley in his article, "Abortion and infanticide," Philosophy and Public Affairs 1972 Fall; 2(1): 37-65. Tooley argued that a being has a right to something only if it has the concept of that thing. He claimed that fetuses and infants do not have a serious right to life because they have no concept of a continuing self, and that therefore abortion and infanticide are morally permissible. Stevens contends that the conceptual possession requirement is not valid, offers a counterexample to Tooley's argument, and defends his reasoning against what he presumes might be Tooley's counterarguments.
 
KIE Responding to accompanying articles by Dan W. Brock and Terrence Reynolds that criticize specific conclusions in his book, The Theory of Morality, Donagan clarifies and defends his arguments concerning the morality of taking innocent human life. The greater part of his article is devoted to a rejoinder to Brock's contention that a "duty-based" theory of the conditions under which it is morally permissible to take human life must be inferior to a "rights-based" one because rights-based theories credit rational beings with more control over what will happen to them, and hence with more autonomy, and because the implications of duty-based theories can be made tolerable only by recourse to the false thesis that, while it is always wrong to kill the innocent, it is not always wrong to let the innocent die. His briefer response to Reynolds expands upon the analysis of a case involving the death of a fetus resulting from a hysterectomy performed on a woman with cancer.
 
KIE Drawing upon his work in medical centers, Caplan explores the question of how well ethicists function in hospitals. He asks if their use of the "engineering model" of applied ethics, which emphasizes conceptual clarification, mastery of ethical theory, and impartiality, has made any difference in the way medicine is practiced. Noting that ethicists have been more effective in influencing heatlh policy at the national than at the institutional level, Caplan concludes that they have been less successful in teaching medical ethics, working with health personnel, and helping to formulate hospital policies. He attributes their difficulties primarily to the inadequacies of the engineering model of applied ethics for solving problems in a clinical setting. Caplan cautions ethicists to be aware both of the limitations of the engineering model and of the motives of health personnel in asking for help which may have little to do with resolving moral dilemmas.
 
KIE The author analyzes the argument that a policy involving distributive justice in the allocation of scarce health care resources, based on the strategy of rational self interest maximation under a veil of ignorance (Rawls/Daniels), would result in an age rationing system of voluntary, socially encouraged, direct termination of the lives of the elderly rather than their medical abandonment. She maintains that such a policy would be a fair response only in a situation of substantial scarcity of resources that cannot be relieved without introducing greater injustices. Battin suggests that some of the current pressure on resources could be reduced by pruning waste and the expenses attributable to paternalistic imposition of treatment and to the practice of defensive medicine. She also advocates reconsideration of societal priorities assigned to various social goods.
 
KIE Issues of social justice in access to health care are examined from the standpoint of the "prospective," or "ex ante," Pareto principle, an ethical principle which holds that one policy is to be preferred over another if it betters the prospects of some persons while the alternative betters no one's prospects. It is suggested that this principle may validate a form of utilitarianism in health policy decisions, with equity demanding that everyone have access to a decent minimum of care but not necessarily to all highly expensive treatments.
 
KIE A lawyer who was assistant director of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research describes the difficulties he sees in participation by philosophers in the making of public policy. He attributes the Commission's considerable success in influencing public policy to its consensus building approach. However, in its analysis of the appropriate governmental response to compensation of injured research subjects, the Commission produced only a "useless" report calling for further study. The problem was that the force of the simple argument for compensation based on justice was undercut by an academic libertarian argument. Technical questions of program design are refractory to philosophical analysis, and philosophers are not receptive to pragmatic compromise. Accordingly, philosophers should provide a moral critique of political compromises, rather than play a direct role in policy making.
 
KIE The authors draw on Kipnis' experiences in the clinical presentation of ethical problems arising in a newborn intensive care unit to analyze substantive criteria for decisions to stop life prolonging treatment and to determine the limits of parental authority to decide for nontreatment. They identify three decisions--treatment obligatory, treatment discretionary, and nontreatment obligatory--and apply the criteria of patient burdens and capability for a subjectively valuable life to each. Kipnis and Williamson consider parental authority to be a custodial role which should be assumed by others if the parents are unable or unwilling to secure for the child a subjectively valuable life.
 
KIE Reflecting on his experiences as a staff philosopher on the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and with other advisory bodies, Brock contends that there is a deep conflict between the goals and constraints of the public policy process and those of scholarly activity in general and philosophical activity in particular. Whereas unconstrained search for the truth is the central virtue of scholarly work, the first concern of policy makers is the impact of their actions on policies and people. The need to persuade policy makers and to maintain their own credibility leads philosophers to cut and trim their views. While the philosophers should be open to radical change if persuasive argument supports it, policy makers deal in incremental change. Philosophers can help widen the policy agenda, but their contribution should be limited and temporary and their primary base should remain an academic one.
 
The article focuses on the flaws of the social contract theory. It explores how hostile the social contract as a bargaining process has been thought to distance disabled people from contract-based justice. It analyzes the argument that the history of social contract theory exclude the people with disabilities from contracting process that gives rise to justice. It addresses the political progressiveness in contracting through a trust culture rather than bargaining culture. journal article
 
KIE The Epicurean argument that death cannot be a misfortune for the person who dies because, when death occurs, there is no longer a person to whom any misfortune can befall, fails to establish the conclusions which its defenders have sought from it. Beginning with the premise that death can be bad, either for the victim or in quasi-impersonal terms, the author seeks to define that badness through philosophical analysis. The belief that to have more life than is worth living is always better than to have less is reconciled with the notion that the badness of death increases with the degree of psychological connectedness, using the examples of the deaths of an unborn fetus and of a 35-year-old woman. The author contends it can be better for a person to suffer a worse death at 35 than never to have lived at all.
 
Lazari-Radek and Singer argue that evolutionary considerations can resolve Sidgwick's dualism of practical reason, because such considerations debunk moral views that give weight to self-interested or partial considerations, but cannot threaten the principle Universal Benevolence. I argue that even if we grant these claims, this appeal to evolution is ultimately self-defeating. Lazari-Radek and Singer face a dilemma. Either their evolutionary argument against partial morality succeeds, but then we need to also give up our conviction that suffering is bad; or there is a way to defend this conviction, but then their argument against partiality fails. Utilitarians, I suggest, should resist the temptation to appeal to evolutionary debunking arguments.
 
KIE Harris postulates that in certain instances it would be morally impermissible for a woman to have an abortion because it would be a wrongful harm to the father and a violation of his autonomy. He constructs and analyzes five cases chosen to elucidate the moral issues involved and concludes that, for a man to lay claim to the fetus being his in a sense that the mother is obligated to respect, the fetus must be the result of his having pursued a legitimate interest in procreation in a morally legitimate way. When a man has satisfied the requirements of autonomy both for himself and for his sexual partner in regard to the interest in procreation, the woman has a prima facie obligation to him not to harm the fetus. Therefore, unless there is some contravening moral consideration that overrides this obligation, the abortion of the fetus is morally impermissible.
 
KIE Lombardi critiques the theistic argument of Baruch Brody concerning the relevance of divine commands to the moral evaluation of suicide. He contends that the religious considerations which Brody introduces fail to justify the alleged differences between his secular and religious evaluations of suicide. In particular, Lombardi suggests, any plausible principle for generating the altruistic exceptions to the prohibition of suicide allowed by Brody's religious argument seems inevitably to generate self-interested exceptions of the sort the religious rationale was designed to preclude. Furthermore, other considerations that might strengthen the religious case prove useless to those religious moralists who wish to prohibit suicide but grant that it is sometimes divinely permissible to let a person die.
 
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