BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic (...) fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities.DiscussionTwo questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die.ConclusionsDeprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease. (shrink)

In this paper, I urge feminists to re-center fetal moral status in their theorizing about abortion. I argue that fundamental feminist normative commitments are at odds with efforts to de-emphasize fetal moral status: The feminist commitment to ensuring care for dependents supports surprising conclusions with regard to the ethics of abortion, and the feminist commitment to politicizing the personal has surprising conclusions regarding the politics of abortion. But these feminist insights also support the conclusion that, conditional on fetal moral status, (...) care for unwanted fetuses would be a social obligation that only derivatively falls to women who are unwillingly pregnant. (shrink)

There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...) that states that the right action is the action that is expected to produce the greatest good. It offers clear operationalizable principles. In this paper we provide a summary of how utilitarianism could inform two challenging questions that have been important in the early phase of the pandemic: (a) Triage: which patients should receive access to a ventilator if there is overwhelming demand outstripping supply? (b) Lockdown: how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID‐19 with causing deaths and reductions in well‐being from other causes? Our aim is not to argue that utilitarianism is the only relevant ethical theory, or in favour of a purely utilitarian approach. However, clearly considering which options will do the most good overall will help societies identify and consider the necessary cost of other values. Societies may choose either to embrace or not to embrace the utilitarian course, but with a clear understanding of the values involved and the price they are willing to pay. (shrink)

Does the morality of abortion depend on the moral status of the human fetus? Must the law of abortion presume an answer to the question of when personhood begins? Can a law which permits late abortion but not infanticide be morally justified? These are just some of the questions this book sets out to address. With an extended analysis of the moral and legal status of abortion, Kate Greasley offers an alternative account to the reputable arguments of Ronald Dworkin and (...) Judith Jarvis Thomson and instead brings the philosophical notion of 'personhood' to the foreground of this debate. Structured in three parts, the book will consider the relevance of prenatal personhood for the moral and legal evaluation of abortion; trace the key features of the conventional debate about when personhood begins and explore the most prominent issues in abortion ethics literature: the human equality problem and the difference between abortion and infanticide; and examine abortion law and regulation as well as the differing attitudes to selective abortion. The book concludes with a snapshot into the current controversy surrounding the scope of the right to conscientiously object to participation in abortion provision. (shrink)

Spontaneous abortion is rarely addressed in moral evaluations of abortion. Indeed, 'abortion' is virtually always taken to mean only induced abortion. After a brief review of medical aspects of spontaneous abortion, I attempt to articulate the moral implications of spontaneous abortion for the two poles of the abortion debate, the strong pro-abortion and the strong anti-abortion positions. I claim that spontaneous abortion has no moral relevance for strict pro-abortion positions but that the high incidence of spontaneous abortion is not (as (...) some claim) eo ipso any sort of justification for voluntarily induced abortion. Secondly, I show that if the strict anti-abortionist position is to be taken seriously in its insistence that prenatal life has a right to be protected by virtue of its being conceived, then it seems necessary to take measures to prevent spontaneous abortion and its presumptive causes, and this as a matter of moral obligation. (shrink)

In this paper, I appeal to two aspects of Immanuel Kant’s philosophy – his metaphysics and ethics – in defense of abortion rights. Many Kantian pro-life philosophers argue that Kant’s second principle formulation of the categorical imperative, which proscribes treating persons as mere means, applies to human embryos and fetuses. Kant is clear, however, that he means his imperatives to apply to persons, individuals of a rational nature. It is important to determine, therefore, whether there is anything in Kant’s philosophy (...) that permits regarding embryos and fetuses as persons, since they lack the capacity for sentience (at least until mid-gestation), let alone rational thought. In the first part of the paper, I will illustrate why there are difficulties maintaining, from a Kantian perspective, that conception marks the genesis of a new person. Even granting that embryos and fetuses are persons, however, this alone would not entail the moral impermissibility of abortion rights, mainly because prohibiting abortion, and compelling women to gestate, violates the formula of humanity against them. Developing this thesis encompasses the second part of my essay. Finally, although I argue that Kant’s philosophy lends strong support to abortion rights, this does not thereby entail that it allows for the complete dehumanization of the human fetus. By appealing to the writings of Kantian scholar Allen Wood, I will argue that a fetus’ status as a potential person does render it worthy of some degree of respect and moral value. (shrink)

In this classic text, Kant sets out to articulate and defend the Categorical Imperative - the fundamental principle that underlies moral reasoning - and to lay the foundation for a comprehensive account of justice and human virtues. This new edition and translation of Kant's work is designed especially for students. An extensive and comprehensive introduction explains the central concepts of Groundwork and looks at Kant's main lines of argument. Detailed notes aim to clarify Kant's thoughts and to correct some common (...) misunderstandings of his doctrines. (shrink)

Embryo rescue cases and minimal miscarriage prevention research have been interpreted as showing that even pro‐lifers are not really committed to the unborn having the same moral status as the born. I will suggest instead that judgments about embryo rescues are often distorted by triage considerations that reveal nothing about differences in moral status between those saved and those not. I will present metaphysical and ethical considerations – none assuming a difference in moral status – why preventing millions of miscarriages (...) does not warrant the massive redistribution of research funds that would occur to prevent the deaths of equal numbers of humans already born. (shrink)

INTRODUCTION We look to rights for protection. The hope of advocates of “human rights” has been that certain protections might be accorded to allof humanity. Even in a world only a minority of whose inhabitants live under liberal democratic regimes, the hope is, certain standards accepted in the liberal democracies will gain universal recognition and respect. These include liberty of persons as opposed to enslavement, freedom from cruelty, freedom from arbitrary execution, from arbitrary imprisonment, and from arbitrary deprivation of property (...) or livelihood, freedom of religion, and freedom of inquiry and expression. Philosophers, of course, concern themselves with the theory of rights, and that is partly because of the ways questions of rights bear on fundamental normative theory. By far the most highly developed general normative theory has been utilitarianism. Now many opponents of utilitarianism argue that considerations of rights discredit utilitarianism, that utilitarianism yields conclusions about rights that we would normally regard as faulty, and that moreover, the reasons for regarding those conclusions as faulty turn out, upon examination, to be stronger than the reasons forregarding utilitarianism as valid. A valid theory cannot have faulty conclusions, and so thinkingabout rights shows utilitarianism not to be a valid normative theory. Jeremy Bentham, the founder of the utilitarian movement in nineteenth century England, accepted the incompatibility of utilitarianism and “the rights of man, ” and rejected talkof the latter as “anarchical fallacies”. His great successor John Stuart Mill, however, argued that a perceptive and far–sighted utilitarianism supports strong rights both of democratic participation and of individual freedom of action. (shrink)

A substantial proportion of human embryos spontaneously abort soon after conception, and ethicists have argued this is problematic for the pro-life view that a human embryo has the same moral status as an adult from conception. Firstly, if human embryos are our moral equals, this entails spontaneous abortion is one of humanity’s most important problems, and it is claimed this is absurd, and a reductio of the moral status claim. Secondly, it is claimed that pro-life advocates do not act as (...) if spontaneous abortion is important, implying they are failing to fulfill their moral obligations. We report that the primary cause of spontaneous abortion is chromosomal defects, which are currently unpreventable, and show that as the other major cause of prenatal death is induced abortion, pro-life advocates can legitimately continue efforts to oppose it. We also defend the relevance of the killing and letting die distinction, which provides further justification for pro-life priorities. (shrink)

Common‐sense morality seems to dictate that newborn babies strictly outrank non‐human animals on an ordered list of subjects of moral consideration. This is best described as the view that newborn babies have a higher moral status than any non‐human animal. In this article, I will argue that this common‐sense claim about the special moral status of newborn babies makes it hard to avoid the conclusion that fetuses, including pre‐conscious fetuses, also have a higher moral status than any non‐human animal—indeed, as (...) high as newborn babies. While this conclusion does not quite entail that abortion is generally seriously immoral, it does seem to follow that it would be no less difficult to justify (even relatively early) abortion than it would be to justify killing a newborn. (shrink)

Opponents of abortion sometimes hold that it is impermissible because fetuses are persons from the moment of conception. But miscarriage, which ends up to 89 % of pregnancies, is much deadlier than abortion. That means that if opponents of abortion are right, then miscarriage is the biggest public-health crisis of our time. Yet they pay hardly any attention to miscarriage, especially very early miscarriage. Attempts to resolve this inconsistency by adverting to the distinction between killing and letting die or to (...) the difficulty of preventing miscarriage fail, leaving a dilemma. Opponents of abortion should either advocate a substantial shift in our political and medical priorities or else give up the view that fetuses are persons from the moment of conception. (shrink)

ABSTRACT As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research – fuelled, by broad socio‐political changes that gave rise to the struggle of women, African Americans, gay men and lesbians, and the antiauthoritarian impulse that characterised the New Left in democratic capitalist societies – little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices (...) of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy‐focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision‐making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health. (shrink)

How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices, or does everyone have the right to decide their own lifestyle? Should we stop treating smokers who refuse to give up smoking? Should we put a tax on fatty foods and ban vending machines in schools to address the obesity epidemic? Should parents be required to have their children vaccinated? Are some of our screening programmes unethical (...) Downs syndrome screening, for example or should we be screening people for more conditions, such as Huntington disease? Such questions are at the heart of public health ethics. Holland shows that to understand and debate these issues requires philosophy: moral philosophies, such as utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology and health promotion. The aim of this book is to provide a lively, accessible and philosophically informed introduction to such issues. It is an ideal textbook for students taking courses in public health ethics. And since this book develops systematic discussions of issues in public health ethics, there is also much here to engage and challenge the more advanced reader. (shrink)

[Allen W. Wood] Kant's moral philosophy is grounded on the dignity of humanity as its sole fundamental value, and involves the claim that human beings are to be regarded as the ultimate end of nature. It might be thought that a theory of this kind would be incapable of grounding any conception of our relation to other living things or to the natural world which would value nonhuman creatures or respect humanity's natural environment. This paper criticizes Kant's argumentative strategy for (...) dealing with our duties in regard to animals, but defends both his theory and most of his conclusions on these topics. /// [Onora O'Neill] Kant's ethics, like others, has unavoidable anthropocentric starting points: only humans, or other 'rational natures', can hold obligations. Seemingly this should not make speciesist conclusions unavoidable: might not rational natures have obligations to the non-rational? However, Kant's argument for the unconditional value of rational natures cannot readily be extended to show that all non-human animals have unconditional value, or rights. Nevertheless Kant's speciesism is not thoroughgoing. He does not view non-rational animals as mere items for use. He allows for indirect duties 'with regard to' them which afford welfare but not rights, and can allow for indirect duties 'with regard to' abstract and dispersed aspects of nature, such as biodiversity, species and habitats. (shrink)