In a thoughtful reassessment of the meaning of life and death, a noted philosopher offers a new definition for life that contrasts a world dependent on biological maintenance with one controlled by state-of-the-art medical technology. Tour.

People with disabilities use more medical care and see health professionals more often than do those of the same age, ethnic group, or economic class who do not have impairments. An indisputable medical goal is.

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)

In this article I examine the proposition that severe cognitive disability is an impediment to moral personhood. Moral personhood, as I understand it here, is articulated in the work of Jeff McMahan as that which confers a special moral status on a person. I rehearse the metaphysical arguments about the nature of personhood that ground McMahan’s claims regarding the moral status of the “congenitally severely mentally retarded” (CSMR for short). These claims, I argue, rest on the view that only intrinsic (...) psychological capacities are relevant to moral personhood: that is, that relational properties are generally not relevant. In addition, McMahan depends on an argument that species membership is irrelevant for moral consideration and a contention that privileging species membership is equivalent to a virulent nationalism (these will be discussed below). In consequence, the CSMR are excluded from moral personhood and their deaths are less significant as their killing is less wrong than that of persons. To throw doubt on McMahan’s conclusions about the moral status and wrongness of killing the CSMR I question the exclusive use of intrinsic properties in the metaphysics of personhood, the dismissal of the moral importance of species membership, and the example of virulent nationalism as an apt analogy. I also have a lot to say about McMahan’s empirical assumptions about the CSMR. (shrink)

The distinction between “passive” and “active” euthanasia, though problematic and highly criticized, retains a certain intuitive appeal. When a patient is allowed to die, nature appears simply to be taking its course. Yet when a patient is killed by, say, a lethal injection, humans appear to be causing his or her death. Guilt seems to follow naturally from the latter act while not from the former. Yet this view only holds up if age‐old and vague ideasabout “nature” and “artifice” go (...) unscrutinized. Once examined more closely the functional relevance of particular machines to particular bodies becomes evident. And the innocence and guilt less clear. (shrink)

The ethical issues around decision making on behalf of infants have been illuminated by two empirical research studies carried out in Scotland. In-depth interviews with 176 medical and nursing staff and with 108 parents of babies for whom there was discussion of treatment withholding/withdrawal, generated a wealth of data on both the decision making process and the management of cases. Both staff and parents believe that parents should be involved in treatment limitation decisions on behalf of their babies. However, whilst (...) many doctors and nurses consider the ultimate responsibility too great for families to carry, the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception found in the two groups. The results of these empirical studies provide both aids to ethical reflection and guidance for clinicians dealing with these vulnerable families. They demonstrate the value of empirical data in the philosophical debate. (shrink)

One of the most contentious ethical issues in the neonatal intensive care unit is the withdrawal of life-sustaining treatment from infants who may otherwise survive. In practice, one of the most important factors influencing this decision is the prediction that the infant will be severely intellectually disabled. Most professional guidelines suggest that decisions should be made on the basis of the best interests of the infant. It is, however, not clear how intellectual disability affects those interests. Why should intellectual disability (...) be more important than physical disability to the future interests of an infant? Is it discriminatory to base decisions on this? This paper will try to unravel the above questions. It seems that if intellectual disability does affect the best interests of the child it must do so in one of three ways. These possibilities will be discussed as well as the major challenges to the notion that intellectual disability should have a role in such decisions. The best interests of the child can be affected by severe or profound intellectual disability. It is, though, not as clear-cut as some might expect. (shrink)

Offers possible solutions to such medical dilemmas as who should receive organ transplants.

Australia has traditionally considered itself to be in the forefront of nations committed to the recognition and respect of human rights, including the right to life of all human beings. Australia has signed and ratified the International Covenant on Civil and Political Rights, which codifies the right to life in international law. Australia has also signed and ratified the Convention on the Rights of the Child, which codifies both the right to life, and a related right to survival and development, (...) for all children and young persons. Additionally, Australia is a wealthy country with relatively well-developed health and social security systems, which include a wide range of specialist services targeted specifically to persons with disability and their families. Together, these factors would appear to provide a strong foundation for securing the rights to life and survival of Australians with disability. However, beneath these calm waters lie deadly currents. This essay analyses the degree to which Australians with disability effectively enjoy the right to life, as it is understood in international law. We adopt an expansive understanding of the right to life that views the right to life as far more than an obligation on states to merely prevent and punish arbitrary deprivation of life, as important as this is. Instead, we argue that the right to life requires states to pursue a range of positive legal, social and economic measures to ensure that this right is fully realized, especially in a disability context. We argue that the rights to life and survival for persons with disability cannot be effectively secured without some transformation of traditional understandings of these rights, and we examine the potential for the Convention on the Rights of Persons with Disabilities to effect such a transformation. (shrink)