ABSTRACT Public health authorities sometimes have to make decisions about the use of preventive medical measures—e.g. vaccination programmes—which could, if realised, save millions of lives, but could also kill a certain (small) number of those subjected to the measures. According to a rough‐and‐ready utilitarian calculation, such measures should be taken, but there are also possible objections to this view. A liberal objection to the use of mandatory preventive measures which might harm human beings is that people have a right to (...) decide for themselves whether or not they want to participate in the programme. A further objection is based on the claims that first, the authorities are directly killing those who die because of, say, vaccination programmes, and second, directly killing human beings is forbidden (since every human being has a right to live). The latter objection is discussed at length in the present paper. The validity of three doctrines, the doctrines of the double effect, of acts and omissions, and of killing and letting die, are considered with reference to the use of preventive measures, and found inapplicable. The objection is, however, refuted by comparing some hypothetical examples, and the initial utilitarian calculation is reinforced. (shrink)

According to what one might call ‘indirect” forms of utilitarian thinking, the proper end of all human action is the greatest happiness of the greatest number of individuals, but due to the fallibility of moral agents this end cannot, and must not, be directly pursued. Instead, according to at least one version of the indirect theory, moral agents have a duty to act in conformity with a set of general rules which, in their turn, have been designed to promote the (...) greatest happiness of humankind. But acts which conform to such general rules can under exceptional circumstances occasion more suffering than happiness. This is clearly problematical to indirect utilitarians. If they follow the rules regardless of the evil consequences, it can be argued that they have abandoned the basic principles of utilitarianism. If, on the other hand, they refuse to follow the rules which normally promote the general good, their view can be seen to collapse into the direct form of the creed. (shrink)

There is a growing feeling in many Western countries that every human being has a right to health, or a right to health care. This feeling is reflected in a declaration of the World Health Organization (WHO) from 1976, which states: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Our intention in the following is to use the WHO (...) declaration as a basis for considering the allocation of resources in health care. We shall first argue that most of the criteria suggested as grounds for fair allocation of scarce medical resources have their difficulties if one tries to apply them one by one to medical practices. We shall then go on to claim that, if we take the right of all human beings to health or health care even moderately seriously, increasing the resources would in most cases be more ethical than attempting to allocate them ‘fairly’. (shrink)

Recent developments in biology have made it possible to acquire more and more precise information concerning our genetic makeup. There are four groups of people who may want to know about our genes. First, we ourselves can have an interest in being aware of own health status. Second, there are people who are genetically linked with us, and who can have an interest in the knowledge. Third, individuals with whom we have contracts and economic arrangements may have an interest in (...) knowing about our genetic makeup. Fourth, society as a whole can have an interest in the composition of our genes. As regards the question of motivation, the term ‘should’ can be interpreted in three ways. Prudentially speaking, to say that individuals should act in a certain manner is to say that the actions in question promote the longterm self-interest of these individuals. From the viewpoint of morality, we should do what is right and avoid doing what is wrong. When it comes to legal thinking, it is held in most liberal societies that grave other-regarding harm should be the primary justification for the use of coercion and constraint. In the paper, all these aspects are examined in more detail. (shrink)

Recent developments in biology have made it possible to acquire more and more precise information concerning our genetic makeup. There are four groups of people who may want to know about our genes. First, we ourselves can have an interest in being aware of own health status. Second, there are people who are genetically linked with us, and who can have an interest in the knowledge. Third, individuals with whom we have contracts and economic arrangements may have an interest in (...) knowing about our genetic makeup. Fourth, society as a whole can have an interest in the composition of our genes. As regards the question of motivation, the term 'should' can be interpreted in three ways. Prudentially speaking, to say that individuals should act in a certain manner is to say that the actions in question promote the long-term self-interest of these individuals. From the viewpoint of morality, we should do what is right and avoid doing what is wrong. When it comes to legal thinking, it is held in most liberal societies that grave other-regarding harm should be the primary justification for the use of coercion and constraint. In the paper, all these aspects are examined in more detail. (shrink)

In different countries responses to important bioethical issues are different, as exemplified by the attitudes towards the voluntary and active forms of medical euthanasia. But why is this the case? My suggestion is that the roots of the variety are, to a considerable degree, ideological. The most important present‐day political ideologies all have their roots in the prevailing doctrines of moral and social philosophy. In the paper these doctrines are outlined and the predicted response towards active voluntary euthanasia within each (...) model is sketched. The conclusion reached is that while it would in some countries be dangerous to allow euthanasia in the prevailing circumstances, the solution is not to hinder the legalization process but to alter the circumstances. (shrink)

_The Limits of Medical Paternalism_ defines and morally assesses paternalistic interventions, especially in the context of modern medicine and health care, particular emphasis is given to the analysis of the conceptual background of the paternalism issue. In this book an anti-paternalistic view is presented and defended.

Abstract.The legitimate impact of common morality on legal restrictions has been continuously discussed within the Western philosophy of law since Lord Patrick Devlin in the late 1950s presented his moralistic arguments against some liberal conclusions drawn by the English Committee on Homosexual Offences and Prostitution in their public report. Devlin's arguments were subsequently identified and refuted by Richard Wollheim, H. L. A. Hart and Ronald Dworkin, but in a way that later provoked further argument. In particular the attack against anti‐moralistic (...) principles set forth by Simon Lee (1986) owes much to the rather naive liberalism represented by the opponents of Devlin. The battle over liberalism and moralism from the Hart‐Devlin debate to the present day is reviewed. In addition to the discussion of the philosophers mentioned above, a potential flaw in the argumentation of Joel Feinberg (1986) is considered. (shrink)

H. L. A. Hart in his Law, Liberty, and Morality (1963) defended the view that legal paternalism and legal moralism can be clearly distinguished from each other. Hart also stated that while legal moralism is always unacceptable, paternalistic laws are often justifiable. In this paper it is argued that Hart held the right view for the wrong reasons. Hart defended legal paternalism by claiming, against J. S. Mill, that for various psychological reasons individuals do not know their own interests best. (...) It will be shown in the paper that if this view is taken, it is impossible to reject legal moralism. The fact that paternalism is sometimes justifiable while moralism is not can be more firmly founded on a distinction made by C. L. Ten (1971). Ten's point is that in matters which concern only the individuals themselves, their actions cannot be legitimately restricted by appeals to the consequences of their action alone. Paternalistic control can be justified only if the decision-making abilities of the controlled individual are temporarily diminished. (shrink)

Except for the lines of argument we have sketched above, there are not many general conclusions that can be drawn from the ethical and philosophical AIDS discussion at the moment. It may happen that a medical research team comes forward tomorrow or next week with an effective cure for all immunodeficiency-related diseases, including full-blown AIDS, and most of our reflections turn out to be useless from the practical viewpoint. But the formulation of ethical guidelines for medical and social practice is (...) not all there is to moral philosophy. Even after each and every one of the problems dealt with in our study has lost all direct ordinary-life relevance, the principles and their application in new practical situatons remain. Therefore, let us hope that no moral philosopher will be reluctant to participate in the AIDS discussion out of the hopefully well-grounded but rather unethical fear that the problem in its primary medical form will cease to exist in the relatively near future. (shrink)

In his book The Principles of Art Robin George Collingwood presents a theory of art as the expression of emotion. The connection between his view and the theories of the Italian neo-idealists Benedetto Croce and Giovanni Gentile is both well known and well documented. What seems to be less known, however, is the intellectual link R. G. Collingwood’s father, William Gershom Collingwood, formed between his son and John Ruskin, the great Victorian essayist, critic and reformer. There are some references in (...) the literature to the fact that W. G. Collingwood was Ruskin’s friend, pupil, assistant and private secretary, later on his intellectual interpreter and biographer. It has also been argued that since R. G. Collingwood was until the age of thirteen exclusively educated by his father, there must have been an educational link between Ruskin and the younger Collingwood. But when it has come to pointing out theoretical similarities between the aesthetic theories of Ruskin and Collingwood, philosophers of art have, by and large, kept a remarkably low profile. (shrink)

The rapid spread of the Acquired Immune Deficiency Syndrome (AIDS) and its causative agent, the Human Immunodeficiency Virus (HIV), has posed people with difficult ethical questions. Philosophically, one of the most interesting problems is whether or not there is a right to remain in ignorance about one's own HIV infection.Being informed about a positive HIV test result has caused many people anguish and led some to suicidal thoughts. On these grounds a prima facte right not to know could be constructed. (...) Paternalistic arguments have been put forward to refute the alleged right, but these arguments are invalid, as is shown in the paper.However, by a utilitarian argument it can be shown that the prima facie right to remain in ignorance is overridden by other people's rights not to be infected. With certain qualifications, even a non-voluntary testing programme for HIV is justifiable. (shrink)

The Limits of Medical Paternalism defines and morally assesses paternalistic interventions, especially in the context of modern medicine and health care, particular emphasis is given to the analysis of the conceptual background of the paternalism issue. In this book an anti-paternalistic view is presented and defended.

This is a short but very interesting book, which repays study. It is essentially a defence and an application to medical ethics of the principle of liberty (page 12), that “the liberty …of competent, well-informed, free agents must be …maximally protected in matters which concern only or mainly themselves”. Adoption of this Millian principle, which is argued for in the introduction, along with the adoption of principles of equality (that the needs and interests of all should be taken into account) (...) and of responsibility for the welfare of one's fellow beings, raises, it may be said, three questions: who is a person (and therefore to be taken into account); when is a person sufficiently competent, and when do people have to sacrifice some liberty to help or protect the welfare of others? Chapter 1 tackles the first of these questions, following the defence of the principle of liberty in the introduction; chapters two to four deal with issues raised by the second question—whether …. (shrink)

Should we make people healthier, smarter, and longer-lived if genetic and medical advances enable us to do so? Matti Häyry asks this question in the context of genetic testing and selection, cloning and stem cell research, gene therapies and enhancements. The ethical questions explored include parental responsibility, the use of people as means, the role of hope and fear in risk assessment, and the dignity and meaning of life. Taking as a starting point the arguments presented by Jonathan Glover, (...) John Harris, Ronald M. Green, Jürgen Habermas, Michael J. Sandel, and Leon R. Kass, who defend a particular normative view as the only rational or moral answer, Matti Häyry argues that many coherent rationalities and moralities exist in the field, and that to claim otherwise is mistaken"--Provided by publisher. (shrink)

The Nordic countries aim to have a unique place within the European and global health data economy. They have extensive nationally maintained and centralized health data records, as well as numerous biobanks where data from individuals can be connected based on personal identification numbers. Much of this phenomenon can be attributed to the emergence and development of the Nordic welfare state, where Nordic countries sought to systematically collect large amounts of population data to guide decision making and improve the health (...) and living conditions of the population. Recently, however, the so-called Nordic gold mine of data is being re-imagined in a wholly other context, where data and its ever-increasing logic of accumulation is seen as a driver for economic growth and private business development. This article explores the development of policies and strategies for health data economy in Denmark and Finland. We ask how nation states try to adjust and benefit from new pressures and opportunities to utilize their data resources in data markets. This raises questions of social sustainability in terms of states being producers, providers, and consumers of data. The data imaginaries related to emerging health data markets also provide insight into how a broad range of different data sources, ranging from hospital records and pharmacy prescriptions to biobank sample data, are brought together to enable “full-scale utilization” of health and welfare data. (shrink)

:Justice can be approached from many angles in ethical and political debates, including those involving healthcare, biomedical research, and well-being. The main doctrines of justice are liberal egalitarianism, libertarianism, luck egalitarianism, socialism, utilitarianism, capability approach, communitarianism, and care ethics. These can be further elaborated in the light of traditional moral and social theories, values, ideals, and interests, and there are distinct dimensions of justice that are captured better by some tactics than by others. In this article, questions surrounding these matters (...) are approached with the hermeneutic idea of a distinction between “American” and “European” ways of thinking. (shrink)

Health care services are constantly assessed by their ability to accommodate values popular in contemporary societies. Autonomy, justice, and human dignity have for some time been among such values in the affluent West. Relative newcomers in the field are the notions of and which seem to attract, in particular, Continental European ethicists. a.

Utilitarianism could still be a viable moral and political theory, although an emphasis on justice as distributing burdens and benefits has hidden this from current conversations. The traditional counterexamples prove that we have good grounds for rejecting classical, aggregative forms of consequentialism. A nonaggregative, liberal form of utilitarianism is immune to this rejection. The cost is that it cannot adjudicate when the basic needs of individuals or groups are in conflict. Cases like this must be solved by other methods. This (...) is not a weakness in liberal utilitarianism, on the contrary. The theory clarifies what we should admit to begin with: that ethical doctrines do not have universally acceptable solutions to all difficult problems or hard cases. The theory also reminds us that not all problems are in this sense difficult or cases hard. We could alleviate the plight of nonhuman animals by reducing meat eating. We could mitigate climate change and its detrimental effects by choosing better ways of living. These would imply that most people’s desire satisfaction would be partly frustrated, but liberal utilitarianism holds that this would be justified by the satisfaction of the basic needs of other people and nonhuman animals. (shrink)

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

Moral and political philosophers no longer condemn harm inflicted on nonhuman animals as self-evidently as they did when animal welfare and animal rights advocacy was at the forefront in the 1980s, and sentience, suffering, species-typical behavior, and personhood were the basic concepts of the discussion. The article shows this by comparing the determination with which societies seek responsibility for human harm to the relative indifference with which law and morality react to nonhuman harm. When harm is inflicted on humans, policies (...) concerning negligence and duty of care and principles such as the ‘but for’ rule and the doctrine of double effect are easily introduced. When harm is inflicted on nonhumans, this does not happen, at least not any more. As an explanation for the changed situation, the article offers a shift in discussion and its basic terminology. Simple ethical considerations supported the case for nonhuman animals, but many philosophers moved on to debate different views on political justice instead. This allowed the creation of many conflicting views that are justifiable on their own presuppositions. In the absence of a shared foundation, this fragments the discussion, focuses it on humans, and ignores or marginalizes nonhuman animals. (shrink)

Is there such a thing as corona solidarity? Does voluntary mutual aid solve the problems caused by COVID-19? I argue that the answer to the first question is “yes” and to the second “no.” Not that the answer to the second question could not, in an ideal world, be “yes,” too. It is just that in this world of global capitalism and everybody looking out for themselves, the kind of communal warmth celebrated by the media either does not actually exist (...) or is too weak to rule out the uglier manifestations of group togetherness, driven partly by the pandemic. I make my point by offering two approaches to understanding what solidarity is. According to the first, it is essentially partiality: “us” against “them.” According to the second, it can be many things, including the impartial promotion of the good of others. I show that the second reading would make it possible for mutual aid to solve the problems caused by COVID-19 and other crises. This would happen at the expense of conceptual clarity, but that is a minor concern. The major concern is that the more natural manifestations of group togetherness are incited by negative feelings. This is par for the course within the narrower reading of solidarity, but it means that the potentially positive ideas of identity, care, communal values, and special relations are displayed in violent confrontation instead of a calm recognition of the threats that most of us face together. (shrink)

In contemporary discussions on practical ethics, the concepts of autonomy and dignity have frequently been opposed. This tendency has been particularly visible in controversies regarding cloning, abortion, organ sales, and euthanasia. Freedom of research and freedom of choice, as instances of professional and personal autonomy, have been cited in arguments favouring these practices, while the dignity and sanctity of human life have been evoked in arguments against them. In the moral theory of Immanuel Kant, however, the concepts of autonomy and (...) dignity seem to coexist in mutual harmony. Respect for the freely chosen moral law and respect for the absolute value of humanity coincide, and give rise to a unified understanding of our duties toward ourselves and others. My question in this paper is, was Kant on to something here? Can autonomy and dignity, in the sense in which they are used in current debates, be brought together, and can the arguments be settled in a way that would satisfy both disagreeing parties? My answer to the question is, yes and no. Kant was definitely on to something in that he recognized two competing views in modern moral philosophy, and tried to consolidate them in an attempt to create a universal model of ethics. But in the end, he failed to fuse the two views together on equal terms. Instead, he sacrificed the modern idea of the self-governance of individuals on the altar of the premodern notion of the absolute inner worth of humanity. (shrink)

Antinatalism is an emerging philosophy and practice that challenges pronatalism, the prevailing philosophy and practice in reproductive matters. We explore justifications of antinatalism—the arguments from the quality of life, the risk of an intolerable life, the lack of consent, and the asymmetry of good and bad—and argue that none of them supports a concrete, understandable, and convincing moral case for not having children. We identify concentration on possible future individuals who may or may not come to be as the main (...) culprit for the failure and suggest that the focus should be shifted to people who already exist. Pronatalism’s hegemonic status in contemporary societies imposes upon us a lifestyle that we have not chosen yet find almost impossible to abandon. We explicate the nature of this imposition and consider the implications of its exposure to different stakeholders with varying stands on the practice of antinatalism. Imposition as a term has figured in reproductive debates before, but the argument from postnatal, mental, and cultural imposition we launch is new. It is the hitherto overlooked and underdeveloped justification of antinatalism that should be solid and comprehensible enough to be used even by activists in support of their work. (shrink)

_Liberal Utilitarianism and Applied Ethics_ explores the foundations of early utilitarianism and, at the same time, the theoretical bases of social ethics and policy in modern Western welfare states. Matti Hayry sees the main reason for utilitarianism's growing disrepute among moral philosophers is that its principles cannot legitimately be extended to situations where the basic needs of the individuals involved are in conflict. He is able to formulate a solution to this fundamental problem by arguing convincingly that by combining a (...) limited version of liberal utilitarianism and the methods of applied ethics, we are able to define our moral duties and rights. _Liberal Utilitarianism and Applied Ethics_ will appeal to students and teachers of philosophy who are interested in the doctrine of utilitarianism or in ethical decison-making. (shrink)

If genetic diagnosis and preimplantation selection could be employed to produce deaf children, would it be acceptable for deaf parents to do so? Some say no, because there is no moral difference between selecting a deaf embryo and deafening a hearing child, and because it would be wrong to deafen infants. It is argued in this paper, however, that this view is untenable. There are differences between the two activities, and it is perfectly possible to condone genetic selection for deafness (...) while condemning attempts to deafen infants at birth. (shrink)

This article presents a revised version of negative utilitarianism. Previous versions have relied on a hedonistic theory of value and stated that suffering should be minimized. The traditional rebuttal is that the doctrine in this form morally requires us to end all sentient life. To avoid this, a need-based theory of value is introduced. The frustration of the needs not to suffer and not to have one’s autonomy dwarfed should,prima facie, be decreased. When decreasing the need frustration of some would (...) increase the need frustration of others, the case is deferred and a fuller ethical analysis is conducted. The author’s perceptions on murder, extinction, the right to die, antinatalism, veganism, and abortion are used to reach a reflective equilibrium. The new theory is then applied to consumerism, material growth, and power relations. The main finding is that the burden of proof should be on those who promote thestatus quo. (shrink)

The reversal of Roe v. Wade by the U.S. Supreme Court allowed the states to regulate terminations of pregnancy more autonomously than during 1973–2022. Those who think that women should be legally entitled to abortions at their own request are suggesting that annulling the reversal could be an option. This would mean continued reliance on the interpretation of privacy that Roe v. Wade stood on. The interpretation does not have the moral support that its supporters think. This can be shown (...) by recalling the shortcomings of Judith Jarvis Thomson’s famous violinist example and its application to abortion laws. Philosophically better reasons for not restricting access to abortion can be found in a simple principle of fairness and in sensible theories on the value of human life. Whether or not philosophy has any use in the debate is another matter. Legal decisions to regulate terminations are probably based on pronatalist state interests, shared by the apparently disagreeing parties and immune to rational argumentation. (shrink)

I present a qualified new defense of antinatalism. It is intended to empower potential parents who worry about their possible children’s life quality in a world threatened by environmental degradation, climate change, and the like. The main elements of the defense are an understanding of antinatalism’s historical nature and contemporary varieties, a positional theory of value based on Epicurean hedonism and Schopenhauerian pessimism, and a sensitive guide for reproductive decision-making in the light of different views on life’s value and risk-taking. (...) My conclusion, main message, to the concerned would-be parents is threefold. If they believe that life’s ordinary frustrations can make it not worth living, they should not have children. If they believe that a noticeably low life quality makes it not worth living and that such life quality can be reasonably expected, they should not have children, either. If they believe that a noticeably low life quality is not reasonably to be expected or that the risk is worth taking, they can, in the light of their own values and beliefs, have children. The conclusion is supported by a combination of the extant arguments for reproductive abstinence, namely the arguments from consent, moral asymmetry, life quality, and risk. (shrink)

ABSTRACT The authors analyse and assess the Universal Draft Declaration on Bioethics and Human Rights published by UNESCO. They argue that the Draft has two main weaknesses. It unnecessarily confines the scope of bioethics to life sciences and their practical applications. And it fails to spell out the intended role of human dignity in international ethical regulation.

ABSTRACT The authors analyse and assess the Universal Draft Declaration on Bioethics and Human Rights published by UNESCO. They argue that the Draft has two main weaknesses. It unnecessarily confines the scope of bioethics to life sciences and their practical applications. And it fails to spell out the intended role of human dignity in international ethical regulation.

Lääketieteellisten teknologioiden kehitys voi tulevaisuudessa johtaa siihen, että ihmisten elinikä voidaan moninkertaistaa. Eri filosofisista lähtökohdista tällaisen toiminnan toivottavuuteen voidaan suhtautua eri tavoin. Jonathan Glover ja John Harris ovat tervehtineet mahdollisuutta ilolla ja suositelleet pyrkimistä sen toteuttamiseen. Enemmän elämää on heidän mielestään parempi kuin vähemmän, eikä asiaa tarvitse sen kummemmin monimutkaistaa. Leon Kass ja Jürgen Habermas ovat puolestaan torjuneet ajatuksen kauhistuneina. Elämämme arvo ei riipu sen pituudesta, vaan sen annetusta tai lahjana saadusta sisällöstä. Kirjoituksessa teen selkoa näistä kahdesta vastakkaisesta kannasta koskien (...) ”elämän tarkoitusta” ja lisään joukkoon oman tulkintani epikurolaisesta ajattelusta. Viimeksi mainitun mukaan eliniän huomattavasta lisäämisestä ei olisi ihmisille sen paremmin haittaa kuin hyötyäkään. (shrink)

Antinatalism assigns reproduction a negative value. There should be fewer or no births. Those who say that there should be fewer births have been called conditional antinatalists. A better name for their view would be selective pronatalism. Those who say that there should be no births face two challenges. They must define the scope of their no-birth policy. Does it apply only to human or sentient beings or can it also be extended to all organic life, perhaps even to machine (...) consciousness? And whatever the scope, they have to justify the eventual extinction of humankind or other life forms, an inevitable consequence of unconditional antinatalism. Different axiologies and moral theories produce different responses to these challenges. It is argued that a two-value conflict-sensitive negative utilitarianism would produce a kind and reasonable justification for ending at least human and factory-animal reproduction. The conclusion is purely moral and supports only voluntary extinction for humankind. (shrink)

Governmental reactions to crises like the COVID-19 pandemic can be seen as ethics communication. Governments can contain the disease and thereby mitigate the detrimental public health impact; allow the virus to spread to reach herd immunity; test, track, isolate, and treat; and suppress the disease regionally. An observation of Sweden and Finland showed a difference in feasible ways to communicate the chosen policy to the citizenry. Sweden assumed the herd immunity strategy and backed it up with health utilitarian arguments. This (...) was easy to communicate to the Swedish people, who appreciated the voluntary restrictions approach and trusted their decision makers. Finland chose the contain and mitigate strategy and was towards the end of the observation period apparently hesitating between suppression and the test, track, isolate, and treat approach. Both are difficult to communicate to the general public accurately, truthfully, and acceptably. Apart from health utilitarian argumentation, something like the republican political philosophy or selective truth telling are needed. The application of republicanism to the issue, however, is problematic, and hiding the truth seems to go against the basic tenets of liberal democracy. (shrink)