In the discussion on rationing health care in The Netherlands, a fundamental tension emerges between two ethical perspectives: liberalism and communitarianism. A Dutch government committee recently issued a report opting for a community-oriented approach. This approach proves less communitarian as compared to the views on rationing elaborated by Callahan. Moreover, the community-oriented approach is conceptualised in such a way that it seems compatible with some basic aspects of the liberal account of a just society.

The prevalent ethic of patient autonomy ignores family interests in medical treatment decisions. Acknowledging these interests as legitimate forces basic changes in ethical theory and the moral practice of medicine.

Virtually any appraisal of a person’s welfare, integrity, or moral status, as well as the moral and political theories built on such appraisals, will rely crucially on the presumption that her preferences and values are in some important sense her own. In particular, the nature and value of political freedom is intimately connected with the presupposition that actions one is left free to do flow from desires and values that are truly an expression of the ‘self-government’ of the agent. However, (...) we all know that no person is self-made in the sense of being a fully formed and intact ‘will’ blossoming out of nowhere. Our values and preferences are explained by essential reference to a variety of influences that have come to bear on our development throughout our personal histories. What is needed, then, is to establish an account of self-determination or autonomy that would help determine just when and if the values and preferences we find ourselves with deserve the centrality that moral and political theories place on them. (shrink)

Her careful building of positions, her unique approaches to analyzing problems, and her excellent insights make this an important work for feminists, those ...

A liberal society seeks not to impose a single way of life, but to leave its citizens as free as possible to choose their own values and ends. It therefore must govern by principles of justice that do not presuppose any particular vision of the good life. But can any such principles be found? And if not, what are the consequences for justice as a moral and political ideal? These are the questions Michael Sandel takes up in this penetrating critique (...) of contemporary liberalism. Sandel locates modern liberalism in the tradition of Kant, and focuses on its most influential recent expression in the work of John Rawls. In the most important challenge yet to Rawls' theory of justice, Sandel traces the limits of liberalism to the conception of the person that underlies it, and argues for a deeper understanding of community than liberalism allows. (shrink)

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

Should the authority to make treatment decisions be extended to the competent patient's family? Neither arguments from fairness nor communitarian concerns justify such an infringement on patient autonomy.

This new edition of Will Kymlicka's best selling critical introduction to contemporary political theory has been fully revised to include many of the most significant developments in Anglo-American political philosophy in the last eleven years, particularly the new debates over issues of democratic citizenship and cultural pluralism. The book now includes two new chapters on citizenship theory and multiculturalism, in addition to updated chapters on utilitarianism, liberal egalitarianism, libertarianism, socialism, communitarianism, and feminism. The many thinkers discussed include G. A. Cohen, (...) Ronald Dworkin, William Galston, Carol Gilligan, R. M. Hare, Chandran Kukathas, Catherine Mackinnon, David Miller, Philippe Van Parijs, Susan Okin, Robert Nozick, John Rawls, John Roemer, Michael Sandel, Charles Taylor, Michael Walzer, and Iris Young. Extended guides to further reading have been added at the end of each chapter, listing the most important books and articles on each school of thought, as well as relevant journals and websites. Covering some of the most advanced contemporary thinking, Will Kymlicka writes in an engaging, accessible, and non-technical way to ensure that the book is suitable for students approaching these difficult concepts for the first time. This second edition promises to build on the original edition's success as a key text in the teaching of modern political theory. (shrink)

Modern medicine has put a new twist on one of our most fundamental values: self-determination. Although advance directives may be used to request treatment, this volume limits its focus to their more common function--the refusal of treatment. Timely and comprehensive, it provides a stimulating overview of this relevant topic, addressing such questions as: What are the individual and societal benefits of advance directives? Does an advance directive tamper with the sanctity of life? Will normalizing directives have an adverse effect on (...) the practice of medicine? Should a patient specify treatments to be withheld within a directive? What legal sanctions should apply against those who ignore directives? and What is a physician's role in helping his patient formulate an appropriate directive? (shrink)

When health care providers make decisions to use resources, their devotion to the patient at hand must be mediated by a framework that puts individual autonomy and social equity into focus simultaneously. The concept of citizenship yields such a framework.