Welfarism is the view that morality is centrally concerned with the welfare or well-being of individuals. The division between welfarist and non-welfarist approaches underlies many important disagreements in ethics, but welfarism is neither consistently defined nor well understood. I survey the philosophical work on welfarism, and I offer a suggestion about how the view can be characterized and how it can be embedded in various kinds of moral theory. I also identify welfarism's major rivals, and its major attractions and weaknesses.

In this paper I analyse who should be able to control the use of human embryonic stem cell lines. I distinguish between different kinds of control and analyse a set of arguments that purport to show that the donors of gametes and embryos should not be able to control the use of stem cell lines derived from their embryos. I show these arguments to be either deficient or of so general a scope that they apply not only to donors but (...) also to those who derived the stem cell lines. Since we normally think that stem cell derivers have the right to control the use of the cell lines they derived, we have no justification for denying donors similar rights of control. In the final section I briefly discuss why informed consent is not an appropriate vehicle for transferring or alienating control rights. (shrink)

The ethical implications of human clones have been much alluded to, but have seldom been examined with any rigour. This paper examines the possible uses and abuses of human cloning and draws out the principal ethical dimensions, both of what might be done and its meaning. The paper examines some of the major public and official responses to cloning by authorities such as President Clinton, the World Health Organisation, the European parliament, UNESCO, and others and reveals their inadequacies as foundations (...) for a coherent public policy on human cloning. The paper ends by defending a conception of reproductive rights of "procreative autonomy" which shows human cloning to be not inconsistent with human rights and dignity. (shrink)

Should advance directives (ADs) such as living wills be employed to direct the care of the severely demented? In considering this question, I focus primarily on the claims of Rebecca Dresser who objects in principle to the use of ADs in this context. Dresser has persuasively argued that ADs are both theoretically incoherent and ethically dangerous. She proceeds to advocate a Best Interest Standard as the best way for deciding when and how the demented ought to be treated. I put (...) forth a compromise position: both ADs and the Best Interest Standard have roles to play in guiding the care of the severely demented. (shrink)

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (shrink)

Patients with disorders of consciousness after severe brain injury need surrogate decision makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decisionmaking generally instruct decision makers to first appeal to a patient’s written advance directive, followed by making a substituted judgment of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. Substituted judgment is preferable because it is taken to preserve patient autonomy, by (...) using a patient’s past wishes and values to reconstruct what they would have chosen for themselves. In this paper, the author argues that for a certain population of patients, the standard interpretation of substituted judgment cannot ensure the preservation of patient autonomy. Patients with “covert awareness” may continue to have values and an authentic sense of self, which may differ from their past values and wishes. Accordingly, surrogate decision makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values. (shrink)

“Intervention” is not synonymous with “care.” For an intervention to constitute care—which patients should have a right to access—it must be technically feasible and licit. Now these criteria do not prove sufficient; numerous archaic interventions remain feasible and legally permissible, yet are now bywords for spurious care. Therefore, we propound another necessary condition for an intervention to become care: the physician must rationally judge the intervention to be conducive to the patient’s good. Consequently, the right of access-to-care relies on physicians (...) being free to practice medicine in accord with their consciences, conscience being the rational faculty with which they judge the reasonableness of even mundane medical decisions. Since physicians operate as part of a community, it is further necessary to consider when central bodies may reasonably compel physicians to engage in interventions that the physician believes are not consistent with the patient’s good and/or are not congruent with the purposes of medicine. (shrink)

Przemysł farmaceutyczny oferuje coraz to nowe leki, które mają przedłużać życie osób cierpiących na nieuleczalne choroby. Innowacyjne terapie są często w jakimś stopniu skuteczniejsze, ale też (w co najmniej takim samym stopniu) droższe. Upoważnieni decydenci reprezentujący społeczeństwo muszą zatem rozstrzygać, które z nich będą finansowane ze środków publicznych. Jednym z głównych kryteriów, na których podstawie podejmuje się takie decyzje, jest stosunek dodatkowych kosztów, związanych z nową terapią, do czerpanych z niej dodatkowych korzyści. Dodatkowe korzyści, wynikające z nowych leków dla osób (...) śmiertelnie chorych, wydają się jednak często niezbyt wielkie w porównaniu do ich zawrotnych dodatkowych kosztów. Rodzi się zatem wątpliwość, czy refundacja tych leków, do której opinia społeczna skądinąd na ogół się skłania, daje się pogodzić z równie powszechnie akceptowaną zasadą ekonomicznej efektywności. Pewną próbą uzgodnienia tych postaw byłoby przyjęcie, że z pozoru niewielkie korzyści, przysparzane osobom zbliżającym się do śmierci — jak marginalne zwiększenie długości ich życia lub nieznaczne podniesienie jego jakości — w rzeczywistości mają większą wartość, ponieważ życie tych osób trzeba cenić wyżej. W przedstawianym artykule zastanawiam się nad tym, czy ta koncepcja jest do utrzymania — czy wartość życia wzrasta wobec bliskiej śmierci. (shrink)

In her important and well-known discussion “On the Moral and Legal Status of Abortion,” Mary Anne Warren regrets that “it is not possible to produce a satisfactory defense of a woman’s right to obtain an abortion without showing that the fetus is not a human being, in the morally relevant sense.” Unlike some more cautious philosophers, Warren thinks that we can definitively demonstrate that the fetus is not a person. In this paper, Warren’s argument is critically examined with a focus (...) especially on the question of the foundation and the boundaries of the moral community. The fundamental thesis of the paper is that Warren’s approach is flawed for at least four reasons: (1) that being a person is not as obviously central to having full moral rights as Warren assumes, (2) that her exclusivism regarding moral status has dubious moral consequences independent of the abortion issue, (3) that it is not clear that a fetus is not a person, even on Warren’s own criteria, and (4) her criteria for personhood are themselves suspect. (shrink)

This essay offers a way to avoid a clash between reasons of love and reasons of ethics that stems from a difference in the conception of the moral value of people. In moralities of lovers, the loved ones are due to be accorded a value superior to that of other people, whereas in ethics there is an inescapable presumption that people have a value that is equal among them. The usual way to avoid this clash has been either to make (...) room in the ethical arsenal for reasons relating to particular agents, agent-relative reasons, or to acknowledge that love-grounded reasons legitimately compete with ethical reasons and that we need a method of negotiating them. Both escapes have serious problems. The essay proposes a third way. The first step is to reshape the notion of ’love,’ in a direction where important characteristics of our common understanding are kept, notably the loved ones’ uniqueness and incomparability, while the characteristic that is problematic in the present context would be eliminated, namely the you-and-me character of love that gives rise to reasons that are wholly personal and partial. The second step is to show how such a reformed notion of love coheres with the assumption of equal value. And the third step is, through this connection, to change our understanding of love as reason-giving, from generating reason directly to generating reason indirectly. This involves a shift of focus from reason to meta-reason, viz. that which makes our system of, or competence for, normative reasons reasonable. The advantage of the proposed solution would not only be that clash between reasons of love and reasons of ethics is avoided, but also that ethical reasons are seen as underpinned by love, which moreover offers the best ultimate explanation of them. (shrink)

Recent psychological research concerning determinantsof and barriers to organ donation is reviewed with theintention of ascertaining acceptable and potentiallyeffective ways of improving organ retrieval. On thebasis of this review, five recommendations are made.(1) Individuals' donation wishes, where explicit,should be decisive. (2) Next of kin should witnessdonor decisions. (3) Mandated choice should replacevoluntary `opting-in'. (4) Initial donation choicesshould be repeatedly re-evaluated. (5) Those involvedin organ procurement should distance themselves frommodel of bodies as machines or gardens and embracemodels where bodies are viewed (...) as sacred extensions ofself. In combination, these recommendations are arguedto be preferable in several ways to opt-out/presumedconsent procurement options. (shrink)

Ronald Dworkin claims in Life's Dominion that our tradition of religious toleration shields decisions to abort a pregnancy and to end one's life with the assistance of others because they pivot on judgements about the value of human life that are essentially spiritual. He further maintains that the state may regulate these decisions to ensure that they honour appropriately life's sacred or intrinsic value. This article disputes the first of Dworkin's claims. Tolerating other people's religious practices does not entail acquiescing (...) in conduct that is not religiously motivated but springs instead from normal moral judgements. This article also questions whether governments justifiably may protect entities or processes simply because some citizens deem them intrinsically valuable. If, despite these doubts, one concludes that the state may assume this protective role, I argue that it probably can enact tighter constraints on abortion and assisted suicide than Dworkin thinks permissible. (shrink)

In this article I argue that the fundamental axiological claim of the New Natural Law Theory, according to which human life has an intrinsically valuable, cannot be defended within the framework assumed by the New Natural Law Theory itself, and further, that such a claim turns out to be false relative to a wider eudaimonistic framework that the Natural Law theorist is committed to accept. I do this this by adopting a dialectical standpoint which excludes any assumptions that could be (...) denied by the New Natural Law theorist, except for the axiological claim, and show that the New Natural Law theorist cannot argue for the axiological claim's plausibility, and moreover, that in such a setting the New Natural Law theorist is compelled to replace the axiological claim by the claim that human life is instrumentally valuable. La afirmación axiológica fundamental de la Nueva Ley Natural según la cual la vida humana tiene un valor intrínseco, no puede ser defendida dentro del marco teórico asumido por dicha teoría, y resulta ser falsa en un marco eudemonista más amplio, que debe ser aceptado por el teórico de la ley natural. Se asume una posición dialéctica que excluye cualquier suposición que pueda ser negada por el teórico de la NLN, con excepción de la afirmación axiológica, y se demuestra que él no puede mostrar la plausibilidad de la afirmación axiológica; más aún, que se ve forzado a reemplazar la afirmación axiológica por la aceptación de que la vida humana tiene un valor instrumental. (shrink)

This paper attempts to explain the conceptual connections between happiness and well-being. It first distinguishes episodic happiness from happiness in the personal attribute sense. It then evaluates two recent proposals about the connection between happiness and well-being: (1) the idea that episodic happiness and well-being both have the same fundamental determinants, so that a person is well-off to a particular degree in virtue of the fact that they are happy to that degree, and (2) the idea that happiness in the (...) personal attribute sense can serve as a ‘‘proxy’’ for well-being, i.e., that a person’s degree of deep or robust happiness approximates their degree of well-being. It is argued that happiness in both these senses is conceptually, metaphysically, and empirically distinct from well- being. A new analysis of welfare, well-being as agential flourishing, can explain welfare’s real connection to happiness in both the episodic and personal attribute senses. It predicts that such happiness is only directly beneficial when it is valued, when it is a form of valuing, or when it underwrites (i.e., serves as the causal basis for) the disposition to realize one’s values. It is therefore a necessary—but not sufficient—condition for especially high levels of well-being. This analysis of welfare integrates many insights from the eudaimonic tradition of welfare and happiness research in psychology, and also addresses common criticisms of these eudaimonic models. (shrink)

Straipsnio tikslas – įrodyti Dworkino knygoje „Teisingumas ežiukams“ bandytos įgyvendinti filosofinės revoliucijos nesėkmę. Ši revoliucija nepasisekė dėl dviejų priežasčių. Pirma, Dworkino mokslo poveikio etikos teorijai kritika yra suaugusi su pirmenybės mokslui teikimu. Kritikuodamas etikos pajungimą mokslinio mąstymo epistemologijai, šis autorius nori ją sieti su moksline pasaulėžiūra. Antra, Dworkinas pernelyg susiaurina metaetikos kritiką, apsiribodamas polemika su mokslo epistemologijos jai primestu „išoriniu skepticizmu“. Metaetika yra daug didesnė filosofinė klaida, negu atrodo Dworkinui. Mokslas veikia ne tik teorijos, bet ir „įprasto požiūrio“ lygmeniu.

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional (...) capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the autonomy paradox, to which (...) the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)

This thesis provides an exploration of how Christian faith actors in the United Kingdom contributed to four high-profile public debates between 2010 and 2019. The case studies explored were Christian engagement in the debate around: High-Cost Short-Term Credit; Hunger and Welfare Reform; The Syrian Refugee Crisis; and Brexit. The exploration of these case studies represents an original contribution because of their novelty in the literature, as well as representing an area of a high level of Christian elite consensus where the (...) elites involved behave and conceive of their position differently relative to other issues more deeply explored in the literature such as abortion. Through a series of elite interviews and discourse analysis of speeches, newspaper articles and other media, the analysis examines how Christian actors used religious values as part of political deliberation, as well as how these individuals saw the place of their faith within British political life. This reflection on values and strategy amongst these elite actors also represents a valuable original contribution to the literature. The research project finds that Christian elites have a distinctive contribution to British politics. The experience of providing practical charitable responses to social need informs a Christian elite response which brings in information, expertise and a lived experience to political debate. Christian elite political engagement is shown to be strategic and closely tied to the needs highlighted through social action. Christian elites are motivated to engage in politics by their faith, but for the most part frame their contributions in politics in secular terms, understanding that overt mentions of Christian theological terms often fail to communicate. However, many Christian elites also felt that the values of British politics are underpinned by a Christian history, and that there is not necessarily a clear contrast between Christian and secular values. (shrink)

[From Euthanasia to Infanticide] The paper revisits the recent controversy over Dr. Mitlőhner’s defense of infanticide, published in this journal. In section 1, I point out the weaknesses of Mitlőhner’s paper. In sections 2 and 3 I turn to the most sophisticated defense of infanticide on offer today, that of Peter Singer’s. Section 2 sums up Singer’s description of the medical practice as already having abandoned the traditional ethic of equal value of all human lives, which motivates ethical revisionism. However, (...) an explicit justification of a revision is necessary. This is the job of Singer’s Replacement Argument, examined in section 3. I argue that this justification of infanticide in completely impersonal terms fails. In section 4, I reject it in favor of Ronald Dworkin’s distinction between experiential interests, possessed by infants, and critical interests that develop later. Hence, neonatal euthanasia can sometimes be justified in terms of a newborn‘s own interests (presumably, to relieve its suffering), not in impersonal terms. The only exception is those infants that lack any capacity for cognitive activity whatsoever, and who thus lack even experiential interests. It is an open question whether their “life” differs from death, and whether by killing them we perform infanticide. (shrink)

This thesis explores the concept of "Sanctity of Life" from the perspective of what "life," in particular human life, means today. With the rapid advances in science and modern medical practice, the concept of life has undergone many changes, shaking the foundations of what before made us view life as sacred. Modern thought has brought new forms of understanding to the concept of life.

Glavna je svrha ovoga članka analizati Argument kontinuiteta, jedan od najutjecajnijih argumenata na kojemu su utemeljeni moralna osuda znanstvenih i medicinskih praksi poput istraživanja i eksperimenata s embrijem, potpomognuta reprodukcije, pobačaja, terapeutskog kloniranja, itd. Prvo se daje vrlo kratko objašnjenje pristupa koji pripisuje status markirajućeg događaja fertilizaciji, identificirajući Argument kontinuiteta među drugim argumentacijama. Nadalje, pokušava se razdvojiti tri moguće interpretacije pojma kontinuiteta pretpostavljenog u Argumentu kontinuiteta, te izdvojiti najuvjerljiviju filozofsku i znanstvenu interpretaciju postfertilizacijskog kontinuiteta. Naposljetku, tvrdim da iz filozofski i (...) znanstveno najprihvatljivije interpretacije ne slijedi: 1) da je fertilizacija nužna odrednica moralnog statusa; 2) da je fertilizacija najrazboritija odrednica moralnog statusa. Ukratko, ovaj članak ima dva cilja: I) pokazati da upravo taj argument ne povlači za sobom stajalište da su gore spomenute prakse moralno nedopustive; II) sugerirati da bi neke pragmatičke strategije koje se bave soritom-prouzročenim paradoksima mogle osigurati filozofijski i znanstveno primjeren okvir za alternativni pristup. (shrink)