Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis (...) is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment. (shrink)

Nationalism is often dismissed today as an irrational political creed with disastrous consequences. Yet most people regard their national identity as a significant aspect of themselves, see themselves as having special obligations to their compatriots, and value their nation's political independence. This book defends these beliefs, and shows that nationality, defined in these terms, serves valuable goals, including social justice, democracy, and the protection of culture. National identities need not be illiberal, and they do not exclude other sources of personal (...) identity, such as ethnicity or religion. An ethics that gives weight to special relationships is more effective in motivating people to pursue justice and other values because it connects peoples’ duties to their identity; but this is consistent with recognizing some universal values, such as human rights. There are strong reasons for making the boundaries of states and nations coincide wherever possible, but in other cases, nations can achieve forms of self‐determination that fall short of full sovereignty. Multicultural arguments in favour of identity politics and special rights for minority groups ignore the benefits that such groups derive from participating in a shared national identity and the kind of democratic politics that such an identity makes possible. Although national identities are often said to be in decline in an increasingly globalized world, they serve such important purposes that our aim should be to rebuild them in a form that makes them more accessible to excluded cultural minorities. (shrink)

Contains an overall account of morality in its philosophical format particularly with regard to problems of observation, evidence, and truth.

My object in this paper is to defend the view that national boundaries may be ethically significant. The duties we owe to our compatriots may be more extensive than the duties we owe to strangers, simply because they are compatriots. On the face of it, such a view is hardly outlandish. On the contrary almost all of us, including our leaders, behave as though it were self-evidently true. We do not, for instance, hesitate to introduce welfare measures on the grounds (...) that their benefits will be enjoyed only by Americans, or Britons, or whomever. Why, then, is it worth defending this view at length? Precisely because there is a powerful thrust in the ethical theories that are most prominent in our culture toward what I shall call universalism: namely, the view that the subject matter of ethics is persons considered merely as such, independent of all local connections and relations; and that the fundamental questions of ethics can be posed in some such form as: What duties do I owe to my fellow human beings? What rights do they have against me?'. (shrink)

Suppose that we develop a medically safe and affordable means of enhancing human intelligence. For concreteness, we shall assume that the technology is genetic engineering (either somatic or germ line), although the argument we will present does not depend on the technological implementation. For simplicity, we shall speak of enhancing “intelligence” or “cognitive capacity,” but we do not presuppose that intelligence is best conceived of as a unitary attribute. Our considerations could be applied to specific cognitive abilities such as verbal (...) fluency, memory, abstract reasoning, social intelligence, spatial cognition, numerical ability, or musical talent. It will emerge that the form of argument that we use can be applied much more generally to help assess other kinds of enhancement technologies as well as other kinds of reform. However, to give a detailed illustration of how the argument form works, we will focus on the prospect of cognitive enhancement. (shrink)

Is it a stronger interference with people's freedom to withdraw options they currently have than to withhold similar options they do not have? Drawing on recent theorizing about sociopolitical freedom, this article identifies considerations that often make this the case for public policy. However, when applied to tobacco control, these considerations are shown to give us at best only very weak freedom-based reason to prioritize the status quo. This supports a popular argument for so-called “endgame” tobacco control measures: If we (...) believe that cigarettes would and should be withheld from entering markets in hypothetical scenarios in which they do not yet exist, then we also have reason to seek their abolition in situations, such as ours, in which cigarettes do exist—if necessary by banning their sale. The same considerations are then used to disarm objections that have recently been raised to using nudges in public policy. (shrink)

Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...) weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions. (shrink)