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Liberalism, legal moralism and moral disagreement.
According to "legal moralism" it is part of law's proper role to "enforce morality as such". I explore the idea that legal moralism runs afoul of morality itself: there are good moral reasons not to require by law all that there is nevertheless good moral reason to do. I suggest that many such reasons have broad common-sense appeal and could be appreciated even in a society in which everyone completely agreed about what morality requires. But I also critique legal moralism from the special perspective of liberal political justice. Liberalism requires that citizens who disagree with one another on a number of morally significant matters nevertheless coexist and cooperate within a political framework of basic rights protections. When it comes to working out the most basic terms of their political association, citizens are expected to address one another within the limits of what Rawls has called "public reason". Critics of liberalism claim that this is an essentially a-moral (or expedient) attempt to evade substantive moral issues--such as the moral status of the fetus. I argue, on the contrary, that liberalism's emphasis on public reason is itself grounded in very deep--though (suitably) "non-comprehensive"--moral considerations.
Freedom, dependency, and the care of the very old.
Difficulties exist in making treatment decisions for the very old and dependent patient. In the years to come, these difficulties will increase. It is argued that such persons should not be abandoned to their "rights" as autonomous persons; yet quality of life judgments should also be avoided except in limited circumstances. Since aging is a process of becoming more dependent, the author proposes a dependency rule, by which greater responsibility for treatment decisions falls on care-givers as a person's dependency increases. In place of quality of life judgments he suggests a medical indications policy, if the latter includes restoration of some affective function. Five kinds of freedom are proposed, of which only some are lost in chronic illness and old age. Finally, it is suggested that life itself involves greater interdependence than the autonomy criterion itself can allow. The author focuses on the problem of dependency in the aged and the role an increase in this dependency plays, with corresponding loss of personal autonomy, in quality of life judgments. These, in turn, form the basis for treatment decisions.
Medical paternalism and patient self-determination.
In response to the common belief that paternalism directed toward a competent patient necessarily transgresses the patient's right of self-determination and is therefore morally suspect, the authors argue that such a general view fails to appreciate the complexity of the patient/physician relationship as it is manifested in various clinical settings. It is the authors' contention that some strongly paternalistic acts may fail to violate the patient's right of autonomy, that other such acts may actually be a function of respect for patient autonomy, and that others may only suspend or momentarily infringe upon patient autonomy. They conclude that if these instances of paternalism differ from the classical examples of strong paternalism, then so also should the moral appraisal.
Dialectical analysis concerning the rational aspect of the art of nursing.
It is often claimed that nursing is both a science and an art. Science, it is argued, involves a rational process in which empirical findings are used to determine what is the case. Art, on the other hand, is associated with creative and intuitive activities. The author steps back from this position and examines the question of whether the art of nursing is properly conceived as involving a rational aspect. The study upon which this paper is based involved the analysis of a discourse contained in the work of 43 nurse scholars, published between 1860 and 1992. A philosophical approach is used to examine two contrary positions regarding the place of the rational aspect in relation to the art of nursing. The analysis attempts to expand the discourse by delineating questions and concerns that, as yet, have not been fully considered.
Choosing for others as continuing a life story: the problem of personal identity revisited.
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Commentary: narrative views of personal identity and substituted judgment in surrogate decision making.
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Commentary: the wizard of oughts.
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Science and psychoanalysis.
A philosophical approach is suggested which regards scientific laws as based upon the structure of the universe but fully open-ended in that the structure does not determine what must occur but only what cannot occur. There are thus infinite future possibilities but nevertheless a firm orderly system which permits reliable expectations within the limits of the system while at the same time there is scope for free will in a real sense. Such a view admits the limitations of a falsification-of-hypotheses approach to research insofar as it depends upon the single-case basis of refutation. However it finds no problems with regard to a multivariate analysis of data assessed in terms of probability theory and considered in relation to its consistency with the total body of scientific theory, which it sees as having its basis in a 'thingness' concept that is both fundamental in our perceptual activity and acceptable as a basis for understanding the systematic orderliness of our mental experiences.
Telling the truth and medical ethics.
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Where respect for autonomy is not the answer.
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On sickness and on health.
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Ethics and surveys.
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Patients' ethical obligation for their health.
In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice.
Why you don't owe it to yourself to seek health.
Sider and Clements provide a critical response to my view that there is no independent obligation to seek one's own health. They then argue that such an obligation exists. They are incorrect in their characterisation of my view; their critical discussion of the view they erroneously attribute to me is unconvincing; the positive argument they offer for their own view is unsatisfactory; they misjudge the significance of what is at issue; and they conclude by affirming a position that lacks a due regard for the rights of patients.
Paternalism and partial autonomy.
A contrast is often drawn between standard adult capacities for autonomy, which allow informed consent to be given or withheld, and patients' reduced capacities, which demand paternalistic treatment. But patients may not be radically different from the rest of us, in that all human capacities for autonomous action are limited. An adequate account of paternalism and the role that consent and respect for persons can play in medical and other practice has to be developed within an ethical theory that does not impose an idealised picture of unlimited autonomy but allows for the variable and partial character of actual human autonomy.