It is my view that one essential difference between persons and other creatures is to be found in the structure of a person's will. Besides wanting and choosing and being moved to do this or that, men may also want to have certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are. Many animals appear to have the capacity for what I shall call "first-order desires" or "desires of the (...) first order," which are simply desires to do or not to do one thing or another. No animal other than man, however, appears to have the capacity for reflective self-evaluation that is manifested in the formation of second-order desires. (shrink)

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

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.

Moral philosophers agree that welfare matters. But they disagree about what it is, or how much it matters. In this vital new work, Wayne Sumner presents an original theory of welfare, investigating its nature and discussing its importance. He considers and rejects all notable theories of welfare, both objective and subjective, including hedonism and theories founded on desire or preference. His own theory connects welfare closely with happiness or life satisfaction. Reacting against the value pluralism that currently dominates moral philosophy, (...) he advances welfare as the only basic ethical value. He concludes by discussing the implications of this thesis for ethical and political theory. Written in clear, non-technical language, and including a definitive survey of other work in this area, Sumner's book is essential reading for moral philosophers, political theorists, and welfare economists. (shrink)

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

At the heart of ethics reside the concepts of good and bad; they are at work when we assess whether a person is virtuous or vicious, an act right or wrong, a decision defensible or indefensible, a goal desirable or undesirable. But there are many varieties of goodness and badness. At their core lie intrinsic goodness and badness, the sort of value that something has for its own sake. It is in virtue of intrinsic value that other types of value (...) may be understood, and hence that we can begin to come to terms with questions of virtue and vice, right and wrong, and so on. This book investigates the nature of intrinsic value: just what it is for something to be valuable for its own sake, just what sort of thing can have such value, just how such a value is to be computed. In the final chapter, the fruits of this investigation are applied to a discussion of pleasure, pain, and displeasure and also of moral virtue and vice, in order to determine just what value lies within these phenomena. (shrink)

This is the earliest critical discussion in the context of modern/contemporary philosophy in the analytical tradition arguing that somebody with a reasonably stable character and the company of the right people would be able to enjoy eternity.

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a (...) wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

This paper discusses the role of consent in decision making generally and its role in end of life decisions in particular. It outlines a conception of autonomy which explains and justifies the role of consent in decision making and criticises some misapplications of the idea of consent, particular the role of fictitious or “proxy” consents.Where the inevitable outcome of a decision must be that a human individual will die and where that individual is a person who can consent, then that (...) decision is ethical if and only if the individual consents. In very rare and extreme cases such a decision will be ethical in the absence of consent where it would be massively cruel not to end life in order to prevent suffering which is in no other way preventable.Where, however, the human individual is not a person, as is the case with abortion, the death of infants like Mary , or in the very rare and extreme cases of those who have ceased to be persons like Tony Bland, such decisions are governed by the ethics of ending the lives of non-persons. (shrink)

Kant's concept of autonomy and the Kantian notion of autonomy are often conflated in bioethics. However, the contemporary Kantian notion has very little at all to do with Kant's original. In order to further bioethics discourse on autonomy, I critically distinguish the contemporary Kantian notion from Kant's original concept of moral autonomy. I then evaluate the practical relevance of both concepts of autonomy for use in bioethics. I argue that it is not appropriate to appeal to either concept toward assessing (...) which patients we ought to respect as autonomous. Finally, I sketch criteria for what I take to be a more promising concept of autonomy for patients. (shrink)

I aim to show that (i) there are good ways to argue about what has intrinsic value; and (ii) good ethical arguments needn't make ethical assumptions. I support (i) and(ii) by rebutting direct attacks, by discussing nine plausible ways to argue about intrinsic value, and by arguing for pains intrinsic badness without making ethical assumptions. If (i) and (ii) are correct, then ethical theory has more resources than many philosophers have thought: empirical evidence, and evidence bearing on intrinsic value. With (...) more resources, we can hope to base all of our moral beliefs on evidence rather than on, say, emotion or mere intuition. (shrink)

In a contribution to The Journal of Medicine and Philosophy , Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only (...) in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know. (shrink)

Much of the literature devoted to the topics of agent autonomy and agent responsibility suggests strong conceptual overlaps between the two, although few explore these overlaps explicitly. Beliefs of this sort are commonplace, but they mistakenly conflate the global state of being autonomous with the local condition of acting autonomously or exhibiting autonomy in respect to some act or decision. Because the latter, local phenomenon of autonomy seems closely tied to the condition of being responsible for an act, we tend (...) to think of the former, global phenomenon as a condition of responsibility as well. But one can act autonomously, or manifest autonomy with respect to some occurrent state, without satisfying the conditions for autonomous agency. Autonomous agency and responsible agency are logically distinct in part due to the varient conceptions of rationality each calls for. Both agent responsibility and holding a person responsible imply a fairly ``thick'''' form of rationality, where rationality embodies a normative component and is a matter of satisfying criteria that are objective in the sense that they are independent of what a person happens to want or to value. But autonomous agency calls for a quite different, ``thin'''' conception of instrumental rationality. (shrink)

Despite being co-opted by economists and politicians for their own purposes, ‘welfare’ traditionally refers to well-being, and it is in this sense that L. W. Sumner understands the term. His book is a clear, careful, and well-crafted investigation into major theories of welfare, accompanied by a one-chapter defense of “welfarism,” the view that welfare is the only foundational value necessary for ethics. Sumner himself is attracted to utilitarianism, but he makes no commitment to it in this work, which will be (...) of interest to many moral philosophers. (shrink)

This best-selling anthology of readings with case studies provides insightful and comprehensive treatment of ethical issues in medicine. Appropriate for courses taught in philosophy departments as well as in schools of medicine and nursing, the collection covers provocative topics such as conflicts of interest in medicine, advance directives, physician-assisted suicide, and the rationing of health care. The text's effective pedagogical features include chapter introductions, argument sketches, explanations of medical terms, headnotes, and annotated bibliographies.

One of the core issues in medical ethics has been and still is autonomy, people's right to make their own self-regarding choices in situations where more than one option is available. Depending on the case, these choices may be influenced by personal life history, one's ethical and other values, and one's future expectancies. A professional soccer player may risk an operation, which for a less athletic individual would represent an unnecessary risk that might jeopardize her ability to even walk. Saying (...) no to painkillers may sound irrational to those who do not see anything ennobling in avoidable suffering, and preferring homeopathic medicine to more evidence-based medicine may lead others to seriously doubt the logic of one's thinking. But although these situations may be difficult,1 they seldom lead to an impasse. Even if serious value conflicts emerge in these patient–medical personnel encounters, they can be overcome by the fact that, in Western countries, honoring patients' autonomy has been widely accepted as part of medical professionalism. (shrink)