In current American medical practice, autonomy is assumed to be more valuable than human life: if a patient autonomously refuses lifesaving treatment, the doctors are supposed to let him die. In this paper we discuss two values that might be at stake in such clinical contexts. Usually, we hear only of autonomy and best interests. However, here, autonomy is ambiguous between two concepts—concepts that are tied to different values and to different philosophical traditions. In some cases, the two values (that (...) of agency and that of authenticity) entail different outcomes. We argue that the comparative value of these values needs to be assessed. (shrink)

Rather, in all the texts of this period Marx tries to mount a compelling critique of the present while altogether avoiding the dilemmas central to philosophy in ...

According to bioethics orthodoxy, the question, “What would the patient choose?” is a question about the patient's autonomy. is at stake. In fact, what underpins the moral force of that question is a value different from either autonomy or best interests. This is the value of doing things in a way that is authentic to the person.

According to bioethics orthodoxy, the question, “What would the patient choose?” is a question about the patient's autonomy. is at stake. In fact, what underpins the moral force of that question is a value different from either autonomy or best interests. This is the value of doing things in a way that is authentic to the person.

Edited by Hans-Christoph Schmidt am Busch & Christopher Zurn. This volume collects original, cutting-edge essays on the philosophy of recognition by international scholars eminent in the field. By considering the topic of recognition as addressed by both classical and contemporary authors, the volume explores the connections between historical and contemporary recognition research and makes substantive contributions to the further development of contemporary theories of recognition.

My topic is a problem with our practice of surrogate decision-making in health care, namely, the problem of the surrogate who is not doing her job—the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job—the team just doesn't like how she (...) is doing it. My analysis raises the question of whether she should be overridden. In approaching this problem, I focus not on the range of difficulties in practice but on the underlying moral conceptual issue. My concern will be to show that the moral values that underpin patient decision-making are fundamentally different from those that underpin surrogate decision-making. Identifying the distinctions will set parameters for any successful solution to the “Who should decide?” question. A patient has a specific kind of moral right to make her own medical decisions. A surrogate has no analogous moral right to decide for someone else. We want the surrogate to make the decision because we believe that she has a relevant epistemological advantage over anyone else on the scene. If and when she has no such advantage or if she refuses or is unable to use it, then there might not be sufficient reason to let her be the decision-maker. (shrink)

When does behavior trigger a lesser claim to medical resources? When does chronic drinking, for example, mean that one has a lesser claim to a liver transplant? Only when one's behavior becomes a callous indifference to others' needs—when one knows the consequences of heavy drinking and knows that by drinking one may end up depriving someone else of a liver.

European Journal of Philosophy, EarlyView.

Among the tasks of modern political philosophy is to develop a favored conception of the relations among modern citizens, among people who can know little or nothing of one another individually and yet are deeply reciprocally dependent. One might think of this as developing a favored conception of civic friendship. In this essay I sketch two candidate conceptions. The first derives from the Kantian tradition, the second from the 1844 Marx. I present the two conceptions and then describe similarities and (...) differences. My approach is both taxonomic and programmatic. My taxonomic goal is to provide an initial sketch of the conceptual territory. My programmatic goal is to provide reasons to think that the conception derived from Marx is both appealing and feasible. (shrink)

In this essay, I raise the question of whether some degree of noncoercive state support for religious conceptions (broadly understood) should be left to the majoritarian branch ofgovernment. I argue that the reason not to do so is that such state support would alienate many citizens. However to take this as a sufficient reason to constrain the majoritarian branch is to accept the thesis that not being alienated from one's polity is a significant part of the human good. Those who (...) would prohibit even a small amount of noncoercive support of religious conceptions must appeal either to pragmatic considerations (the worry that noncoercive will lead to coercive support, i.e., to tyranny) or to a conception of the good that puts great value on the agent's sense of connectedness to the polity. And the latter is something that reasonable citizens in a modern democracy could reasonably reject. (shrink)

This article starts by examining the appeal to hypothetical consent as used by law and economics writers. I argue that their use of this kind of argument has no moral force whatever. I then briefly examine, through some remarks on Rawls and Scanlon, the conditions under which such an argument would have moral force. Finally, I bring these considerations to bear to criticize the argument of judge Frank Easterbrook's majority opinion in Flamm v. Eberstadt.

This chapter compares the 1844 Marx (the Marx of the Economic and Philosophic Manuscripts of 1844) and the Rawls of A Theory of Justice, with the central topic being the young Marx and the middle‐aged Rawls. It starts with the standard Marxian criticism of Theory, and then discusses the two ways in which the writers resemble one another. Eventually, the discussion returns to the standard criticism, casting it as a difference in the writers’ conceptions of “alienation.” The 1844 Marx condemns (...) capitalism for its deep and multiform alienation of labor but misses the fact that a theory of distribution asks, among other things, what ought to be distributed. The alienation associated with the absence of the difference principle in a restricted utility society stems from a perceived deficit of concern. Rawls claims in Theory that the difference principle is “an interpretation of the principle of fraternity”. (shrink)

It is a clinician’s cliché that a physician only challenges a patient’s capacity to make a treatment decision if that decision is not what the physician wants. Agreement is proof of decisional capacity; disagreement is proof or at least evidence of capacity’s absence. It is assumed that this asymmetry cannot be justified, that the asymmetry must be a form of physicians’ paternalism. Instead what is at issue when patient and physician disagree are usually two laudable impulses. The first is physicians’ (...) commitment to patients’ well-being: physicians have a professional obligation as well as, ideally, a personal commitment to take care of patients—to do their best to bring about a positive medical outcome. The second impulse is common to much of human life, namely, the urge to find and to understand the source of our disagreements with one another. In this article we argue that, jointly, these impulses justify the asymmetry with regard to examining patients’ capacity. (shrink)

Jack, who is seventy‐five years old, is in the hospital with a terminal condition that has undermined his cognitive faculties. He has left no advance directive and has never had a conversation in which he made his treatment wishes remotely clear. Yet now, a treatment decision must be made, and in modern American medicine, the treatment decision for Jack is supposed to be made by a surrogate decision‐maker, who is supposed to use a decision‐making standard known as “substituted judgment.” According (...) to the substituted judgment standard, Jack’s surrogate decision‐maker, his wife, is supposed to decide on his treatment by determining what Jack would do if he did have decisional capacity. That is, she is supposed to answer the question, what would the patient choose? I will argue that this is the wrong question to ask because when the question has a determinate answer, that answer is sometimes not sufficiently connected to the value that is supposed to make the question morally salient, and because sometimes, perhaps often, there is no determinate answer to the question of what the patient would choose. Jointly, these two problems suggest the need for a different question. (shrink)

A new kind of argument has been proposed to explain why health-care workers can sometimes refuse to offer a service or treatment. But this new kind of argument must also be evaluated and invoked differently.

When literary texts are included in a course on moral philosophy they tend to be classical tragedies or existentialist novels: texts filled with major moral transgressions and agonized debates over rights, wrongs, and relativism. Recently, however, the focus of much discussion on literature and moral philosophy has been Henry James’s last novel, The Golden Bowl. This ought to seem surprising. For The Golden Bowl is a quintessential Jamesian novel. Almost nothing happens. In the course of more than five hundred pages (...) there are two marriages, one affair, and a single act of violence, the smashing of the golden bowl. The rest is reflection, nuance, detail: the creation and preservation of a “‘brilliant, perfect surface,’” one “scarcely more meant to be breathed upon, it would seem, than the cheek of royalty.”1 There are no extreme actions or high-flown speculations. The moral issues among the four central characters either go unspoken or are raised expressly to be suppressed, banished from articulation. And what counts as the expression of the moral maturity and insight of the heroine, Maggie Verver, is her extraordinary ability to keep the truth silen00to put it precisely, to lie. If even there was a novel in which the protagonists shied away from moral debate, it is The Golden Bowl.The challenge for the philosophical critic, it seems to me, is to argue that it is just this stress on surface and silence that makes this novel of interest to moral philosophers, that makes it exemplary for how literature can do something philosophically important that philosophy cannot. 1. Henry James, The Golden Bowl , pp. 445, 172; hereafter cited by page number. Daniel Brudney is an assistant professor of philosophy at the University of Chicago. (shrink)

Let’s start with three cases of refusal of treatment.[A] 24-year old graduate student is brought to the emergency room by a friend. Previously in good health, he is complaining of a severe headache and stiff neck. Physical examination shows a somnolent patient without focal neurologic signs but with a temperature of 39.5 degrees centigrade and nuchal rigidity. Examination of spinal fluid reveals cloudy fluid with a white blood cell count of 2000; Gram stain of the fluid shows many Gram-positive diplococcic. (...) A diagnosis of bacterial meningitis is reached, and administration of antibiotics is recommended.... When [the patient] was told his diagnosis and that he would be admitted to the hospital for treatment... (shrink)

In this article I note two ways in which current assessments of patients’ decisional capacity rest on disputable philosophical assumptions. The first disputable assumption concerns the nature of practical reason; the second concerns patients’ articulation of their preferences. I do not argue that clinical practice should be changed. Still, relying on disputable philosophical assumptions can distort the description of such practice. It would be good for philosophers and philosophically oriented clinicians to work with a philosophically accurate account of clinical practice. (...) Moreover, every so often more accurate description might make for better practice. (shrink)

Communitarians have long criticized John Rawls′ theory of justice as fairness. In this paper I sketch a picture of communal relationships and use it to examine the nature of community in Rawls′ theory. In the first section I extract a picture of communal relationships from Karl Marx′s work of 1844; in the second section I argue for this picture′s distinctiveness; finally, I look at a shift in the nature of Rawlsian community between A Theory of Justice and Rawls′ later book, (...) Political Liberalism. I argue that a picture structurally similar to that in Marx is exhibited by the well-ordered society of A Theory of Justice, although not by that of Political Liberalism. The communitarian charge – the charge that Rawls′ view is at odds with an emphasis on community – turns out to be justified, but not with respect to A Theory of Justice, the standard communitarian target. (shrink)

argue that there are two forms of perfectionism in John Stuart Mill's work, two ideals of the person. One, the self-development ideal, is found in On Liberty. The other, the strong identification ideal, is tied to Mill's advocacy of a 'religion of humanity' and is found in Utilitarianism, 'Utility of Religion', and other texts. My first concern is to show that Mill's work contains this latter ideal. Next, I situate the strong identification ideal historically. Finally, I ask whether both ideals (...) could be substantially realized in a single life. The ideals are not logically incompatible. Their incompatibility will be one or another form of practical incompatibility. Most importantly, any form of perfectionism concerns the kind of person to be: it involves a distinctive habit of mind. The fundamental tension between the Millian ideals concerns the difficulty of combining their different habits of mind. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.2 (2003) 318-340 [Access article in PDF] Marlow's Morality Daniel Brudney "Good is a transcendent reality" means that virtue is the attempt to pierce the veil of selfish consciousness and join the world as it really is. —Iris Murdoch, The Sovereignty of Good I THE REPUTATION OF Conrad's sailor-narrator, Charlie Marlow, has risen and fallen through the years. Initially seen as a simple master mariner or (...) at most as a technical device, a way to get a tale told, with the work of Albert Guérard he began to receive his due, becoming lionized as the true subject at least of Heart of Darkness, and of more than technical interest in the other stories. 1 In recent years, however, his reputation has slumped hard as his racism and sexism have come to the fore. In this article, I attempt no full-scale rehabilitation but simply point out that, despite his failings, Marlow possesses a virtue worth remarking and that his failings involve a failure to extend that virtue far enough.I call that virtue attentiveness, and more specifically, attentiveness to the other. It has been neglected, at least by philosophers, although as a virtue it is utterly obvious. This is not surprising. The moral life is generally the sphere of the obvious and progress here often consists merely in noting what has been overlooked. The presence or absence of this virtue is revealed less by what the agent feels or doesn't feel or does or doesn't do than by her stance or orientation toward others. And as orientations are slippery things to describe (and this one more than most) there is an advantage in looking at literary characters: they show palpably the virtue (or corresponding vice) at issue. My focus in this [End Page 318] article is the forms that Marlow's tales (particularly Lord Jim and Heart of Darkness) show attentiveness to the other can take—and fail to take—in a human life. II Let's begin with Marlow's sexism, and specifically as manifested in his lie to Kurtz's Intended. She asks for Kurtz's final words, and Marlow replies not "The horror! The horror!" but "The last words he pronounced was—your name" (HD, p. 161). 2 Marlow says that the truth "would have been too dark, too dark altogether" (p. 162). But what doesn't Marlow want the Intended to know? That her beloved went mad in the jungle, became evil? And why shouldn't she know this? Because it would bring her pain? But Marlow insists that the Intended has "a mature capacity" for suffering (p. 157; a capacity to handle it, presumably, not a proneness to it). Anyway, Marlow's lie will perpetuate suffering, her mourning for her image of Kurtz: smash her idol and she might be able to get on with her life. In any event, the issue of suffering does not explain why the truth is "too dark."Marlow does not class the Intended as "one of us" (LJ, p. 43). This is the phrase he, like Conrad, uses to characterize Jim in Lord Jim. It is usually taken to refer to national or racial identity or perhaps to membership in the merchant service. However, the phrase also has a biblical resonance. Genesis 3:22 says, "Behold, the man has become like one of us, knowing good and evil." I think the reason the Intended is not "one of us" is that she does not know good and evil—does not know that there are good and evil. That is the mystery into which Kurtz's final words would have initiated her."There is a taint of death, a flavour of mortality in lies," Marlow says, "which is exactly what I hate and detest in the world—what I want to forget" (HD, p. 82). Yet he does lie, so there must be something he thinks worth saving even at the cost of siding with mortality. What might that be? In the beginning of Paradise Lost, Milton declares that he will sing Of Man's first disobedience, and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Nostromo and Negative LongingDaniel BrudneyWhat, as the upshot of this exhibition of human motive and attitude, do we feel Conrad himself to endorse? What are his positives? It is easier to say what he rejects or criticizes.—F. R. Leavis, The Great Tradition1IWriters, playwrights, filmmakers have often seen their work as political. In this essay I discuss one way in which a narrative might be political. My proof text will (...) be Joseph Conrad's novel Nostromo.2Let's start by noting several ways in which a narrative might criticize the present.(1). It highlights a shortcoming, say, an injustice, of the present.(2). It shows the possibility of a different and better society, usually inhabited by people with a different and better psychology.(3). It shows nothing positive, and yet it elicits a desire for a radically different and radically better future, that is, for something very different from the present.The first option divides into:(1a) The narrative shows a particular injustice, the sort of thing that concrete institutional change might eliminate or ameliorate. There are plenty of examples of (1a): Uncle Tom's Cabin, The Jungle, the movie Dirty Pretty Things. We could debate how far particular instances are propaganda, journalism, or "literature," and what difference these categories might make. Here, I merely note that narrative is capable of pointing to, making palpable, evoking outrage at, this or that particular injustice. Narrative will rarely tell us the best way to fix the injustice ("There ought to be a law" merely begins that conversation), but it can convince us that a particular injustice exists and needs to be addressed. [End Page 369](1b) The narrative shows what is wrong with something more general: a pervasive social institution, such as the market, imperialism (of one or another kind), some general pattern of social feeling and conduct. Many classic works do this, such as Middlemarch and Madame Bovary. Of course, precisely because such works criticize large and pervasive phenomena, they usually do not point to any specific solution. They say, "This (something fairly general) is bad."When we move to narratives that try to present better worlds, things get more complicated. We can see the issue by noting a distinction in (2) and between (2) and (3). With (2a), we are in the realm of what John Rawls calls a "realistic utopia."3 This is supposed to be (i) sufficiently specifiable, in terms of, say, principles of distribution, a conception of the person, and a conception of justification; that is, in terms of several central organizing ideas. It is also supposed to be (ii) sufficiently realistic in terms of the moral psychology needed for its instantiation. Rawls often talks of full compliance in his well-ordered society, but for that society to be sufficiently realistic, the psychology of its citizens must merely be a sufficiently real possibility in the sufficiently near future to generate sufficient compliance to make for sufficient stability.Call a realistic utopia realizably realistic if (I) the better angels of our nature upon which it calls are sufficiently like our actual nature to be plausible in the relatively near term, and (II) it does not require too often the instantiation of those better angels. The contrast is to (2b), a realistic utopia that is unrealizably realistic because although it satisfies (I) it does not satisfy (II): it is too dependent on the more or less constant instantiation of those better angels. It assumes that "can implies will" even though in real life the inference often fails.4 Still, such a society remains "realistic" since it is possible for us always to instantiate those better angels.With (3), condition (i) is not satisfied. The issue is not that we cannot or that we believe human beings will not realize something specifiable in terms of institutions and citizen psychology. It is that we have only a vague and primarily negative understanding of what we want. It is substantially (perhaps entirely) a political via negativa. And so (ii) cannot be known to be satisfied.The distinction between (2a) (and maybe also [2b]) on the one hand, and (3) on the other, tracks two ways... (shrink)

European Journal of Philosophy, EarlyView.

This chapter contains sections titled: Literature and the Moral Life David Lurie Moses Herzog The Category of Orientation.