In general, we think that when it comes to the good of another, we respect that person’s will by acting in accordance with what he wills because he wills it. I argue that this is not necessarily true. When it comes to the good of another person, it is possible to disrespect that person’s will while acting in accordance with what he wills because he wills it. Seeing how this is so, I argue, enables us to clarify the distinct roles (...) that the wills of competent and incompetent people should play in third-party deliberations about their welfare. (shrink)

In her provocative discussion of the challenge posed to the traditional impartialist, justice-focused conception of morality by the new-wave care perspective in ethics, Annette Baier calls for ‘a “marriage” of the old male and newly articulated female... moral wisdom,’ to produce a new ‘cooperative’ moral theory that ‘harmonize[s] justice and care.’ I want in this paper to play matchmaker, proposing one possible conjugal bonding: a union of two apparently dissimilar modes of what Nel Noddings calls ‘meeting the other morally,’ a (...) wedding of respect and care. (shrink)

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a (...) wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

The moral authority for professional ethics in medicine customarily rests in some source external to medicine, i.e., a pre-existing philosophical system of ethics or some form of social construction, like consensus or dialogue. Rather, internal morality is grounded in the phenomena of medicine, i.e., in the nature of the clinical encounter between physician and patient. From this, a philosophy of medicine is derived which gives moral force to the duties, virtues and obligations of physicians qua physicians. Similarly, an ethic specific (...) to the other healing professions, law, teaching or ministry, can be derived from the specific ends to telos of each of these professions, which like medicine, are focused on a special type of human relationship. (shrink)

This paper argues that participation in an intimate relationship can generate additional or stronger reasons for one to act paternalistically toward the intimate. Moreover, participation in such a relationship can also weaken or cancel some of the presumptive reasons of respect one would otherwise have not to interfere. The paper also reflects, more generally, on the nature of intimate relationships, the normative significance of paternalism, and the normative differences between paternalism in larger-scale institutional contexts and paternalism in closer, interpersonal ones. (...) -/- . (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her (‘hard paternalism’). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not (...) to respect a person’s decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person’s own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities. I argue that we should openly recognize the multi-dimensional nature of this judgment. This implies rejecting both the threshold conception of competence and the categorical distinction between hard and soft paternalism. (shrink)

As late as 1984, five years after the first edition of the seminal Principles of Biomedical Ethics appeared, Tom Beauchamp lamented that applied ethics is not taken seriously as a distinct field of philosophy. In order to change that attitude he argued for effacing the distinction between applied and classical ethics. After all, philosophers of applied ethics do the same as all other philosophers: they analyze concepts, use certain strategies to test or justify beliefs, and explicate hidden premises in arguments. (...) Since 1984, applied ethics has grown progressively within philosophy. This is especially true of bioethics, which is viewed as the initial field of more practical ethical.. (shrink)

This volume contains essays which cover a range of aspects in the debate over genetic testing. It looks at both the advantages and disadvantages involved in knowing or not knowing whether one is a carrier of certain genetic traits.

ABSTRACT Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that (...) on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests. (shrink)

I take as my starting point the “one very simple principle” proclaimed by Mill in On Liberty … “That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. He cannot rightfully be compelled to do (...) or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right.”. (shrink)

Donald VanDeVeer probes the moral complexities of the question: under what conditions is it permissible to intervene invasively in the lives of competent persons--for example, by deception, force, or coercive threat--for their own good? In a work with broad significance for law, public policy, professional-client relations, and private interactions, he presents a theory of an autonomy-respecting" paternalism. Originally published in 1986. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist (...) of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

I argue that rationally persuading another to do something for their own good is sometimes (objectionably) paternalistic. Rational persuasion may express, and be guided by, the motive of distrust in the other’s capacity to gather or weigh evidence, and may intrude on the other’s deliberative activities in ways that conflict with respecting their agency and autonomy. I also examine factors that make a difference to whether (and when) the provision of reasons is respectful.

The four-principle approach to biomedical ethics is used worldwide by practitioners and researchers alike but it is rather unclear what exactly people do when they apply this approach. Ranking, specification, and balancing vary greatly among different people regarding a particular case. Thus, a sound and coherent applicability of principlism seems somewhat mysterious. What are principlists doing? The article examines the methodological strengths and weaknesses of the applicability of this approach. The most important result is that a sound and comprehensible application (...) of the four principles is additionally ensured by making use of the organizing meta-principle of common morality, which is the starting point and constraining framework of moral reasoning. (shrink)

We believe we owe one another respect. We believe we ought to pay what we owe by treating one another ‘with respect.’ If we could understand these beliefs we would be well on the way to understanding morality itself. If we could justify these beliefs we could vindicate a central part of our moral experience.Respect comes in many varieties. We respect some people for their upright character, others for their exceptional achievements. There are people we respect as forces of nature: (...) we go to great lengths to accommodate their moods, wiles, and demands. Finally, most of us seem to respect people simply because they are people. This is the sort of respect of special interest to moral theory.In order to be worthy of this last sort of respect, it is not only sufficient but necessary that one be a person. We can, of course, take a similar attitude towardnonpersons. (shrink)

In 1997, a Scottish surgeon by the name of Robert Smith was approached by a man with an unusual request: he wanted his apparently healthy lower left leg amputated. Although details about the case are sketchy, the would-be amputee appears to have desired the amputation on the grounds that his left foot wasn’t part of him – it felt alien. After consultation with psychiatrists, Smith performed the amputation. Two and a half years later, the patient reported that his life had (...) been transformed for the better by the operation [1]. A second patient was also reported as having been satisfied with his amputation [2]. (shrink)

Philosophers have recently revived the study of the ancient Greek topics of virtue and the virtues—justice, honesty, temperance, friendship, courage, and so on as qualities of mind and character belonging to individual people. But one issue at the center of Greek moral theory seems to have dropped out of consideration. This is the question of the unity of virtue, the unity of the virtues. Must anyone who has one of these qualities have others of them as well, indeed all of (...) them—all the ones that really do deserve to be counted as virtues? Even further, is there really no set of distinct and separate virtuous qualities at all, but at bottom only a single one—so that the person who has this single condition of “virtue” is entitled also to the further descriptions “honest” and “well-controlled” and “just” and “friendly” and “courageous” and “fostering” and “supportive,” and so on, as distinguishable aspects or immediate effects of his unitary “virtue”? (shrink)

Philosophers have recently revived the study of the ancient Greek topics of virtue and the virtues—justice, honesty, temperance, friendship, courage, and so on as qualities of mind and character belonging to individual people. But one issue at the center of Greek moral theory seems to have dropped out of consideration. This is the question of the unity of virtue, the unity of the virtues. Must anyone who has one of these qualities have others of them as well, indeed all of (...) them—all the ones that really do deserve to be counted as virtues? Even further, is there really no set of distinct and separate virtuous qualities at all, but at bottom only a single one—so that the person who has this single condition of “virtue” is entitled also to the further descriptions “honest” and “well-controlled” and “just” and “friendly” and “courageous” and “fostering” and “supportive,” and so on, as distinguishable aspects or immediate effects of his unitary “virtue”? (shrink)

In this book, I make use of an idea from economics to suggest how noble human tendencies might not only have survived the ruthless pressures of the material world, but actually have been nurtured by them.

These four volumes address the question of the kinds of conduct may the state make criminal without infringing on the moral autonomy of individual citizens.

Bioethical decision-making depends on presuppositions about the function and goal of bioethics. The authors in this issue of The Journal of Medicine and Philosophy share the assumption that bioethics is about resolving cases, not about moral theory, and that the best method of bioethical decision-making is that which produces useful answers. Because we have no universally agreed upon background moral theory which can serve as the basis for bioethical decision-making, they try to move bioethics away from theory. For them, a (...) good method of bioethical decision-making is one which resolves cases in ways that are justifiable to the parties involved, not necessarily in ways that bring us ‘close’ to the right and the true. The authors consider how the move away from theory and toward actual cases is best accomplished. In particular, the debate in this issue is about specification, specified principlism, and casuistry. (shrink)

The notion that it is useful to specify norms progressively in order to resolve doubts about what to do, which I developed initially in a 1990 article, has been only partly assimilated by the bioethics literature. The thought is not just that it is helpful to work with relatively specific norms. It is more than that: specification can replace deductive subsumption and balancing. Here I argue against two versions of reliance on balancing that are prominent in recent bioethical discussions. Without (...) meaning to address the substance or the overall merits of either view I criticize, I attack Gert, Culver and Clouser's implicit reliance on some overall dimension of balancing as a basis of resolving conflicts among norms and Beauchamp and Childress's residual acceptance of 'justified balancing'. The former authors' description of resolving conflicts depends upon a type of value commensurability that (as they otherwise seem to admit) does not obtain, while the latter authors' role for justified balancing would be better served by continued specification. (shrink)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)