A moral dilemma is a situation in which an agent ought to do each of two actions, Both of which he cannot do. If there are genuine moral dilemmas, The ethical theorist is presented with a problem: he must reject several very plausible principles of standard deontic logic. The main reasons usually given to show that there are moral dilemmas are examined, And it is argued that they are not sufficient. Several positive arguments are then presented, Arguments which try to (...) show that an adequate moral theory must rule out the possibility of genuine dilemmas. (shrink)

Most codes of research ethics and the practice of Institutional Review Boards (IRBs) allow human subjects to withdraw from research at any time. Consent forms invariably make a statement to this effect. So understood, a subject's right to withdraw from research is inalienable; she cannot, through her consent, surrender this right. Recently critics have argued that in selected circumstances the right to withdraw from research is alienable; subjects have the moral authority, through their consent, to obligate themselves not to withdraw. (...) Two kinds of cases have been cited to support this. In one case, there will be great benefits lost if subjects are permitted to withdraw before the completion of the protocol. In the other case, there will be harm to third parties if subjects withdraw from the experiment. In this paper, I defend the inalienability of the right to withdraw from research. I argue, first, that securing the desired benefits and avoiding the feared harms can be achieved without allowing waiver. Second, I show that permitting waiver in these cases does not guarantee that the ends sought will be achieved. And third, I articulate positive reasons for conceiving subjects' right to withdraw from research as inalienable. (shrink)

This paper has two purposes. One is primarily (but not exclusively) conceptual and the other is normative. The first aim is to say what inalienable rights are. To explain this, inalienable rights are contrasted with the notions of forfeitable rights and absolute rights. A recent novel analysis of inalienable rights by Feinberg is explained and criticized. The first task is concluded by discussing what duties inalienable rights imply. The second aim is to see what moral principles, if any, justify designating (...) some rights as inalienable. The claim of Nozick and others that inalienable rights must be paternalistically grounded is examined and rejected. After a brief critical discussion of the Lockean and Hobbesean accounts of the basis of inalienable rights, it is argued that the harm principle can serve as an adequate ground for categorizing at least the right to life (and perhaps other rights) as inalienable. (shrink)

Recently a well-known magazine published an article entitled ‘Moral Specialist.’ This article recounts the activities of Russell McIntyre, described by the authors as a theologian and philosopher who specializes in bioethics. McIntyre is routinely consulted by physicians for help in solving ethical problems. He is asked for moral advice on such matters as abortion, euthanasia, and sterilization for teenagers. McIntyre even wears an electronic ‘beeper’ so that when untimely moral quandaries arise he can easily be reached. McIntyre says that ultimately (...) such moral decisions should be made by the people involved — the physician, the patient, and the family. However, he claims that there are still many gray areas in bioethics ‘where it is best to call in an expert for consultation.’. (shrink)

Authors such as Francis Fukuyama, the President's Council on Bioethics, and George Annas have argued that biotechnological interventions that aim to promote genetic enhancement pose a threat to human nature. This paper clarifies what conclusions these critics seek to establish, and then shows that there is no plausible account of human nature that will meet the conditions necessary to support this position. Appeals to human nature cannot establish a prohibition against the pursuit of genetic enhancement.

Many maintain that if a beneficiary has a right to a benefit provided by his benefactor, then the former cannot owe the latter gratitude for that benefit. In this paper I argue against that view. I provide examples in which benefactors provide others with benefits to which they have a right even though most others are denying them that right. These benefactors are moral standouts; they do what is right when most similarly situated agents fail to do so. I then (...) spell out some of the features of these benefactors’ actions that make them worthy of gratitude. (shrink)

Consent forms given to potential subjects in research protocols typically contain a sentence like this: “You have a right to withdraw from this study at any time without penalty.” If you have ever served on an institutional review board or a research ethics committee, you have no doubt read such a sentence often. Moreover, codes of ethics governing medical research endorse such a right. For example, paragraph 24 of the Declaration of Helsinki says, “The subject should be informed of the (...) right… to withdraw consent to participate at any time without reprisal.” Similarly, section C of the Belmont Report says that subjects must be informed that they have the right “to withdraw at any time from the research.” And in section 46.116 of the Common Rule, it says that one of the elements of informed consent must include a statement that “the subject may discontinue participation at any time without penalty or loss of benefit to which the subject is otherwise entitled.”. (shrink)

This paper examines two contexts in ethical theory that some have thought support the claim that attempts, rather than actions, are what are morally required of agents. In each context there is an appeal to the principle that 'ought' implies 'can'. I begin by explaining how I think appeals to this principle typically work. I conclude that not only do the contexts in question not demonstrate that moral requirements range over attempts, but also that any argument in support of that (...) conclusion has serious obstacles to overcome. (shrink)

McConnell presents the unusual and distinctive argument that inalienable rights differ from other types of rights in that, rather than restraining the behaviour of others, inalienable rights seem to put limits on the possessors themselves, because even the possessor's consent does not justify others in encroaching on them. He offers a full account of what it means for a right to be inalienable, distinguishing them from other kinds of rights in the contexts of moral and political issues in medicine and (...) law: for example, the right to life, the right of conscience, and, in particular, the right of informed consent. McConnell's book is intended as a distinctive conception and persuasive defence of inalienable rights, which ties into current discussions of informed consent. It should appeal to applied ethicists and philosophers of law among others. (shrink)

Psychologists and philosophers have written much about gratitude recently. Many of these contributions have endorsed expansionist views of gratitude, counseling agents to feel and express gratitude in many circumstances. I argue that the essential features of the moral norm of gratitude are that a beneficiary acknowledges and appreciates benefits provided by another who is acting from beneficence, and is disposed to provide a comparable benefit to the benefactor if a suitable occasion arises. The best-known philosophical version of expansionist views claims (...) that gratitude is apt even in cases where the “benefactor” not only did not intend to benefit the other, but intended to harm her. In the psychological literature, expansionists typically do distinguish between being grateful to and being grateful that. But they also write as if there is one general character trait of gratefulness. In this paper I argue that the philosophical position considered is mistaken on conceptual and moral grounds, and that the dominant view among psychologists fails to recognize the difference between two different traits of gratitude, one a moral virtue and the other a prudential virtue. (shrink)

Several authors, including Michael Sandel, distinguish between two different attitudes toward nature: mastery and giftedness. Giftedness is the superior attitude, Sandel argues, because it better accords with the values of humility, responsibility, and solidarity. And giftedness, in combination with these values, provides a rational basis for opposing the employment of genetic enhancement. Against this, I argue that talents and genetic endowment are more plausibly viewed as undeserved, that not everything undeserved is a gift, and that even if talents and endowment (...) were gifts, this would not support a prohibition against pursuing genetic enhancement. (shrink)

Over the past decade, genetic tests have become available for a wide variety of disorders. As a result we are able to predict, with some degree of certainty, whether or not an individual will develop such diseases as breast cancer, Huntington's disease, polycystic kidney disease, and familial adenomatous polyposis. The ability to predict disease poses several unique ethical considerations for clinical decisionmaking regarding the provision of genetic testing. Patients must be able to comprehend the complexities of genetic testing and the (...) potential meaning of the results. Patients must consider the emotional, social, and economic consequences of revelations regarding their risk status. Also, obtaining information on risk status may have implications for persons other than the individual seeking genetic testing. (shrink)

Codes of medical ethics issued by professional organizations typically contain statements affirming the importance of confidentiality between patients and health-care practitioners. Seldom, however, is the confidentiality obligation depicted as absolute. Instead, exceptions are noted, the most common of which is that health-care professionals are justified in breaching the confidence of a patient if required by law to do so. Reasons that might be given to support this exception are critically discussed in this paper. The conclusion argued for is that this (...) is not a legitimate exception to the confidentiality rule. (shrink)

In "The Theory of Morality" Alan Donagan discusses two problems recently raised for anti-consequentialist moral theories. He calls these "cases of necessity" and "the problem of dirty hands." What is common to each is that anticonsequentialist theories seem to posit requirements the fulfillment of which sometimes results in disastrous consequences. Donagan argues that the anticonsequentialist theory which underlies the Hebrew-Christian moral tradition can avoid these problems. It is argued that Donagan's defense is inadequate. At the end of the paper what (...) the anticonsequentialist must do to deal with these problems is discussed. (shrink)

When discussing the allocation of medical resources, it is common to distinguish between macroallocation and microallocation. The former refers to an entire system of healthcare; it determines who gets access to what healthcare and on the basis of what criteria.

This book explains what inalienable rights are and how they restrict the behavior of their possessors. McConnell develops compelling arguments to support the inalienability of the right to life, the right of conscience, and a competent person's right not to have medical treatment administered without consent. Yet, surprisingly, he argues that the inalienability of the right to life does not entail that voluntary euthanasia or assisted suicide are wrong. This distinctive defense of inalienable rights will appeal to medical ethicists and (...) other applied ethicists, political theorists, and philosophers of law. (shrink)

When the demand for a medical resource exceeds the supply, we have a problem of scarcity. There are many instantiations of this issue. The time of health care providers during an emergency, organs for transplantation, a bed in an intensive care unit, and a slot in a research protocol can all be scarce resources. Interest in this issue has been renewed because of recent concerns about a pandemic and shortages of vaccines. In each of these cases there is a problem (...) of distributive justice. If the resource is lifesaving, then the question is especially poignant: Who shall be saved when not all can be? This was the problem faced by Sir Dr. Colenso Ridgeon in Bernard Shaw's 'The Doctor's Dilemma', a play first performed a century ago. (shrink)

Included among the many topics on which Aristotle writes in the Nicomacheon Ethics is an account of incontinence or akrasia. Many controversies have arisen among interpreters of Aristotle on this issue, and a few of these disputes will be discussed in this paper. In the first part of this paper I shall indicate the usual way of reading Aristotle's account of incontinence, which I shall call the natural interpretation. In the second section I shall raise some apparent difficulties with the (...) natural interpretation by pointing out three passages in the Nicomacheon Ethics which seem to be inconsistent with it. Finally, in the concluding three sections of this paper I shall argue that the three passages allegedly inconsistent with the natural interpretation can be shown to be consistent with the general line of argument that the natural interpretation takes Aristotle to be following. In showing how these passages can be reconciled with the usual way of reading Aristotle's account of akrasia, a much clearer and more complete picture of what his view is emerges. In addition, this reading makes Aristotle's account of incontinence more philosophically acceptable - though it is not without its problems - than it is normally supposed to be. (shrink)

Next SectionDr Thomas Stockmann, the protagonist of Ibsen's play, An Enemy of the People, discovers a serious health threat in the Baths of his Norwegian town. The Baths have been marketed as a health resort to lure visitors. Dr Stockmann alerts officials about the problem and assumes that they will close the Baths until it is corrected. He is met with fierce resistance, however. His brother, the town's mayor, favors keeping the Baths open and correcting the problem gradually. He advances (...) multiple arguments that appeal to the economic interests of the town and Thomas's role-related obligation as a citizen. His wife, Katherine, wants him to cooperate with the mayor. She marshals several arguments that appeal to his obligations as a father. This paper reconstructs and examines the competing arguments, shows how Ibsen's play has both contemporary relevance and moral depth, and demonstrates how Dr Stockmann's responses can be interpreted as an argument that complying with his duties to protect the public health do not force him to renege on his core commitments as a parent and as a citizen. (shrink)

Suitable for courses in Medical Ethics, Bioethics, Moral Issues in Medicine/Health Care, or as a supplement for courses in Contemporary Moral Issues. Appropriate for use in nursing, pre-med, and public administration programs as well as in philosophy departments.