A timely and penetrating investigation, this book seeks to transform moral philosophy. In the face of continuing disagreement about which general moral principles are correct, there has been a resurgence of interest in the idea that correct moral judgements can be only about particular cases. This view--moral particularism --forecasts a revolution in ordinary moral practice that has until now consisted largely of appeals to general moral principles. Moral particularism also opposes the primary aim of most contemporary normative moral theory that (...) attempts to show that either one general principle, or a set of general principles, is superior to all its rivals. (shrink)

In this article, I urge that mainstream discussions of abortion are dissatisfying in large part because they proceed in polite abstraction from the distinctive circumstances and meanings of gestation. Such discussions, in fact, apply to abortion conceptual tools that were designed on the premiss that people are physically demarcated, even as gestation is marked by a thorough-going intertwinement. We cannot fully appreciate what is normatively at stake with legally forcing continued gestation, or again how to discuss moral responsibilities to continue (...) gestating, until we appreciate in their own terms the goods and evils distinctive of gestational connection. To underscore the need to explore further the meanings of gestation, I provide two examples of the difference it might make to legal and moral discussions of abortion if we appreciate more fully that gestation is an intimacy. (shrink)

I develop two different epistemic roles for emotion and desire. Caring for moral ends and people plays a pivotal though contingent role in ensuring reliable awareness of morally salient details; possession of various emotions and motives is a necessary condition for autonomous understanding of moral concepts themselves. Those who believe such connections compromise the "objective" status of morality tend to assume rather than argue for the bifurcated conception of reason and affect this essay challenges.

Though much progress has been made on inclusion of non-pregnant women in research, thoughtful discussion about including pregnant women has lagged behind. We outline resulting knowledge gaps and their costs and then highlight four reasons why ethically we are obliged to confront the challenges of including pregnant women in clinical research. These are: the need for effective treatment for women during pregnancy, fetal safety, harm from the reticence to prescribe potentially beneficial medication, and the broader issues of justice and access (...) to benefits of research participation. Going forward requires shifting the burden of justification from inclusion to exclusion and developing an adequate ethical framework that specifies suitable justifications for excluding pregnant women from research. (shrink)

In this article, we present an analysis of defeasible generalizations -- generalizations which are essentially exception-laden, yet genuinely explanatory -- in terms of various notions of privileged conditions. We argue that any plausible epistemology must make essential use of defeasible generalizations so understood. We also consider the epistemic significance of the sort of understanding of context that is required for understanding of explanatory defeasible generalizations on any topic.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, (...) not evidence. (shrink)

This chapter sets out to distinguish the sorts of claims have been advanced under the rubric of “moral particularism,” and to sort through the insights and costs of each. In particular, it distinguishes those who are animated by suspicion of theory itself from those who aim to reconfigure — sometimes radically — the nature of theory. It defends as key the particularist insight that exceptions to substantive moral explanations are ubiquitous. It argues that the lesson of this insight is not (...) to abandon moral generalizations, but to change the picture of what they must look like to do their work. (shrink)

If particularism is right, the broad moral claims we make are usually riddled with exceptions. But such generalizations can still be a useful, even necessary part of moral life. They help us show what we should do, and they are essential for understanding why we should do it.

In this paper, I urge that the very real lessons Carol Gilligan's work in moral psychology offer to moral philosophy can best be appreciated if we take seriously the gap between the two disciplines. The care and justice perspectives Gilligan explores are psychological orientations, and orientations are defined as much by matters of emphasis, selectivity of interpretation, and gestalt as they are by propositional commitment. As such, I argue, their contribution to moral theory is best seen as stances from which (...) to do theory, rather than as constituting ready-made theories themselves. In pursuing this train of thought, I examine how Gilligan's work has developed over time and how, in the end, we should understand the juxtaposition between the two orientations. (shrink)

When a woman is pregnant, how should we understand the moral status of the life within her? How should we understand its status as conceptus, as embryo, when an early or again matured fetus? According to some, human life in all of these forms is inviolable: early human life has a moral status equivalent to a person from the moment of conception. According to others, such life has no intrinsic status, even late in pregnancy. According to still others, moral status (...) emerges when sentience does. Until the fetus is conscious - a point somewhere at the end of the second trimester, it has no moral status at all; after it is conscious, it does. (shrink)

Thinking about Reasons collects fourteen new essays on ethics and the philosophy of action, inspired by the work of Jonathan Dancy—one of his generation's most influential moral philosophers.

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not (...) seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (shrink)

: Many have asked how and why feminist theory makes a distinctive contribution to bioethics. In this essay, I outline two ways in which feminist reflection can enrich bioethical studies. First, feminist theory may expose certain themes of androcentric reasoning that can affect, in sometimes crude but often subtle ways, the substantive analysis of topics in bioethics; second, it can unearth the gendered nature of certain basic philosophical concepts that form the working tools of ethical theory.

Many have asked how and why feminist theory makes a distinctive contribution to bioethics. In this essay, I outline two ways in which feminist reflection can enrich bioethical studies. First, feminist theory may expose certain themes of androcentric reasoning that can affect, in sometimes crude but often subtle ways, the substantive analysis of topics in bioethics; second, it can unearth the gendered nature of certain basic philosophical concepts that form the working tools of ethical theory.

When a woman or girl finds herself pregnant, is it morally permissible for her to end that pregnancy? One dominant tradition says “no”; its close cousin says “rarely” - exceptions may be made where the burdens on the individual girl or woman are exceptionally dire, or, for some, when the pregnancy results from rape. On both views, though, there is an enormous presumption against aborting, for abortion involves the destruction of something we have no right to destroy. Those who reject (...) this claim, it is said, do so by denying the dignity of early human life - and imperiling their own. I think these views are deeply flawed. They are, I believe, based on a problematic conception of how we should value early human life; more than that, they are based on a profoundly misleading view of gestation and a deontically crude picture of morality. I believe that early abortion is fully permissible, widely decent, and, indeed, can be honorable. This is not, though, because I regard burgeoning human life as “mere tissue”: on the contrary, I think it has a value worthy of special respect. It is, rather, because I believe that the right way to value early human life, and the right way to value what is involved in and at stake with its development, lead to a view that regards abortion as both morally sober and morally permissible. Abortion at later stages of pregnancy becomes, for reasons I shall outline, multiply more complicated; but it is early abortions - say, abortions in the first half of pregnancy - that are most at stake for women. (shrink)

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

To make progress on the moral status of abortion, it turns out, requires us not just to arbitrate already familiar controversies in metaphysics and ethics, but to attend to the distinctive aspects of pregnancy that often stand at their margins. In the following, I want to argue that if we acknowledge gestation as an intimacy. motherhood as a relationship, and creation as a process, we will be in a far better position to appreciate the moral textures of abortion. I explore (...) these textures, in the first half on stipulation that the fetus is a person, in the second half under supposition that early human life has an important value worthy of respect. (shrink)

This chapter contains sections titled: Fetal Personhood: From Wrongful Interference to Positive Responsibilities The Sanctity of Life: Respect Revisited.

: Originally presented during Ethic Rounds at the Dana-Farber Cancer Institute, this commentary on the case of a patient treated for life-threatening cancer explores the responsibilities of health care providers when addressing the patient's desire to adopt a child.

In lieu of an abstract, here is a brief excerpt of the content:IntroductionMargaret Olivia Little (bio)Increasingly, conversations in bioethics include questions or claims about the contribution that feminist analyses might offer the field. In March 1995, the Kennedy Institute of Ethics devoted its annual Advanced Bioethics Course to an exploration of feminist approaches to bioethics. This special issue of the Kennedy Institute of Ethics Journal, which supplements the September 1995 issue on principlism and several alternative approaches to health care ethics, (...) grew out of that course, containing articles written by those who presented its central lectures.The first article serves as an introduction to the topic. I take seriously the often-asked questions of why and in what way feminism should be thought relevant to bioethics. Appreciating feminism’s distinctive contribution to the field requires appreciating some of the central themes common to virtually all feminist theory. Accordingly, I set out and develop two themes that are basic to feminism; I then give several examples of how various bioethical issues might be framed and analyzed differently when approached with awareness of these tenets. Feminist theory offers a critical tool for bioethics, I argue, both by revealing androcentric reasoning that can affect—sometimes subtly and sometimes crudely—substantive analyses of bioethical issues, and by helping us to re-think and refine aspects of ethical theory that form the conceptual tools of use to bioethicists.In the second article, Alisa Carse and Hilde Lindemann Nelson take up one of the most famous theories associated with feminist philosophy, the “ethic of care,” inspired originally by Carol Gilligan’s work. While the ethic is much touted, it is also much criticized—sometimes, importantly, from distinctly feminist angles. Carse and Nelson deepen the debate by suggesting directions that a sophisticated version of the theory should take. They address four common criticisms of the care approach, some from “mainstream” theorists and some from feminist voices, and then outline how the ethic can be developed to answer these concerns.It is often pointed out that feminism is not a monolithic theory. While the diversity of approaches and policy recommendations contained within feminism is in many ways a healthy one, such diversity can be frustrating and potentially undermining of feminism’s contribution to fields such as bioethics. In the third article, Rosemarie Tong discusses the differences and commonalities among various feminist theories, with an eye [End Page vii] toward developing a strategy that feminists might take in their attempts to advance conversations in bioethics. She first provides a lucid outline of the three main branches of feminist theory—liberal, cultural, and radical—and illustrates their distinct approaches by contrasting how each would approach the controversial topic of “surrogate” or contract motherhood. Having highlighted the differences among the three approaches, she then indicates their shared theoretical base. She ends by suggesting strategies that feminists might want to take, in light of these common factors, to maximize the influence their voices can and should have in bioethics.One question commonly asked is what difference feminism’s distinctive theoretical approach makes when applied to the concrete issues bioethicists have traditionally discussed. In the fourth article, James Lindemann Nelson considers a topic of central importance to modern bioethics, the distribution of scarce health care resources, and demonstrates how differently we might analyze the issue if we view it through the lens of feminist theory. More specifically, he examines the work of several sophisticated, mainstream authors writing on the subject, such as Frances Kamm, Norman Daniels, Dan Brock, and Ezekiel Emanuel, and indicates various places in which a feminist analysis will reveal problems in the analyses that might otherwise remain hidden—problems, for instance, in methodology, in how the issues are framed, in the conceptions of justice employed, and in the relative insensitivity to questions about power distribution. At the same time, Nelson explores ways in which such mainstream work offers material that is valuable to a feminist picture of allocation questions. In the end, he urges, both sides have lost by the lack of dialogue between them.In the final article, Karen Rothenberg discusses the intersection of bioethics, feminist theory, and the law. She traces how the differences among the three central camps of feminist theory yield different theories of feminist jurisprudence... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Procreative Liberty, Biological Connections, and MotherhoodMargaret Olivia Little (bio)Given the complex and dramatic array of issues currently facing us in reproductive ethics, bioethicists working on the topic might be forgiven feelings of trepidation when they cast their minds toward the next century. Currently, technologies such as artificial insemination by donor (AID), once the source of intense controversy, are used on a routine basis; mainstream newspapers carry advertisements offering “excellent (...) compensation” to ova “donors;” courts are arguing whether women who serve as gestational or “surrogate” mothers have any parental rights; and proposals resurface to jail pregnant women who take street drugs. Sorting out which developments are to be welcomed and which are to be resisted—and why—will require us not only to clarify some of our most basic value commitments, but also to reflect on our understanding of concepts, such as motherhood, that we previously had the luxury of thinking obvious. Let me highlight two issues I think we will be forced to confront as we try to navigate the ethics of reproduction into the twenty-first century—namely, the value of biological connection and the meaning of motherhood.Procreative Liberty and the Value of Biological ReproductionPeople who are unable to conceive a child or to carry one to term now face a variety of extraordinary means of procreative assistance: they can buy sperm and ova, undergo in vitro fertilization, or contract another woman to gestate and give birth to the baby. Those who are enthusiastic about these new technologies [End Page 392] and arrangements often explain their support in terms of many people’s deep desire or even right to bear children biologically related to them; those who are suspicious of the techniques often explain their resistance by criticizing our culture’s “pronatalist” emphasis on biological rather than social relations with children. Focusing on such clear-cut positions, though, undersells the complexity and difficulty of the issues involved. Few want to dismiss altogether the importance of biological connection; but the question remains, what measure of importance should it be granted? Or again, while most agree that procreative liberty is one of our most fundamental rights, the question remains, whose procreation, in what context, and by which means? The truly difficult questions, that is, pertain to how we are to value biological relatedness and how we are to draw the contours of procreative liberty.One perspective emerging in current debates urges an expansive answer to these questions, arguing that the new reproductive technologies and arrangements deserve constitutional protection. Procreative liberty is deeply important, it is urged, given how fundamental the decision to have or to refrain from having children is to our sense of dignity, identity, and meaning of life. But if we recognize a right to reproduce coitally, it is claimed, we should also recognize a right to reproduce noncoitally: people with infertile partners should no more be barred from exercising their right to “beget, bear, and raise” children biologically linked to them by using surrogate arrangements or AID than those who are blind should be barred from exercising their right to written information by using Braille texts. 1The fundamental question is whether the value of biological reproduction persists when pursued outside of the intimacies of marriage and family that form its traditional home. The new reproductive technologies and arrangements, after all, represent a departure not simply because they are noncoital but because they involve reproduction with strangers, under contract, and for pay. One question that demands our reflection, then, is whether the procreative liberty we value attaches to individuals atomistically, as it were, or to individuals only insofar as they are in relationships of an intimate and ongoing nature.Other developments on the horizon sound a restrictive note about procreative liberty. Many IVF clinics, for instance, have denied services to would-be single parents or to gay or lesbian couples. Some legislators have proposed making certain welfare payments for women conditional upon their use of contraceptives such as Norplant—an odd view if one regards procreative liberty as a fundamental right. After all, we do not usually make the receipt of public aid contingent on waiving a constitutional right. (Imagine the government stipulating that... (shrink)

I defend moral objectivism against charges that it cannot plausibly preserve or explain morality's action-guiding nature. I take as my starting point the intuitive view that morality has a special connection to motivation: one who genuinely accepts a moral verdict must have a motivating reason to follow its dictates and, indeed, must often enough be motivated to act as it recommends. ;Many have argued that this connection vindicates subjectivism. Some argue that there can be no universally accessible truths whose acknowledgements (...) necessarily give one reason to act, because all reasons for action are based on desires that vary across rational agents. I argue against the Humean doctrine, implicit in this claim, that beliefs alone cannot move rational agents. The 18th-century metaphors of "passive" belief and "active" desire rest on arguments which either beg the question, equivocate, or misunderstand what would be involved in attributing the appropriate motivational power to belief. Others ground their objection in morality's holistic tie to desire, claiming that desires distort truth, rather than reveal it to us. I argue that there is nothing mysterious about the idea that possession of certain desires can be preconditions to seeing how things are. (shrink)