One of the most common policy-related messages that economists present to non-economists is the superiority of cash over in-kind transfers as a policy tool. A good deal of government policy on behalf of the poor consists, of course, of various forms of in-kind assistance, such as medical care or food stamps. However, if we wish to help the poor, the argument goes, in-kind transfers are an inferior way to do so.

What moral status should we attribute to stem cells? To answer this neglected question, we look in this essay at the properties of embryos and other entities that could develop into beings who have uncontested moral status, namely, adult humans. Our analysis indicates that those who grant moral status to embryos should also grant it to stem cells. This has implications that verge on absurdity, since even if we were to try to do what we can to protect these entities, (...) we would face the dilemma that the development of any embryo requires the destruction of other potential beings. We respond to objections, including the claim that the destruction of human embryos is wrong not because of the potential of human embryos but because human embryos are actual beings with a rational nature. We conclude that the more plausible position is to deny moral status to embryos, and thus to stem cells as well. (shrink)

One major argument against prohibiting euthanasia and physician-assisted suicide (PAS) is that there is no rational basis for distinguishing between killing and allowing to die: if we permit patients to die by forgoing life-sustaining treatments, then we also ought to permit euthanasia and PAS. In this paper, the author argues, contra this claim, that it is in fact coherent to differentiate between killing and allowing to die. To develop this argument, the author provides an analysis of Saint Augustine’s distinction between (...) martyrdom and suicide, highlighting the relevance of intention in the assessment of an agent’s actions. As a general matter of ethics, the intentions of agents, not just the outcomes of their actions, matter enormously for drawing distinctions between what is permissible and what is impermissible. Constructing an Augustinian account of this distinction between killing and allowing to die, the author argues that it is coherent to hold that assisted suicide is wrong, while also accepting that it is permissible to withhold or withdraw life-sustaining treatments. (shrink)

The problem of act individuation is a debate about the identity conditions of human acts. The fundamental question about act individuation is: how do we distinguish between actions? Three views of act individuation have dominated the literature. First, Donald Davidson and G.E.M. Anscombe have argued that a number of different descriptions refer to a single act. Second, Alvin Goldman and Jaegwon Kim have argued that each description designates a distinct act. Finally, Irving Thalberg and Judith Jarvis Thomson have averred that (...) some acts are sequences of causally related events, which include both a primitive bodily action and some of its effects. All of these accounts have assumed that a simple invariantist account of act individuation captures how ordinary people distinguish between acts. For my dissertation, I devised an experiment to test the action theorists' assumptions. My data show that people's intuitions seem to depend on the valence of the consequences of the action under consideration. So, an invariantist account is not possible. In light of the empirical results, I argue that if we seek a folk account of act individuation, then that account should be able to explain the variability that seems to be present in people's intuitions about different cases. (shrink)

Western ethics and law have been slow to come to conclusions about the right to choose the time and manner of one's death. However, policies, practices, and legal precedents have evolved quickly in the last quarter of the twentieth century, from the forgoing of respirators to the use of Do Not Resuscitate (DNR) orders, to the forgoing of all medical technologies (including hydration and nutrition), and now, in one U.S. state, to legalized physician-assisted suicide. The sweep of history—from the Quinlan (...) case in New Jersey to legislation in Oregon that allows physician-assisted suicide—has been as rapid as it has been revolutionary. (shrink)

As an initial approximation, pluralism may be understood as the combination of four theses. First, there are many incommensurable values whose realization is required for living a good life. Second, these values often conflict with each other, and, as a result, the realization of some excludes the realization of others. Third, there is no authoritative standard that could be appealed to to resolve such conflicts, because there is also a plurality of standards; consequently, no single standard would be always acceptable (...) to all fully informed and reasonable people. Fourth, there are, nevertheless, reasonable ways of resolving conflicts among incommensurable values. (shrink)

The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient’s autonomy and doctor’s duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this (...) discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive. (shrink)

I defend the Doctrine of Doing and Allowing: the claim that doing harm is harder to justify than merely allowing harm. A thing does not genuinely belong to a person unless he has special authority over it. The Doctrine of Doing and Allowing protects us against harmful imposition – against the actions or needs of another intruding on what is ours. This protection is necessary for something to genuinely belong to a person. The opponent of the Doctrine must claim that (...) nothing genuinely belongs to a person, even his own body. (shrink)

End-of-life decisions concerning euthanasia, stopping life-support machines, or handling advance directives are very complex and highly disputed in industrialized, democratic countries. A main controversy is how to balance the patient’s autonomy and right to self-determination with the doctor’s duty to save life and the value of life as such. These EoL dilemmas are closely linked to legal, medical, religious, and bioethical discourses. In this paper, we examine and deconstruct these linkages in Germany and Israel, moving beyond one-dimensional constructions of ethical (...) statements as “social facts” to their conflicting and multifaceted embedding within professional, religious, and cultural perspectives. (shrink)

In recent years the idea of geoengineering climate has begun to attract increasing attention. Although there was some discussion of manipulating regional climates throughout the l970s and l980s. the discussion was largely dormant. What has reawakened the conversation is the possibility that Earth may be undergoing a greenhouse-induced global wamring, and the paucity of serious measures that have been taken to Prevent it. ln this paper Iassess the ethical acceptability of ICC, based on my impressions of the conversation that is (...) now taking place. Rather than offering a dispassionate analysis, I argue for a point of view. I propose a set of conditions that must be satisfied for an ICC project to be morally permissible and conclude that these conditions are not now satisfied. However, research on ICC should go forward.. (shrink)

Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the definition and modeling (...) of complex disease states. (shrink)

With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)

People commonly believe that any form of deception, no matter how innocuous it is and no matter whether the deceiving person intended it otherwise, is always morally wrong. In this paper, I will argue that deceiving in real-time is morally distinguishable from deceiving on-line because online actions aren’t as fine-grained as actions occurring in real-time. Our failure to detect the fine-grained characteristics of another avatar leads us to believe that that avatar intended to do a moral harm. Openly deceiving someone (...) on Facebook or Twitter is not a way to build wholesome virtual friendships but to destroy them. This paper will show how the traditional understanding of the doing / allowing distinction fails to apply in cyberspace. (shrink)

Solar radiation management (SRM), a form of climate engineering, would offset the effects of increased greenhouse gas concentrations by reducing the amount of sunlight absorbed by the Earth. To encourage support for SRM research, advocates argue that SRM may someday be needed to reduce the risks from climate change. This paper examines the implications of two moral constraints—the Doctrine of Doing and Allowing, and the Doctrine of Double Effect—on this argument for SRM and SRM research. The Doctrine of Doing and (...) Allowing, and perhaps the Doctrine of Double Effect, shows that the argument is weaker than it appears. (shrink)