Despite its virtues, lay decision-making in medicine shares with professional decision-making a disturbing common feature, reflected both in formal policies prohibiting high-risk research and in informal policies favoring treatment decisions made when a crisis or change of status occurs, often late in a downhill course. By discouraging patient decision-making but requiring dedication to the patient's interests by those who make decisions on the patient's behalf, such practices tend to preclude altruistic choice on the part of the patient. This eclipse is (...) to be regretted not just because widescale altruism has the capacity to provide important social goods and correct injustices in distribution, but for intrinsic reasons as well. It is argued that preserving the possibility of altruism obliges patients – and future patients – to make decisions about dying and other medical matters in advance, thus avoiding that displacement of decision-making onto lay and professional second parties which results in altruism's eclipse. Keywords: altruism, medical decision-making, patient's interest, self-interest, autonomy, death and dying decisions, refusal of treatment, prolongation of life, allowing to die, high-risk research CiteULike Connotea Del.icio.us What's this? (shrink)

This is a defense of John Stuart Mill’s proof of the principle of utility in the fourth chapter of his Utilitarianism. The proof is notorious as a fallacious attempt by a prominent philosopher, who ought not to have made the elementary mistakes he is supposed to have made. This book shows that he did not. The aim is not to glorify utilitarianism, in a full sweep, as the best normative ethical theory, or even to vindicate, on a more specific level, (...) Mill’s universalistic ethical hedonism as the best form of utilitarianism. The book is concerned only with Mill’s utilitarianism, and primarily with his proof of the principle of utility. The purpose is to show that Mill proceeds intelligibly and systematically in pursuing a well-defined project in the fourth chapter of Utilitarianism, and that he successfully defends what he sets out to establish in his proof of the principle of utility. (shrink)