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PubMed2002

Sex selection and disability avoidance: is their opposed treatment conceptually consistent?

Sex selection and disability avoidance receive opposed treatment in bioethics literature, legislative practice and public opinion. However, some theorists question this state of affairs by drawing analogies between the harmful consequences of these practices. This paper shares their disapproval of gender selection and disability avoidance, but bases its resistance to these practices on an examination of the concepts of gender and disability. Here it identifies conceptual confusions as another cause of approval of sex selection and disability avoidance. Further, in clarifying the nature of the concepts at issue, and their relationship with the subjects that they apply to, this discussion highlights the existence of relevant analogies between the concepts of gender and disability. Here the social construction and universality of gender and disability allow their differential treatment to be resisted at the conceptual level, creating a strong foundation for more consequentialist arguments against sex selection and disability avoidance.

Abortion, Eugenic↗

PubMed2002

Euthanasia, double effect, and proportionality.

I discuss the Principle of Double Effect (PDE) as a means of exploring aspects of the motivation of active voluntary euthanasia (a.v.e). It is argued that the objective of a.v.e. is not death but the relief of suffering. Nor is death the means, it is a concomitant. I entertain no hope of convincing the typical proponent of PDE that a.v.e. is morally acceptable. However, I point out that a central strength of the PDE is its insistence on due proportionality between outcomes. When a.v.e. is appropriate, as sometimes it is, death is not out of proportion to the relief of suffering.

Double Effect Principle↗

PubMed2006

Reproductive cloning and arguments from potential.

The possibility of human reproductive cloning has led some bioethicists to suggest that potentiality-based arguments for fetal moral status become untenable, as such arguments would be committed to making the implausible claim that any adult somatic cell is itself a potential person. In this article I defend potentiality-based arguments for fetal moral status against such a reductio. Starting from the widely-held claim that the maintenance of numerical identity throughout successive changes places constraints on what a given entity can plausibly be said to have the potential to become, I argue that the cell reprogramming that takes place in reproductive cloning is such that it produces a new individual, and so adult somatic cells cannot be potential persons.

Cell Differentiation↗

PubMed2005

What should we want to know about our future? A Kantian view on predictive genetic testing.

Recent advances in genomic research have led to the development of new diagnostic tools, including tests which make it possible to predict the future occurrence of monogenetic diseases (e.g. Chorea Huntington) or to determine increased susceptibilities to the future development of more complex diseases (e.g. breast cancer). The use of such tests raises a number of ethical, legal and social issues which are usually discussed in terms of rights. However, in the context of predictive genetic tests a key question arises which lies beyond the concept of rights, namely, What should we want to know about our future? In the following I shall discuss this question against the background of Kant's Doctrine of Virtue. It will be demonstrated that the system of duties of virtue that Kant elaborates in the second part of his Metaphysics of Morals offers a theoretical framework for addressing the question of a proper scope of future knowledge as provided by genetic tests. This approach can serve as a source of moral guidance complementary to a justice perspective. It does, however, not rest on the-rather problematic--claim to be able to define what the "good life" is.

Ethical Theory↗

PubMed2000

The use of genetic test information in insurance: the argument from indistinguishability reconsidered.

In the bioethical literature, discrimination in insurance on the basis of genetic risk factors detected by genetic testing has been defended and opposed on various ethical grounds. One important argument in favour of the practice is offered by those who believe that it is not possible to distinguish between genetic and non-genetic information, at least not for practical policy purposes such as insurance decision-making. According to the argument from indistinguishability, the use of genetic test information for insurance purposes should be permitted, because genetic test information is no different from non-genetic medical information in any relevant respect, therefore it would be inconsistent to prohibit the former whilst permitting the latter. This paper discusses and defends this argument and suggests a new, more tenable foundation.

Ethics, Medical↗

PubMed1985

An ethical analysis of double bind conflicts as experienced by care workers feeding severely demented patients.

When patients with incurable dementia diseases no longer take food or fluid voluntarily, the care workers experience distress and anxiety. Thirty-nine care workers were interviewed about their thoughts, feelings and attitudes towards feeding severely demented patients. A phenomenological approach was used and the interviews were developed, attention paid to Bateson's double bind theory, Kohlberg's theory of moral development and ethical theories. Ethical theories, principles and rules, containing messages at different logical levels and the lack of empirical knowledge of the demented patients' inner world, led to the care worker's difficult double bind situations. To solve the conflicts the care workers need insight in all aspects of the problem. In order to understand all the components in a double bind situation it is important to redefine it from outside.

Beneficence↗

PubMed1984

Courage: a neglected virtue in the patient-physician relationship.

The contribution that the virtues can make to the moral life in general and to the moral community constituted in the patient-physician relationship more specifically is gaining increased scholarly attention. This paper explores the meaning and relevance of the virtue of courage for patients and physicians. Courage is presented as a virtue for physicians in addition to the excellences of competence and compassion and a virtue for patients in addition to the excellences of compliance and gratitude. In agreement with Alasdair MacIntyre, courage is held to be necessary, at times, to our expression of care and concern for one another. The patient-physician relationship is shown to be a context in which care and concern is expressed, a context in which courage can be a relevant virtue. Certain conditions are listed as necessary to courage: freedom, fear, risk, uncertainty, an endangered good and a morally worthy end. Equivalents to these necessary conditions are discussed and held to be potentially present in patient-physician encounters. Physicians are pictured as a 'sustaining presence' who have duties toward patients of 'encouragement' that can be fulfilled in ways relative to the requirements of each circumstance. Patients are held to have a duty to learn about the nature of human existence and to develop the character necessary to its negotiation. Patients and physicians can be agents of courage who come together in a context of care and concern where certain goods are preserved even, at times, in the midst of loss. Thus, courage is presented as a relevant and important moral virtue for the patient-physician relationship in which those qualities that define who we are as a moral community are expressed and sustained.

Moral Obligations↗

PubMed1985

Why solutions continue to elude us.

Three issues addressed in Robert Weir's book Selective Nontreatment of Handicapped Newborns raise important questions about the social and political context of moral judgment, and the relation of moral judgment to moral theory. Arguments to the effect that infants are not moral "persons" as we normally understand the concept of personhood, illuminate the dialectical relationship between sound, confident moral judgments and moral theories. The way we describe and label decisions to offer or not to offer particular treatments to specific individuals has political and moral consequences. In general, we should opt for descriptions that display, rather than conceal, the problematic and controversial aspects of our decisions. The active killing of patients can only be defended from the narrowest viewpoint of minimizing that individual's suffering. It ignores the requirements made of other moral actors, and it fails to acknowledge a number of important facts about social institutions. Workable solutions must be attentive to the political and social context of moral dilemmas.

Persons with Disabilities↗

PubMed1985

A problem with refusing certain forms of psychiatric treatment.

Certain affective disorders are associated with compromised cognitive and emotional capacities and thus, with one's ability to act as a fully autonomous individual. Some of these personality problems have been treated very successfully with specified drug regimes. Continued treatment with lithium has rendered previously incompetent manic patients fully capable of competent self-governance. If the competent have the right to refuse medical attention (even when the refusal is not in the patient's best interest) does the drug-induced competent psychiatric patient have the right to refuse that medical treatment necessary for his continued competency? This paper investigates this issue.

Beneficence↗

PubMed1996

The ethics of death-hastening or death-causing palliative analgesic administration to the terminally ill.

Double-effect reasoning is a nonconsequentialist analysis of a hard ethical case. In a hard ethical case, one can achieve some good end only if one also causes harm. Sometimes palliative analgesic administration to a terminally ill patient is a hard ethical case, for by it one relieves pain or distress while unavoidably hastening or causing the patient's death. Is it ethically in the clear to administer an analgesic to relieve pain or distress knowing that one will hasten or cause the patient's death? Using double-effect reasoning, the author argues that death-hastening or death-causing palliative analgesic administration to a terminally ill patient is sometimes ethically in the clear and, at times, even obligatory.

Analgesics, Opioid↗

PubMed1985