Suicide and the value of a rational life In recent Kantian discussions about suicide, it is not uncommon to find relatively ‘mild’ approaches towards suicide. Even though as a rule suicide is still impermissible, some argue that there may be circumstances that can make suicide morally permissible. If a person suffers such that she cannot be considered to have a rational life any more, suicide is no longer immoral because the object of the moral duty is no longer present. In (...) this paper, I investigate this argumentative strategy by exploring what it might mean to have a ‘rational life’. I argue that on a minimal conception, people who suffer unbearably still lead rational lives and suicide is thus not morally justified. On substantial conceptions, however, not only does having a rational life become a contingent affair, it also leads to a more liberal approach towards suicide than ‘mild Kantians’ may be prepared to accept. (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)

: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)

Christopher Boorse is very skeptical of there being a pathocentric internal morality of medicine. Boorse argues that doctors have always engaged in activities other than healing, and so no internal morality of medicine can provide objections to euthanasia, contraception, sterilization, and other practices not aimed at fighting pathologies. Objections to these activities have to come from outside of medicine. I first argue that Boorse fails to appreciate that such widespread practices are compatible with medicine being essentially pathocentric. Then I contend (...) that the pathocentric essence, properly understood, does not prohibit physicians from engaging in actions that are not aimed at combating pathologies, but rather supports an internal morality of medicine that allows medical providers to refuse without penalty to engage in practices that promote pathologies. (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)

Philosophers such as Plato, Aristotle, Kant, Brentano, Moore, and Chisholm suggest marks of intrinsic value. Contemporary philosophers such as Christine Korsgaard have insightful discussions of intrinsic value. But how do we verify that some specific thing really is intrinsically valuable? I propose a natural way to test for intrinsic value: first, strip the candidate bare of all considerations of good consequences; and, second, see if what remains is still a good thing. I argue that we, as ordinary human beings, have (...) an astonishingly difficult time completing this test for plausible candidates. More precisely, for us as we are, it seems that the conditions for completing the first step of the test militate against the conditions for completing the second step. I conclude, then, that we have a good reason to think that we cannot verify whether or not particular things are intrinsically good. I explore some implications and I consider a number of important objections. (shrink)

The principle of moral equality is one of the cornerstones of any liberal theory of justice. It is usually assumed that persons’ equal moral status should be grounded in the equal possession of a status-conferring property. Call this the property-first approach to the basis of moral equality. This approach, however, faces some well-known difficulties: in particular, it is difficult to see how the possession of a scalar property can account for persons’ equal moral status. A plausible way of circumventing such (...) difficulties is to explore another avenue for the justification of persons’ equal moral status: moral equality should be grounded in the wrongness of treating others as inferiors. Call this the relation-first approach to the basis of moral equality. This paper aims at providing some reasons as to why this approach should be rejected and clarifying why the property-first approach still represents the most promising way of justifying our commitment to moral equality. Two objections will be pressed against the relation-first approach: first, grounding moral equality in the wrongness of treating others as inferiors gives rise to some disturbing normative implications; second, relation-first accounts cannot vindicate the idea that a range of beings has equal fundamental rights. This, however, is precisely what an account of moral equality is meant to justify. The paper, then, concludes that the relation-first approach fails to provide a plausible answer to the question of the basis of moral equality. Property-first accounts, whatever problems they encounter, are still more viable in principle. (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)

Feminist work in the history of philosophy has been going on for several decades. Some scholars have focused on the ways philosophical concepts are themselves gendered. Others have recovered women writers who were well known in their own time but forgotten in ours, while still others have firmly placed into a philosophical context the works of women writers long celebrated within other disciplines in the humanities. The recovery of women writers has challenged the myth that there are no women in (...) the history of philosophy, but it has not eradicated it. What, we may ask, is impeding our progress? This paper argues that so often we treat early modern women philosophers’ texts in ways that are different from, or inconsistent with, the explicit commitments of the analytic tradition, and in so doing, we may be triggering our audiences to reject these women as philosophers, and their texts as philosophical. Moreover, this is the case despite our intention to achieve precisely the opposite effect. (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)

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)

Mental capacity and autonomy are often understood to be normatively neutral? the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders (such as depression, anorexia nervosa and schizophrenia) that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder, and (...) functional tests requiring consistency, expression of identity, reflective non-alienation or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty. (shrink)

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)

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)

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)

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)

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)

Kant formulated a secular argument against suicide’s permissibility based on what he regarded as the intrinsic value of humanity. In this paper, I first show that Kant’s moral framework entails that some types of suicide are morally permissible. Just as some homicides are morally permissible, according to Kant, so are suicides that are performed according to equivalent maxims. Intention, foreseeability, voluntariness, diminished responsibility, and mental capacity determine the moral characterization of the killing. I argue that a suicide taxonomy that differentiates (...) types of suicide according to morally relevant criteria is compatible with Kantian ethics; it establishes that even where we hold a robust deontological sanctity of life position, we are not obligated to preserve the lives of people whose future life only offers profound suffering, and helping them to die may be justifiable if doing so honors their dignity and autonomy. Nevertheless, homicide and suicide are only weakly morally symmetrical in that even if a given suicide is morally impermissible, we do not normally have the right to prevent it forcibly, though this may be altered by juridical laws under some circumstances. (shrink)

Recent works on the concept of dignity have opened up the otherwise quite deadlocked debate about assisted death (AD). Rather than just reinforcing already fixed positions, it seems to me that these conceptions of dignity make room for a moderate and normatively richer position on the moral permissibility of AD. I do not think that we have seen the full potential of the said conceptions and interpretations. I try in this article to contribute my part. First, I briefly recapitulate some (...) of the paradoxical ways in which dignity is typically invoked in the debate and try to clear up some of the obvious confusions. Then, I go on to explore a particular Kantian line of thought in some recent works on dignity and AD that seems to pave the way for a moderate position with a more principled foundation than the usual compromise positions. (shrink)

This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different (...) understandings. Finally, we consider the ethical challenges of building policy on what is still an extremely controversial social practice. While MAID is currently available to capable patients in Canada who are 18 years or older—a small but important subsection of the population our hospital serves—we write our policy with an eye to the near future when capable young people may gain access to MAID. We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves. Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID. We offer a view of the roads taken and considered along the way, and our justifications for travelling the paths we chose. By providing a record of our in-progress thinking, we hope to stimulate wider discussion about the issues and questions encountered in this work. (shrink)

In “Vindicating the Normativity of Rationality,” Nicholas Southwood proposes that rational requirements are best understood as demands of one’s “first-personal standpoint.” Southwood argues that this view can “explain the normativity or reason-giving force” of rationality by showing that they “are the kinds of thing that are, by their very nature, normative.” We argue that the proposal fails on three counts: First, we explain why demands of one’s first-personal standpoint cannot be both reason-giving and resemble requirements of rationality. Second, the proposal (...) runs headlong into the now familiar “bootstrapping” objection that helped illuminate the need to vindicate the normativity of rationality in the first place. Lastly, even if Southwood is right—the demands of rationality just are the demands or our first-personal standpoints—the explanation as to why our standpoints generate reasons will entail that we sometimes have no reason at all to be rational. (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)

The use of tanning beds has been identified as being among the most significant causes of melanoma and non-melanoma skin cancer. Accordingly, the activity is properly seen as one that involves profound harm to self. The article examines paternalistic reasons for restricting sunbed usage. We argue that both so-called soft and hard paternalistic arguments support prohibiting the use of sunbeds. We make the following three arguments: an argument from oppressive patterns of socialization suggesting that the autonomous nature of the conduct (...) in question is questionable; an argument from so-called evaluative delusions in which individuals attach incorrect weights to some of their values; a strictly hard paternalistic argument appealing to the harm in itself pertaining to the use of sunbeds. (shrink)