This paper takes up the question of the role of philosophical moral theory in our attempts to resolve the ethical problems that arise in health care, with particular reference to the contention that we need theory to be determinative of our choice of actions. Moral theorizing is distinguished from moral theories and the prospects for determinacy from the latter are examined through a consideration of the most promising candidates: utilitarianism, deontology and the procedures involved in reflective equilibrium. It is argued (...) that the current lack of any generally accepted method of solving moral problems, together with the extreme improbability of philosophy achieving a plausibly determinate theory, should encourage us to approach the problems in a spirit of agnosticism regarding the way in which theoretical material might be of relevance. The practical test for both moral theorizing and moral theories is thus not determinacy but the degree to which they increase our understanding of moral problems by serving, as they do in philosophy, as a means of inquiry into their nature. (shrink)

Derek Parfit, Philip Pettit and Michael Smith defend a version of consequentialism that covers everything. I argue that this version of consequentialism is false. Consequentialism, I argue, can only cover things that belong to a combination of things that agents can bring about.

In this introduction, I summarize the main themes of my book, particularly those that my critics have focused on in their papers that follow. I also argue that I could not have reached the conclusions that I have if I hadn’t employed a peacemaking rather than a warmaking way of doing philosophy. I provide a characterization of a peacemaking way of doing philosophy and show how the conclusions of my book depend on doing philosophy in that way.

Cases—be they real or fictional—are commonplace both in the medical ethics literature and in the public media. Cases take on a variety of forms: from streamlined to book length narratives. They also serve a variety of different purposes, from illustration, to decision making, and from debunking to heuristics. Drawing on the rhetorical analysis of « exemplum », I shall describe what cases are, and what their role is in the practice of clinical ethics. I identify two basic ways in which (...) cases can be brought to bear on ethical thinking and practice: a « tamed » and a « wild » way, and show how « wild cases » can serve a useful heuristic function despite their appeal to emotions and their unusual and striking character. In conclusion, I will argue that cases, both in their wild and their tamed form, are not only useful pedagogical tools, but can serve as a legitimate empirical basis for medical ethics. (shrink)

The concept of responsibility for health is a significant feature of health discourse and public health policy, but application of the concept is poorly understood. This paper offers an analysis of the concept in two ways. Following an examination of the use of the word ‘responsibility’ in the nursing and wider health literature using three examples, the concept of ‘responsibility for health’ as fulfilling a social function is discussed with reference to policy documents from the UK. The philosophical literature on (...) moral responsibility is introduced, and in considering two versions, reactive attitudes and accountability, it is argued that in application both can be regarded, though with different emphasis, as being constituted in three parts: a responsible agent; having obligations ; and being susceptible to being held responsible if he fails to meet them. The three‐stage model is consistent with the examples of the word responsibility in use, but application to the social function model causes a number of problems for healthcare practice, especially for the reactive attitudes account. Apart from considerable problems in stating what exactly the obligations are and how they can be justified; and how blame might justly be apportioned and by whom, the very ideas of obligation and blame are in conflict within healthcare systems and professional nursing practice which have foundations deeply embedded in the notion of the supremacy of personal autonomy. It is concluded that current application of the concept of responsibility for health is conceptually incoherent, and if it is to retain its place in health policy and discourse, urgent remedy is required. (shrink)

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a (...) wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

John Coggon argues that the important question for analysts in the fields of public health law and ethics is 'what makes health public?' He offers a conceptual and analytic scrutiny of the salient issues raised by this question, outlines the concepts entailed in, or denoted by, the term 'public health' and argues why and how normative analyses in public health are inquiries in political theory. The arguments expose and explain the political claims inherent in key works in public health ethics. (...) Coggon then develops and defends a particular understanding of political liberalism, describing its implications for critical study of public health policies and practices. Covering important works from legal, moral, and political theory, public health, public health law and ethics, and bioethics, this is a foundational text for scholars, practitioners and policy bodies interested in freedoms, rights and responsibilities relating to health. (shrink)

This essay argues, flouting paradox, that Mill was a utilitarian but not a consequentialist. First, it contends that there is logical space for a view that deserves to be called utilitarian despite its rejection of consequentialism; second, that this logical space is, in fact, occupied by John Stuart Mill. The key to understanding Mill's unorthodox utilitarianism and the role it plays in his moral philosophy is to appreciate his sentimentalist metaethics—especially his account of wrongness in terms of fitting guilt and (...) resentment. Mill recognizes a fundamental moral asymmetry between the agent and others, which conflicts intractably with a presupposition of consequentialism. This allows him to differentiate three potentially conflicting evaluative spheres: morality, prudence, and aesthetics. This essay's account of Mill's utilitarianism coheres with his defense of individual liberty and his embrace of supererogation, both of which elude traditional interpretations. (shrink)

What are the appropriate criteria for assessing a theory of morality? In this enlightening work, Brad Hooker begins by answering this question. He then argues for a rule-consequentialist theory which, in part, asserts that acts should be assessed morally in terms of impartially justified rules. In the end, he considers the implications of rule-consequentialism for several current controversies in practical ethics, making this clearly written, engaging book the best overall statement of this approach to ethics.

In his article ‘Why Moral Philosophers Are Not and Should Not Be Moral Experts’ David Archard attempts to show that his argument from common-sense morality is more convincing than other competing arguments in the debate. I examine his main line of argumentation and eventually refute his main argument in my reply.

Argument from analogy is a common and formidable form of reasoning in law and in everyday conversation. Although there is substantial literature on the subject, according to a recent survey ( Juthe 2005) there is little fundamental agreement on what form the argument should take, or on how it should be evaluated. Th e lack of conformity, no doubt, stems from the complexity and multiplicity of forms taken by arguments that fall under the umbrella of analogical reasoning in argumentation, dialectical (...) studies, and law. Modeling arguments with argumentation schemes has proven useful in attempts to refine the analyst’s understanding of not only the logical structures that shape the backbone of the argument itself, but also the logical underpinning of strategies for evaluating it, strategies based on the semantic categories of genus and relevance. By clarifying the distinction between argument from example and argument from analogy, it is possible to advance a useful proposal for the treatment of argument from analogy in law. (shrink)

Many people working in bioethics take pride in the subject’s embrace of a wide range of disciplines. This invites questions of what in particular is added by each. In this paper, I focus on the role of philosophy within the field: what, if anything, is its unique contribution to bioethics? I sketch out a claim that philosophy is central to bioethics because of its particular analytic abilities, and defend its place within bioethics from a range of sceptical attacks.

This paper begins by celebrating Sidgwick's Methods of Ethics. It then discusses Sidgwick's moral epistemology and in particular the coherentist element introduced by his argument from common-sense morality to utilitarianism. The paper moves on to a discussion of how common-sense morality seems more appealing if its principles are formulated as picking out pro tanto considerations rather than all-things-considered demands. Thefinal section of the paper considers the question of which version of utilitarianism follows from Sidgwick's arguments.

I investigate whether tobacco health warnings’ interference with autonomy is ethically justifiable in order to deter people from smoking. I dissociate first the informational role and the persuasive role of tobacco health warnings and show that both roles enable typical addicted smokers to better rule themselves, fostering their autonomy. The fact that some messages address people’s non-deliberative faculties is therefore compensated by a larger positive influence on their autonomy. However, misleading messages are not ethically justified and should be avoided. Tobacco (...) health warnings’ effect on autonomy highlights an important difference between libertarian paternalism and classical paternalism. (shrink)

Professional philosophers are members of bioethical committees and regulatory bodies in areas of interest to bioethicists. This suggests they possess moral expertise even if they do not exercise it directly and without constraint. Moral expertise is defined, and four arguments given in support of scepticism about their possession of such expertise are considered and rejected: the existence of extreme disagreement between moral philosophers about moral matters; the lack of a means clearly to identify moral experts; that expertise cannot be claimed (...) in that which lacks objectivity; and that ordinary people do not follow the advice of moral experts.I offer a better reason for scepticism grounded in the relation between moral philosophy and common-sense morality: namely that modern moral philosophy views even a developed moral theory as ultimately anchored in common-sense morality, that set of basic moral precepts which ordinary individuals have command of and use to regulate their own lives.Even if moral philosophers do nevertheless have a limited moral expertise, in that they alone can fully develop a set of moral judgments, I sketch reasons – grounded in the values of autonomy and of democracy – why moral philosophers should not wish non-philosophers to defer to their putative expertise. (shrink)

_Liberal Utilitarianism and Applied Ethics_ explores the foundations of early utilitarianism and, at the same time, the theoretical bases of social ethics and policy in modern Western welfare states. Matti Hayry sees the main reason for utilitarianism's growing disrepute among moral philosophers is that its principles cannot legitimately be extended to situations where the basic needs of the individuals involved are in conflict. He is able to formulate a solution to this fundamental problem by arguing convincingly that by combining a (...) limited version of liberal utilitarianism and the methods of applied ethics, we are able to define our moral duties and rights. _Liberal Utilitarianism and Applied Ethics_ will appeal to students and teachers of philosophy who are interested in the doctrine of utilitarianism or in ethical decison-making. (shrink)

This book combines the two most common approaches used to introduce students or general readers to ethics: the historical and the applied. Using these approaches, Sterba examines traditional ethical theories and disagreements, exploring Aristotelian, Kantian, and utilitarian ethics, as well as their contemporary defenders. But rather than focusing on formal aspects of these views, Sterba applies the best practical arguments from each of these perspectives to a variety of moral problems, such as sexual harassment, affirmative action, and international terrorism and (...) the second Iraqi war. (shrink)

By the time of his death in 2003, Bernard Williams was one of the greatest philosophers of his generation. Ethics and the Limits of Philosophy is not only widely acknowledged to be his most important book, but also hailed a contemporary classic of moral philosophy. Presenting a sustained critique of moral theory from Kant onwards, Williams reorients ethical theory towards ‘truth, truthfulness and the meaning of an individual life’. He explores and reflects upon the most difficult problems in contemporary philosophy (...) and identifies new ideas about central issues such as relativism, objectivity and the possibility of ethical knowledge. (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)

This book offers the fullest and most sophisticated account of Gert's influential moral theory, a model first articulated in the classic work The Moral Rules: A New Rational Foundation for Morality, published in 1970. In this final revision, Gert makes clear that the moral rules are only one part of an informal system that does not provide unique answers to every moral question but does always provide a range of morally acceptable options. A new chapter on reasons includes an account (...) of what makes one reason better than another and a second new chapter is devoted to the question of justifying violations of the rules. Moral impartiality, the moral ideals, and virtue and vice, are all treated in greater detail. Throughout, Gert attempts to answer all of the challenges that his work has provoked. (shrink)

_Liberal Utilitarianism and Applied Ethics_ explores the foundations of early utilitarianism and, at the same time, the theoretical bases of social ethics and policy in modern Western welfare states. Matti Hayry sees the main reason for utilitarianism's growing disrepute among moral philosophers is that its principles cannot legitimately be extended to situations where the basic needs of the individuals involved are in conflict. He is able to formulate a solution to this fundamental problem by arguing convincingly that by combining a (...) limited version of liberal utilitarianism and the methods of applied ethics, we are able to define our moral duties and rights. _Liberal Utilitarianism and Applied Ethics_ will appeal to students and teachers of philosophy who are interested in the doctrine of utilitarianism or in ethical decison-making. (shrink)

Why should we be tolerant? What does it mean to ‘live and let live’? What ought to be tolerated and what not? Catriona McKinnon presents a comprehensive, yet accessible introduction to toleration in her new book. Divided into two parts, the first clearly introduces and assesses the major theoretical accounts of toleration, examining it in light of challenges from scepticism, value pluralism and reasonableness. The second part applies the theories of toleration to contemporary debates such as female circumcision, French Headscarves, (...) artistic freedom, pornography and censorship, and holocaust denial. Drawing on the work of philosophers, such as Locke, Mill and Rawls, whose theories are central to toleration, the book provides a solid theoretical base to those who value toleration, whilst considering the challenges toleration faces in practice. It is the ideal starting point for those coming to the topic for the first time, as well as anyone interested in the challenges facing toleration today. (shrink)

_Paradoxes from A to Z, Third edition_ is the essential guide to paradoxes, and takes the reader on a lively tour of puzzles that have taxed thinkers from Zeno to Galileo, and Lewis Carroll to Bertrand Russell. Michael Clark uncovers an array of conundrums, such as Achilles and the Tortoise, Theseus’ Ship, and the Prisoner’s Dilemma, taking in subjects as diverse as knowledge, science, art and politics. Clark discusses each paradox in non-technical terms, considering its significance and looking at likely (...) solutions. This third edition is revised throughout, and adds nine new paradoxes that have important bearings in areas such as law, logic, ethics and probability. Paradoxes from A to Z, Third edition is an ideal starting point for those interested not just in philosophical puzzles and conundrums, but anyone seeking to hone their thinking skills. (shrink)

In this book John Kekes examines the indispensable role enjoyment plays in a good life. The key to it is the development of a style of life that combines an attitude and a manner of living and acting that jointly express one's deepest concerns. Since such styles vary with characters and circumstances, a reasonable understanding of them requires attending to the particular and concrete details of individual lives. Reflection on works of literature is a better guide to this kind of (...) understanding than the futile search for general theories and principles that preoccupies much of contemporary moral thought. -/- Enjoyment proceeds by the detailed examination of particular cases, shows how this kind of reflection can be reasonably conducted, and how the quest for universality and impartiality is misguided in this context. Central to the argument is a practical, particular, pluralistic, and yet objective conception of reason that rejects the pervasive contemporary tendency to regard reasons as good only if they are binding on all who aspire to live reasonably and morally. Reason in morality is neither theoretical nor general. Reasons for living and acting in particular ways are individually variable and none the worse for that. -/- Kekes aims to reorient moral thought from deontological, contractarian, and consequentialist preoccupations toward a reasonable but pluralistic reflection on what individuals can do to make their lives better. (shrink)

Ethics: The Heart of Health Care - a classic ethics text in medical, health and nursing studies - is recommended around the globe for its straightforward introduction to ethical analysis. In this new edition David Seedhouse demonstrates tangibly and graphically how ethics and health care are inextricably bound together, and creates a firm theoretical basis for practical decision-making. He not only clarifies ethics but, with the aid of the acclaimed Ethical Grid, teaches an essential practical skill which can be productively (...) applied in day-to-day health care. This edition, which is even more readable than the first, includes additional case studies and teaching exercises, contains new material on ethical theory and offers two further decision-making tools - The Rings of Uncertainty and the Autonomy Test. The engaging new introduction reveals the genesis of the Ethical Grid, illuminates the intent and argument of the first edition, and explains why the book is needed today as much as ever. Intended for all who work in health care or health studies - indeed for anyone with an interest in health issues - this is a highly original, innovative and accessible work on a subject traditionally regarded as lofty and obscure. It clarifies a wide variety of complex ethical issues and will give the reader fresh inspiration and renewed confidence in dealing with the demands of modern health work. (shrink)

This important new book develops a new concept of autonomy. The notion of autonomy has emerged as central to contemporary moral and political philosophy, particularly in the area of applied ethics. professor Dworkin examines the nature and value of autonomy and uses the concept to analyse various practical moral issues such as proxy consent in the medical context, paternalism, and entrapment by law enforcement officials.

The doyen of living English philosophers, by these reflections, took hold of and changed the outlook of a good many other philosophers, if not quite enough. He did so, essentially, by assuming that talk of freedom and responsibility is talk not of facts or truths, in a certain sense, but of our attitudes. His more explicit concern was to look again at the question of whether determinism and freedom are consistent with one another -- by shifting attention to certain personal (...) rather than moral attitudes, first of all gratitude and resentment. In the end, he arrived at a kind of Compatibilist or, as he says, Optimist conclusion. That is no doubt a recommendation but not the largest recommendation of this splendidly rich piece of philosophy. (shrink)

Most people believe that we have a duty to gather evidence on both sides of central moral and political controversies, in order to fulfil our epistemic responsibilities and come to hold justified cognitive attitudes on these matters. I argue, on the contrary, that to the extent to which these controversies require special expertise, we have no such duty. We are far more likely to worsen than to improve our epistemic situation by becoming better informed on these questions. I suggest we (...) do better to embrace the views of experts who are also morally wise. I argue that this is likely to lead to more accurate beliefs about these political and moral controversies; in any case, it will avoid the incoherence and irrationality which are the likely consequence of open-minded evidence gathering. (shrink)