This paper examines what it is for a condition to be a disease. It falls into two sections. In the first I examine the best existing account of disease (as proposed by Christopher Boorse) and argue that it must be rejected. In the second I outline a more acceptable account of disease. According to this account, by disease we mean a condition that it is a bad thing to have, that is such that we consider the afflicted person to have (...) been unlucky, and that can potentially be medically treated. All three criteria must be fulfilled for a condition to be a disease. The criterion that for a condition to be a disease it must be a bad thing is required to distinguish the biologically different from the diseased. The claim that the sufferer must be unlucky is needed to distinguish diseases from conditions that are unpleasant but normal, for example teething. Finally, the claim that for a condition to be a disease it must be potentially medically treatable is needed to distinguish diseases from other types of misfortune, for example economic problems and legal problems. (shrink)

I argue that extant accounts of harm all fail to account for important desiderata, and that we should therefore jettison the concept when doing moral philosophy.

Although the counterfactual comparative account of harm, according to which someone is harmed when things go worse for her than they otherwise would have, is intuitively plausible, it has recently come under attack. There are five serious objections in the literature: some philosophers argue that the counterfactual account makes it hard to see how we could harm someone in the course of benefitting that person; others argue that Parfit’s non-identity problem is particularly problematic; another objection claims that the account forces (...) us to see many harms where there is just one; a fourth objection is based on the claim that the counterfactual account makes mysterious the distinction between harms and mere failures-to-benefit; and a final problem arises from cases of pre-emption, in which the nearest possible world in which the harmful event does not occur is a world in which some other harmful event occurs. This paper argues that, properly understood, harm essentially involves a counterfactual comparison, and that these comparisons are sensitive to context in the manner typical of counterfactual conditionals, and that, augmented with two plausible distinctions, this account has the resources to provide satisfying responses to each of the objections that have been raised against it. (shrink)

Conceptual analysis of health and disease is portrayed as consisting in the confrontation of a set of criteria—a “definition”—with a set of cases, called instances of either “health” or “ disease.” Apart from logical counter-arguments, there is no other way to refute an opponent’s definition than by providing counter-cases. As resorting to intensional stipulation is not forbidden, several contenders can therefore be deemed to have succeeded. This implies that conceptual analysis alone is not likely to decide between naturalism and normativism. (...) An alternative to this approach would be to examine whether the concept of disease can be naturalized. (shrink)

A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and (...) defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism. (shrink)

The non-identity problem concerns actions that affect who exists in the future. If such an action is performed, certain people will exist in the future who would not otherwise have existed: they are not identical to any of the people who would have existed if the action had not been performed. Some of these actions seem to be wrong, and they seem to be wrong in virtue of harming the very future individuals whose existence is dependent on their having been (...) performed. The problem arises when it is argued that the actions do not harm these people—because the actions do not make them worse off than they would otherwise be.1 Consider: Radioactive Waste Policy: We are trying to decide whether to adopt a permissive radioactive waste policy. This policy would be less inconvenient to us than our existing practices. If we enact the newly-proposed policy, then we will cause there to be radioactive pollution that will cause illness and suffering. However, the policy will have such significant effects on public policy and industry functioning, that different people will exist in the future depending on whether we enact the policy. Two things should be emphasized. First, the illness and suffering caused will be very serious: deformed babies, children with burns from acid rain, and adults dying young from cancer. Second, the policy will affect who will exist in the future because our present practices invade people’s everyday lives, for example by affecting recycling practices in the home; these practices will change if the policy is adopted. Furthermore, whether we adopt the policy will determine which plants are built where, what jobs are available, and what trucks are on the road. These effects will create small differences in everyone’s lives which ultimately affect who meets whom and who conceives with whom, or at least when people conceive. This affects who exists in the future. (shrink)

Challenging, with several powerful arguments, some of our deepest beliefs about rationality, morality, and personal identity, Parfit claims that we have a false view about our own nature. It is often rational to act against our own best interersts, he argues, and most of us have moral views that are self-defeating. We often act wrongly, although we know there will be no one with serious grounds for complaint, and when we consider future generations it is very hard to avoid conclusions (...) that most of us will find very disturbing. (shrink)

In Enhancing Evolution, leading bioethicist John Harris dismantles objections to genetic engineering, stem-cell research, designer babies, and cloning and makes an ethical case for biotechnology that is both forthright and rigorous. Human enhancement, Harris argues, is a good thing--good morally, good for individuals, good as social policy, and good for a genetic heritage that needs serious improvement. Enhancing Evolution defends biotechnological interventions that could allow us to live longer, healthier, and even happier lives by, for example, providing us with immunity (...) from cancer and HIV/AIDS. Further, Harris champions the possibility of influencing the very course of evolution to give us increased mental and physical powers--from reasoning, concentration, and memory to strength, stamina, and reaction speed. Indeed, he says, it's not only morally defensible to enhance ourselves; in some cases, it's morally obligatory. In a new preface, Harris offers a glimpse at the new science and technology to come, equipping readers with the knowledge to assess the ethics and policy dimensions of future forms of human enhancement. (shrink)

The Elements of Moral Philosophy 9e by James Rachels and Stuart Rachels is a best-selling text for undergraduate courses in ethics. Thirteen thought-provoking chapters introduce readers to major moral concepts and theories in philosophy through clear, understandable explanations and compelling discussions. Chapters are written so that they may be read independently of one another thus providing greater flexibility for students and instructors.

David Boonin presents a new account of the non-identity problem: a puzzle about our obligations to people who do not yet exist. He provides a critical survey of solutions to the problem that have been proposed, and concludes by developing an unorthodox alternative solution, one that differs fundamentally from virtually every other approach.

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...) these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

Christopher Boorse’s biostatistical theory of medical disorder claims that biological part-dysfunction (i.e., failure of an internal mechanism to perform its biological function), a factual criterion, is both necessary and sufficient for disorder. Jerome Wakefield’s harmful dysfunction analysis of medical disorder agrees that part-dysfunction is necessary but rejects the sufficiency claim, maintaining that disorder also requires that the part-dysfunction causes harm to the individual, a value criterion. In this paper, I present two considerations against the sufficiency claim. First, I analyze Boorse’s (...) central argument for the sufficiency claim, the “pathologist argument,” which takes pathologists’ intuitions about pathology as determinative of medical disorder and conclude that it begs the question and fails to support the sufficiency claim. Second, I present four counterexamples from the medical literature in which salient part-dysfunctions are considered nondisorders, including healthy disease carriers, HIV-positive status, benign mutations, and situs inversus totalis, thus falsifying the sufficiency claim and supporting the harm criterion. (shrink)

Disability rights activists often claim that disability is not—by itself—something that makes disabled people worse off. A popular objection to such a view of disability is this: were it correct, it would make it permissible to cause disability and impermissible to cause nondisability. The aim of this article is to show that these twin objections don’t succeed.

The question I address in this paper is whether and under what conditions it is morally right to bring a person into existence. I defend the commonsensical thesis that, other things being equal, it is morally wrong to create a person who will be below some threshold of quality of life, even if the life of this potential person, once created, will nevertheless be worth living. However commonsensical this view might seem, it has shown to be problematic because of the (...) so-called 'Non-Identity Problem'. Both utilitarian and rights-based approaches have been unable to provide a solution to this problem. I rest my thesis on two premises: that causing a disability or impairment in a future person is prima facie wrong, so long as we can avoid causing such a disability to that very person; and that reproduction, under normal conditions, is prima facie morally indifferent. From these two premises, I conclude that it is prima facie wrong to bring into existence a person with a non-trivial disability or impairment (which might be, nonetheless, compatible with a worthwhile life), even if the only available alternative is to remain childless. (shrink)

According to the Harm Principle, roughly, the state may coerce a person only if it can thereby prevent harm to others. Clearly, this principle depends crucially on what we understand by harm. Thus, if any sort of negative effect on a person may count as a harm, the Harm Principle will fail to sufficiently protect individual liberty. Therefore, a more subtle concept of harm is needed. I consider various possible conceptions and argue that none gives rise to a plausible version (...) of the Harm Principle. Whether we focus on welfare, quantities of welfare or qualities of welfare, we do not arrive at a plausible version of this principle. Instead, the concept of harm may be moralized. I consider various ways this may be done as well as possible rationales for the resulting versions of the Harm Principle. Again, no plausible version of the principle turns up. I also consider the prospect of including the Harm Principle in a decision-procedure rather than in a criterion of rightness. Finally, in light of my negative appraisal, I briefly discuss why this principle has seemed so appealing to liberals. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, 'what is a mental disorder?'. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, as (...) well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

Clear, accurate presentation of the most important classical and contemporary theories in normative and metaethics-utilitarianism (act and rule), egoism, the categorical imperative, social contract theory, formalism, relativism (belief and conceptual), naturalism and non- naturalism, emotivism and prescriptive. Integrates thorough discussion of related concepts including justice, the will, autonomy, promises, punishment and universal law.

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, ‘what is a mental disorder?’. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, as (...) well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions , which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as ‘harmful dysfunctions’, and not simply as ‘mental dysfunctions’. (shrink)

Much recent work on the ethics of new biomedical technologies is committed to hidden, contestable views about the nature of biological reality. This selection of essays by Tim Lewens explores and scrutinises these biological foundations, and includes work on human enhancement, synthetic biology, and justice in healthcare decision-making.

In this paper, I construct and defend an account of harm, specifically, all-things-considered overall harm. I start with a simple comparative account, on which an event harms a person provided that she would have been better off had it not occurred. The most significant problems for this account are overdetermination and preemption cases. However, a counterfactual comparative approach of some sort is needed to make sense of harm, or so I argue. I offer a counterfactual comparative theory that accounts nicely (...) for such cases, by taking claims about harm to be, potentially, irreducibly plural. In some cases, there are some events such that they are harmful, even if no one of them is such that it is harmful. I try to work out the details. (shrink)

Given that a person's death is bad for her,whenis it bad? I defendsubsequentism, the view that things that are bad in the relevant way are bad after they occur. Some have objected to this view on the grounds that it requires us to compare the amount of well-being the victim would have enjoyed, had she not died, with the amount she receives while dead; however, we cannot assign any level of well-being, not even zero, to a dead person. In the (...) population ethics literature, many philosophers have argued along similar lines that bringing someone into existence can neither harm nor benefit her. Working within the comparative framework (on which harms make us worse off), I respond by proposing a good sense in which we can say that dead people, and actual people at alternatives in which they do not exist, have a well-being level of zero. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, "What is a mental disorder?". In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, as well (...) as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)