Respect for autonomy is typically considered a key reason for allowing physician assisted suicide and euthanasia. However, several recent papers have claimed this to be grounded in a misconception of the normative relevance of autonomy. It has been argued that autonomy is properly conceived of as a value, and that this makes assisted suicide as well as euthanasia wrong, since they destroy the autonomy of the patient. This paper evaluates this line of reasoning by investigating the conception of valuable autonomy. (...) Starting off from the current debate in end-of-life care, two different interpretations of how autonomy is valuable is discussed. According to one interpretation, autonomy is a personal prudential value, which may provide a reason why euthanasia and assisted suicide might be against a patient’s best interests. According to a second interpretation, inspired by Kantian ethics, being autonomous is unconditionally valuable, which may imply a duty to preserve autonomy. We argue that both lines of reasoning have limitations when it comes to situations relevant for end-of life care. It is concluded that neither way of reasoning can be used to show that assisted suicide or euthanasia always is impermissible. (shrink)

There is currently much concern over the use of pharmaceuticals and other biomedical techniques to enhance athletic performance—a practice we might refer to as doping. Many justifications of anti-doping efforts claim that doping involves a serious moral transgression. In this article, I review a number of arguments in support of that claim, but show that they are not conclusive, suggesting that we do not have good reasons for thinking that doping is wrong.

In this open access book, Timothy Aylsworth and Clinton Castro draw on the deep well of Kantian ethics to argue that we have moral duties, both to ourselves and to others, to protect our autonomy from the threat posed by the problematic use of technology. The problematic use of technologies like smartphones threatens our autonomy in a variety of ways, and critics have only begun to appreciate the vast scope of this problem. In the last decade, we have seen a (...) flurry of books making “self-help” arguments about how we could live happier, more fulfilling lives if we were less addicted to our phones. But none of these authors see this issue as one involving a moral duty to protect our autonomy. (shrink)

While suicide is typically associated with personal despair, people do sometimes kill themselves in the hope or expectation that their death will advance a political cause by way of its impact on the conscience of others, or in extreme cases simply as an expression of protest against a status quo felt to be unjust. Paradigm cases of such protest suicide may be public acts of self-immolation. This chapter distinguishes between instrumental and expressive protest suicide, examines the possible motivations behind them, (...) their possible moral justification, and their potential contribution to the meaning of the suicide’s life. It argues that when the value of the aim pursued by way of instrumental suicide is proportionate, killing oneself promotes it sufficiently, and other morally acceptable options are exhausted, instrumental protest suicide can be morally permissible and consistent with human dignity. It can even be an admirable act of self-sacrifice, provided that the agent’s motivations are suitable. Some of the standard moral objections to suicide don’t apply to such cases. But protest suicide remains morally risky, because one might be mistaken about the worth of one’s cause or the availability of alternatives, and because even these extreme acts typically have limited effect. (shrink)

According to Kant’s ethics, at least on one common interpretation, persons have a special worth or dignity that demands respect. But personhood is not coextensive with human life; for example, individuals can live in severe dementia after losing the capacities constitutive of personhood. Some philosophers, including David Velleman and Dennis Cooley, have suggested that individuals living after the loss of their personhood might offend against the Kantian dignity the individuals once possessed. Cooley has even argued that it is morally required (...) on Kantian grounds for those who realize that they will lose their personhood as a result of dementia (e.g. Alzheimer’s) to hasten their deaths (e.g. commit suicide). This article specifies circumstances in which post-personhood living might indeed involve an affront to the Kantian dignity of a person who once was. However, the article contends, Kant implies that it is neither morally required nor even morally permissible for someone in an early stage of Alzheimer’s to hasten their death to avoid such an affront, even if they have autonomously chosen to do so. The article adds an ethical perspective to debate on physician-assisted dying, in particular on the moral permissibility of the soon-to-be-demented ending their lives. (shrink)

A wide body of psychological research corroborates the claim that whether one’s life is (or will be) meaningful appears relevant to whether it is rational to continue living. This article advances conceptions of life’s meaningfulness and of suicidal choice with an eye to ascertaining how the former might provide justificatory reasons relevant to the latter. Drawing upon the recent theory of meaningfulness defended by Cheshire Calhoun, the decision to engage in suicide can be understood as a choice related to life’s (...) meaningfulness insofar as an individual can see no point in investing her agency in her anticipated future. These meaning-based reasons relevant to suicidal choice either cannot be reduced to the reasons of well-being that philosophers have typically used to analyse suicide decisions or at least forms a distinct class of reasons within those that contribute to well-being. (shrink)

The idea that people’s numerical identity may sometimes be discontinuous over time initially appears to provide useful material for defending restrictions on putatively self-harming behaviour in a non-paternalistic manner. According to this line of thinking, sometimes a putatively self-harming act is, in fact, a matter of ‘harm to others’. Yet, in this paper I argue that if we, as we ought to do, take into consideration the non-identity problem, this challenges the notion that the agent at T1 is in fact (...) imposing harm on anyone, even when we accept that he or she is numerically different from the agent at T2. If the life of the agent at T2 is still worth living, the agent is not worse off than he or she would have been in spite of the consequences pertaining to the putatively self-harming act since he or she would otherwise never have come into existence. In this way, the argument I put forward in this paper calls in question the ability of the shifting identity argument to actually justify imposing restrictions on self-harming behaviour. (shrink)

That Kant’s moral thought is invoked by both advocates and opponents of a right to assisted dying attests to both the allure and and the elusiveness of Kant’s moral thought. In particular, the theses that individuals have a right to a ‘death with dignity’ and that assisting someone to die contravenes her dignity appear to gesture at one of Kant’s signature moral notions, dignity. The purposes of this article are to outline Kant’s understanding of dignity and its implications for the (...) ethics of assisted dying. According to Kant, that which has dignity must be treated as an end in itself and may not permissibly be exchanged for that which merely has price. Kant’s reasoning thus seems to preclude acts of self-killing, including voluntary assisted dying, that rest on individual self-interest, since a person’s interests merely have price. However, a recognizably Kantian view of dignity can permit assisted dying under two sets of circumstances: First, it can be permissible for agents who anticipate a degradation of their rational agency due to conditions such as dementia to direct others to end their lives once sufficiently demented. In so doing, such agents in effect exercise a right to impose obligations on others regarding how their bodies, which will at some future point no longer be the vessels of their rational agency, are to be disposed of. Second, Kant errs in supposing that our dignity can stem solely from our moral personality, i.e., from our capacity to abide by universalizable moral principles. Rather, complete dignity also requires the capacity for setting discretionary ends and the means to those ends, i.e., the dignity of humanity. Individuals with prolonged and intense depression, in severe pain, or with serious disability may lack humanity while retaining their moral personality. In such cases, I propose that their opting to end their lives, with or without the assistance of others, does not amount to exchanging their dignified selves for something which merely has price and is therefore not objectionable on Kantian grounds. (shrink)

Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access (...) to medical treatments that significantly prolong life, relieve suffering, or cure or mitigate disabilities. Government should ensure this even if doing so involves leveling down and even if it is unclear whether egalitarian provision of necessary treatment would provide better care to the poor than a less egalitarian health care system would. (shrink)

Some sacrifices—like giving a kidney or heroically dashing into a burning building—are supererogatory: they are good deeds beyond the call of duty. But if such deeds are really so good, philosophers ask, why shouldn’t morality just require them? The standard answer is that morality recognizes a special role for the pursuit of self-interest, so that everyone may treat themselves as if they were uniquely important. This idea, however, cannot be reconciled with the compelling picture of morality as impartial—the view that (...) we are each anyone’s equal. I propose an alternative Self-Other Symmetric account of our moral freedom: the limits on what morality may demand of us are set by the duties we owe to ourselves. I begin with a defense of the Self-Other Symmetry: the idea that we owe the same duties to ourselves—and have the same rights against ourselves—as any relevantly similar other. Because we are consenting parties to our own actions, I argue, our rights against ourselves do not function like the rights of unwilling others. Instead, they play a permissive function, allowing us to block the demand to give up what is ours. I conclude by uniting, aggravating, and trying to solve some paradoxes of supererogatory permissions, guided by the idea that morality cannot be reduced to a ranking of options from best-to-worst. Rights against oneself are an irreducible second dimension, one that we need if we are to unify rights and supererogation into an impartial moral vision. (shrink)

_ Source: _Page Count 24 Seat belt mandates seem like a paradigmatic case of justified paternalism. Even those who generally object to paternalism often concede that seat belt laws are justified. Against this near-consensus in favor of mandates, I argue that seat belt laws are unjust and public officials should not enforce them. The most plausible exceptions to a principle of anti-paternalism do not justify seat belt mandates. Some argue that seat belt mandates are not paternalistic because unbelted riders are (...) not fully autonomous. Others claim that the decision to ride unbelted harms other people. Yet these attempts to defend seat belt mandates on non-paternalistic grounds cannot overcome the case against seat belt mandates. I therefore conclude that _even_ seat belt mandates are unjust. With this comprehensive case against seat belt mandates, I demonstrate the more general difficulties in justifying any form of coercive paternalism. (shrink)

Kant has famously argued that human beings or persons, in virtue of their capacity for rational and autonomous choice and agency, possess dignity, which is an intrinsic, final, unconditional, inviolable, incomparable and irreplaceable value. This value, wherever found, commands respect and imposes rather strict moral constraints on our deliberations, intentions and actions. This paper deals with the question of whether, as some Kantians have recently argued, certain types of (physician-assisted) suicide and active euthanasia, most notably the intentional destruction of the (...) life of a terminally-ill, but rational and autonomous patient in order to prevent certain serious harms, such as enduring or recurring pain or the loss of the meaning in life, from befalling him really are inconsistent with respect for the patient’s human dignity. I focus on two independent, though interrelated explications of the rather vague initial idea that the patient (as well as the doctor), in intending and bringing about his death, treats his person or rational nature merely as a means and so denigrates his dignity: (i) that in doing what he is doing, he does not act for the sake of his person, but for the sake of something else; (ii) that, by trading his person for pain relief, he engages himself in an irrational and hence immoral exchange. After critically discussing some suggestions about how to understand this charge, I eventually find Kantian objections to suicide and (active) euthanasia, based on the idea of human dignity, less than compelling. For all the paper proves, suicide and (active) euthanasia may still be morally impermissible, but then this must be so for some other reason than the one given above. (shrink)

Recently there has been a somewhat surprising interest among Kantian theorists in the moral standing of animals, coupled with a no less surprising optimism among these theorists about the prospect of incorporating animal moral standing into Kantian theory without contorting its other attractive features. These theorists contend in particular that animal standing can be incorporated into Kantian moral theory without abandoning its logocentrism: the claim that everything that is valuable depends for its value on its relation to rationality. In this (...) essay I raise doubts about the prospects for accommodating animal moral standing within a logocentric Kantianism. I argue instead that the best way to incorporate animal moral standing into Kantian theory is to admit more radical departures from Kant’s position by maintaining that consciousness is a locus of moral standing independent from rationality. I propose that we should attribute moral standing to all conscious animals because the capacity of consciousness is the criterion distinguishing individuals whose well-being generates reasons from individuals whose well-being fails to do so. We need such a criterion because we speak of the well-being of things, such as artifacts and meteorological phenomena, which clearly lack moral standing. Having already argued against the Kantian view that the criterion of moral standing is rationality, I proceed to argue that consciousness is also superior to its other principal rival for the criterion of moral standing: life. On the view that emerges from this discussion, we have obligations to show concern for conscious individuals by treating their well-being as providing us with reasons for action; the view thus endorses the criterion of moral standing typically advanced by utilitarians. On this view we also have a distinct class of obligations to show respect for conscious rational individuals; the view thus endorses the Kantian claim that persons have a distinctive moral status in virtue of their possession of rational capacities. In this essay thus begin to show how a principal insight of each leading approach to modern moral theory may be captured in a unified theory. (shrink)

Our ambivalent attitudes toward the notion of ‘a life worth living’ present a philosophical puzzle: Why are we of two minds about the birth of a severely disabled child? Is the child’s life worth living or not worth living? Between these two apparently incompatible evaluative judgments, which is true? If one judgment is true and the other false, what makes us continue to find both evaluations appealing? Indeed, how can we manage to hold these inconsistent judgments simultaneously at all? I (...) critically examine two solutions to this puzzle: the hidden-indexical account and Velleman’s anti-realist account. I propose an alternative explanation which appeals to (a) state-given, as opposed to object-given, reasons for belief and (b) the distinction between belief and acceptance. I argue that (1) the fact that a severely disabled life is not worth living provides object-given reason to believe that that life is not worth living, but (2) after the birth of a severely disabled child, the psychological utility of positive evaluation gives us a state-given reason to believe that that child’s life is worth living, and a reason to accept that, in our relation with the child, her life is worth living. I conclude by drawing a practical lesson about wrongful life suits. (shrink)

Hazing is a widespread moral phenomenon that has attracted little theoretical discussion. Here are my purposes are two fold: First, I provide a characterization of hazing that captures the features relevant to analyzing and evaluating hazing from a moral point of view. Hazing is harmful or humiliating transaction between members of a coveted group and an individual seeking membership in said group where the transaction bears no intrinsic relationship to the group’s mission. Second, I provide an analysis of the moral (...) wrongs of hazing that is broadly Kantian in spirit. The wrongfulness of hazing cannot be captured in terms of familiar categories of wrongdoing wherein individuals are treated as mere means (e.g., deception or coercion). However, hazing has no place in Kant’s Kingdom of Ends, for as a form of social interaction, it exploits and endorses an inequality between the hazer and the hazed that is antithetical to the equality of rational worth characteristic of social interaction in the Kingdom of Ends. In addition, hazing amounts to an invitation for a person to trade their humanity or self-respect in exchange for full inclusion in a group or organization. Issuing such an invitation, I claim, violates a Kantian duty to treat others’ humanity as an end in itself, violating a duty not to “give scandal” by tempting others to act in ways they will later have grounds to rationally regret. -/- . (shrink)

In his critique of egoism as a doctrine of ends, G. E. Moore famously challenges the idea that something can be someone. Donald Regan has recently revived and developed the Moorean challenge, making explicit its implications for the very idea of individual welfare. If the Moorean is right, there is no distinct, normative property good for, and so no plausible objectivism about ethics could be welfarist. In this essay, I undertake to address the Moorean challenge, clarifying our theoretical alternatives so (...) that we may better decide what to admit into our moral ontology and better assess what may be at stake in whether objectivists treat good or good for (or neither) as fundamental. I compare the Moorean and welfarist pictures of value, providing an account of the form and function of good for. According to this account expresses a distinct relational value that has its source in the value of persons. Good for value is thus a form of extrinsic value that provides agent-neutral reasons for action, and it plays a pervasive normative role in regulating child rearing, guiding individual life choices, and shaping social policy formation. (shrink)

ABSTRACT Over the past few decades the concept of (human) dignity has deeply pervaded medical ethics. Appeals to dignity, however, are often unclear. As a result some prefer to eliminate the concept from medical ethics, whereas others try to render it useful in this context. We think that appeals to dignity in medical ethics can be clarified by considering the concept from an historical perspective. Firstly, on the basis of historical texts we propose a framework for defining the concept in (...) medical debates. The framework shows that dignity can occur in a relational, an unconditional, a subjective and a Kantian form. Interestingly, all forms relate to one concept since they have four features in common: dignity refers, in a restricted sense, to the ‘special status of human beings’; it is based on essential human characteristics; the subject of dignity should live up to it; and it is a vulnerable concept, it can be lost or violated. We argue that being explicit about the meaning of dignity will prevent dignity from becoming a conversation‐stopper in moral debate. Secondly, an historical perspective on dignity shows that it is not yet time to dispose of dignity in medical ethics. At least Kantian and relational dignity can be made useful in medical ethics. (shrink)

Proponents of the legalization of assisted suicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assisted suicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception of dignity fits best (...) with our intuitions about the conditions under which a life has dignity, it supports the legalization of assisted suicide only under very limited circumstances. (shrink)

Resumen Es muy conocida la opinión de Kant en relación con la inmoralidad del suicidio. De ahí que, muchos autores lo consideren como un prohibicionista absoluto. Sin embargo, no hay hasta el momento un análisis puntual sobre la definición metafísica-conceptual del suicidio en la teoría kantiana. En este artículo propongo entender el suicidio en Kant como una muerte física, total, autorreferencial, voluntaria e inmoral. Esta definición contrastará con la privación de la vida, la cual no implica inmoralidad. Al ser voluntarios, (...) tanto la privación de la vida, como el suicidio son actos racionales y entendibles a partir de las máximas de acción. La inmoralidad del suicidio sólo surgirá al considerar la primacía de las razones morales por encima de razones no morales.It is common knowledge theposition of Kant regarding the immorality of suicide. Several authors attribute him an absolutist-forbidden criterion. Nerveless, there is no extended analysis about the metaphysical-conceptual definition of suicide in Kantian theory. In this paper I hold that suicide in Kant can be defined asphysical death, full, self-referential, voluntary, and immoral. This definition conflicts with the definition of deprivation of life which is not immoral. As voluntarily acts, both suicide and deprivation of life are rational acts that can be understood as maxims of action. The immorality property of suicide is due to the primacy of moral over non-moral reasons. (shrink)

McCarthy, Homan, and Rozier (2020) state that the Christian bioethical categories, namely sin, human dignity, and the common good, can shed light on bioethical issues, whereas secular bioethics may...

In this short paper I will discuss the ambiguous and, even, controversial term ‘right to die’ in the context of the euthanasia debate and, in particular, in the case of passive euthanasia. First I will present the major objections towards the moral legitimacy of a right to die, most of which I also endorse myself; then I will investigate whether the right to die could acquire adequate moral justification in the case of passive euthanasia. In the light of the Kantian (...) tradition I will argue that since rights are understood as based upon duties, the right to die should also presuppose a corresponding duty, which to me could be either an imperfect, solidarity-related duty, or an autonomy-related one, at least as far as the unwanted prolongation of life is concerned. I will conclude with the view that the right to die could actually be considered a legitimate one in the case of passive euthanasia, when the application of life-supporting techniques is against the wishes and the best interests of the patient. (shrink)

In recent years, debates about euthanasia and assisted suicide have increased to the point that now, many people defend the recognition of the right to die, the right for people to decide upon the end of their life. Consistently, advocates fight to legalise practices such as euthanasia to guarantee patients’ possibility to die when they request it. In this paper, I review two of the strongest arguments invoked by proponents of physician-assisted suicide: the argument for compassion and the argument for (...) dignity. The focus of this paper is to propose a review of these arguments through the lens of virtue ethics to inform the debate on physician-assisted suicide and question the relevance of such arguments for the legalisation of that right that would greatly ease the possibilities to end the life of a patient asking for it. (shrink)

Here I pursue two main aims: (1) to articulate and defend a Kantian conception of duties to self, and (2) to explore the ramifications of such duties for the moral justification of paternalism. I conclude that there is a distinctive reason to resent paternalistic intercessions aimed at assisting others in fulfilling their duties to self (or the self-regarding virtues necessary thereunto), based on the fact that the goods realized via their fulfillment are historical, i.e., their value depends on an individual's (...) casual contribution to their fulfillment. (shrink)

Ethical arguments about assisted dying often focus on whether or not respect for an individual’s autonomy gives a reason to offer them an assisted death if they want it. In this paper, I present an argument for legalising assisted dying which appeals to the autonomy of people who don’t want to die. Adding that option can transform the nature of someone’s choice set, enabling them to pursue other options voluntarily where that would otherwise be harder or impossible. This does not (...) contradict the more familiar arguments for legalising assisted dying based on the autonomy of those who seek to die. But it does suggest that a wider constituency of support for that legislative change might be created by emphasising that one need not be in that position to be benefited by the change. (shrink)

Many theories of social justice maintain that concern for the social bases of self-respect grounds demanding requirements of political and economic equality, as self-respect is supposed to be dependent on continuous just recognition by others. This paper argues that such views miss an important feature of self-respect, which accounts for much of its value: self-respect is a capacity for self-orientation that is robust under adversity. This does not mean that there are no social bases of self-respect that such theories ought (...) to incorporate. It means that they are different: they consist of the motivational and epistemic resources needed to develop and maintain such robustness. (shrink)

Recent work in the psychology of happiness has led some to conclude that we are unreliable assessors of our lives and that skepticism about whether we are happy is a genuine possibility worth taking very seriously. I argue that such claims, if true, have worrisome implications for procreation. In particular, they show that skepticism about whether many if not most people are well positioned to create persons is a genuine possibility worth taking very seriously. This skeptical worry should not be (...) confused with a related but much stronger version of the argument, which says that all human lives are very bad and not worth starting. I criticize the latter stance, but take seriously the former stance and hope it can be answered in future work. (shrink)

This essay explores the nature of narrative representations of individual lives and the connection between these narratives and personal good. It poses the challenge of determining how thinking of our lives in story form contributes distinctively to our good in a way not reducible to other value-conferring features of our lives. Because we can meaningfully talk about our lives going well for us at particular moments even if they fail to go well overall or over time, the essay maintains that (...) our good must consist in something more than an accumulation of good discrete moments. Since persons have the capacities to reason, remember, and imagine, our good depends on a larger view of our lives that integrates its particular moments in a narrative. That narrative provides shape and texture to our lives. Storytelling serves to connect the events of our lives to each other, and to explain why the meaning and value of past events or features of our lives can shift as the life, and hence the story of the life, continues to unfold. The essay concludes that narrative enables us to see our lives in ways that support, encourage, or promote our self-concept and self-worth as agents who have controlling authority over our own lives. (shrink)

In recent defenses of moral responsibility skepticism, which is the view that no human agents are morally responsible for their actions or character, a number of theorists have argued against Peter Strawson’s (and others’) claim that “the sort of love which two adults can sometimes be said to feel reciprocally, for each other” would be undermined if we were not morally responsible agents. Among them, Derk Pereboom (2001, 2009) and Tamler Sommers (2007, 2012) most forcefully argue against this conception of (...) love. However, in this paper, I plan to defend the claim that there is an essential connection between love and moral responsibility, a thesis I will call love internalism. To begin, I will specify the content and scope of love internalism, and consider ways in which other theorists have attempted to motivate it. I will then consider the various arguments that Pereboom and Sommers advance against love internalism. These arguments, it seems to me, offer us powerful reasons to reject several of the ways in which philosophers have tried to connect moral responsibility to love. Consequently, in light of these criticisms, I will further precisify the content of love internalism. And as we will see, love internalism (as I argue for it) is immune to Pereboom’s and Sommers’ criticisms. Moreover, when its content is sufficiently clarified, love internalism can serve as a plausible premise in an anti-skeptical argument. I thus conclude by arguing that this suitably reformulated statement of love internalism offers a significant challenge to moral responsibility skepticism of the sort Pereboom and Sommers endorse. (shrink)

Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents a (...) rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour. (shrink)

Moral philosophy is often said to be about what we owe to each other. Do we owe anything to ourselves?

For several decades, Kant scholars, inspired by the Groundwork false-promising example, have constructed consent-based criteria for using another merely as a means. Unfortunately, these consent-based accounts produce assessments that are both counter-intuitive and un-Kantian in relatively simple cases. This article investigates why these consent-based accounts fail and offers an alternative. The Groundwork false-promising example has encouraged a problematically narrow understanding of the conditions for using another merely as a means in virtue of the fact that the example involves a consent-sensitive (...) duty. This article demonstrates that the scope of the prohibition on using another merely as a means includes both consent-sensitive and consent-insensitive duties and offers a duty-based account that reflects this. (shrink)

Recently several authors have proposed proxies of welfare that equate some (as opposed to all) choices with welfare. In this paper, I first distinguish between two prominent proxies: one based oncontext-independent choicesand the other based onreason-based choices. I then propose an original proxy based on choices that individuals state they would want themselves to repeat at the time of the welfare/policy evaluation (confirmed choices). I articulate three complementary arguments that, I claim, support confirmed choices as a more reliable proxy of (...) welfare than context-independent and reason-based choices. Finally, I discuss the implications of these arguments fornudgesandboosts. (shrink)

This book offers a solution to the ancient philosophical problem regarding the nature and the justification of morality. The importance of this subject matter is obvious, not merely as an abstract philosophical problem, but perhaps even more as a practical challenge, regarding the way we ought to live our lives: the values that ought to direct us, and the ends that we ought to pursue. -/- In the course of this inquiry, a wide array of philosophical topics is explored: the (...) nature of intentional action, and the role played by reason and desires in agency; the question of the final end of agency – better known in ancient terminology as the question of the purpose of life, and in modern terms as the question of the meaning of life; the nature of moral obligations and their rational justification; the challenge posed by determinism for the freedom of the will, with its implications on fatalism and moral responsibility; and normative questions regarding the value of life. (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

This is a review essay of Jeff McMahan's recent book The Ethics of Killing : Problems at the Margins of Life. In the first part, I lay out the central features of McMahan's account of the wrongness of killing and its implications for when it is permissible to kill. In the second part of the essay, I argue that we ought not to accept McMahan's rejection of species membership as having any bearing on whether it is permissible to kill a (...) particular individual, as there are ways of understanding its relevance that are more plausible than McMahan allows. (shrink)

In The Sources of Normativity and elsewhere, Korsgaard defends a Kantian ethical theory by arguing that valuing anything commits one to valuing humanity as the source of all value. I reconstruct Korsgaard’s influential argument to show how she can resist many of the objections that critics have raised. I also show how the argument fails because, at a crucial point, it begs the question in favor of the value of humanity. It thus fails for internal reasons that do not depend (...) on rejecting Korsgaard’s metaethical constructivism or her conception of rational agency. (shrink)

:Something strange has happened to the concept of dignity in bioethics. After a long period in which U.S. pragmatist and U.K. consequentialist philosophers have argued that the concept is useless and vacuous, and in which they have been reasonably successful in expunging it from mainstream English-language academic bioethics, dignity has suddenly become popular again in debates about the legalization of physician-assisted dying. And, even stranger, it is deployed not by conservatives but by liberals. In the debates about PAD, liberal proponents (...) of legalization seem to accept without question that there is such a state or process as “death with dignity,” which is juxtaposed to “undignified dying.” It also seems to be accepted that both of these states can be fairly easily identified and that they carry great moral weight. This article provides an analysis of the current resurgence of “undignified” arguments and argues on the basis of that analysis that a proper understanding of the concept of dignity shows that the previous reductive arguments against dignity are partially incomplete and therefore partially misguided and that, despite dignity having meaning, the idea of an undignified death cannot carry the moral weight it is given by proponents of the legalization of PAD. (shrink)

As persons, beings with a capacity for autonomy, we face a certain practical task in living out our lives. At any given period we find ourselves with many desires or preferences, yet we have limited resources, and so we cannot satisfy them all. Our limited resources include insufficient economic means, of course; few of us have either the funds or the material provisions to obtain or pursue all that we might like. More significantly, though, we are limited to a single (...) life and one of finite duration. We also age, and pursuits that were possible at earlier points within a life may become impossible at later stages; we thus encounter not only an ultimate time limit but episodic limits as well. Because we must live our lives with limited resources—material and temporal—we are pressed to choose among and to order our preferences. Without some selection and ordering, few if any of them would be satisfied, and we would be unable to live lives that are recognizably good at all. Moreover, we would be unable to function well as the autonomous beings that we are. Our practical task then is to form a coherent, stable, and attractive ordering of aims—to develop a conception of our good. (shrink)

Several authors have recently advocated a so-called new case for paternalism, according to which empirical findings from distinct decision sciences provide compelling reasons in favour of paternalistic interference. In their view, the available behavioural and neuro-psychological findings enable paternalists to address traditional anti-paternalistic objections and reliably enhance the well-being of their target agents. In this paper, I combine insights from decision-making research, moral philosophy and evidence-based policy evaluation to assess the merits of this case. In particular, I articulate and defend (...) three complementary arguments that, I claim, challenge even the best available calls for such case. In doing so, I identify the main justificatory challenges faced by the new paternalists and explicate the implications of these challenges for the ongoing philosophical debate about the justifiability of paternalistic interference. (shrink)

Kantian moral concepts concerning respect for human dignity have played a central role in articulating ethical guidelines for medical practice and research, and for articulating some central positions within bioethical debates more generally. The most common of these Kantian moral concepts is the obligation to respect the dignity of patients and of human research subjects as autonomous, self-determining individuals. This article describes Kant’s conceptual distinction between dignity and autonomy as values, and draws on the work of several contemporary Kantian philosophers (...) who employ the distinction to make sense of some common moral intuitions, feelings, and norms. Drawing on this work, the article argues that the conceptual distinction between dignity and autonomy as values is indispensable in the context of considering our obligations to those who are dependent and vulnerable. (shrink)

This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does not destroy (...) capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation—for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons. (shrink)

In this essay I argue that the same considerations that justify the strong commitment to anti-paternalism that has been affirmed in bioethics over the past half century, also calls for anti-paternalistic public health policies. First, I frame the puzzle—why are citizens morally entitled to make unhealthy and medically inadvisable decisions as patients but not as consumers? I then briefly sketch the reasons why bioethicists typically reject paternalism. Next, I argue that those same reasons tell against paternalism in public health ethics (...) as well. Patients do not waive their rights to make medically inadvisable decisions when they leave their physician’s care. James Wilson disagrees. After I sketch Wilson’s arguments for paternalism in public health policy, I then argue, contra Wilson, that public health paternalism is wrong for the same reason that medical paternalism is wrong, and that the prevalence of paternalism in public policy does not mean that paternalism is morally permissible. I discuss the state’s authority to enforce paternalistic policies and I sketch an anti-paternalist vision for health policymakers. To close, I consider several objections. (shrink)

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)

This article treats recent bioethical discussions of double effect reasoning (DER), offering a summary account of DER and construing it as rooted in a sensible view of what is central to someone's identity as a moral agent. It then treats objections raised in recent years by Judith Thomson, Alison McIntyre, and Frances Kamm against familiar ways of applying DER to certain controversies within medical ethics, especially, that over physician-assisted suicide. After detailing, interpreting, and attempting to rebut the challenges from these (...) philosophers, who are especially interesting because their criticisms of DER come from allies in DER's struggle against consequentialist reasoning, the essay engages DER's contribution to a recent dispute over treatment of patients in what is called ‘persistent vegetative state.' Near its end, the paper sketches several possible points of entry to DER and sources of justification for it. The essay concludes by indicating a connection between these paths and its opening idea of moral identity. (shrink)

Kant's claim that the rational will has absolute value or dignity appears to render any prudential suicide morally impermissible. Although the previous appeals of Kantians (e. g., David Velleman) to the notion that pain or mental anguish can compromise dignity and justify prudential suicide are unsuccessful, these appeals suggest three constraints that an adequate Kantian defense of prudential suicide must meet. Here I off er an account that meets these constraints. Central to this account is the contention that some suicidal (...) agents, because they are unable to fashion a rational conception of their own happiness, are diminished with respect to their dignity of humanity, and as a result, lack the pricelessness that makes prudential suicide wrong on a Kantian view. (shrink)

One often hears Catholic and non-Catholic politicians and private citizens claim “I am personally opposed to abortion . . . ” but add that it is morally permissible for others to accept abortion. We consider a Rawlsian defense of this position based on the recognition that one’s opposition to abortion stems from acomprehensive doctrine which is incompatible with Public Reason. We examine a second defense of this position based upon respecting the autonomy of others and a third grounded in the (...) harm to the unwilling mother overriding that to the aborted fetus. We look at a fourth and fifth defense based upon our epistemic ignorance regarding the burdens on others of unwanted pregnancies and the ontological and moral status of embryo. We find most versions of these defenses to be wanting and conclude that only if the proponents of the position are subjectivist about morals, which few are, can they offer a coherent defense. (shrink)