What proportion of available healthcare funds should be allocated to hip replacement operations and what proportion to psychiatric care? What proportion should go to cardiac patients and what to newborns in intensive care? What proportion should go to preventative medicine and what to treating existing conditions? In general, how should limited healthcare resources be distributed If not all demands can be met?

Few subjects have generated so many newspaper headlines and such heated controversy as the treatment, or non-treatment, of handicapped newborns. In 1982, the case of Baby Doe, a child born with Down's syndrome, stirred up a national debate in the United States, while in Britain a year earlier, Dr. Leonard Arthur stood trial for his decision to allow a baby with Down's syndrome to die. Government intervention and these recent legal battles accentuate the need for a reassessment of the complex (...) issues involved. This volume--by two authorities on medical ethics--presents a philosophical analysis of the subject based on particular case studies. Addressing the doctrine of the absolute sanctity of life, Singer and Kuhse examine some actual cases where decisions have been reached; consider the criteria for making these decisions; investigate the differences between killing and letting die; compare Western attitudes and practices with those of other cultures; and conclude by proposing a decision-making framework that offers a rational alternative to the polemics and confusion generated by this highly controversial topic. (shrink)

This second edition of _A Companion to Bioethics,_ fully revised and updated to reflect the current issues and developments in the field, covers all the material that the reader needs to thoroughly grasp the ideas and debates involved in bioethics. Thematically organized around an unparalleled range of issues, including discussion of the moral status of embryos and fetuses, new genetics, life and death, resource allocation, organ donations, AIDS, human and animal experimentation, health care, and teaching Now includes new essays on (...) currently controversial topics such as cloning and genetic enhancement Topics are clearly and compellingly presented by internationally renowned bioethicists A detailed index allows the reader to find terms and topics not listed in the titles of the essays themselves. (shrink)

The expanded and revised edition of _Bioethics: An Anthology_ is a definitive one-volume collection of key primary texts for the study of bioethics. Brings together writings on a broad range of ethical issues relating such matters as reproduction, genetics, life and death, and animal experimentation. Now includes introductions to each of the sections. Features new coverage of the latest debates on hot topics such as genetic screening, the use of embryonic human stem cells, and resource allocation between patients. The selections (...) are independent of any particular approach to bioethics. Can be used as a source book to complement _A Companion to Bioethics_. (shrink)

This chapter contains sections titled: Medical Ethics Nursing Ethics Bioethics References.

New developments in reproductive technology have made headlines since the birth of the world's first in vitro fertilization baby in 1978. But is embryo experimentation ethically acceptable? What is the moral status of the early human embryo? And how should a democratic society deal with so controversial an issue, where conflicting views are based on differing religious and philosophical positions? These controversial questions are the subject of this book, which, as a current compendium of ideas and arguments on the subject, (...) makes an original contribution of major importance to this debate. (shrink)

Impartialism in ethics has been said to be the common ground shared by both Kantian and utilitarian approaches to ethics. Lawrence Blum describes this common ground as follows: Both views identify morality with a perspective of impartiality, impersonality, objectivity and universality. Both views imply the ‘ubiquity of impartiality” – that our commitments and projects derive their legitimacy only by reference to this impartial perspective.

We examine the view that all human life is of equal worth or sanctity. We find that this view is a legacy of the Judeo- Christian tradition, and cannot be justified in non - religious terms. We therefore argue that it should be rejected, and that we should openly acknowledge that some Jives are of less worth than others. We then consider a common objection: that this will lead us down a slippery slope to Nazi- style atrocities. We give our (...) reasons for finding this objection unpersuasive. We explain why no-one has any grounds for feeling threatened by our proposal. Finally we discuss who should make the decision involved in selecting whether a person should come into existence, and how that decision should be carried out. (shrink)

In _The Moral of the Story,_ Peter and Renata Singer draw on some of the best works of fiction, playwriting, and poetry in order to shed light on the perennial questions of ethics. A vivid montage of literature that touches on a broad range of ethical subjects and themes Offers a unique contribution to the study of moral philosophy and literature Demonstrates how literary sources can add richness to discussions of real-life moral questions and dilemmas Brings together selections (...) and excerpts from the world’s most celebrated short stories, novels, plays, and poetry Features substantive section introductions by Peter and Renata Singer Peter Singer is a leading moral philosopher, widely credited with triggering the modern animal-rights movement. His collection of essays, _Unsanctifying Human Life,_ edited by Helga Kuhse, was published by Blackwell Publishing in 2001. (shrink)

The association of women with caring dispositions and thinking has become a persistent theme in recent feminist writing. There are a number of reasons for this. One reason is the impetus that has been provided by the empirical work of Carol Gilligan on women’s moral development. The fact that this association is not merely an ideologically or philosophically postulated one, but is argued for on empirical grounds, tends to add to its credibility. Another reason for the resilience of the association (...) is the existence of an increasingly prominent theme in feminist thought and action that focuses on the importance of women’s difference from men, both as a fact and as a goal. Within this theme, there are various views on what the relevant differences are between women and men, and why the differences ought to be emphasized and properly respected. Women’s caring, as will be seen, turns out to have a firm presence in all of these views, and as a result, many women argue that caring should form the basis of a distinctive feminist ethic. On these views, women’s approaches to understanding moral situations, defining selfconceptions, choosing goals and roles, and guiding behaviour, should all be informed by and based upon dispositions of caring. However, if this idea of a feminist ethic of care is to be plausible, it will need to be reconciled with another strong theme in feminism, according to which in fundamental moral respects women ought not be considered or treated differently from men. We will examine the standing of a feminist ethic of care in the context of this tension between the difference theme and the sameness theme in feminism. The discussion begins by re-characterizing the justice and care debate in terms of impartialist and partialist ethical perspectives, and it then goes on to indicate the various ways in which women’s presumed disposition to caring and partialism finds prominence within the difference theme. The central focus of the discussion, however, will be the question of how to reconcile the conflict that exists between impartialist, justice-based moral thinking, and a partialist, caring approach to morality.. (shrink)

This article presents an empirical study of approaches to ethical decision-making among nurses and doctors. It takes as its starting point the distinction between the perspectives of care and of justice in ethical thinking, and the view that nurses' thinking will be aligned with the former and doctors' with the latter. It goes on to argue that the differences in these approaches are best understood in terms of the distinction between partialist and impartialist modes of moral thinking. The study seeks (...) to determine the distribution of these modes of thinking between nurses and doctors, and finds that there are no signif icant differences between them. A 'two-level' philosophical view of the nature of moral thinking is appealed to in order to explain the study findings. (shrink)

To give priority to the young over the elderly has been labelled ‘ageism’. People who express ‘ageist’ preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this as egalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call this utilitarian ageism. Both these (...) forms of ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits, and hence old age, should count in prioritising at the budget level in health care. (shrink)

To give priority to the young over the elderly has been labelled ‘ageism’. People who express ‘ageist’ preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this asegalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call thisutilitarian ageism. Both these forms of (...) ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits, and hence old age, should count in prioritising at the budget level in health care. (shrink)

Since 1989 there has been an ongoing controversy about the limits of public discussion of bioethical issues in the German-speaking world. While a number of scholars have been involved, Peter Singer and Helga Kuhse have been the principal targets of those seeking to limit bioethical debates. Those who have supported silencing discussion of certain issues have argued that such public discussion leads to a loss of freedom. In the article we argue that toleration is not based (...) on subjectivism but rather on reason. Furthermore, the efforts to suppress debate are often based on a failure to understand our position. Such efforts at suppression also rest on an elitist view of society that must assume that the general public cannot debate such topics. (shrink)

In German-speaking countries, there have been concerted and successful attempts to prevent any discussion of euthanasia from taking place. Both the present writers have been invited to give lectures on this topic, and had these lectures cancelled at short notice because of this opposition. Against that background, we welcome Pauer-Studer’s airing of these issues, and her clear statement that attempts to prevent advocates of euthanasia from speaking are “definitely unacceptable.” Nevertheless, we find much that Pauer-Studer says to be in error.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Peter Singer and Christian Ethics: Beyond Polarization by Charles E. CamosyWerner WolbertPeter Singer and Christian Ethics: Beyond Polarization CHARLES E. CAMOSY Cambridge: Cambridge University Press, 2012. 278 pp. $29.99Peter Singer’s “Copernican revolution” against a sanctity of life ethic may be regarded, from a Roman Catholic viewpoint, as an expression of the “culture of death” denounced by John Paul II. One must keep in mind, (...) however, that “we know that historically there have been times where those participating in discussions about ethics disagree deeply about theory, but nevertheless come to important and even broad agreement about applied or practical ethics” (179). The aim of Camosy’s book is to sketch the various areas of agreement and disagreement between Peter Singer and Catholic moral theology as well as the possibilities of working together.There are issues even about the subject of abortion on which Singer and the Church agree: that moral relativism is wrong; that it is seriously wrong to kill a person; that the right to privacy (see Roe vs. Wade) does not apply to acts harming others; and that the right to abortion is not a constitutional matter (chapter 1). Both positions see a connection between abortion and infanticide, but both draw different conclusions. The disagreements between them are about who is to count as a person, which Camosy comments on in the rest of chapter 1 (27–37). In the area of euthanasia, the Church and Singer share some skepticism about brain death (chapter 2). Camosy discusses the church’s position on one’s moral status at the end of life and the Roman Catholic understandings of ordinary and extraordinary means, acts, and omissions. Commenting on public policy in that field, Camosy gives some useful and convincing illustrations of the slippery slope effect in different countries that have legalized active euthanasia or assisted suicide (68–81).With regard to problems of killing, however, Helga Kuhse’s The Sanctity of Life Doctrine in Medicine (Oxford University Press, 1987) should perhaps have been considered. On the subject of acting and refraining, I would recommend Dieter Birnbacher’s Tun und unterlassen (Reclam 1995).Commenting on Singer’s championing of the moral status of nonhuman animals, Camosy points to elements in the Christian tradition that may support Singer’s issue of animal liberation (chapter 3). I wonder why the discussion concentrates on domestic animals and the problems of eating meat or [End Page 225] vegetarianism but omits problems of environmental ethics (e.g., ecological balance). Would the aim of avoiding animal harm include saving animals from predators? And if some animals are to be regarded as persons, we may get in trouble with our basic conviction of the equality (of the dignity) of human beings—as the debate on the margins of human life shows.Duties to the poor are not in dispute except for “partial preferences” (166) for members of our family, kinship, or country (chapter 4). Speaking of “partiality” in this context is, however, a bit misleading. Since no one can care for all people, preferences of an ordo caritatis (order of love) are a necessary part of a system of coordination from which—ideally—all humans can benefit. (Recall Augustine in De doctrina Christiana, 1.28–29: “The interests of society, however, and its common bonds will be best conserved if kindness be shown to each individual in proportion to the closeness of his relationship.”) Chapter 5, which compares Singer’s ethical theory with Catholic moral theology, would need more discussion (e.g., on double effect, object, and act), which I cannot cover within the limits of this review. Overall, Camosy’s book makes a valuable contribution to the dialogue between Christian and secular ethics.Werner WolbertUniversity of SalzburgCopyright © 2014 Society of Christian Ethics... (shrink)

Helga Kuhse and Peter Singer recently examined the view expressed by John Lorber that whereas at times it is permissible to allow severely handicapped infants to die, killing them must never be allowed. In attempting to demonstrate the mistaken nature of Lorber's fear that allowing active infanticide would lead us onto a slippery slope Kuhse and Singer make much use of John Harris's paper in the Journal of Medical Ethics in which he criticised Lorber's (...) views. This paper examines some aspects of the case advanced by Kuhse and Singer and of the earlier paper by Harris. (shrink)

Peter Singer and Helga Kuhse reject my claim that because their views on the mortality of infanticide are metaphysically incommensurate with those of Paul Ramsey they cannot refute his position. According to them, I have failed to see that Ramsey contradicts himself. Once this is seen, no further refutation is needed. I argue that there is no contradiction and offer further thoughts on the metaphysically incommensurate.

_ _ _Unsanctifying Human Life_ offers a collection of Singer's best and most challenging articles from 1971 to the present. The book includes early critiques of various approaches to philosophy and the role of philosophers, followed by controversial works on the moral status of animals, infanticide, euthanasia, the allocation of scarce health care resources, embryo experimentation, environmental responsibility, and reflections on how we should live.

The article examines five controversial views, expressed in Jonathan Swift’s _A Modest Proposal_, Helga Kuhse and Peter Singer’s _Should the Baby Live? The Problem of Handicapped Infants_, Alberto Giubilini and Francesca Minerva’s “After-birth abortion: why should the baby live?”, Julian Savulescu’s “Procreative beneficence: why we should select the best children”, and the author’s “A rational cure for prereproductive stress syndrome”. These views have similarities and differences on five levels: the grievances they raise, the proposals they make, (...) the justifications they explicitly use, the justifications they implicitly rely on, and the criticisms that they have encountered. A comparison of these similarities and differences produces two findings. First, some controversial views based on utilitarian considerations would probably fare better flipped upside down and presented as Juvenalian satires. Secondly, a modicum of humor or modesty could help presenters of controversial views to stir polite critical discussion on the themes that they put forward. (shrink)

The multidisciplinary nature of bioethics can result in narrow sub-specialists within the field, whose work reflects the issues and concerns most relevant to their home discipline. This can result in work which is insensitive to the important ways in which particular areas of bioethics are interrelated, and which (while viable in the context of the sub-specialty) is not viable in a broader context. The narrow focus of many healthcare ethics committees on issues directly related to clinical patient care can exacerbate (...) this problem. Increasingly, issues in the clinical care of patients cannot be separated from issues in research, organizational ethics, and public policy. I argue that these problems call for a need to identify core areas for bioethics education. This is especially true for education of hospital ethics committees, which incresingly face complex cases involving concerns that fall outside traditional patient care issues. I then consider nine areas examined in detail in A Companion to Bioethics edited by Helga Kuhse and Peter Singer, as potential candidates for core areas of bioethics education. At the same time, I evaluate the range of issues examined in each area of the book, in the context of the books ability to provide an introduction to each area. (shrink)

This paper discusses the attempt in this issue of the journal by Peter Singer, John McKie, Helga Kuhse and Jeff Richardson, to defend QALYs against the argument from double jeopardy which I first outlined in 1987. In showing how the QALY and other similar measures which combine life expectancy and quality of life and use these to justify particular allocations of health care resource, remain vulnerable to the charge of double jeopardy I am able to clarify (...) some of the central issues concerning the value of life. In particular, the idea that the value of a life varies with its life expectancy and with its quality, understood in terms of its richness, variety, success etc, is subjected to special examination. It is shown how defenders of QALYs are committed to the view that so far from all lives being of equal value, all lives are necessarily of subtly different value. The paper then analyses the use to which the notorious 'veil of ignorance' has been put both by Singer et al and by others and shows how this device of John Rawls's cannot do the work so often assigned to it. The paper then considers the issue of hypothetical consent and the role that it can play in justifying disposing of the lives of people who have not in fact consented to their lives being disposed of in particular ways. Finally, the paper makes some points about the comprehensive nature of the data collection and storage which would be required by QALY advocates and points out the independent problems attaching to licensing such comprehensive collection and use of personal data. (shrink)