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At least 1,261 records · Page 70Linked to original sources
PubMed1993

Killing, letting die, and withdrawing aid.

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.

Abortion, Induced↗
PubMed1987

The profit motive in medicine.

The ethical implications of the growth of for-profit health care institutions are complex. Two major moral criticisms of for-profit medicine are analyzed. The first claim is that for-profit health care institutions fail to fulfill their obligations to do their fair share in providing health care to the poor and so exacerbate the problem of access to health care. The second claim is that profit seeking in medicine will damage the physician-patient relationship, creating conflicts of interest that will diminish the quality of care and erode patients' trust in their physicians and the public's trust in the medical profession. The authors conclude that while the continued expansion of for-profit health care may exacerbate in some respects problems of access, trust and conflicts of interest, it is a mistake to consider these problems as unique to for-profit health care; they are problems for not for-profit health care as well. Though these issues justify continuing moral concern, they do not at this time provide decisive grounds for substantially curbing or eliminating for-profit enterprise in health care.

Economic Competition↗
PubMed1997

Degrees of personhood.

In this paper I argue that a Naturalist conception of personhood, such as the one defended by Derek Parfit, implies that there are degrees of personhood, i.e., that it makes sense to say one individual has a greater degree of personhood than another. I describe both criteria of general personhood, which distinguish between persons and non-persons, and criteria of particular personhood, which distinguish between one person and another. I examine some of the consequences for ethics, including the rights to life, self-determination, and treatment. There may be circumstances in medicine where we have to judge the value of a patient's life in order to decide what medical treatment, if any, to provide, and although it may be emotionally difficult and politically dangerous, one relevant factor is what degree of personhood that individual has.

Ethical Analysis↗
PubMed2002

Identity, prudential concern, and extended lives.

Recent advances in human genetics suggest that it may become possible to genetically manipulate telomerase and embryonic stem cells to alter the mechanisms of aging and extend the human life span. But a life span significantly longer than the present norm would be undesirable because it would severely weaken the connections between past- and future-oriented mental states and turn the psychological grounds for personal identity and prudential concern for our future selves. In addition, the collective effects of longer lives might lower the quality of life for all people. These two problems provide reasons against genetic manipulation of cells to alter the length of the human life span.

Aging↗
PubMed2003

Co-operation despite disagreement: from politics to healthcare.

Political interaction among citizens who hold opposing moral views commonly requires reaching beyond toleration, toward actual co-operation with policies one opposes. On the more personal level, however, regarding (e.g.) interactions between healthcare providers and patients, several authors emphasize the importance of preserving integrity. But those who oppose any 'complicity in evil' often wrongly conflate instances in which the other's position is (and should be) totally rejected with instances of legitimate, although deep, disagreement. Starting with a striking example from the context of a particular tradition, I argue generally that in the latter sort of disagreements, talk of 'complicity' should be largely replaced with a more co-operative moral stance, grounded in a pluralistic framework. Co-operation Despite Disagreement (CDD) should be sought either for institutional reasons--akin to the political--or for relational reasons. CDD involves sharing another's perspective and sometimes calls for adopting another's moral judgements in preference to one's own. I seek to identify some of the conditions and circumstances that would justify such a shift, particularly in scenarios involving assistance, such as physician-assisted suicide (PAS) or the role of an anaesthesiologist in abortion. This discussion is meant to provide examples of the kind of second-order reasons appropriate for determining the terms for CDD-- in distinction from first-order considerations (e.g., the much-contested 'active/passive' distinction) which are likely to be the subject of the initial disagreement and hence cannot serve to resolve it.

Abortion, Induced↗
PubMed1995

Principlism and the ethical appraisal of clinical trials.

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as "principlism", has come under scrutiny. In this paper we argue that these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be "specified" as described by De Grazia (1992), and (2) that the principle-based approach should be supplemented by formally incorporating "sensitivity to context" into the evaluation of clinical trials.

Altruism↗
PubMed2004

Essential properties and the right to life: a response to Lee.

In 'The Pro-Life Argument from Substantial Identity: A Defence', Patrick Lee argues that the right to life is an essential property of those that possess it. On his view, the right arises from one's 'basic' or 'natural' capacity for higher mental functions: since human organisms have this capacity essentially, they have a right to life essentially. Lee criticises an alternative view, on which the right to life arises from one's 'developed' capacity for higher mental functions (or development of some other accidental property). I argue that his criticisms of this alternative view are misguided or self-defeating, and that there are good reasons to hold we have a right to life accidentally rather than essentially.

Anencephaly↗
PubMed1983

Suicide: bad act or good intervention.

This article develops a different perspective on the ethics of suicide, based on theoretical and clinical grounds. In terms of value theory, applying "good" or "bad" to the suicide act makes no sense. We need to shift our focus from a search for an ethical statement about suicide (e.g., "rational suicide") to the ethical justification for intervention based on the needs and interests of an affirming therapeutic profession. We choose to intervene because of values we hold about well-functioning, existence, potential for human life; and because as emphatic, social beings, we feel for others and are motivated by that feeling. This justification leads us to suggest a situational case-centered ethics for suicide intervention.

Ethics, Medical↗
PubMed1996

Double jeopardy, the equal value of lives and the veil of ignorance: a rejoinder to Harris.

Harris levels two main criticisms against our original defence of QALYs (Quality Adjusted Life Years). First, he rejects the assumption implicit in the QALY approach that not all lives are of equal value. Second, he rejects our appeal to Rawls's veil of ignorance test in support of the QALY method. In the present article we defend QALYs against Harris's criticisms. We argue that some of the conclusions Harris draws from our view that resources should be allocated on the basis of potential improvements in quality of life and quantity of life are erroneous, and that others lack the moral implications Harris claims for them. On the other hand, we defend our claim that a rational egoist, behind a veil of ignorance, could consistently choose to allocate life-saving resources in accordance with the QALY method, despite Harris's claim that a rational egoist would allocate randomly if there is no better than a 50% chance of being the recipient.

Australia↗
PubMed1996

Would Aristotle have played Russian roulette?

This paper continues the debate between myself and Peter Singer et al started in the Journal of Medical Ethics volume 21, no 3 about the ethical respectability of the use of QALYs in health care allocation. It discusses the question of what, in the way of health care provision, would be chosen by rational egoists behind a Rawlsian "veil of ignorance", and takes forward the vexed question of what is to count as "doing good" and hence as "doing the most good" in health care. Most importantly, this paper argues that it would be unfair to discriminate against people because they have been disadvantaged by their genetic condition. It notes that McKie et al in their reply to my first contribution to this debate continue to fail to distinguish between chance and probability and it is argued that this failure causes them to miss the whole point of the argument.

Ethical Theory↗
PubMed1996

Forget about equality.

Justice is widely thought to consist in equality. For many theorists, the central question has been: Equality of what? The author argues that the ideal of equality distorts practical reasoning and has deeply counterintuitive implications. Moreover, an alternative view of distributive justice can give a better account of what egalitarians should care about than can any of the competing ideals of equality.

Civil Rights↗
PubMed1999

The concept of the person and the value of life.

The concept of the person has come to be intimately connected with questions about the value of life. It is applied to those sorts of beings who have some special value or moral importance and where we need to prioritize the needs or claims of different sorts of individuals. "Person" is a concept designating individuals like us in some important respects, but possibly including individuals who are very unlike us in other respects. What are these respects and why are they important? This paper sets out to answer these questions and to develop a coherent and useful concept of the person.

Animal Rights↗