Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person (...) is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization. (shrink)

Most of us believe that we are entitled to treat members of other species in ways which would be considered wrong if inflicted on members of our own species. We kill them for food, keep them confined, use them in painful experiments. The moral philosopher has to ask what relevant difference justifies this difference in treatment. A look at this question will lead us to re-examine the distinctions which we have assumed make a moral difference.

Is it wrong to bring children who will have serious diseases and disabilities into the world? In particular, is it unfair to them? The notion that existence itself can be an injury is the basis for a recent new tort known as "wrongful life" (Steinbock, 1986). This paper considers Feinberg's theory of harm as the basis for a claim of wrongful life, and concludes that rarely can the stringent conditions imposed by his analysis be met. Another basis for maintaining that (...) it is morally wrong to have children under extremely adverse conditions is suggested: a principle of parental responsibility. We also argue that having children under such conditions may be unfair to the children, even if they have not been (in Feinberg's sense) harmed. Finally, we consider when conditions are sufficiently awful that having children might be viewed as incompatible with being a good parent and unfair to the child. (shrink)

Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance. The requirement of contemporary competence is intended to ensure that PAD is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, (...) arguably the strongest objections to legalizing PAD.The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia. (shrink)

This collection contains twenty-one thought-provoking essays on the controversies surrounding the moral and legal distinctions between euthanasia and "letting die." Since public awareness of this issue has increased this second edition includes nine entirely new essays which bring the treatment of the subject up-to-date. The urgency of this issue can be gauged in recent developments such as the legalization of physician-assisted suicide in the Netherlands, "how-to" manuals topping the bestseller charts in the United States, and the many headlines devoted to (...) Dr. Jack Kevorkian, who has assisted dozens of patients to die. The essays address the range of questions involved in this issue pertaining especially to the fields of medical ethics, public policymaking, and social philosophy. The discussions consider the decisions facing medical and public policymakers, how those decisions will affect the elderly and terminally ill, and the medical and legal ramifications for patients in a permanently vegetative state, as well as issues of parent/infant rights. The book is divided into two sections. The first, "Euthanasia and the Termination of Life-Prolonging Treatment" includes an examination of the 1976 Karen Quinlan Supreme Court decision and selections from the 1990 Supreme Court decision in the case of Nancy Cruzan. Featured are articles by law professor George Fletcher and philosophers Michael Tooley, James Rachels, and Bonnie Steinbock, with new articles by Rachels, and Thomas Sullivan. The second section, "Philosophical Considerations," probes more deeply into the theoretical issues raised by the killing/letting die controversy, illustrating exceptionally well the dispute between two rival theories of ethics, consequentialism and deontology. It also includes a corpus of the standard thought on the debate by Jonathan Bennet, Daniel Dinello, Jeffrie Murphy, John Harris, Philipa Foot, Richard Trammell, and N. Ann Davis, and adds articles new to this edition by Bennett, Foot, Warren Quinn, Jeff McMahan, and Judith Lichtenberg. (shrink)

Bonnie Steinbock presents The Oxford Handbook of Bioethics - an authoritative, state-of-the-art guide to current issues in bioethics.

Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be (...) eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions—as I shall assume in this article—then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want? (shrink)

This article begins with an introduction to the biology behind embryonic stem cell research. Next it presents briefly four views of moral status, based on four different criteria: biological humanity, personhood, possession of interests, and having a future-like-ours. On two of these views, embryos clearly lack moral status, but they most likely do not have moral status on the FLO account either. Only the biological humanity criterion combined with the view that life begins at conception results in the conclusion that (...) very early extracorporeal embryos have full moral status, making ESC research that destroys embryos morally wrong. This explains why even some who are anti-abortion are not against ESC research: they do not view the very early, extracorporeal embryo as having the same moral status as the fetus. (shrink)

Applied ethics is relatively new on the philosophical scene, having grown out of the various civil rights movements of the 1950s and 1960s, as well as the student demand that college courses be relevant. Even today, there are those who think that there are no philosophically interesting practical ethical questions, and that applied ethics is not a branch of philosophy at all. This article rejects that view, both because some of the most interesting and respectable philosophers in the world have (...) worked in applied ethics and because applied ethics has been the source of many difficult conceptual questions in theoretical ethics and even metaphysics. These include the grounds for moral status, human identity, how to conceive rights in general and the right to life in particular, the question whether existence itself can be a harm (the nonidentity problem), and the nature of moral principles. (shrink)

The morality of embryonic stem cell research depends on the moral status of human embryos. I defend the interest view against some of Don Marquis's objections, and show that on his own Valuable Futures account, ESCR is morally permissible.

Embryonic stem cell research is morally and politically controversial because the process of deriving the embryonic stem cells kills embryos. If embryos are, as some would claim, human beings like you and me, then ES cell research is clearly impermissible. If, on the other hand, the blastocysts from which embryonic stem cells are derived are not yet human beings, but rather microscopic balls of undifferentiated cells, as others maintain, then ES cell research is probably morally permissible. Whether the research can (...) be justified depends on such issues as its cost, chance of success, and numbers likely to benefit. But this is an issue for any research project, not just ES cell research. What makes the debate over ES cell research controversial is that it, like the debate over abortion, raises “questions that politicians cannot settle: when does human life begin, and what is the moral status of the human embryo?” This paper looks at several theories of moral status and their implications for embryo research. (shrink)

A growing number of states have banned abortion after twenty weeks on the grounds that the fetus at that stage experiences pain. Such laws run contrary to current abortion law, and so are almost certain to be challenged in court. In Roe v. Wade the Supreme Court said that the constitutional right to abortion extends until the fetus is viable, between twenty-four and twenty-eight weeks. After viability, states may ban abortion entirely except where continuing the pregnancy would threaten the woman’s (...) life or health. The viability threshold was upheld in Planned Parenthood v. Casey. Maternal health should be paramount. Why viability? The Roe court said that this is “the ‘compelling’ point.... (shrink)

On 27 September 2002, the Bush administration issued final rules allowing states to define a fetus as a child eligible for government‐subsidized health care under the Children's Health Insurance Program. CHIP does not cover any illegal immigrants and only covers legal immigrants who have been in the country for five years. Babies born in the United States, however, are citizens and therefore eligible for assistance. The response from women's groups and pro‐choice advocates was swift and unanimously negative.

John Robertson, Children of Choice: Freedom and the New Reproductive Technologies Princeton, NJ: Princeton University Press, 1994, 281 pp.