Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Since it appeared in 1971, John Rawls's A Theory of Justice has become a classic. The author has now revised the original edition to clear up a number of difficulties he and others have found in the original book. Rawls aims to express an essential part of the common core of the democratic tradition--justice as fairness--and to provide an alternative to utilitarianism, which had dominated the Anglo-Saxon tradition of political thought since the nineteenth century. Rawls substitutes the ideal of the (...) social contract as a more satisfactory account of the basic rights and liberties of citizens as free and equal persons. "Each person," writes Rawls, "possesses an inviolability founded on justice that even the welfare of society as a whole cannot override." Advancing the ideas of Rousseau, Kant, Emerson, and Lincoln, Rawls's theory is as powerful today as it was when first published. (shrink)

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

Though the revised edition of A Theory of Justice, published in 1999, is the definitive statement of Rawls's view, so much of the extensive literature on Rawls's theory refers to the first edition.

This articles assesses the arguments that bioethicists have presented for the view that patient’ autonomy has value over and beyond its instrumental value in promoting the patients’ wellbeing. It argues that this view should be rejected and concludes that patients’ autonomy should be taken to have only instrumental value in medicine.

In Reasons and the Good Roger Crisp answers some of the oldest questions in moral philosophy. Fundamental to ethics, he claims, is the idea of ultimate reasons for action; and he argues controversially that these reasons do not depend on moral concepts. He investigates the nature of reasons themselves, and how we come to know them. He defends a hedonistic theory of well-being and an account of practical reason according to which we can give some, though not overriding, priority to (...) our own good over that of others. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

In this much-anticipated book, Jonathan Dancy offers the only available full-scale treatment of particularism in ethics, a view with which he has been associated for twenty years. Dancy now presents particularism as the view that the possibility of moral thought and judgement does not in any way depend on an adequate supply of principles. He grounds this claim on a form of reasons-holism, holding that what is a reason in one case need not be any reason in another, and maintaining (...) that moral reasons are no different in this respect from others. Ethics Without Principles offers detailed treatment and criticism of opposing positions of all sorts, with useful summaries. It also contains three chapters on the nature of what Dancy calls 'contributory' reasons, which, though the topic of much interest at the moment, are not often discussed in anything like the detail given here. And it offers a distinctive form of value-holism to go with the holism of reasons. As Dancy's definitive statement on particularism, the book will be required reading for all those working on moral philosophy and ethical theory. (shrink)

Moral problems do not always come in the form of great social controversies. More often, the moral decisions we make are made quietly, constantly, and within the context of everyday activities and quotidian dilemmas. Indeed, these smaller decisions are based on a moral foundation that few of us ever stop to think about but which guides our every action. Here distinguished philosopher Bernard Gert presents a clear and concise introduction to what he calls "common morality" -- the moral system that (...) most thoughtful people implicitly use when making everyday, common sense moral decisions and judgments. Common Morality is useful in that -- while not resolving every disagreement on controversial issues -- it is able to distinguish between acceptable and unacceptable answers to moral problems. In the first part of the book Gert lays out the fundamental features of common morality: moral rules, moral ideals, and a two-step procedure for determining when a violation of a moral rule is justified. Written in a non-technical style, the ten general moral rules include rules on which everyone can agree, such as "do not kill," "do not deceive," and "keep your promises." The moral ideals include similarly uncontroversial precepts such as "Relieve pain" and "Aid the needy." In the second part of the book Gert examines the underlying concepts that justify common morality, such as the notions of rationality and impartiality. The distillation of over 40 years of scholarship, this book is the most accessible version of Gert's influential theory of morality as well as an eye-opening look at the moral foundations of our everyday actions. Throughout the discussion is clear enough for a reader with little or no philosophy background. (shrink)

Our lives are such that moral wrongdoing is sometimes inescapable for us. We have moral responsibilities to persons which may conflict and which it is wrong to violate even when they do conflict. Christopher W. Gowans argues that we must accept this conclusion if we are to make sense of our moral experience and the way in which persons are valuable to us. In defending this position, he critically examines the recent moral dilemmas debate. He maintains that what is important (...) in this debate is not whether there are irresolvable moral conflicts, but whether there are moral conflicts in which wrongdoing is unavoidable. Though it would be incoherent to conclude moral deliberation by deciding to perform incompatible actions, he argues that there is nothing incoherent in supposing that we have conflicting moral responsibilities. In this way, he shows that it is possible to capture the intuitions of those who have defended the idea of moral dilemmas while meeting the objections of those who have rejected this idea. Gowans carefully evaluates utilitarian and Kantian analyses of moral dilemmas. He argues that these approaches eliminate genuine moral conflict only by displacing persons as direct objects of moral concern. As an alternative, he develops a more concrete account in which moral responsibilities to persons are central. The book also includes discussions of Melville's Billy Budd, methodology in moral philosophy, moral pluralism, moral tragedy, and "dirty hands" in politics. (shrink)

In contemporary medical ethics, it is widely accepted that concern for individual autonomy provides the ethical foundation for the doctrine of informed consent. It is taken that treating a competent patient is morally acceptable only if she has given her informed consent to being treated, because failing to secure the patient’s informed consent to her treatment would violate the patient’s autonomy. In a recent issue of this journal, James Stacey Taylor argues that this conventional view is mistaken. Taylor maintains that (...) a patient lacking information relevant to her medical decisions can be fully autonomous with respect to such decisions, because a person suffers from a diminution in her autonomy with respect to her medical decisions only if she is deliberately kept ignorant or deceived by her healthcare provider. In Taylor’s view, the patient’s autonomy would thus not be compromised if her healthcare provider fails to secure her informed consent to her treatment as a result of negligently omitting to provide relevant information to her. However, since it is intuitively plausible that the healthcare provider is still morally culpable for her negligence, it should, Taylor writes, be taken that the ethical foundation of informed consent is concern for patient wellbeing. While there is reason to be sympathetic to the conclusion that informed consent should be taken to be based on the value of wellbeing, Taylor’s argument does not support that result. (shrink)

Autonomy generally is a valued condition for persons in liberal cultures such as the United States. We uphold autonomous agents as the exemplar of persons who, by their judgment and action, authenticate the social and political principles and policies that advance their interests. But questions about the value of autonomy are often problematic. They are problematic because they concern the kind of value autonomy has and not just how much value autonomy has when weighed against competing goods. The two questions (...) are frequently conflated. For example, in asking what happens when the putative right to autonomy is tested against competing goods, such as personal contentment or political security, we might overlook the fact that we are comparing goods that are valued for different reasons. My aim in this paper is to explore in a very general way some of the issues surrounding these questions about the value of autonomy. I plan to do so by focusing on the phenomenon of being “blinded” by an inarticulate ideal of the value of autonomy. (shrink)

This paper is a short review of Roger Crisp's book Reasons and the Good.

Can we legitimately speak of ethicsexperts? Recent literature in philosophy and medical ethics addresses this important question but does not offer a satisfactory answer. Part of the problem is the absence of an examination of what it means to be an expert in general. I therefore begin by reviewing my analysis of expertise which appeared earlier in this journal. We speak of two kinds of experts: persons whose expertise is in virtue of what theyknow (epistemic expertise), or what theydo (performative (...) expertise). Applying this analysis to the domain of ethics, I argue that we may speak of ethical expertise in three epistemic senses: a) expertise indescriptive ethics, b) expertise inmetaethics, c) expertise innormative ethics, and in a performative sense: d) expertise inliving a good life. I conclude with a brief description of some social roles of ethics experts. (shrink)

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or (...) constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition. (shrink)

This chapter begins with a weak understanding of intuitions as beliefs that do not result from more familiar sources, but that the person currently holds simply because the proposition believed seems true to the person upon due consideration. Nearly all moral inquiry makes significant use of moral intuitions. Reflective equilibrium is perhaps the most sophisticated intuitionistic approach to moral inquiry. It modifies the usual understanding of reflective equilibrium by arguing that inquirers must not merely mold their moral intuitions into a (...) coherent system via a process of mutual adjustment, but must also strive to enhance their competence at making moral judgments. It then considers and rejects an argument for the reliability of moral intuitions that takes them to provide evidence regarding our own moral concepts. Finally, it defends reflective equilibrium by arguing that there is no sensible alternative to accepting the intuitions we have after full reflection, which is, in essence, what reflective equilibrium does. (shrink)

New medical technologies provide us with new possibilities in health care and health care research. Depending on their degree of novelty, they may as well present us with a whole range of unforeseen normative challenges. Partly, this is due to a lack of appropriate norms to perceive and handle new technologies. This article investigates our ways of establishing such norms. We argue that in this respect analogies have at least two normative functions: they inform both our understanding and our conduct. (...) Furthermore, as these functions are intertwined and can blur moral debates, a functional investigation of analogies can be a fruitful part of ethical analysis. We argue that although analogies can be conservative; because they bring old concepts to bear upon new ones, there are at least three ways in which they can be creative. First, understandings of new technologies are quite different from the analogies that established them, and come to be analogies themselves. That is, the concepts may turn out to be quite different from the analogies that established them. Second, analogies transpose similarities from one area into another, where they previously had no bearing. Third, analogies tend to have a figurative function, bringing in something new and different from the content of the analogies. We use research-biobanking as a practical example in our investigations. (shrink)

This book combines the two most common approaches used to introduce students or general readers to ethics: the historical and the applied. Using these approaches, Sterba examines traditional ethical theories and disagreements, exploring Aristotelian, Kantian, and utilitarian ethics, as well as their contemporary defenders. But rather than focusing on formal aspects of these views, Sterba applies the best practical arguments from each of these perspectives to a variety of moral problems, such as sexual harassment, affirmative action, and international terrorism and (...) the second Iraqi war. (shrink)

We all have beliefs, even strong convictions, about what is just and fair in our social arrangements. How should these beliefs and the theories of justice that incorporate them guide our thinking about practical matters of justice? This wide-ranging collection of essays by one of the foremost medical ethicists in the USA explores the claim that justification in ethics, whether of matters of theory or practice, involves achieving coherence between our moral and non-moral beliefs. Amongst the practical issues addressed in (...) the volume are the design of health-care institutions, the distribution of goods between the old and the young, and fairness in hiring and firing. In combining ethical theory and practical ethics this volume will prove especially valuable to philosophers concerned with ethics and applied ethics, political theorists, bioethicists, and others involved in the study of public policy. (shrink)

Leading accounts of personal autonomy are content-neutral: they insist that there are no a priori constraints on the content of the desires or values that might motivate an autonomous action. In Gerald Dworkin's provocative words, ‘the autonomous person can be a tyrant or a slave, a saint or sinner, a rugged individualist or champion of fraternity, a leader or follower.’ ‘There is nothing in the idea of autonomy that precludes a person from saying, “I want to be the kind of (...) person who acts at the command of others. I define myself as a slave and endorse those attitudes and preferences. My autonomy consists in being a slave.” ’ John Christman similarly claims that ‘any desire, no matter how evil, self-sacrificing, or slavish it might be’ could be autonomously formed. The same seems to apply to Harry Frankfurt's view, that actions are autonomous if they stem from second-order volitions that reflect what the agent cares about; it puts no constraints on the content of what a person might care about. All of these accounts hold that the mere content of a desire or value is never sufficient to rule out that it might be autonomously acted on by someone. (shrink)

“Multiculturalism”, “pluralism” and “tolerance” have become buzz words in applied ethics. While serious and well thought out work is going on in these areas, a misunderstanding of the importance of tolerance, and the difficulties raised by multicultural moral conflict seems common. In this paper I argue that intolerance of some cultural traditions is morally required, and suggest that the forging of a moral mono-culture is preferable to pluralism.

In this introduction, I summarize the main themes of my book, particularly those that my critics have focused on in their papers that follow. I also argue that I could not have reached the conclusions that I have if I hadn’t employed a peacemaking rather than a warmaking way of doing philosophy. I provide a characterization of a peacemaking way of doing philosophy and show how the conclusions of my book depend on doing philosophy in that way.

There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they (...) argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism. (shrink)

Services of ethics committees are nowadays commonly used in such various spheres of life as health care, public administration, business, law, engineering, and scientific research. It is taken that as their members have expertise in ethics, these committees can have valuable contributions to make in solving practical moral problems. It has, however, also been maintained that it is simply absurd to claim that one has some special knowledge and skills in moral matters; in connection with moral questions there is no (...) expertise to be had. In this paper, I assess this criticism of the use of ethics committees and ethics consultants. I argue that there is no sufficient reason to reject the possibility of ethical expertise. (shrink)

Leading accounts of personal autonomy arecontent-neutral:they insist that there are noa prioriconstraints on the content of the desires or values that might motivate an autonomous action. In Gerald Dworkin's provocative words, ‘the autonomous person can be a tyrant or a slave, a saint or sinner, a rugged individualist or champion of fraternity, a leader or follower.’ ‘There is nothing in the idea of autonomy that precludes a person from saying, “I want to be the kind of person who acts at (...) the command of others. I define myself as a slave and endorse those attitudes and preferences. My autonomy consists in being a slave.” ’ John Christman similarly claims that ‘any desire, no matter how evil, self-sacrificing, or slavish it might be’ could be autonomously formed. The same seems to apply to Harry Frankfurt's view, that actions are autonomous if they stem from second-order volitions that reflect what the agent cares about; it puts no constraints on the content of what a person might care about. All of these accounts hold that the mere content of a desire or value is never sufficient to rule out that it might be autonomously acted on by someone. (shrink)

Services of ethics committees are nowadays commonly used in such various spheres of life as health care, public administration, business, law, engineering, and scientific research. It is taken that as their members have expertise in ethics, these committees can have valuable contributions to make in solving practical moral problems. It has, however, also been maintained that it is simply absurd to claim that one has some special knowledge and skills in moral matters; in connection with moral questions there is no (...) expertise to be had. In this paper, I assess this criticism of the use of ethics committees and ethics consultants. I argue that there is no sufficient reason to reject the possibility of ethical expertise. (shrink)

Using the bench trial of Colorado’s Amendment 2 as an example, this article focuses on the more general question of expert testimony in moral philosophy. It argues that there is indeed expertise in moral philosophy but argues against admitting such expert testimony in cases dealing with what John Rawls terms “constitutional essentials” and ‘matters of basic justice.” Developing the idea of public reason inherent in the Rawlsian concept of political liberalism, the article argues that philosophers can and should speak out (...) on public issues, if they do so with due respect for certain restrictions, but that they should not serve as expert witnesses on core constitutional questions, since doing so suggests that they claim a type of authority that would require fellow citizens to defer to their views. Such claims to authority in basic ethical matters threaten the mutual respect for divergent comprehensive doctrines that lies at the core of political liberalism. Philosophers have a duty to serve the public good, and they perform this service in fruitful ways. But they should refuse a public role that appears incompatible with equal respect for the committed ethical searching of their fellow citizens. (shrink)

Is expertise in applied ethics compatible with individual autonomy and democratic self‐governance? This depends on whether a ‘tracking condition’ is satisfied for expert claims about issues in applied ethics. This condition requires that, when expert deliberations are properly conducted they ‘track’ the courses of reasoning that the experts’ clients would themselves have undertaken if they had (perhaps subject to certain conditions) considered the matters for themselves. Pluralism of the kind thematised by Isaiah Berlin and Stuart Hampshire suggests that the tracking (...) condition typically will not be satisfied and, hence, that whatever experts are praticising in applied ethics they are doing it contrary to democratic principles of autonomy and self‐government. The implications of this result are sketched and some standard objections briefly considered. (shrink)