In the light of increasing public mistrust, there is an urgent need to clarify the moral status of the medical profession and of the relationship of the clinician to his/her patients. In addressing this question, I first establish the coherence, within moral philosophy generally, of the concept of supererogation . I adopt the notion of an act of “unqualified” supererogation as one that is non-derivatively good, praiseworthy, and freely undertaken for others' benefit at the risk of some cost to the (...) agent. I then argue that committing oneself to the profession of clinical medicine is an act of this kind. This is the case, not because the aim of medicine is to help patients, but because of the open ended commitment of time and the vulnerability to the consequences of failure that the clinician must accept. (shrink)

This article examines Leon Kass's contention that a choice for physician-assisted suicide is “undignified.” Although Kass is Jewish rather than Christian, he argues for positions that most Christians share, and he argues for these positions without presupposing the truth of specific religious claims. I argue that although Kass has some important intuitions, he too readily assumes that these intuitions will be shared by his audience, and that this assumption diminishes the force of his argument. An examination of the limitations of (...) Kass's argument is helpful insofar as it illustrates the real challenge faced by religious believers who wish to defend their beliefs in the “public forum.” For it illustrates that what needs to be made “accessible” is the Judeo-Christian understanding of man and his place in the world. While I do not wish to claim that this task is impossible, I do think that it is far more difficult than most realize. Like all important tasks, however, unless we wrestle with the difficulties it raises, our arguments will strike many as unconvincing. (shrink)

The thesis explores and suggests a solution to a problem that I identify in John McDowell’s and Lynne Rudder Baker’s approaches to mental and intention-dependent (ID) causation in the physical world. I begin (chapter 1) with a brief discussion of McDowell’s non-reductive and anti-scientistic account of mind and world, which I believe offers, through its vision of the unbounded conceptual and the world as within the space of reasons, to liberate and renew philosophy. However, I find an inconsistency in McDowell’s (...) criticism of Davidson’s anomalous monism (chapter 2), stemming from a tension between McDowell’s naïve common sense view of mental causation and an understanding of ordinary physical causation which I think McDowell ought to embrace, which portrays it as both objective, in the sense of being recognition- independent, and as belonging within the space of reasons. The question of the relation between these two concepts of causation is an aspect of the more general question of the relation between the space of reasons and the realm of law. In chapter 3 I begin examining the possibility that Baker’s account of material and property constitution could form the basis of a bridge between the two spaces, and find it generally promising. However, I find that her defence of her version of non-reductive monism against Kim’s causal arguments also runs into problems, which I attribute to the fact that she holds a view of causation as secondary to causal explanation. 2 3 In chapter 4 I develop an account of what I call manifest physical causation – of objective causal relations in the world of Sellars’s manifest image. Based upon McDowell’s transcendental empiricism, which takes the existence of the ordinary perceived world as a condition of the possibility of our possession of conceptual capacities, I contend that it is this picture of reality, rather than that of fundamental physics, that should be the starting point of our theorizing. Causation in the manifest image, I argue, covers the behaviour of the familiar physical world as well as that of its well-understood extensions into the special sciences and engineering. Manifest physical causation, on my account, is productive, acts through mechanisms which are almost entirely mechanical, electromagnetic, and/ or chemical, and is causally closed. In my view, normative, semantic, contentful property-instances are not part of the manifest physical causal nexus. In my final chapter I suggest a modification of Baker’s constitution account, which I call Constituted Causation, whereby higher-level – mental and other ID – causal relations are constituted, in favourable circumstances, by lower-level ones. ID causal relations belong in their own causal nexus but are connected to the manifest physical world through constitution, a relation of unity without identity. Causation and constitution are, respectively, intra- and inter-level relations, and they are non-overlapping. The constituted network of rational and normative relations bears, I believe, striking parallels with McDowell’s view of reality. According to Baker’s view of constitution, the essential properties of constituted entities subsume those of their constituters; extending this to my account enables us to say that the real cause and explanation of someone’s action is that they consciously performed it 4 rather than that certain manifest causal processes occurred at the lower level. (shrink)