For thirty years, Peter Singer's Practical Ethics has been the classic introduction to applied ethics. For this third edition, the author has revised and updated all the chapters and added a new chapter addressing climate change, one of the most important ethical challenges of our generation. Some of the questions discussed in this book concern our daily lives. Is it ethical to buy luxuries when others do not have enough to eat? Should we buy meat from intensively reared animals? Am (...) I doing something wrong if my carbon footprint is above the global average? Other questions confront us as concerned citizens: equality and discrimination on the grounds of race or sex; abortion, the use of embryos for research and euthanasia; political violence and terrorism; and the preservation of our planet's environment. This book's lucid style and provocative arguments make it an ideal text for university courses and for anyone willing to think about how she or he ought to live. (shrink)

It is both an ideal and an assumption of traditional conceptions of justice for liberal democracies that citizens are autonomous, self-governing persons. Yet standard accounts of the self and of self-government at work in such theories are hotly disputed and often roundly criticized in most of their guises. John Christman offers a sustained critical analysis of both the idea of the 'self' and of autonomy as these ideas function in political theory, offering interpretations of these ideas which avoid such disputes (...) and withstand such criticisms. Christman's model of individual autonomy takes into account the socially constructed nature of persons and their complex cultural and social identities, and he shows how this model can provide a foundation for principles of justice for complex democracies marked by radical difference among citizens. His book will interest a wide range of readers in philosophy, politics, and the social sciences. (shrink)

The topic of self-interest raises large and intractable philosophical questions–most obviously, the question “In what does self-interest consist?” The concept, as opposed to the content of self-interest, however, seems clear enough. Self-interest is interest in one's own good. To act self-interestedly is to act on the motive of advancing one's own good. Whether what one does actually is in one's self-interest depends on whether it actually does advance, or at least, minimize the decline of, one's own good. Though it may (...) be difficult to tell whether a person is motivated by self-interest in a particular instance, and difficult also to determine whether a given act or decision really is in one's self-interest, the meaning of the claims in question seems unproblematic. My main concern in this essay is to make a point about the content of self-interest. Specifically I shall put forward the view that meaningfulness, in a sense I shall elaborate, is an important element of a good life. It follows, then, that it is part of an enlightened self-interest that one wants to secure meaning in one's life, or, at any rate, to allow and promote meaningful activity within it. Accepting this substantial conception of self-interest, however, carries with it a curious consequence: the concept of self-interest which formerly seemed so clear begins to grow fuzzy. Fortunately, it comes to seem less important as well. In Reasons and Persons, Derek Parfit distinguishes three sorts of theories about self-interest–hedonistic theories, preference theories, and what he calls “objective-list theories." Hedonistic theories hold that one's good is a matter of the felt quality of one's experiences. (shrink)

A meaningful life, we shall argue, is a life upon which a certain sort of valuable pattern has been imposed by the person in question - a pattern which involves in serious ways the person having an effect upon the world. Meaningfulness is thus a special kind of value which a human life can bear. Two interrelated difficulties face ths proposal. One concerns responsiblity: how are we to account for the fact that a life that satisfies the above criteria can (...) have more meaning than a life with the same positive outcomes but which lacks responsiblity on the part of the agent? The other turns on these outcomes themselves: how can the meaningfulness engendered by actions you perform now be affected by what those actions go on to produce in the future, perhaps even after your death? We provide a response to both of these difficulties. (shrink)

Whether the law should permit voluntary euthanasia or physician-assisted suicide is one of the most vital questions facing all modern societies. Internationally, the main obstacle to legalisation has proved to be the objection that, even if they were morally acceptable in certain 'hard cases', voluntary euthanasia and physician-assisted suicide could not be effectively controlled; society would slide down a 'slippery slope' to the killing of patients who did not make a free and informed request, or for whom palliative care would (...) have offered an alternative. How cogent is this objection? This book provides the general reader with a lucid introduction to this central question in the debate, not least by reviewing the Dutch euthanasia experience. It will interest all in any country whether currently for or against legalisation, who wish to ensure that their opinions are better informed. (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)

Theories of individual well‐being fall into three main categories: hedonism, the desire‐fulfilment theory, and the list theory (which maintains that there are some things that can benefit a person without increasing the person's pleasure or desire‐fulfilment). The paper briefly explains the answers that hedonism and the desire‐fulfilment theory give to the question of whether being virtuous constitutes a benefit to the agent. Most of the paper is about the list theory's answer.

An adaptive preference is a preference that is regimented in response to an agent’s set of feasible options. The fabled fox in the sour grapes story undergoes an adaptive preference change. I consider adaptive preferences more broadly, to include adaptive preference formation as well. I argue that many adaptive preferences that other philosophers have cast out as irrational sour-grapes-like preferences are actually fully rational preferences worthy of pursuit. I offer a means of distinguishing rational and worthy adaptive preferences from irrational (...) and unworthy ones. The distinction is based on the agent’s own appraisal of the adaptive preference. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

In this timely book L.W. Sumner addresses these issues within the wider context of palliative care for patients in the dying process.

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

This article addresses the utilitarian theory of life's meaning according to which a person's existence is significant just in so far as she makes those in the world better off. One aim is to explore the extent to which the utilitarian theory has counter-intuitive implications about which lives count as meaningful. A second aim is to develop a new, broadly Kantian theory of what makes a life meaningful, a theory that retains much of what makes the utilitarian view attractive, while (...) avoiding the most important objections facing it and providing a principled explanation of their force. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

It is generally held that doctors and researchers have an obligation to obtain informed consent. Over time there has been a move in relation to this obligation from a requirement to disclose information to a requirement to ensure that that information is understood. Whilst this change has been resisted, in this article I argue that both sides on this matter are mistaken. When investigating what information is needed for consent to be informed we might be trying to determine what information (...) a person would need in order to consent at all, or we might be trying to determine what information a person needs in order to make an informed choice about whether or not to consent. I argue that the obligation to ensure understanding only applies to information generated by the first type of enquiry; but that much of the information generally thought necessary in order for consent to be informed is only required if our concern is with the second type of enquiry. For this reason it is neither the case that doctors and researchers should ensure all the information they provide is understood, nor is it the case that their only obligation is to disclose it. (shrink)

ABSTRACT The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that (...) practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too. (shrink)

Margaret Pabst Battin has established a reputation as one of the top philosophers working in bioethics today. This work is a sequel to Battin's 1994 volume The Least Worst Death. The last ten years have seen fast-moving developments in end-of-life issues, from the legalization of physician-assisted suicide in Oregon and the Netherlands, to a furor over proposed restrictions of scheduled drugs used for causing death, and the development of "NuTech" methods of assistance in dying. Battin's new collection covers a remarkably (...) wide range of end-of-life topics, including suicide prevention, AIDS, suicide bombing, serpent-handling and other religious practices that pose a risk of death, genetic prognostication, suicide in old age, global justice and the "duty to die." It also examines suicide, physician-assisted suicide, and euthanasia in both American and international contexts. As with the earlier volume, these new essays are theoretically adroit but draw richly from historical sources, fictional techniques, and ample factual material. (shrink)

One of the requirements in the Dutch regulation for euthanasia and assisted suicide is that the doctor must be satisfied ‘that the patient's suffering is unbearable, and that there is no prospect of improvement.’ In the notorious Chabot case, a psychiatrist assisted a 50 year old woman in suicide, although she did not suffer from any somatic disease, nor strictly speaking from any psychiatric condition. In Seduced by Death, Herbert Hendin concluded that apparently the Dutch regulation now allows physicians to (...) assist anyone in suicide simply because he or she is unhappy.In this paper, I reject Hendin's conclusion and in particular his description of Mrs Boomsma as someone who was ‘simply unhappy.’ After a detailed narration of her lifestory, I turn to the American philosopher Harry Frankfurt's account of volitional incapacity and love for a more accurate characterization of her suffering. Having been through what she had, she could only go on living as another person than the one she had been when she was a happy mother. That would have violated her integrity, and that she could not bring herself to do. (shrink)

The relief of suffering is the great goal of medicine. That physicians give up on suffering when they can do nothing about the underlying condition is one of the contemporary criticisms of medicine. Yet even in irremediable suffering there is something noble, to which physicians should attend.

_10 Good Questions about Life and Death_ makes us think again about some of the most important issues we ever have to face. Addresses the fundamental questions that many of us ask about life and death. Written in an engaging and straightforward style, ideal for those with no formal background in philosophy. Focuses on commonly pondered issues, such as: Is life sacred? Is it bad to die? Is there life after death? Does life have meaning? And which life is best? (...) Encourages readers to think about and respond to the human condition. Features case studies, thought-experiments, and references to literature, film, music, religion and myth. (shrink)

ABSTRACTIn this paper, I examine the arguments against physician assisted suicide . Many of these arguments are consequentialist. Consequentialist arguments rely on empirical claims about the future and thus their strength depends on how likely it is that the predictions will be realized. I discuss these predictions against the backdrop of Oregon's Death with Dignity Act and the practice of PAS in the Netherlands. I then turn to a specific consequentialist argument against PAS – Susan M. Wolf's feminist critique of (...) the practice. Finally, I examine the two most prominent deontological arguments against PAS. Ultimately, I conclude that no anti‐PAS argument has merit. Although I do not provide positive arguments for PAS, if none of the arguments against it are strong, we have no reason not to legalize it. (shrink)

What is the meaning of life? It is a question that has intrigued the great philosophers--and has been hilariously lampooned by Monty Python. Indeed, the whole idea strikes many of us as vaguely pompous, a little absurd. Is there one profound and mysterious meaning to life, a single ultimate purpose behind human existence? In What's It All About?, Julian Baggini says no, there is no single meaning. Instead, Baggini argues meaning can be found in a variety of ways, in this (...) life. He succinctly breaks down six answers people commonly suggest when considering what life is all about--helping others, serving humanity, being happy, becoming successful, enjoying each day as if it were your last, and "freeing your mind." By reducing the vague, mysterious question of meaning to a series of more specific (if thoroughly unmysterious) questions about what gives life purpose and value, he shows that the quest for meaning can be personal, empowering, and uplifting. If the meaning of life is not a mystery, if leading meaningful lives is within the power of us all, then we can look around us and see the many ways in which life can have purpose. We can see the value of happiness while accepting it is not everything. We can see the value of success, without interpreting that too narrowly. We can see the value of seizing the day as well as helping others lead meaningful lives. We can recognize the value of love, as perhaps the most powerful motivator of all. Illustrating his argument with the thoughts of many of the great philosophers and examples drawn from everyday life, Baggini convincingly shows that the search for meaning is personal and within the power of each of us to find. (shrink)

One principal challenge to the rationalist thesis that the demands of morality are requirements of rationality has been that posed by the "rational egoist." In attempting to answer's the egoist's challenge, some rationalists have supposed that an adequate reply must take the form of a deductive argument that "converts" the egoist by showing that her position is contradictory, arbitrary, or violates some precept that defines practical rationality as such. Here I argue (a) that such rationalist replies will fail to persuade (...) the egoist to adopt a recognizably moral way of life; (b) that this failure can be traced to epistemic assumptions that underlie typical rationalist replies; (c) that egoist conversion can better be understood by rejecting these assumptions and seeing egoist conversion as akin to a paradigm shift in the sciences; and (d) that conceptualizing egoist conversion as a paradigm shift accords with empirical psychological evidence regarding the acquisition and modification of individuals' moral attitudes and beliefs. (shrink)

This paper examines accounts of the moral wrongness of killing persons in addition to determining what conclusions, if any, can be drawn from the morality of killing persons about the equality of persons, and vice versa. I will argue that a plausible way of thinking about the moral wrongness of killing implies that the permissibility of killing innocent, nonthreatening persons depends on a person’s age. I address objections to this conclusion and discuss some potential implications of the view.

The ethical problems surrounding voluntary assisted suicide remain formidable, and are unlikely to be resolved in pluralist societies. An examination of historical attitudes to suicide suggests that modernity has inherited a formidable complex of religious and moral attitudes to suicide, whether assisted or not. Advocates usually invoke the ending of intolerable suffering as one justification for euthanasia of this kind. This does not provide an adequate justification by itself, because there are (at least theoretically) methods which would relieve suffering without (...) causing the physical death of the suffering person. Carried to extremes, these methods would finish the life worth living, but leave a being which was technically alive. Such acts, however, would provide no moral escape, since they would create beings without meaning. Arguments seeking to justify ending the lives of others need some grounding in concepts of the meaning of a life. The euthanasia discourse therefore needs to take at least some account of the meaning we construct for our lives and the lives of others. (shrink)

Although suicide has traditionally carried a negative sanction in Western societies, this is now being challenged, and while there remains substantial public concern surrounding youth and elder suicide, there is a paradoxical push to relax the prohibition under certain circumstances. Central to the arguments behind this are the principles of respect for autonomy and the importance of rationality. It is argued here that the concepts of rationality and autonomy, while valuable, are not strong enough to substantiate a categorical "right to (...) suicide" and that the concepts of "understandability" and "respect" are more useful and able to provide the foundation for responding to a person expressing a wish to die. Roman suicide, sometimes held as an example of "rational suicide", illustrates the effects of culture, tradition and values on the attitudes to, and the practice of, suicide. (shrink)

Every one of us will die, and the processes we go through will be our own - unique to our own experiences and life stories. End-of-Life Care and Pragmatic Decision Making provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death. D. Micah Hester takes seriously the complexities of experiences and argues that when making end-of-life decisions, healthcare providers ought to pay close attention to the narratives of patients and the communities they inhabit so that (...) their dying processes embody their life stories. He discusses three types of end-of-life patient populations - adults with decision-making capacity, adults without capacity, and children - to show the implications of pragmatic empiricism and the scope of decision making at the end of life for different types of patients. (shrink)

The difficulty in discovering a difference between killing and letting die has led many philosophers to deny the distinction. This paper seeks to develop an argument defending the distinction between killing and letting die. In relation to Rachels’ cases, the argument is that (a) even accepting that Smith and Jones may select equally heinous options from the choices they have available to them, (b) the fact that the choices available to them are different is morally relevant, and (c) this difference (...) in available choices can be used to distinguish between the agents in certain circumstances. It is the principle of justice, as espoused by Aristotle, which requires that equal things are treated equally and that unequal things are treated unequally that creates a presumption that Smith and Jones should be treated differently. The magnitude of this difference can be amplified by other premises, making the distinction morally relevant in practical reality. (shrink)

The essential outlines of the debate over voluntary euthanasia have not changed very much since Glanville Williams and Yale Kamisar debated the issues almost fifty years ago. On the one hand, there is an appeal to considerations of autonomy and the relief of suffering: individuals should be able to choose the timing and mode of their dying and they should not have to suffer from pain and other modes of indignity such as incontinence, paralysis, muscular wastage, and mental deterioration. So (...) far these would only generate a right or permission to take one's own life, but when we consider the problems in the context of end-of-life medical care and the uncontroversial duty of physicians to relieve the suffering of their patients we get a claim to assistance in dying. (shrink)

A central problem in moral theory is how it is to be defended against those who think that there is no harm in being immoral, and that immorality can be in one's self-interest, assuming the perpetrator is not caught and punished. The argument presented here defends the idea that being immoral prevents one from having self-respect. If it makes sense to think that one cannot be happy without self-respect, then the conclusion follows that one cannot be both immoral and happy. (...) Immorality is harmful because its self-disrespecting nature keeps immoralists from being happy. This is the harm of immorality. (shrink)