According to the Asymmetry, it is wrong to bring a miserable child into existence but permissible not to bring a happy child into existence. When it comes to procreation, we don’t have complete procreative liberty. But we do have some discretion. The Asymmetry seems highly intuitive. But a plausible account of the Asymmetry has been surprisingly difficult to provide, and it may well be that most moral philosophers – or at least most consequentialists – think that all reasonable efforts to (...) provide such an account have by now been exhausted. In this paper, I argue that, despite the difficulties, the Asymmetry is too important to be set aside. I also note a handful of accounts of the Asymmetry that have been proposed and why they fail. It seems, for example, that it will not do to say that some people matter morally and others don’t, or that a person matters morally in some worlds but not others. My own conclusion is that, while we are bound to say all people matter morally – you, me and the merely possible – we are not bound to say that all their losses– or all ours– matter morally. We can instead distinguish between morally significant and insignificant losses, with the distinction between the two being a matter of where the loss is incurred in relation to the person who incurs it. This way of looking at things – which I call Variabilism– provides the basis for a plausible account of the Asymmetry. The availability of such an account suggests, I think, that our prospects for rescuing the Asymmetry are bright. (shrink)

Neonatal intensive care units represent simultaneously one of the great success stories of modern medicine, and one of its most controversial developments. One particularly controversial issue is the resuscitation of extremely preterm infants. Physicians in the United States generally accept that they are required to resuscitate infants born as early as 25 weeks and that it is permissible to resuscitate as early as 22 weeks. In this article, I question the moral pressure to resuscitate by criticizing the idea that resuscitation (...) in this context “saves” a human life. Our radical medical advancements have allowed us to intervene in the life of a human before it makes sense to say that such an intervention “saves” someone; rather, what the physician does in resuscitating and treating an extremely preterm infant is to take over creating it. This matters, I argue, because “rescues” are much more morally urgent than “creations.”. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, healthcare professionals (...) bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)