Informed consent is valid only if the person giving it is competent. Although allegedly informed consents are routinely tendered, there are nonetheless serious problems with the concept of competence as it stands. First, conceptual work upon competence is incomplete: the concept is unanalyzed and no logic of competence has been identified. It is thus virtually impossible to reliably discern who is competent. ;Traditional work on competence has explicated three dichotomies from which the necessary conditions for the possibility of competence will (...) be identified, viz., that competence is either a global or a specific notion; is present in varying degrees or in virtue of a threshold; and may or not include appeals to consequences. Past efforts have failed to notice a fourth dichotomy: competence as an affective or cognitive notion. Failure to designate the appropriate arms of these dichotomies is responsible for there being, at present, no reliable test for competence. The inadequacies of a highly regarded particular test for competence, the mental status examination, are examined in light of this failure. ;Competence is located within the rule-governed practice of informed consent. That practice and hence, competence, is justified through a Kantian analysis of respect for persons. This analysis reveals that the logic of competence requires assessment in terms of specific rather than global concerns; degrees of ability rather than a threshold; both cognitive and affective abilities; and no appeal to consequences. ;Based upon the analyses of consent as an example of decision making within the practice of informed consent and of respect for persons, the capacities which jointly comprise competence are identified. These are the capacities to receive, recognize, and retrieve information; to reason about, relate to oneself, and rank options; to choose among alternatives; and, under certain circumstances, to defend one's choice. ;Identification of the logic of competence and explication of and justification for the capacities that comprise competence to consent provide a conceptual foundation for the crucial concept of competence that the informed consent process currently lacks. It should facilitate construction of a test for competence. (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)

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

In recent decades in North American social and moral philosophy, alongside the development and discussion of widely influential theories of justice, taken as Rawls takes it as the ‘first virtue of social institutions,’ there has been a counter-movement gathering strength, one coming from some interesting sources. For some of the most outspoken of the diverse group who have in a variety of ways been challenging the assumed supremacy of justice among the moral and social virtues are members of those sections (...) of society whom one might have expected to be especially aware of the supreme importance of justice, namely blacks and women. Those who have only recently won recognition of their equal rights, who have only recently seen the correction or partial correction of long-standing racist and sexist injustices to their race and sex, are among the philosophers now suggesting that justice is only one virtue among many, and one that may need the presence of the others in order to deliver its own undenied value. Among these philosophers of the philosophical counterculture, as it were - but an increasingly large counterculture - I include Alasdair MacIntyre, Michael Stocker, Lawrence Blum, Michael Slote, Laurence Thomas, Claudia Card, Alison Jaggar, Susan Wolf and a whole group of men and women, myself included, who have been influenced by the writings of Harvard educational psychologist Carol Gilligan, whose book In a Different Voice caused a considerable stir both in the popular press and, more slowly, in the philosophical journals. (shrink)

Conceptions of individual autonomy and of rational autonomy have played large parts in twentieth century moral philosophy, yet it is hard to see how either could be basic to morality. Kant's conception of autonomy is radically different. He predicated autonomy neither of individual selves nor of processes of choosing, but of principles of action. Principles of action are Kantianly autonomous only if they are law-like in form and could be universal in scope; they are heteronomous if, although law-like in form, (...) they cannot have universal scope. Puzzles about claims linking morality, reason and autonomy are greatly reduced by recognising the distinctiveness of Kantian autonomy. (shrink)

: Debates about commodification in bioethics frequently appeal to Kant's famous second formulation of the categorical imperative, the formula requiring us to treat the rational (human) being as "an end in itself" and "never as a means only." In the course of her own treatment of commodification, Margaret Jane Radin observes that Kant's application of this formula "does not generate noncontroversial particular consequences." This is so, I argue, because Kant offers three different--and largely incompatible--interpretations of the formula. One focuses on (...) the obligation to preserve rational willing; the second stresses respect for human (physical) dignity and integrity; the third views respect for others as "ends in themselves" as primarily involving a willingness to govern one's conduct by a procedure of impartial co-legislation. Only the third of these interpretations, I conclude, offers a reasonable and coherent approach to moral judgment about the limits of commodification. (shrink)

This essay critically assesses two strategies of accommodation used by defenders of impartialism in ethics to argue that the care orientation represents no genuine challenge to impartialist theoretical paradigms. One strategy focuses on impartiality as a constraint on moral deliberation, the other as a constraint on moral justification. While highlighting respects in which the commitment to impartiality is more consonant with the care orientation than many advocates of care have acknowledged, this essay attempts to clarify crucial ways in which each (...) accommodationist strategy falls, thus locating some of the more important contributions and challenges the care orientation offers to moral theory. (shrink)

Wie weit reicht die menschliche Freiheit? Ausgehend vom Bewältigungsdefizit des autonomen Menschen in der Postmoderne gegenüber seiner Handlungsmacht setzt sich die vorliegende Arbeit interdisziplinär mit dem Autonomie- und Freiheitsverständnis Karl Barths und Immanuel Kants auseinander. Die praktische Relevanz der Überlegungen wird am Beispiel der medizin-ethischen Urteilsbildung ausgewiesen. [Herausgeber].

What picture do we get when wie apply gender analysis to mainstream moral philosophy? Starting with an analysis of Kant, Hume and Rawls, Pauer–Studer develops the categorical framework of a moral theory that is free from any "male bias".

The author agrees with the critiques of moral theory offered by such writers as Bernard Williams and Alasdair MacIntyre, and uses ideas from Heidegger and Levinas to argue that caring is an ontological structure of human existence which takes two forms: caring about on self (which he calls our "self-project") and caring-about-others. This dual form of caring is expressed on four Aristotelian levels of human living which the author describes and illustrates with reference to the phenomenon of pain. It is (...) concluded from this analysis that traditional notions of morality as imposing obligations should give way to an understanding of ethics as the social forms given to our caring for ourselves and for others. A number of implications for ethical theory are sketched out with the conclusion that virtue theory should be preferred and that the model could be worked out more fully to show that virtue theory can be internalist, particularist, pluralist, personalist and objectivist. (shrink)

Conceptions of individual autonomy and of rational autonomy have played large parts in twentieth century moral philosophy, yet it is hard to see how either could be basic to morality. Kant's conception of autonomy is radically different. He predicated autonomy neither of individual selves nor of processes of choosing, but of principles of action. Principles of action are Kantianly autonomous only if they are law-like in form and could be universal in scope; they are heteronomous if, although law-like in form, (...) they cannot have universal scope. Puzzles about claims linking morality, reason and autonomy are greatly reduced by recognising the distinctiveness of Kantian autonomy. (shrink)