Scholars of ethics, and of human behavior more generally, will find this book consistently stimulating and rewarding.

The relief of suffering is the great goal of medicine. That physicians give up on suffering when they can do nothing about the underlying condition is one of the contemporary criticisms of medicine. Yet even in irremediable suffering there is something noble, to which physicians should attend.

Kögel et al propose a multicriteria alternative to the standard early clinical selection method for xenotransplantation trials. As they note, existing recommendations for inclusion criteria indicate that only the most seriously ill—those lacking any viable alternative—should be considered for xenotransplantation. Rather than basing selection on, to put it indelicately, a Hail Mary in the face of certain death, Kögel et al recommend a selection system based on four ethical criteria: medical need, capacity to benefit, patient choice and compliance (the latter (...) being an exclusion criterion). Taken together, they paint a picture of an ethically ideal first-in-human xenotransplantation clinical trial participant: someone ‘in need of a heart replacement with a good capacity to benefit from a xenotransplantation who [has] a choice in terms of alternative potentially life-sustaining treatment options.’1 In other words, they argue that potential xenotransplantation organ recipients (they specify heart, but said criteria would apply to any vital organ recipient) should not be facing their imminent demise as this would inherently constrain that person’s freedom of choice, thus rendering them vulnerable. Instead, Kögel et al argue that trial participants should be selected from groups possessing genuine alternatives to xenotransplantation but opt to receive an animal organ. Now, their concern regarding the presence of coercion in the context of what is an experimental medical intervention is fully justified, as is their claim that those facing limited viable choices at the end of their lives are an inherently vulnerable population. Autonomy and consent are largely uncontroversial bedrocks on which most medical and research ethics theories are built. We are, all of us, familiar with the horrors from history—both distant and recent—where participant consent has taken …. (shrink)

The article explains a rule-Utilitarian normative thesis about when actions are morally excused; that an act otherwise morally objectionable in some way is excused if a moral system, The acceptance of which in the agent's society would be utility-Maximizing, Would not condemn it. What is meant by a "moral system condemning" an action is explained. The parallel between this moral thesis and the benthamite theory of criminal justice is developed. It is argued that this rule-Utilitarian thesis implies that an action (...) is morally excused (not blameworthy) if it does not manifest a defective trait of character. (shrink)

I wish to consider what can helpfully be meant by the phrase “rational to believe” as it might appear in the statement “It is rational for the person S in his circumstances at t to place more confidence in p than in q, provided his overriding interest at the time is to place confidence, among any propositions he is considering, in true propositions and not in false ones.” The reference here to the interest of the person is intended to avoid (...) discussing persons for whom it is rational to believe something for extraneous reasons, e.g., for a man to believe his wife is loyal to him irrespective of the evidence. I shall take this term as paradigmatic of “epistemic terms”, examples of which philosophers take to be such terms as “is epistemically justified in believing”, “is warranted in believing”, “is credible”, and so on. I do not claim that all these terms have or should bear the same meaning, but I propose to ignore possible distinctions. (shrink)

This essay demonstrates proof-theoretically the consistency of a type-free theoryC with an unrestricted principle of comprehension and based on a predicate logic in which contraction (A (A B)) (A B), although it cannot holds in general, is provable for a wide range ofA's.C is presented as an axiomatic theoryCH (with a natural-deduction equivalentCS) as a finitary system, without formulas of infinite length. ThenCH is proved simply consistent by passing to a Gentzen-style natural-deduction systemCG that allows countably infinite conjunctions and in (...) which all theorems ofCH are provable.CG is seen to be a consistent by a normalization argument. It also shown that in a senseC is highly non-extensional. (shrink)

Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice – that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that (...) of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of (...) health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Rodger et al argue for the disenhancement of animals intended for xenotransplantation; that is, the transference of tissues or organs from one species to another. The crux of their claim is that the conditions necessary to facilitate xenotransplantation will be hostile to those subjected to them. Thus, to minimise the suffering of living under such conditions, ‘ethically defensible xenotransplantation should entail the use of genetic disenhancement if it becomes possible to do so and if that pain and suffering cannot be (...) eliminated by other means.’1 In other words, if we can eliminate or meaningfully reduce the suffering of animals destined for xenotransplantation by obliterating their experiential capacity and lacking a less contentious method to achieve the same result, we should do so. When isolated, this argument is compelling. Suffering is terrible and should be avoided. Additionally, when we have the option to reduce another’s suffering—be that human, animal or otherwise—there are strong prima facie arguments that we should do so. This point is reinforced when we collectively are responsible for that suffering, as would be the case with xenotransplantation, and it is true regardless of how justified we are in causing that suffering. Thus, on the restrictive terms of Rodger et al ’s argument, I agree with them. We should eliminate, or if not possible, reduce, suffering wherever we can, and this applies to animals too. Having said that, when situated in the xenotransplantation context, issues with their proposal …. (shrink)

Richard Brandt is one of the most eminent and influential of contemporary moral philosophers. His work has been concerned with how to justify what is good or right not by reliance on intuitions or theories about what moral words mean but by the explanation of moral psychology and the description of what it is to value something, or to think it immoral. His approach thus stands in marked contrast to the influential theories of John Rawls. The essays reprinted in (...) this collection span a period of almost 30 years and include many classic pieces in metaethical and normative ethical theory. The collection is aimed at both those moral philosophers familiar with Brandt's work and at those philosophers who may be largely unfamiliar with his work. The latter group will be struck by the lucid unpretentious style and the cumulative weight of Brandt's contributions to topics that remain at the forefront of moral philosophy. (shrink)

In her paper, Robinson asserts that if one is convinced by the arguments assigning personhood according to a threshold criterion, one should also be open to the potential for a secondary personhood threshold, satisfied when one is pregnant, which confers temporary enhanced moral status. Rather than grounding such a claim on a fetus’s possession, or lack thereof, of personhood, Robinson argues that the pregnant person’s status as a ‘unique being’ is enough to satisfy the requirements of such an additional personhood (...) classification. 1 She justifies her claim via three arguments: (1) that the pregnant person is, in fact, more than a singular individual; (2) that pregnant people play a critical role in the human race’s continuation and (3) that the significant harms and burdens to which pregnant people have been exposed to historically and contemporary requires counterbalancing with enhanced protections. Unfortunately, despite Robinson’s best efforts, she does not... (shrink)

Systems-oriented social epistemology, studies epistemic systems in which individuals work together to determine the epistemic status (true, justified, true beyond a reasonable doubt, e...

Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering from body (...) integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting ‘classical’ amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world. (shrink)

This paper criticizes Analytic philosophy with its reliance on intuitions in pursuit of conceptual analysis. Rejecting naturalism as an alternative philosophical method, I offer in its place a pragmatic and revisionary conception of philosophical method. I explain the method of Analytic philosophy and show why reliance on intuitions is essential to that method, which is unable to provide substantive answers to philosophical problems. I further show that reflective equilibrium or wide analysis requires some criterion of intuition choice and that this (...) criterion can be applied directly to definitions themselves. (shrink)

This paper explores the impact that developments in the field of neuroprosthetics will have on the ethical viability of healthy limb amputation, specifically in cases of Body Integrity Identity Dis...

Sexual violence is explained using a social psychological theory of aggression that emphasizes bounded rationality. The approach challenges feminist approaches that examine violence against women in isolation and attribute it to sexism. It suggests that sex differences in sexuality lead men to attempt to influence women to have sex using various means. Sex differences in physical strength create opportunities for them to use violence while chivalry encourages them to act like “gentlemen.” Research on the age of victims, sexual arousal, self-reported (...) motives, legalized prostitution, and modus operandi support the commonsense notion that most incidents are sexually motivated. As a result of sexual motivation, rape is as much a crime against teenagers as it is a crime against women. However, evidence suggests that some rapes–like other violent crimes– are motivated by real or imagined grievances. The role of grievances is supported by research on self-reported motives and justifications, and the offender’s use of gratuitous violence during the incident. It is argued that sexual assault can be explained by bounded rationality and well-established social psychological processes. (shrink)

This is the text of The Lindley Lecture for 1963, given by Richard B. Brandt (1910-1997), an American philosopher.