This book, like the practice of medicine itself, is about the value of life. Health care is one of the clearest and most visible expressions of a society's ...

本书系统地分析和探讨了清教伦理思想、启蒙伦理思想、先验主义伦理思想、实用主义伦理思想、唯心主义伦理思想、自然主义伦理思想、元伦理学、应用伦理学在美国的发展状况,展现了美国伦理思潮演变的历史脉络,勾画了 其中比较清晰的三条线索:重个人的倾向;重实用的倾向;与宗教捆绑的倾向。.

The Value of Life is an exploration of the actual and perceived importance of biological diversity for human beings and society. Stephen R. Kellert identifies ten basic values, which he describes as biologically based, inherent human tendencies that are greatly influenced and moderated by culture, learning, and experience. Drawing on 20 years of original research, he considers: the universal basis for how humans value nature differences in those values by gender, age, ethnicity, occupation, and geographic location how (...) environment-related activities affect values variation in values relating to different species how vlaues vary across cultures policy and management implications Throughout the book, Kellert argues that the preservation of biodiversity is fundamentally linked to human well-being in the largest sense as he illustrates the importance of biological diversity to the human sociocultural and psychological condition. (shrink)

Friedrich Nietzsche insisted that despite what philosophers and prophets have taught, suffering is desirable because it increases vitality and provides opportunities for growth. This is why one of his main criticisms of the pessimism and nihilism of his time is that they treat suffering as an argument against the value of life and in doing so, life is devalued by them. In an effort to find an alternative mode of valuation, he proposes that human beings should adopt (...) an attitude of acceptance and affirmation toward suffering, making it possible to positively value life despite its pain. However, while some experiences of suffering are beneficial, even necessary, others are utterly destructive. Nietzsche’s critique of his culture is deeply incisive and rightly insists that a revaluation of existing values is in order, the goals of which are rooted in his commitment to “make life bearable” and increase wellbeing. However, because his interpretation of suffering fails to acknowledge destructive suffering, the value of his proposed mode of valuation is limited in two ways. First, destructive suffering, which causes only harm, undermines both of the goals of revaluation. Attempting to affirm destructive suffering would also constitute masochism, which Nietzsche finds objectionable. Second, Nietzsche’s insistence that suffering is beneficial informs his view that compassion is bad. However, attending to the suffering of others will not make it impossible to leave them in pain when that pain is necessary and preserves the possibility of interceding on their behalf when doing so will limit destructive suffering, which increases wellbeing. Furthermore, because it ignores the social aspect of our lives life affirmation cannot be used to revalue all of our values. The value of the affirmative attitude is limited and Nietzsche fails to account for this because, in regards to both one’s own experiences and the experiences of others, his account of suffering disregards the existence of destructive suffering. Ultimately, if the goals of Nietzsche’s project are to be met, the use of additional methods of revaluation will be necessary. (shrink)

That life has value is a tenet eliciting all but universal agreement, be it amongst philosophers, policy-makers, or the general public. Yet, when it comes to its employment in practice, especially in the context of policies which require the balancing of different moral choices—for example in health care, foreign aid, or animal rights related decisions—it takes little for cracks to appear and for disagreement to arise as to what the value of life actually means and how (...) it should guide our actions in the real world. I argue that in no small part this state of affairs is a consequence of the infirmity of the foundations that the claim respecting the value of life supervenes upon once its theological foundations are abandoned. Hence, I depart radically from the contemporary thought and argue that life has no inherent value. Far from lowering the portcullis to Pandemonium, the abandonment of the quasi-Platonistic claim that life has intrinsic value, when understood and applied correctly, leads to a comprehensive, consistent, and compassionate ethical framework for understanding the related problems. I illustrate this using several hotly debated topics, including speciesism and show how the ideas I introduce help us to interpret people’s choices and to resolve outstanding challenges which present an insurmountable obstacle to the existing ethical theories. (shrink)

This paper argues that the Quality Adjusted Life Year or QALY is fatally flawed as a way of priority setting in health care and of dealing with the problem of scarce resources. In addition to showing why this is so the paper sets out a view of the moral constraints that govern the allocation of health resources and suggests reasons for a new attitude to the health budget.

First published in 1985. Routledge is an imprint of Taylor & Francis, an informa company.

Modern medicine provides unprecedented opportunities in diagnostics and treatment. However, in some situations at the end of a patient’s life, many physicians refrain from using all possible measures to prolong life. We studied the incidence of different types of treatment withheld or withdrawn in 6 European countries and analyzed the main background characteristics.

Low opportunity cost, weak influence of quality of life in the face of death, the social value of life extension to others, shifting psychological reference points, and hope have been proposed as factors to explain why people apparently perceive marginal life extension at the end of life to have disproportionately greater value than its length. Such value may help to explain why medical spending to extend life at the end of life (...) is as high as it is, and the various factors behind this value might provide normative rationale for that spending. Upon critical analysis, however, most of these factors turn out to be questionable or incompletely conceived; this includes hope, which is examined here in special detail. These factors help to explain complexity and nuance in the normative issues, but they do not provide adequate justification for spending as high as it often is. In any case, two additional factors must be added to the descriptive explanation of high spending, and they throw its normative justification into further doubt: the “insurance effect” and provider-created demand. Overall, the perception of especially high value of life at the end of life provides some normative justification for high spending, but seldom strong justification, and not for spending as high as it often is. (shrink)

“The thing about life is that one day you’ll be dead.” Indeed. But even total and honest acceptance of this brute fact about our relationship to death does not diminish the value we see in short remaining life at the end of life. Few just “give in” and no more fight for life because death is seen as an inherent part of life. They still invest small amounts of additional life with huge (...) class='Hi'>value. How high may that value plausibly be? What is the value of a relatively short extension of life when death is inevitably near? (shrink)

The Ministry of Transport is planning for the construction of new roads in its territory. Many projects are being considered, and the Ministry needs to identify the worthwhile projects for which the benefits exceed the costs. Among costs and benefits are the expense of constructing the road, the time saved by motorists using the new road rather than some other road, the time saved through the reduction of congestion on other roads, and the expected increase or decrease in the number (...) of deaths due to traffic accidents. I am concerned in this paper with the last item on the list. It is, of course, difficult to estimate fatalities accurately, but this difficulty is neither unique nor central to our problem. The problem is how best to place a monetary value on fatalities, so that the expected number of fatalities can be compared with other costs and benefits in deciding whether to build a road. However chosen, the monetary value of fatalities for use in this context is what the economist means by “the value of life.” The term is almost a joke, a bit of gallows humor to exorcise the ghoulishness that inevitably clings to analysis of life and death in monetary terms. (shrink)

If humans eventually attain the ability to create new life forms, how will it affect the value of life? This is one of several questions that can be sources of concern when discussing synthetic life, but is the concern justified? In an attempt to answer this question, I have analyzed some possible reasons why an ability to create synthetic life would threaten the value of life in general (that is, not just of the (...) synthetic creations), to see if they really give us reason to worry. The main conclusion is that it is unlikely that a future human ability to create life will really have a great negative impact on these characteristics of life. It therefore seems unlikely that the value of life will be negatively affected by the ability to create synthetic life, though it is possible that the properties in question will be less salient in the synthetic life and thus that the value of the synthetic life will be lower than that of existing life, which in turn can lead to a disturbing difference in value between different kinds of life. (shrink)

Anything within the causal economy of the universe is entirely natural, including values, humans themselves, together with their artifacts and products, and lifespans either as presently the case, or else radically extended. Further, normality of itself is no predicator of normativity. In view of this, arguments concerning the appropriate length of life from naturalness or normalness, are akin to the kind of hardened prejudice manifested by Procrustes in his beliefs concerning the appropriate length of beds, and the sleepers therein. (...) Various modern commentators have taken up the suggestion, initiated in the discourse by Williams, using the example of Karel Capek's opera The Makropulos Secret, that we should not seek to extend life because it will end in boredom. For a person‐process that has achieved self‐resolution, and come to a processual end, for a true Makropulos, there would be no passion, no fear, no affect, no boredom, no disvalue, no wailing. (shrink)

This volume in the King's College (London) Studies in Medical Law and Ethics series covers a wide range of issues (euthanasia, abortion, embryo research and fetal transplantation, the teaching of medical ethics, AIDS and sex selection) while focusing on a series of related themes. Contributors to this collection of essays include doctors, lawyers, theologians and philosophers and their viewpoints will be of immense interest to a wide range of professionals in related fields and/or students of medicine, philosophy and nursing.

Lord Sumption, a former Justice of the Supreme Court, has been a prominent critic of coronavirus restrictions regulations in the UK. Since the start of the pandemic, he has consistently questioned both the policy aims and the regulatory methods of the Westminster government. He has also challenged rationales that hold that all lives are of equal value. In this paper, I explore and question Lord Sumption’s views on morality, politics and law, querying the coherence of his broad philosophy and (...) his arguments regarding coronavirus regulations with his judicial decision in the assisted-dying case of R v Ministry of Justice. In Nicklinson, Lord Sumption argued for restrictions on liberty given the priority of the sanctity of life principle and the protection of others who may be vulnerable, as well as for deference to policy-making institutions in instances of values-based disagreement. The apparent inconsistencies in his positions, I argue, are not clearly reconcilable, and invite critical analysis of his impacts on health law and policy. (shrink)

The notion of the value of life is often invoked in discussions regarding medical care for the sick and the dying. This theme has figured in arguments about medical ethics for decades, but many of the phrases associated with this concept have received little serious scrutiny. It is true that some philosophers have declared a few commonly used phrases such as “the sanctity of life,” “the infinite value of life,” and “the value of (...) class='Hi'>life itself” to be unclear at best or misguided at worst. Their hasty dismissal of these phrases, however, is not the end of the story. I generally agree with this philosophical judgment but for reasons very different from those typically given by others. Moreover, the reasons I wish to .. (shrink)

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ABSTRACT The emerging discourse concerning the desirability of intervention in senescence to achieve radical life extension for persons has featured some striking blurring in traditional liberal and conservative commitments and positions. This affords an opportunity for re‐evaluation of these same. The canonical conservative view of the intrinsic value of life is re‐examined and found primarily to involve a denial of human prerogative, rather than an active underwriting of the value of life extension. A critique is (...) offered of an attempted argument against aging intervention from a proto‐conservative worry about a purported threat to human nature. Immortality is found to be a red herring, but a revealing one. Further, the classic liberal view is examined and found wanting in terms of the gravity of its own commitment to, and fullness of its account of the value of life, and the value of life extension. An analysis of the liberal conception of personhood is proposed that both defines persons necessarily as processes, and demonstrates the inalienable quality of the value of life extension to persons so defined. (shrink)

In theory, at least, we might achieve a certain sort of invulnerability right at the end of life. Suppose that under favorable circumstances we can live a certain number of years, say 125, but no longer, and also that we can make life as a whole better and better over time. Under these assumptions we might hope to disarm death by spending 125 years making life as good as it can be. If we were lucky enough to (...) accomplish that, afterwards we would be immune to mortal harm. Especially for those who are closer to the beginning of life than to the end, however, this strategy leaves much to be desired. It is like devouring an entire banquet so as to eliminate the danger of someone stealing it from us. Like a feast, a good life is safely ours after it is over, but then safety comes too late to be of any use to us. To be of practical value, we need protection from mortal harm much earlier in life. (shrink)

The doctrine of the sanctity of life has traditionally been characterised as a Judeo‐Christian doctrine that has it that bodily human life is an intrinsic good and that it is always impermissible to kill an innocent human. Abortion and euthanasia are often assumed to violate the doctrine. The doctrine is usually understood as being derived from religious dogma and, as such, not amenable to debate. I show that this characterisation of the doctrine is problematic in a number of (...) ways, and I go on to rethink the doctrine. In doing so I follow in the footsteps of Ronald Dworkin, who offered a characterisation of the doctrine in his 1993 Life's Dominion, drawing on a conceptualisation of sacredness that is radically different from standard ones and not dependent on religious dogma. I'll argue that although Dworkin's efforts have much to recommend, his conceptualisation of sacredness is inadequate. Dworkin attempted to reconceptualise sacredness ‘from the armchair’. Here I explain how sacred values are thought of in anthropology and psychology and argue that the sanctity of human life should be understood in the same way. I'll explain how doing so allows us to resolve a number of conceptual problems that bedevil standard characterisations of the doctrine of the sanctity of life. I'll also consider the possibility of a compromise over the sanctity of human life, and as a consequence, compromise over the permissibility of abortion and euthanasia. I'll argue that such compromise is possible, albeit difficult to achieve. (shrink)

The article discusses the meanings of life and value priorities of the post- Soviet society. The author argues that, at present, there are symptoms of a global ideological crisis in the world, that the West does not have its own vision of where and how to move on and has no understanding of the future. Unfortunately, most of the post-Soviet countries do not have such vision as well. In these conditions, there are mistrust, confusion, paradoxical manifestation of human (...) consciousness. The main meanings that determine our life-world are: the desire of citizens for social justice and social security, the desire to figure out and understand the basic values of modern society, how honestly and equally the authorities act toward their fellow citizens, and to what extent they reflect their interests. The meanings of life, which are the answers to the challenges of the time, are embodied in the cultural code of each nation, state. The growth points of new values, which will become the basis for the future sustainable development of a new civilization, have yet to be discovered in the systemic transformative changes of the culture. In this process, the emergence of a new system of values that governs human life is inevitable. However, modern technology brings new troubles to humans. It has provided wide opportunities for informational violence and public consciousness manipulation. Nowadays, the scenario that is implemented in Western consumer societies claims to be the dominant scenario. Meanwhile, today there is no country in the world that is a role model, there is no ideal that others would like to borrow. Most post-Soviet states failed to advance their societies to more decent levels of economic development, to meet the challenges of the modern information age, and to provide the population with new high living standards. Therefore, in conditions of growing confrontation, we should realistically understand the world and be ready to implement changes that will ensure sustainable development of the state and society without losing our national identity. (shrink)

When considering the social valuation of a life-year, there is a conflict between two basic intuitions: on the one hand, the intuition of universality, according to which the value of an additional life-year should be universal, and, as such, should be invariant to the context considered; on the other hand, the intuition of complementarity, according to which the value of a life-year should depend on what this extra-life-year allows for, and, hence, on the quality (...) of that life-year, because the quantity of life and the quality of life are complement to each other. This paper proposes three distinct accounts of the intuition of universality, and shows that those accounts either conflict with a basic monotonicity property, or lead to indifference with respect to how life-years are distributed within the population. Those results support the abandon of the intuition of universality. But abandoning the intuition of universality does not prevent a social evaluator from giving priority, when allocating life-years, to individuals with the lowest quality of life. (shrink)

Most properties have comparatives, which are relations. For instance, the property of width has the comparative relation denoted by `_ is wider than _'. Let us say a property is reducible to its comparative if any statement that refers to the property has the same meaning as another statement that refers to the comparative instead. Width is not reducible to its comparative. To be sure, many statements that refer to width are reducible: for instance, `The Mississippi is wide' means the (...) same as `The Mississippi is wider than most rivers'. But some statements that refer to width are not reducible: for instance, `Electrons have zero width' is not. A property is not reducible to its comparative if it has absolute degrees, and specifically an absolute zero. A property's comparative relation places things in an order from those that have the property least to those that have it most. If there is an absolute zero point somewhere in this ordering, the property is not reducible to its comparative. For width, there is an absolute zero at one end of the ordering, so width is not reducible. The property of goodness is reducible to its comparative, betterness. In particular, there is no absolute zero of goodness. Things are ordered by betterness – some things are better than others – but nothing is absolutely good or absolutely bad. This is an exaggeration. In certain applications, goodness does have absolute degrees of a sort, and an absolute zero. For instance, it makes sense to say an event is good, and another event bad. These are absolute degrees of a sort, but they are themselves reducible to betterness. To say an event is good simply means the event is better than what would otherwise have happened. The goodness of lives has a different sort of absolute zero. Lives are ordered by betterness; some lives are better than others. We can make sense of the question `Where in this ordering is the division between lives that are good and those that are bad?' The division between good and bad lives is again reducible to betterness. To say a person's life is good means it is better that the person should continue living, rather than that she should die. Or it may mean it is better that her life should be lived rather than that it should never have been lived at all. As it is often put: a good life is a life worth living. Derek Parfit appears to attach a different sense to the idea of a good life. He appears to mean a life that contains a preponderance of good things (such as pleasure) over bad things (such as pain). If a life contains no good things and no bad things, it has zero goodness in this sense. In this sense, absolute goodness and the absolute zero of goodness are not reducible to betterness. However, this is a naturalistic sense of goodness, and it is subject to the open-question objection. If a life contains no good things and no bad things, it is an open question whether it has zero goodness. It might, for instance, be a bad thing that this life should be lived. In discussing the evil of death, some philosophers seem to have been searching for an absolute goodness that is not reducible to betterness. Thomas Nagel speaks of an asymmetry between what is good about life and what is bad about death. But if a person's life is good, that only means it would be better that she should continue living than that she should die. And if a person's death would be bad, that only means it would be worse that she should die than that she should continue living. So there can be no asymmetry. (shrink)

Pain alone does not settle the issue of vivisectionIn his paper, Lab animals and the art of empathy, David Thomas presents his case against animal experimentation. That case is a rather unusual one in certain respects. It turns upon the fact that, for Thomas, nothing can be proved or established in ethics, with the result that what we are left to operate with, apart from assumptions about cases that we might choose to make, are people’s feelings. We cannot show or (...) demonstrate that Pol Pot did anything morally wrong; we just have to hope, as seems not unreasonably demanding, that most people feel pretty strongly about large scale slaughter of human beings. Since nothing can be proven, we turn instead to our feelings and the three claims that Thomas features in his paper: that we should empathise with all creatures who can feel pain and suffer; that we should be consistent in condemning things based upon a similar degree of suffering involved and so treat like cases alike, and that we should take consent seriously, and, where the possibility of consent is absent, take seriously the notion of the best interests of the creature involved. Thomas concludes his paper with a succinct statement of his position: “In other words, we should look at things from the perspective of the victim, human or animal, not that of the would be exploiter. By this yardstick, animal experiments are as immoral as non-consensual experiments on people. In each case, the degree of immorality is in direct proportion to the degree of suffering caused—experiments causing severe suffering are more immoral than those causing only mild, transient suffering. Crucially, however, an experiment causing severe suffering to an animal is as immoral as one causing severe suffering to a person.”All animal experiments, therefore, have …. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 (...) focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

Daniel Callahan, in his short article “Hans Jonas and Death,” writes that while he appreciates the perspective on death offered by Jonas in his “The Burden and Blessing of Mortality,” he is concerned by certain omissions that suggest Jonas may not have fully appreciated the value of life. Callahan writes that Jonas does not say “a great deal about why life is worth living,” give an account of the “meaning of evolution for human life,” or describe (...) the “experiences and possibilities in the content of the lives of the human species not found in any other one”. I argue that Jonas not only explicitly addresses the meaning of evolution for human life but also develops an ethics rooted in the inherent value of all present and future life, with particular emphasis on the value of human life. (shrink)

In the Germany of the 1860s and 1870s, the problem of the value of life was urgently debated, as a consequence of the two culture-defining systems of thought that had risen to prominence in those decades—Schopenhauerian Weltschmerz and the theory of evolution—and the degree to which they could be reconciled. On one hand, the struggle for existence affirmed the pessimistic inference as to the suffering and meaninglessness of the cosmos; on the other, it appeared to promise moral and (...) material improvement in human affairs. This article reconstructs the historical connections between the emergence of pessimism and Darwinism, most clearly represented by the work of Eduard von Hartmann, and it argues that Nietzsche’s programmatic statements on life, culture, and pessimism, from the Untimely Meditations on, are best understood in light of this context and his engagement with Hartmann’s writings. (shrink)

As an initial approximation, pluralism may be understood as the combination of four theses. First, there are many incommensurable values whose realization is required for living a good life. Second, these values often conflict with each other, and, as a result, the realization of some excludes the realization of others. Third, there is no authoritative standard that could be appealed to to resolve such conflicts, because there is also a plurality of standards; consequently, no single standard would be always (...) acceptable to all fully informed and reasonable people. Fourth, there are, nevertheless, reasonable ways of resolving conflicts among incommensurable values. (shrink)

If we understand death as the irreversible loss of the good of life, we can give meaning to the idea that for suffering patients in the end stage of their illness, life may become an evil and death no longer a threat. Life may lose its good already in the living person. But what does the good of life consist in, then? I defend an internalist view according to which the goodness of life is intrinsically (...) related to the attitudes, concerns, interests and experiences of the person who is leading the life. This results in the contention that the core of what we understand as the value of a person’s life is to be identified with what makes life go well for the person living the particular life. This internalist view does not presuppose (or imply) hedonism or mentalism, nor does it pose an experience requirement. Something may be good for you, because it is valuable as seen from your authentic viewpoint, even if you do not actually experience this goodness, or think otherwise because you are mistaken about your own well‐being. To test this position, and the authenticity‐requirement it includes, I discuss three cases of patients who are persistent in denying that in their life any value is left and who contend that death is no worse than further living. Internalism acknowledges that in the life of these patients there may be ’functionings’ and ’beings’ that are worthwhile, where the test of value is at least partially independent of subjective assessment. Still, internalism claims that something truly valuable can only contribute to the good of one’s life of it has positive meaning as seen from the attitudinal viewpoint that identifies oneself. (shrink)

If we understand death as the irreversible loss of the good of life, we can give meaning to the idea that for suffering patients in the end stage of their illness, life may become an evil and death no longer a threat. Life may lose its good already in the living person. But what does the good of life consist in, then? I defend an internalist view according to which the goodness of life is intrinsically (...) related to the attitudes, concerns, interests and experiences of the person who is leading the life. This results in the contention that the core of what we understand as the value of a person’s life is to be identified with what makes life go well for the person living the particular life. This internalist view does not presuppose (or imply) hedonism or mentalism, nor does it pose an experience requirement. Something may be good for you, because it is valuable as seen from your authentic viewpoint, even if you do not actually experience this goodness, or think otherwise because you are mistaken about your own well‐being. To test this position, and the authenticity‐requirement it includes, I discuss three cases of patients who are persistent in denying that in their life any value is left and who contend that death is no worse than further living. Internalism acknowledges that in the life of these patients there may be ’functionings’ and ’beings’ that are worthwhile, where the test of value is at least partially independent of subjective assessment. Still, internalism claims that something truly valuable can only contribute to the good of one’s life of it has positive meaning as seen from the attitudinal viewpoint that identifies oneself. (shrink)