In a world of rapid technological advances, the moral issues raised by life and death choices in healthcare remain obscure. _Life and Death in Healthcare Ethics_ provides a concise, thoughtful and extremely accessible guide to these moral issues. Helen Watt examines, using real-life cases, the range of choices taken by healthcare professionals, patients and clients which lead to the shortening of life. The topics looked at include: * euthanasia and withdrawal of treatment * the persistent vegetative state * abortion (...) * IVF and cloning * life-saving treatment of pregnant women Clearly written and insightful, _Life and Death in Healthcare Ethics_ presupposes no prior knowledge of philosophy. It will be of interest to anyone confronting healthcare ethics for the first time, or seeking to develop his or her understanding of some core topics in the field. (shrink)

Cooperation in evil or wrongdoing is one of the most perplexing areas in bioethics, both for those working in the field and those seeking their advice. The papers collected in this book are written by philosophers, theologians and lawyers who have studied these problems and / or by those who have faced these problems in their own work in law, healthcare and research, and political campaigning. The volume includes both general treatments of the subject of cooperation and conscientious objection, and (...) more specific treatments of topics such as voting to improve unjust laws, research on fetal / embryonic cells, and care of suicidal patients. The book is offered as a guide to a field which is both of academic interest and of personal concern to those who face cooperation problems in their own life and work. Contributors include: Bishop Donal Murray, Bishop Anthony Fisher OP, Jane Adolphe, Mike Delany, John Finnis, Luke Gormally, Colin Harte, Cathleen Kaveny, Richard Myers, Charlie O'Donnell, Alexander Pruss, Neil Scolding and Helen Watt. (shrink)

The guidelines on Decisions Relating to Cardiopulmonary Resuscitation begin with a reassuringly objective view of medicine: its “primary goal” is to benefit patients by “restoring or maintaining their health as far as possible, thereby maximising benefit and minimising harm”. Some might want to add that medicine has several goals, not all of which relate to promoting health; however, those who see the aim of the profession as more than consumer satisfaction will welcome the suggestion here that not just any choice (...) counts as medicine. In the same way, the statement which heads the next paragraph would be rejected by very few readers if “quality of life” were suitably defined. If all we mean by “quality of life” is the patient's level of wellbeing, with no suggestion that the value of his or her “being” can fall to zero or below, it is uncontroversial that “it is not an appropriate goal of medicine to prolong life at all costs with no regard to its quality or the burdens of treatment on the patient”. This is, however, an overly benign interpretation of “quality of life” observations as they appear in the guidelines. (shrink)

What are the duties of carers and health professionals to people with mental incapacity? How ought we to think about the ethical and legal issues? What can any of us do to improve and safeguard the lives of those cared for? This book seeks to examine in detail and find ethically robust answers to such questions. Among the topics discussed are withholding treatment, tube-feeding patients with dementia, the 'persistent vegetative state', medical research, and sterilisation of intellectually disabled adults. Contributors come (...) from a wide range of disciplines, including psychiatry, nursing, philosophy, theology and law. The book includes an account by Wendy Hiscox of non-voluntary euthanasia in the Netherlands and Belgium, and a chapter by John Finnis exploring some aspects of Britain's Mental Capacity Act 2005. (shrink)

_The Ethics of Pregnancy, Abortion and Childbirth_ addresses the unique moral questions raised by pregnancy and its intimate bodily nature. From assisted reproduction to abortion and ‘vital conflict’ resolution to more everyday concerns of the pregnant woman, this book argues for pregnancy as a close human relationship with the woman as guardian or custodian. Four approaches to pregnancy are explored: ‘uni-personal’, ‘neighborly’, ‘maternal’ and ‘spousal’. The author challenges not only the view that there is only one moral subject to consider (...) in pregnancy, but also the idea that the location of the fetus lacks all inherent, unique significance. It is argued that the pregnant woman is not a mere ‘neighbor’ or helpful stranger to the fetus but is rather already in a real familial relationship bringing real familial rights and obligations. If the status of the fetus is conclusive for at least some moral questions raised by pregnancy, so too are facts about its bodily relationship with, and presence in, the woman who supports it. This lucid, accessible and original book explores fundamental ethical issues in a rich and often neglected area of philosophy in ways of interest also to those from other disciplines. (shrink)

Biological sex should be “acknowledged” and “accepted”—but which responses to gender dysphoria might this preclude? Trans-identified people may factually acknowledge their biological sex and regard transition as purely palliative. While generally some level of self-deception and even a high level of nonlying deception of others are sometimes justified, biological sex is important, and there is a nontrivial onus against even palliative, nonsexually motivated cross-dressing. The onus is higher against co-opting the body, even in a minor and/or reversible way, to make (...) a false communication concerning one’s sex. Hardest to defend is the destruction of sexual–reproductive functions and causally downstream functions such as lactation: due to the transcendent nature of sexual–reproductive functions, an appeal to the “principle of totality” here is misplaced. This is not to say that social, and milder medical, transition is absolutely excluded even for severe unmanageable dysphoria, nor that subsequent to any transition, detransition is necessarily required. (shrink)

Fetuses and their mothers (and other adults) share many objective interests. These include interests in disjunctive ways of achieving human well-being, including the formation and success of good projects such as particular friendships. Pursuing such good projects is in the individual’s interests and is what growing up is all about. Some interests are time-sensitive, and determining which interests apply at what stages in life requires asking which benefits are in some sense appropriate to the individual and still in his/her actual (...) or possible or even hypothetical future. Human individuals not only have interests in unconditional benefits to them, including the welfare of existing family members, but in conditional benefits to them, including the welfare of possible future family members. Even if not all interests apply to the individual at every stage, if an adult-type benefit is still in the (long-term) future, the young individual including the fetus has a stake in that benefit, conditional as the benefit may sometimes be. Fulfilment is enhanced by pursuit and conscious enjoyment of ‘human goods’, but as with adults, the stake in these remains strong even if psychological links with the long-term future in which this happens are tenuous or non-existent. (shrink)

Cooperation in wrongdoing is an everyday matter for all of us, though we need to discern when such cooperation is morally excluded as constituting formal cooperation, as opposed to material (unintended) cooperation whether justified or otherwise. In this paper, I offer examples of formal cooperation such as referral of patients for certain procedures where the cooperating doctor intends an intrinsically wrongful plan of action on the part of the patient and a medical colleague. I also consider a case of formal (...) cooperation where the cooperator intends a choice on the part of another person that is not intrinsically wrong, but wrong in the circumstances because the person believes it will cause serious uncompensated harm. (shrink)

What kind of interventions on the body of an innocent human being may be licitly intended? This question arises in relation to maternal–fetal conflicts such as ectopic pregnancy and obstructed labor, and to other cases such as organ harvesting and separation of conjoined twins. Many assume that harm must be intended for absolute moral prohibitions to apply; however, it is not always the case that foreseen harm is merely a factor to weigh against benefits we intend. On the contrary, foreseen (...) harm (and absence of benefit) for someone we affect can be morally conclusive when linked to an immedi­ate intention to affect the person’s body or invade the space it fills. (shrink)

Abortion for life-limiting foetal anomaly is often an intensely painful choice for the parents; though widely offered and supported, it is surprisingly difficult to defend in ethical terms. Abortion on this ground is sometimes defended as foetal euthanasia but has features which sharply differentiate it from standard non-voluntary euthanasia, not least the fact that any suffering otherwise anticipated for the child may be neither severe nor prolonged. Such abortions may be said to reduce suffering for the family including siblings – (...) a consideration rarely stated so explicitly in defences of postnatal euthanasia – or for the woman who must in any case face the eventual loss of her baby, and for whom the abortion is seen as therapeutic in minimising pain. Finally, the abortion may be said to constitute the cessation of morally optional life support on the part of the woman, and/or to be a ‘social’ choice she is entitled to make, whether or not this in fact promotes her interests or those of her child. These defences need honest exploration: the intense parental suffering caused by the choice to end an often much-wanted pregnancy should not preclude but rather encourage the question whether this choice can indeed be ethically proposed to couples, especially compared with the neonatal palliative care (‘perinatal hospice’) approach so well received by parents who experience it. (shrink)

May a couple have the aim of conceiving as their primary purpose in having marital relations? In this paper, I argue against the view of Alexander Pruss that it is wrong to do this since it treats human beings as fungible in their creation when their unique features are not known to their parents. I argue that Pruss cannot separate seeking reproduction as part of a marital vocation from seeking the unknown, unspecified child who is part of what makes for (...) success in this particular area. While neither spouse should treat the other as a mere tool for having a child, success in the shared goal of conceiving, as well as the goal itself and its pursuit, is very much part of the conjugal good. Existing human beings are morally irreplaceable in the sense that they must be individually valued and respected, but we may promote the lives of unknown existing people under a ‘catch all’ description—and may also deliberately conceive new people of some unknown, indeterminate kind. (shrink)

The proposal for reproducing human generations in vitro raises the question to what extent parenthood is possible in embryos and to what extent human rights and interests are dependent on conscious awareness. This paper argues that the interest in not being made a parent non-consensually for the benefit of others persists throughout the lifespan of the individual human organism. We do not become genetic parents by learning that we are parents; rather, we discover (or fail to discover) an existing genetic (...) relationship between our offspring and ourselves. The claim to genetic parenthood of an embryo used for reproduction in vitro is, if anything, clearer than the claim of the adult for whom gametes are derived via ips cells, in that an embryo’s cells, unlike an adult’s somatic cells, are already functionally geared to producing gametes (among other types of cell). An embryo used to make gametes that are used in reproduction is immediately and non-consensually made a genetic parent and to that extent is wronged whether or not the parent embryo survives – as some could survive – the harvesting of cells. All human individuals carry objective interests in benefits appropriate to the kind of being they are; these include the stake in not being made a parent without one’s consent, whether posthumously or otherwise. (shrink)

Is the “act itself” of separating a pregnant woman and her previable child neither good nor bad morally, considered in the abstract? Recently, Maureen Condic and Donna Harrison have argued that such separation is justified to protect the mother’s life and that it does not constitute an abortion as the aim is not to kill the child. In our article on maternal–fetal conflicts, we agree there need be no such aim to kill (supplementing aims such as to remove). However, we (...) argue that to understand “abortion” as performed only where the death of the child is intended is to define the term too narrowly. Respect for the mother, the fetus, and the bond between them goes well beyond avoiding any such aim. We distinguish between legitimate maternal treatments simply aimed at treating or removing a damaged part of the woman and illegitimate treatments that focus harmfully on the fetal body and its presence within the mother’s body. In obstetrics as elsewhere, not all side effects for one subject of intervention can be outweighed by intended benefits for another. Certain side effects of certain intended interventions are morally conclusive. (shrink)

The presence of a human being/organism—a living human ‘whole’, with the defining tendency to promote its own welfare—has value in itself, as do the functions which compose it. Life is inseparable from health, since without some degree of healthy functionality the living whole would not exist. The value of life differs both within a single life and between lives. As with any other form of human flourishing, the value of life-and-health must be distinguished from the moral importance of human beings: (...) less fulfilled means not less important morally, but more in need of being fulfilled. That said, to say that life and health has value is not to say exactly what—if anything—that value requires by way of active promotion at a given time. Many factors must be taken into account in making health care decisions, even if the worth of all lives, and the dignity of all human beings, must in every case be acknowledged. (shrink)

A difficult task for politicians who want to fight injustice without doing wrong themselves is identifying where it is permissible to vote for and/or promote so-called “imperfect laws” which somewhat improve existing unjust legal situations but leave closely related injustices intact. One approach is to seek a “selective ban” on some injustices which are politically preventable. This approach is acceptable at least in principle, unlike the approach of “regulation”—i.e., permitting or instructing others to do, or prepare to do, the unjust (...) act in specified ways. The latter necessarily involves us in formal cooperation with evil: wrongly intending that others choose wrongly; for example, that abortion doctors deliberately prepare for abortion, albeit in ways that make an abortion less risky or less likely. In relation to parental consent or parental notification, and to pregnancy counselling and provision of information to pregnant women, while there may be ways of requiring these without complicity in others’ wrongful choices, this is at least more difficult than is often recognised. There can also be problems of principle in seeking consensus with fellow-legislators who may positively intend and even promote the continuation of remaining injustices even as they collaborate with more consistent reformers in passing laws which mitigate injustice overall. (shrink)

Some laws cannot yet be entirely abrogated in a current political situation, though permitting grave injustices against some individuals; for example, unborn and/or disabled individuals. In supporting the passing of new ‘imperfect’ laws that protect only some of those who now lack protection, do we ourselves discriminate unjustly against those remaining unprotected? Or does that depend on factors such as our intentions – including what we intend that others intend? How may we collaborate with colleagues who intend, and perhaps explicitly (...) defend, the continuation of remaining, closely-related injustices, although they are willing to join us in trying to improve some aspects of the status quo? This paper explores the moral constraints on our attempts to extend the law’s protection to some, but not to all, of those individuals currently deprived of such ­protection and at risk of serious harm. (shrink)

The term “value of life” can refer to life’s intrinsic dignity: something nonincremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer (...) their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life. (shrink)

Preimplantation genetic diagnosis (PGD) raises serious moral questions concerning the parent-child relationship. Good parents accept their children unconditionally: they do not reject/attack them because they do not have the features they want. There is nothing wrong with treating a child as someone who can help promote some other worthwhile end, providing the child is also respected as an end in him or herself. However, if the child's presence is not valued in itself, regardless of any further benefits it brings, the (...) child is not being treated as an end in the full sense of the term. In this paper, I argue that these principles apply to human embryos, as well as to born human offspring: the human moral subject is a bodily being, whose interests and rights begin with the onset of his or her bodily life. The rights of the living, bodily human individual include a right not to be attacked/abandoned because of his or her genetic profile. PGD is harmful to the parent-child relationship, and we give mixed messages to parents by expecting them to show unconditional commitment to offspring after birth, while inviting them to take a very different approach at the prenatal stage. (shrink)

Germ-line therapy has long been regarded with great caution both by scientists and by ethicists. Even those who do not reject germ-line therapy in principle have tended to reject it in practice as carrying unacceptable risks in our current state of knowledge. For this reason, a recent paper by Rubenstein, Thomasma, Shon, and Zinaman is unusual in putting forward a serious proposal for the use of germ-line therapy in the foreseeable future.

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. While hypocrisy (...) is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)

What does it mean to respect life and health in an innocent fellow-human being? Separating conjoined twins where one twin will die as a result need not involve the intention to kill or harm. Arguably, however, not all side-effects are “mere” side-effects which could, in principle, be outweighed by sufficiently good intended effects. Rather, foreseen serious harm for an innocent person we non-therapeutically affect can be morally conclusive when linked to the intention to affect the person’s body or invade the (...) space it fills. In the case of infant conjoined twins, such as the Maltese twins Jodie and Mary, the twin who dies from separation has no unjust, or any, intentions as regards the twin saved. She thus has the moral immunity of any innocent person from lethal bodily invasions and other serious bodily harm. Neither the final act which killed Mary nor previous acts of cutting into Mary, including parts shared with her twin Jodie, were therefore morally permissible. (shrink)

The clinical years of medical student education are an ideal time for students to practise and refine ethical thinking and behaviour. We piloted a new clinical ethics teaching activity this year with undergraduate medical students within the Rural Clinical School at the University of New South Wales. We used a modified teaching ward round model, with students bringing deidentified cases of ethical interest for round-table discussion. We found that students were more engaged in the subject of clinical ethics after attending (...) the teaching sessions and particularly appreciated having structured time to listen to and learn from their peers. Despite this, we found no change in student involvement in managing or planning action in situations that they find ethically challenging. A key challenge for educators in clinical ethics is to address the barriers that prevent students taking action. (shrink)

In responding to an unjust legal situation involving human rights abuses, one approach is to seek a selective ban on some abuses if a more comprehensive ban is not feasible politically. While such an approach to embryo research or abortion, for example, can reasonably be applied, much harder to defend is regulation—that is, giving permission or instructions for others to do or prepare to do what we believe is morally wrong. Regulation necessarily involves us in wrongly intending that others choose (...) wrongly, that is, in formal cooperation with evil. We should choose other means of making a bad situation better: selective banning or discouragement by, for example, withholding funding, and the mandating of acts that are good or potentially good in the context in which they are mandated. (shrink)

What is sex and why is it important? Does marriage have a basic rationale? How should couples manage their fertility, and when and how should pregnancy be achieved? How should we respond to 'embryo adoption', teenage pregnancy, population growth, HIV/AIDS and other STIs, same-sex attraction? This collection of original essays looks at these and other pivotal issues in reproductive and sexual ethics, from the perspectives of philosophy, theology, psychology and economic science.

Is it possible to donate unpaired vital organs, foreseeing but not intending one’s own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on “double effect donation.” Where we disagree with these authors is that we see double-effect donation not as a morally praiseworthy act akin to mar- tyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill; not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double-effect donation falls foul of the first condition of double-effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such don- ation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

Educational reformers all around the globe are continuously searching for ways to make schools more effective and efficient. In Germany, this movement has led to reforms that reduced overall school time of high track secondary schools from 9 to 8 years, which was compensated for by increasing average instruction time per week in lower secondary school. Based on prior research, we assumed that this reform might increase gender disparities in STEM-related outcomes, stress, and health because it required students to learn (...) similar content in less amount of time. Therefore, we investigated how the school time reform affected gender disparities at the end of upper secondary school between 2011 and 2013. Specifically, we considered representative data of the last two cohorts who completed lower secondary school before the reform and the first two cohorts after the reform from the National Educational Panel Study. Potential differences in gender disparities were investigated for upper secondary school outcomes of subject-specific standardized test performance, self-concept, and interest in mathematics, biology and physics, as well as outcomes of school-related stress and health. Overall, we found substantial disparities between girls and boys, which seemed to change little after the reform. Exceptions were the statistically significant gender × reform interactions for one stress dimension and two health dimensions which increased for both boys and girls, but more strongly for girls. (shrink)

This paper anticipates a peril involved in Catholic writing on trans issues, which I call perlocutionary dominion: the empowerment of cisgender voices, and disempowerment of transgender voices within our theological communities through perlocutionary acts. It finds an example of this peril in Helen Watt's paper, ‘Gender Transition: The Moral Meaning of Bodily and Social Presentation’, focusing specifically on the use of negative themes; as well as the less obvious, positive-affective feature of gestures of care. It then looks to Pope (...) Francis's ‘four principles’ in Evangelii gaudium as the basis for a methodological principle that can help to avoid it. It argues that Francis's principles exhort us towards a project of community building that embraces alterity and invites critical engagement with our own convictions, while reflecting honestly on how our speech shapes that community in ways beyond their constative function. It concludes by suggesting the principle, ‘Everything About Us, For Us’, which encapsulates the kinds of behaviours required by this project. (shrink)

Essentialism--roughly, the view that natural kinds have discrete essences, generating truths that are necessary but knowable only _a posteriori_--is an increasingly popular view in the metaphysics of science. At the same time, philosophers of language have been subjecting Kripke’s views about the existence and scope of the necessary _a posteriori_ to rigorous analysis and criticism. Essentialists typically appeal to Kripkean semantics to motivate their radical extension of the realm of the necessary _a posteriori_; but they rarely attempt to provide any (...) semantic arguments for this extension, or engage with the critical work being done by philosophers of language. This collection brings authors on both sides together in one volume, thus helping the reader to see the connections between views in philosophy of language on the one hand and the metaphysics of science on the other. The result is a book that will have a significant impact on the debate about essentialism, encouraging essentialists to engage with debates about the semantic presuppositions that underpin their position, and, encouraging philosophers of language to engage with the metaphysical presuppositions enshrined in Kripkean semantics. (shrink)

Drawing on ancient and modern sources, "a lucid discussion of Taoism and the Chinese language [that's] profound, reflective, and enlightening." —Boston Globe According to Deepak Chopra, "Watts was a spiritual polymatch, the first and possibly greatest." Watts treats the Chinese philosophy of Tao in much the same way as he did Zen Buddhism in his classic The Way of Zen. Critics agree that this last work stands as a perfect monument to the life and literature of Alan (...) class='Hi'>Watts. "Perhaps the foremost interpreter of Eastern disciplines for the contemporary West,... Watts begins with scholarship and intellect and proceeds with art and eloquence to the frontiers of the spirit."—Los Angeles Times. (shrink)

Sixteen centuries ago the Neoplatonist philosopher Hypatia was murdered by a mob of Christians. Ever since, she has been remembered in poems, plays, paintings, and films as a victim of religious intolerance whose death symbolized the end of the classical world. But before she was a symbol Hypatia was a person. As one of antiquity's best-known female scholars, Hypatia's immense skills as a philosopher and mathematician redefined the intellectual life of her home city of Alexandria. Her talent as a teacher (...) enabled her to assemble a circle of dedicated male students. Her devotion to public service made her a force for peace and good government in a city that struggled to maintain trust and cooperation between pagans and Christians. These intellectual and political triumphs were all the more astonishing for being accomplished in a climate of gossip, scrutiny, and misogyny.Hypatia: The Life and Legend of an Ancient Philosopher is a major new account of this remarkable woman and the culturally rich and turbulent context in which she lived. Utilizing new techniques for reading ancient letters and mathematical and philosophical commentaries-as well as a number of previously unnoticed early modern sources-Edward J. Watts provides a revelatory narrative of Hypatia's life, her formidable achievements, the tragic story of the events that led to her murder, and the rich legacy of her life and death. (shrink)

Psychology, Religion, and Spirituality provides readers with a critical overview of what psychology tells us about religion and spirituality. It is concise without being simplistic, and the first such broad overview to be published for some years. Fraser Watts recognizes that 'religion' is complex and multi-faceted, taking different forms in different people and contexts. The book presents a broad view of psychology; whatever kind of psychology you are interested in, you will find it covered here, from biological to social, (...) and from experimental to psychoanalytic. It focuses particularly on the varied concepts that psychologists have employed to make sense of religion and subjects them to critical examination. The book is also concerned with practical applications, helping those engaged in religious ministry. It will be of interest to undergraduates and general readers, as well as specialists in religious studies, psychology, and philosophy of religion. (shrink)

A dual-processing model of moral whistleblowing in organizations is proposed. In this theory paper, moral whistleblowing is described as a unique type of whistleblowing that is undertaken by individuals that see themselves as moral agents and are primarily motivated to blow the whistle by a sense of moral duty. At the individual level, the model expands on traditional, rational models of whistleblowing by exploring how moral intuition and deliberative reasoning processes might interact to influence the whistleblowing behavior of moral agents. (...) The model combines individual variables, organizational variables, and external, societal variables to explain the moral whistleblowing process and the impact of moral agents on organizations and society. (shrink)