Steve Biko died in detention in South Africa in 1977. Critical ethical issues are raised both by the conduct of the doctors responsible for Biko's care and by the subsequent response of the medical profession as a whole. Because those issues are relevant to all healthcare professionals everywhere, the Biko affair provides a useful case study in medical ethics. We discuss the case in this article, describing how we use it in our teaching.

Controversies about abortion and women's reproductive technologies often seem to reflect personal experience, religious commitment, or emotional response. Laura M. Purdy believes, however, that coherent ethical principles are implicit in these controversies and that feminist bioethics can help clarify the conflicts of interest which often figure in human reproduction. As she defines the underlying issues, Purdy emphasizes the importance of taking women's interests fully into account. Reproducing Persons first explores the rights and duties connected with conception and pregnancy. Purdy asks (...) whether conceiving a child or taking a pregnancy to term can ever be morally wrong. She challenges the thinking of those who feel the prospect of disability or serious genetic disease should not constrain conception or justify abortion. The essays next look at abortion from a variety of angles. One contends that killing fetuses is not murder; others emphasize the moral importance of access to abortion. Purdy considers the conflicting interests of women and men regarding abortion, and argues against requiring a husband's consent. The book concludes with a consideration of new reproductive technologies and arrangements, including the controversial issue of surrogacy, or contract pregnancy. Throughout, Purdy combines traditional utilitarianism with some of the most powerful insights of contemporary feminist ethics. Her provocative essays create guidelines for approaching new topics and inspire fresh thinking about old ones. (shrink)

This paper originated in a conference presentation with my colleague Michael Tooley, at which we were both asked to re-evaluate articles about abortion that each of us had written over twenty years earlier. While Tooley and I both contended that abortion should be legally unrestricted, there were striking differences in the style and content of our respective arguments. Contemplating these differences has reinforced my own belief in the importance of emphasizing the centrality of gender when discussing abortion. Since gender as (...) we know it is a system of dominance as well as difference , I take this to mean that contemporary discussions of abortion must address the relationship between abortion access and the social status of women. My early article addressed this relationship to some extent, but the present paper will raise a number of additional gender issues that the early article did not mention. (shrink)

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

When a woman or girl finds herself pregnant, is it morally permissible for her to end that pregnancy? One dominant tradition says “no”; its close cousin says “rarely” - exceptions may be made where the burdens on the individual girl or woman are exceptionally dire, or, for some, when the pregnancy results from rape. On both views, though, there is an enormous presumption against aborting, for abortion involves the destruction of something we have no right to destroy. Those who reject (...) this claim, it is said, do so by denying the dignity of early human life - and imperiling their own. I think these views are deeply flawed. They are, I believe, based on a problematic conception of how we should value early human life; more than that, they are based on a profoundly misleading view of gestation and a deontically crude picture of morality. I believe that early abortion is fully permissible, widely decent, and, indeed, can be honorable. This is not, though, because I regard burgeoning human life as “mere tissue”: on the contrary, I think it has a value worthy of special respect. It is, rather, because I believe that the right way to value early human life, and the right way to value what is involved in and at stake with its development, lead to a view that regards abortion as both morally sober and morally permissible. Abortion at later stages of pregnancy becomes, for reasons I shall outline, multiply more complicated; but it is early abortions - say, abortions in the first half of pregnancy - that are most at stake for women. (shrink)

Steve Biko died in detention in South Africa in 1977. Critical ethical issues are raised both by the conduct of the doctors responsible for Biko's care and by the subsequent response of the medical profession as a whole. Because those issues are relevant to all healthcare professionals everywhere, the Biko affair provides a useful case study in medical ethics. We discuss the case in this article, describing how we use it in our teaching.

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention (...) in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician. -/- Critical to a proper appreciation of the significance of this conflict is a distinction that the literature on biomedical ethics has largely failed to draw: that between medical paternalism and physician integrity. (shrink)

As commonly understood, professional ethics consists of shared duties and episodic dilemmas--the responsibilities incumbent on all members of specific professions joined together with the dilemmas that arise when these responsibilities conflict. Martin challenges this "consensus paradigm" as he rethinks professional ethics to include personal commitments and ideals, of which many are not mandatory. Using specific examples from a wide range of professions, including medicine, law, high school teaching, journalism, engineering, and ministry, he explores how personal commitments motivate, guide, and give (...) meaning to work. (shrink)

Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience‐based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are examined, and it is argued that the most promising one is respect for moral integrity. It (...) is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented. (shrink)

In this article, I urge that mainstream discussions of abortion are dissatisfying in large part because they proceed in polite abstraction from the distinctive circumstances and meanings of gestation. Such discussions, in fact, apply to abortion conceptual tools that were designed on the premiss that people are physically demarcated, even as gestation is marked by a thorough-going intertwinement. We cannot fully appreciate what is normatively at stake with legally forcing continued gestation, or again how to discuss moral responsibilities to continue (...) gestating, until we appreciate in their own terms the goods and evils distinctive of gestational connection. To underscore the need to explore further the meanings of gestation, I provide two examples of the difference it might make to legal and moral discussions of abortion if we appreciate more fully that gestation is an intimacy. (shrink)

The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. Understanding (...) the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. -/- McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. -/- McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy. (shrink)

Abortion raises a number of difficult questions for morality, law, and public policy. When, if ever, is abortion morally permissible? Do women have a legal right to abortion, and how is that right to be justified? Ought abortions for poor women be funded by the state? These questions are related in the sense that answers to any one of them have implications for answers to the others. But it is crucial to remember that they are different questions. For example, suppose (...) abortion is never morally permissible. It would not. (shrink)