Medical complicity in torture is prohibited by international law and codes of professional ethics. But in the many countries in which torture is common, doctors frequently are expected to assist unethical acts that they are unable to prevent. Sometimes these doctors face a dilemma: they are asked to provide diagnoses or treatments that respond to genuine health needs but that also make further torture more likely or more effective. The duty to avoid complicity in torture then comes into conflict with (...) the doctor’s duty to care for patients. Sometimes the right thing for a doctor to do requires complicity in torture. Whether this is the case depends on: the expected consequences of the doctor’s actions; the wishes of the patient; and the extent of the doctor’s complicity with wrongdoing. Medical associations can support physicians who face this dilemma while maintaining a commitment to clear principles denouncing torture. (shrink)

With much of the world's population facing restricted access to adequate medical care, how to allocate scarce health-care resources is a pressing question for governments, hospitals, and individuals. How do we decide where funding for health-care programs should go? Tannsjo here approaches the subject from a philosophical perspective, balancing theoretical treatments of distributive ethics with real-world examples of how health-care is administered around the world today. Tannsjo begins by laying out several popular ethical theories-utilitarianism, which recommends maximizing the best overall (...) outcome; egalitarianism, which recommends smoothing out the differences between people as much as possible; and the maximin/leximin theory, which urges people to give absolute priority to those who are worst off. Tannsjo shows how, in abstract thought experiments, these theories come into conflict with each other and reveal puzzling implications. He goes on to argue, however, that when we consider health-care in the real-world, these theories all agree on a central point: in a well-ordered welfare state, more resources should be directed to the care and cure of people suffering from mental illness, and less to the marginal life extension of elderly patients. Tannsjo's book thus recommends a shift in spending to increase fairness and overall utility-while also recognizing that this kind of dispassionate suggestion, with its purely economic foundation, is unlikely to take hold in policy. Tannsjo's analysis is a case study in how ethical theories can sometimes lead to rational conclusions and recommendations that we are not prepared to accept. (shrink)

This is a short reply to Professor Reichlin’s comment on my book Setting Health-Care Priorities. What Ethical Theories Tell Us. The version of prioritarianism I rely on in the book is defended as the most plausible one. The general claim that there is convergence between all plausible theories on distributive justice is also defended with regard to assisted reproduction, disability, and enhancement.

This paper considers the implications of Chiara Lepora and Robert Goodin's On Complicity and Compromise (OUP, 2013) for our understanding of international law. That volume systematizes and evaluates individuals’ ethical choices in getting (too) close to evil acts. For the law of nations, these concepts are relevant in three critical ways. First, they capture the dilemmas of those charged with implementing international law, e.g., Red Cross delegates pledged to confidentiality learning of torture in a prison. Second, they offer a rubric (...) for understanding when a state may use coercion against certain actors, e.g., international law's rules for when one state may use force against another based on the latter's ties to terrorist acts. Third, they offer a moral grounding for many international obligations of states based on the need to avoid their own complicity in others' wrongs, e.g., by not expelling refugees to a state persecuting them or by preventing private actors from committing human rights abuses. In the case of the last two, the law reflects decisions by states about how much complicity they will tolerate – either complicity by others or complicity by the states themselves. (shrink)

Complicity consists in one person contributing to someone else's wrongdoing. But there is a diverse cluster ways of being involved in another’s wrongdoing. For a ‘diagnosis by exclusion’, we first fix the meaning of complicity in contrast to that with which it is often wrongly conflated. Literally cooperating in wrongdoing with others, for instance, is more than complicity. Each and every cooperator is actually a co-principal in the wrong jointly committed; and each bears the full responsibility, shared with all co-principals, (...) for the outcomes of that wrongdoing. Other sorts of involvement with wrongs committed by others amount to less than complicity because the involvement there is causally inert and hence does not actually contribute to the other’s wrongdoing at all. Pardoning wrongs wholly in the past may be like that. So too may be some cases of wilfully overlooking wrongs that others commit under one's very nose. Complicity is a very precise way of being involved in wrongdoing. Complicity consists in a secondary contribution of a causal (or potentially causal) sort to a wrong committed by someone else. That ‘contribution factor’ can be graded on many axes, in terms of how proximate, reversible or frequent the contribution was. Other things being equal, one is more complicit the …. (shrink)

Zones of social abandonment are emerging everywhere in Brazil’s big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die. This haunting, unforgettable story centers on a young woman named Catarina, increasingly paralyzed and said to be mad, living out her time at Vita. Anthropologist João Biehl leads a detective-like journey to know Catarina; to unravel the cryptic, poetic words that are part of the “dictionary” she is compiling; and to trace the (...) complex network of family, medicine, state, and economy in which her abandonment and pathology took form. As Biehl painstakingly relates Catarina’s words to a vanished world and elucidates her condition, we learn of subjectivities unmade and remade under economic pressures, pharmaceuticals as moral technologies, a public common sense that lets the unsound and unproductive die, and anthropology’s unique power to work through these juxtaposed fields. _Vita’s_ methodological innovations, bold fieldwork, and rigorous social theory make it an essential reading for anyone who is grappling with how to understand the conditions of life, thought and ethics in the contemporary world. (shrink)

Zones of social abandonment are emerging everywhere in Brazil’s big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die. This haunting, unforgettable story centers on a young woman named Catarina, increasingly paralyzed and said to be mad, living out her time at Vita. Anthropologist João Biehl leads a detective-like journey to know Catarina; to unravel the cryptic, poetic words that are part of the “dictionary” she is compiling; and to trace the (...) complex network of family, medicine, state, and economy in which her abandonment and pathology took form. An instant classic, _Vita_ has been widely acclaimed for its bold fieldwork, theoretical innovation, and literary force. Reflecting on how Catarina’s life story continues, this updated edition offers the reader a powerful new afterword and gripping new photographs following Biehl and Eskerod’s return to Vita. Anthropology at its finest, _Vita_ is essential reading for anyone who is grappling with how to understand the conditions of life, thought, and ethics in the contemporary world. (shrink)

Doctor's Dilemmas, a fascinating study of the moral dilemmas confronting health professionals and patients alike, examines areas of health care where ethical conflicts often arise. Gorovitz illuminates these conflicts by clearly explaining and applying a broad range of philosophical concepts. He lays the groundwork for informed ethical decision-making and provides the general reader with a lucid overview of the complexities of medical practice. Written in accessible, conversational style and making extensive use of anecdotes, examples, and references to literature, Doctor's Dilemmas (...) offers profound insights into medical ethics for all those involved with the health professions--be they doctors, nurses, administrators, or patients. (shrink)