Mitochondrial replacement techniques are designed to allow couples to have children without passing on mitochondrial diseases. Recently, Giulia Cavaliere and César Palacios-González argued that prospective parents have the right to use MRTs to pursue genetic relatedness, such that some same-sex couples and/or polygamous triads could use the process to impart genetic relatedness between a child and more of its caregivers. Although MRTs carry medical risks, Cavaliere and Palacios-González contend that because MRTs are identity-affecting, they do not cause harm to an (...) existing human being, and our intuitions otherwise arise from the non-identity problem. Here, I review several attempts to address the non-identity problem, and propose a solution to the problem. Furthermore, I argue that regardless of one’s stance on whether MRTs are identity-affecting, the use of MRTs to pursue genetic relatedness alone falls outside the scope of the medical profession, as they involve substantive medical risk for no medical benefit. (shrink)

Bioethicists involved in end‐of‐life debates routinely distinguish between ‘killing’ and ‘letting die’. Meanwhile, previous work in cognitive science has revealed that when people characterize behaviour as either actively ‘doing’ or passively ‘allowing’, they do so not purely on descriptive grounds, but also as a function of the behaviour’s perceived morality. In the present report, we extend this line of research by examining how medical students and professionals (N = 184) and laypeople (N = 122) describe physicians’ behaviour in end‐of‐life scenarios. (...) We show that the distinction between ‘ending’ a patient’s life and ‘allowing’ it to end arises from morally motivated causal selection. That is, when a patient wishes to die, her illness is treated as the cause of death and the doctor is seen as merely allowing her life to end. In contrast, when a patient does not wish to die, the doctor’s behaviour is treated as the cause of death and, consequently, the doctor is described as ending the patient’s life. This effect emerged regardless of whether the doctor’s behaviour was omissive (as in withholding treatment) or commissive (as in applying a lethal injection). In other words, patient consent shapes causal selection in end‐of‐life situations, and in turn determines whether physicians are seen as ‘killing’ patients, or merely as ‘enabling’ their death. (shrink)

Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the definition and modeling (...) of complex disease states. (shrink)

This paper demonstrates that the skeptical theist’s response to the problem of evil deprives the analytic theologian of theoretical resources necessary to avoid accepting as veridical merely apparent divine commands that endorse cruelty. In particular, I argue that the same skeptical considerations that lead analytic theologians to endorse skeptical theism also lead to what I call “divine command skepticism”—an inability to make certain kinds of judgements about what a good God would or would not command. The danger of divine command (...) skepticism is not that it generates new reasons to think that God has commanded horrors, but, rather, that it undercuts the defeaters we might otherwise have for thinking that God has commanded those horrors. It does so both by rendering illicit certain theological and hermeneutical methodologies employed within liberatory frameworks and by depriving the theologian of some of the more “traditional” mechanisms for resolving such apparent conflicts. (shrink)

When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it becomes (...) part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

Many assume that the best, and perhaps only, way to address the so-called Problem of Evil is to claim that God does not do evil, but that God merely allows evil. This assumption depends on two claims: the doing-allowing distinction exists and the doing-allowing distinction is morally significant. In this paper I try to undermine both of these claims. Against I argue that some of the most influential analyses of the doing-allowing distinction face grave difficulties and that these difficulties are (...) only exacerbated when applied to God. Against I argue that broadly Kantian considerations give a better explanation of the moral differences in paradigm cases than the doing-allowing distinction and, when applied to God, effectively dissolve the moral significance of the doing-allowing distinction. The upshot of this is that those who claim God does evil are no worse off than those who claim God allows evil regarding the PoE. (shrink)

The distinction between harm that is intended as a means or end, and harm that is merely a foreseen side-effect of one’s action, is widely cited as a significant factor in a variety of ethical contexts. Many use it, for example, to distinguish terrorist acts from certain acts of war that may have similar results as side-effects. Yet Bennett and others have argued that its application is so arbitrary that if it can be used to cast certain harmful actions in (...) a more favorable light, then it can equally be manipulated to do the same for any kind of harmful action. In response, some have tried to block such extensions of the intend/foresee distinction by rejecting its application in cases where the relation between the plainly intended means and the harm is “too close”. This move, however, has been attacked as vague and obscure, and Bennett has argued that all the plausible candidates for explicating the idea of excessive closeness ultimately fail. In this paper, I develop and defend an account of excessive closeness with the aim of rescuing the intend/foresee distinction from such charges of arbitrariness. The account is based on the distinction between merely causal and constitutive relations among states of affairs, and I show both how it escapes Bennett’s objections to other accounts and how it applies to a variety of cases. Finally, I also examine Quinn’s alternative move of shifting the focus of the intend/foresee distinction in an attempt to sidestep the issue of closeness, and argue that it is not ultimately successful. In fact, Quinn’s view has shortcomings that can be resolved only by returning to an appeal to some notion of closeness, underscoring the need for the sort of account I offer. (shrink)

The Doctrine of Double Effect (DDE) is an influential non-consequentialist principle positing a role for intention in affecting the moral permissibility of some actions. In particular, the DDE focuses on the intend/foresee distinction, the core claim being that it is sometimes permissible to bring about as a foreseen but unintended side-effect of one’s action some harm it would have been impermissible to aim at as a means or as an end, all else being equal. This article explores the meaning and (...) application of the DDE along with current debates over the nature of the intend/foresee distinction and its moral significance. How is the line between intended effects and merely foreseen but unintended side-effects to be drawn, and how are problem cases best handled? What is an appropriate methodology for debating the tenability of the DDE? How might the DDE interact with other non-consequentialist principles, and how might it be modified to capture other related factors (resulting perhaps in a Doctrine of Triple Effect) or to avoid certain problem cases? Does the DDE make permissibility turn on the actual intentions of particular agents, as critics such as Thomson and Scanlon assume, or is the role of intention more abstract? (shrink)

With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)

After a review of terminology, I identify—in addition to Margaret Battin’s list of five primary arguments for and against aid-in-dying—the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan’s generalized empirical method. Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude that aid-in-dying must be justified on (...) its own merits and not on the basis of these well-established palliative care practices; and that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this part of their operative value structure. (shrink)

It can sound absurd to report that you have forgotten a moral truth. Described cases in which people who have lost moral beliefs exhibit the behavioural and phenomenological symptoms of forgetting can seem similarly absurd. I examine these phenomena, and evaluate a range of hypotheses that might be offered to explain them. These include the following proposals: that it is hard to forget moral truths because they are believed on the basis of intuition; that moral forgetting seems puzzling for the (...) same reason that forgetting what you approve or disapprove of seems puzzling; and that moral truths matter too much to us to be easily forgotten. I conclude that the best explanation for the phenomena is a non-cognitivist one: moral forgetting seems puzzling because moral judgements are attitudes of a sort that cannot be lost through forgetting. (shrink)

Helen Frowe (2006/2010) contends that there is a substantial moral difference between killing and letting die, arguing that in Michael Tooley's infamous machine case it is morally wrong to flip a coin to determine who lives or dies. Here I argue that Frowe fails to show that killing and letting die are morally inequivalent. However, I believe that she has succeeded in showing that it is wrong to press the button in Tooley's case, where pressing the button will change who (...) lives and dies. I argue that because killing and letting die are morally equivalent we have no reason to press the button in the machine case. Pressing the button in this case is morally wrong because there is no reason to do it; to press the button is to treat matters of life and death irreverently. (shrink)