A member of Jehovah’s Witnesses agreed to receive blood when alone, but rejected it once the elders were present. She insisted that the elders should stay, they were allowed to do so, and she bled to death. Was it all right to allow her to have the elders present when she made her final decision? Was it all right to allow her to bleed to death? It was, according to an anti-paternalist principle, which I have earlier defended on purely utilitarian (...) grounds. The thrust of the present argument is that the principle stands even in cases with context-sensitive preferences. However, my utilitarian argument to this effect must now rely on something other than J.S. Mill’s standard presumption that in most cases the individual makes the right choices for herself. A reference to the general trust in the system of healthcare is essential to the utilitarian defense of the anti-paternalistic principle. (shrink)

Michael Hardimon’s new book is a valuable study of Hegel’s social and political philosophy. Hardimon takes seriously Hegel’s intention to offer a social philosophy that can reconcile people to the modern social world. Since Hegel’s own presentation of his philosophy is motivated by a number of competing concerns, Hardimon’s admirable success at reconstructing Hegel’s view in accordance with this fundamental intention offers an important and insightful perspective on Hegel’s project. The focal points of Hardimon’s reconstruction—the aim of reconciliation and the (...) problem of alienation it is meant to overcome—are explained and interpreted with considerable clarity in a way that shows their significance to the tradition of modern political philosophy. Hardimon deliberately resists using Hegel’s technical terminology and engaging in detailed scholarly disputes in a successful effort to avoid obscurity and distraction. The result is a book that should be prized by anyone seeking an accessible presentation of Hegel’s social philosophy, particularly as a vehicle for teaching Hegel’s political thought without having to devote an entire course to the task. (shrink)

Practical Reason and Norms focuses on three problems: In what way are rules normative, and how do they differ from ordinary reasons? What makes normative systems systematic? What distinguishes legal systems, and in what consists their normativity? All three questions are answered by taking reasons as the basic normative concept, and showing the distinctive role reasons have in every case, thus paving the way to a unified account of normativity. Rules are a structure of reasons to perform the required act (...) and an exclusionary reason not to follow some competing reasons. Exclusionary reasons are explained, and used to unlock the secrets of orders, promises, and decisions as well as rules. Games are used to exemplify normative systems. Inevitably, the analysis extends to some aspects of normative discourse, which is truth-apt, but with a diminished assertoric force. (shrink)

When is one person entitled to sanction another for moral wrongdoing? When, instead, must one mind one’s own business? Stephen Darwall argues that the legitimacy of social sanctioning is essential to the very concept of moral obligation. But, I will argue, Darwall’s “second person” theory of accountability unfortunately implies that every person is entitled to sanction every wrongdoer for every misdeed. In this essay, I defend a set of principles for differentiating those who have the standing to sanction from those (...) who do not. (shrink)

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

Although written primarily for medical research, the Belmont principles have permeated clinical medicine as well. In fact, they are part of a broad cultural shift that has dramatically reworked the relationship between doctor and patient. In the early 1950s, medicine was about making the patient better and maintaining optimism when the patient could not get better. By the 1990s, medicine was about the treatment of specific physiological systems, as directed by the patient, but as limited by the society's concern for (...) justice. (shrink)

ABSTRACT In contemporary American medical practice, certain physicians are critical and wary of the current emphasis on patient autonomy in medicine, questioning whether it really serves the complex needs of severely ill patients. Physicians such as Eric Cassell and Thomas Duffy argue that the duty of beneficence should override the duty to respect autonomy when conflicts arise in clinical situations. After evaluating their claim that severe illness robs patients of their autonomy, I will argue that this perceived conflict between beneficence (...) and autonomy is ill‐conceived, resting on misperceptions about both the capacity for autonomy and the meaning of hope. Considering insights on hope from phenomenologist Gabriel Marcel and theologian William Lynch, as well as drawing upon a case study involving a bone marrow patient, I claim that respecting and nurturing patients’ capacity for autonomy is a necessary condition for acting beneficently and fostering authentic hope. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Many people have claimed that integrity requires sticking to one's convictions come what may. Greg Scherkoske challenges this claim, arguing that it creates problems in distinguishing integrity from fanaticism, close-mindedness or mere inertia. Rather, integrity requires sticking to one's convictions to the extent that they are justifiable and likely to be correct. In contrast to traditional views of integrity, Scherkoske contends that it is an epistemic virtue intimately connected to what we know and have reason to believe, rather than an (...) essentially moral virtue connected to our values. He situates integrity in the context of shared cognitive and practical agency and shows that the relationship between integrity and impartial morality is not as antagonistic as many have thought - which has important implications for the 'integrity objection' to impartial moral theories. This original and provocative study will be of great interest to advanced students and scholars of ethics. (shrink)

Three pictures of integrity have gained philosophical currency. On the integrated self picture, integrity involves the integration of "parts" of oneself into a whole. On the identity picture, integrity means fidelity to projects and principles constitutive of one's core identity. On the clean hands picture, integrity means maintaining the purity of one's agency, especially in dirty hands situations. I sketch each picture and suggest two general criticisms. First, integrity is reduced to something else with which it is not equivalent--to the (...) conditions of unified agency, to the conditions for continuing as the same self, and to the conditions for having reason to refuse cooperating with evil. Second, integrity is understood as a personal, but not also a social virtue; this limits the analysis of what integrity is and why it is a virtue. In the last section, I suggest a way of understanding integrity as the social virtue of standing before others for what, in one's best judgment, is worth persons' doing. (shrink)

When I was an undergraduate in Oxford, we were taught economics almost as though it were a natural science. The subject matter of economics might be different from physics, but only in the way that the subject matter of chemistry or biology is different from physics. The actual results were presented to us as if they were scientific theories. So when we learned that savings equals investment, it was taught in the same tone of voice as one teaches that force (...) equals mass times acceleration. And we learned that rational entrepreneurs sell where marginal cost equals marginal revenue in the way that we once learned that bodies attract in a way that is directly proportional to the product of their mass and inversely proportional to the square of the distance between them. At no point was it ever suggested that the reality described by economic theory was dependent on human beliefs and other attitudes in a way that was totally unlike the reality described by physics or chemistry. Some years ago, when I published The Construction of Social Reality, I was aware that it had implications for the ontology of economics, but I was not aware that there had already been an important revival of the tradition of institutional economics. It would be an understatement to say that I welcome this interest in institutions; I enthusiastically support it. But I think that in the institutional literature there is still an unclarity about what exactly an institution is. What is the ontology, the mode of existence, of institutional reality? This article tries to add to this discussion. Economics as a subject matter, unlike physics or chemistry, is largely concerned with institutional facts. Facts about money and interest rates, exchange and employment, corporations and the balance of payments, form the very heart of the subject of economics. When Lionel Robbins, in a classic work, tells us that “Economics is a study of the disposal of scarce commodities,”2 he takes for granted a huge invisible institutional.... (shrink)