: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)

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)

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)

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)

The current debate on recreational drug policy is roughly a contest between prohibition advocates and legalization advocates. This paper offers a third alternative that is a compromise between those two. The centralized-use compromise can secure the autonomy interests that are important to defenders of legalization, and it can prevent harms to others that are the focus of prohibition arguments. The centralized-use compromise also offers a possible way to reduce the black market while also reducing the rate of addiction and the (...) associated debasing harms to self. (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)

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)

In this article I articulate two pairs of theses about the relationship between the right and the good and I sketch an account of morality that systematically vindicates all four theses, despite a nearly universal consensus that they are not all true. In the first half I elucidate and motivate the theses and explain why leading ethical theorists maintain that at least one of them is false; in the second half I present the outlines of an account of the relationship (...) between the right and the good satisfying all four theses. (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)

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)

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)

_ 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)

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 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)

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)

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)

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)

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 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)

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)

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)