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All lecture notes for PHI2396 + tips for final take home exam

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Paul Forster

Lecture 1 What is Bioethics? • Atype of applied ethics. What is being applied? General ethical theories, principles and rules to problems of therapeutic practice, health care delivery and medical and biological research (general ethical theories can cause problems with therapeutic practice) th • The beginning of bioethics dates back to 5 century BC with the Hippocratic Oath which is the first code of ethics for health care professionals • Bioethics and the LAW, hold a close relationship (because many medical laws are based on whether it is ethical or not, such as abortion) • On the one hand, the law defines the social boundaries, and conditions for health care delivery. On the other hand, ethical theory and research may serve as a resource to developing a case law (Morgentalers case)-Abortion used to be against the law, so he argued that abortion is ethical in supreme court, and therefore the law changed. What are general ethical theories and principles that we will be using this course? • But before that, a question: why is it that we are concerned with ethics at all? What is it about ethics that makes it important for us to know about it? Example: research in stem cells, or who to give a bed in a hospital when non are available • Some people believe that what is right and wrong (good or bad) depends upon how they feel about it. • These people share a non-cognitivist meta-ethical position, also known as ethical non-cognitivism (this is a theory that states one cannot learn to be good or bad, it is not about moral or ethical knowledge, but about feeling) • The problem is different people have different feelings, thus feelings cannot really be used in every case. Ethical non-cognitivism • It argues that no matter how much logic or reasoning (based on knowledge) you use, you can never settle a disagreement on what is right. In other words, we think we are right because it feels right. • It assumes that because everyone acts a certain way, it must be the right way. But there is also a cultural aspect, which is the filter that helps you feel one way or another. No two philosophers can be put in the same room and come upon the same decision. • For example: we feel that killing is wrong • The disadvantage of ethical non-cognitivist is that rationale is cut off, or does not play a role in decision making • Other people believe that what is right or wrong is relative to a particular point of view. This is called ethical relativism 1 Ethical Relativism • Is the position that what is right or wrong is based on reasoning, and not just feelings, but there is no objective or universal right or wrong • Every individual or group has their own values and understanding of what is right or wrong. For example: pro-choice or pro-life, religious versus non-religious • Yet other people believe that right or wrong, good or bad etc are objective in nature. This is the so-called ethical objectivism, example killing is wrong in any circumstance Ethical Objectivism • Is the position that right and wrong are objective phenomena, that is, phenomena that are recognized by everyone. So, when we make ethical claims, we make claims about how the world really is. • In other words, ethical objectivism believes that people’s actions and dispositions have moral qualities and are not just a matter of a point of view, or a feeling • This is the position we’ll accept as true in this course. • There are a few objectivist ethical theories: the first type is teleological or consequentialist theories. The best known teleological theory is utilitarianism Utilitarianism (made most famous by John Stuart Mill) • Its fundamental principle is the so-called principle of utility • The principle of utility says: the greatest good and the least harm for the greatest number of people (what makes the majority happy, example who to save during war). This theory quantifies happiness and wellbeing which is one of its greatest flaws because it doesn’t consider the individual • The principle of utility does not however tell us the nature of what this good or harm is. • Because of that, there are different types of utilitarianisms depending on the definition of good or bad, how we identify this good or bad, and how to apply the principle of utility Act Utilitarianism • Proposes that we should apply the principle of utility on a case-by-case basis, without reference to universal rules • Example anAfrican Canadian doctor in the emergency has two patients, but he can only operate on one. But when he pursues the operation he finds the patient to have a swastika or racist tattoos; this fact in turn might change the doctor’s decision to operate on the patient. Rule Utilitarianism • It proposes that utility cannot be calculated for individual acts but only for general rules of conduct. Thus, when we deal with an actual moral dilemma, the decision 2 making process should depend upon identifying the general rule to be applied in the given situation. • Hospitals apply both • Read carefully the case explained page 6 and 7, from the first article titled Ethical Theory Deontological Theories • Are not concerned with outcomes but with rights and duties (it considers individual rights; status of person does not matter). There are two major types of deontological approach: monistic (singular) and pluralistic (many) • Immanuel Kant’s ethical theory is the best known deontological monistic approach. It is called categorical imperative (defines one main duty that we all have) Categorical Imperative • The first definition of categorical imperative: you should ‘act only according to that maxim by which you can at the same time will that it should become a universal law’(this means you act in a way you think all people should act, example do not kill) • The second definition of categorical imperative, which Kant called ‘practical imperative’: you should ‘act so that you treat humanity always as an end and never as a means only’(it takes the person as an individual and what is good for that person and not what benefits others). When Kant says never as a means only, he means try not to use people deliberately in order to achieve your goals, which is a very altruistic ethics that is very difficult to follow since humans are very selfish • Read example on page 8 of course pack Pluralistic DeontologicalApproach • The pluralistic deontological approach says that there are several universal moral principles which should be balanced against each other in a given situation and that should be used more as guidelines than as rigid rules • The following six principles have found acceptance among pluralistic deontologists: 1. Principle of autonomy and respect for persons 2. Principle of impossibility 3. Principle of fidelity or best action 4. Principle of equality and justice 5. Principle of beneficence 6. Principle of non-malfeasance (or non-maleficence) • Read definition of these principles on page 9 of your text! • The last two principles are teleological in nature but they could be interpreted as deontological. • In its deontological interpretation the principle of beneficence should read as “everyone has a duty to maximize the good of other persons themselves”. 3 • In its deontological interpretation the principle of non-malfeasance should read as “everyone has a duty to minimize harm to other where the nature of this harm Is defined by the other persons themselves”. • On the side, professional paternalism arises when we fail to interpret these two principles in this derivative sense. • What is paternalism? • Oxford English Dictionary, paternalism: is the principle and practice of paternal administration; government as by a father; the claim or attempt to supply the needs or to regulate the life of a nation or community in the same way as a father does those of his children. • Professional paternalism involves two main characteristics; • 1) that the health-care professional is benevolent and beneficent, that is, that he or she has the interests of the patients at heart, and that • 2) he or she makes all or at least some of the decisions for the patients instead of letting them make decisions for themselves • Weak paternalism occurs when one prevents self-regarding conduct only when it is substantially non-voluntary or when temporary intervention is necessary to establish whether it is voluntary or not. • Ex: when a doctor prevents someone on LSD or suffering from severe clinical depression from killing themselves. • Strong paternalism holds that it is sometimes proper to protect or to benefit a person or to benefit a person by limiting her liberty even when choices are informed and voluntary. Feminist ethics • Also referred to, as “ethics of care” believes that we should look at moral dilemmas from the point of view of the difference moral and social experiences that men and women have, instead of balancing universal rights and duties. • Afeminist ethicist would argue that traditionally our societies male-dominated, and therefore, the ethical principles that reign are male-dominated principles, while women’s opinions and moral input have been discriminated • According to feminist ethics the principle of autonomy, which has been traditionally regarded as a universal principle, should be abolished and we should focus on the relationship that the different participants in a given moral situation have. • In order to resolve a given moral dilemma, we should rely on the caring responsibility that each of the participants has. (what is our responsibility towards this situation, instead of looking at different rules and definitions) • In other words, feminist ethicists believe that we can solve a moral dilemma only by co-operating and not by isolating a given moral principle and applying it blindly. • Such an issue as abortion, then, if approached from the point of view of a feminist ethicist, should be resolves not by appealing to virtues, rights and duties, but by looking at the social situation in a women in a male-dominated society. 4 Virtue Ethics • Virtue ethics believes that a moral person is virtuous person, and that the main concern of ethics is not with universal rights and duties, but with developing the virtuous character. • For example, in bioethics the most important virtues: care and compassion (as well as courage and forbearance, justice and beneficence). Religiously oriented ethics. • It uses moral principles that are grounded in a given religion. • These principles differ from religion to religion but there are some overlapping principles used in the three main monotheistic religions: Judaism, Christianity, and Islam. • We should note that in Canada there is definite limit, set by the Canadian law to the impact of religiously oriented ethics in the field of health care. • The Canadian Charter of rights and freedoms guarantees freedom of religion. However, any health care provider under public jurisdiction may not establish or follow principles that have sectarian or religious basis. Agapistic ethics, • also called ethics of respect for life preaches love and respect for all living things. • Agapistic ethics is mainly concerned with medical experimentation on non-human animals • SomeAgapistic ethicists say that all living things have equal moral standing; while others think that only sentient beings have equal moral standing to humans. • AllAgapistic ethicists believe that animal experimentation and the use of animals should occur only if absolutely necessary, and only if the cost in animal terms is proportionate to the advancement in health care that would result form such an undertaking. Jan 15/13 Daniel Callahan, The WHO definition of health • The concept of health an overly general concept, no a par with concepts such as “truth”, “happiness”, “love”, “good” etc. • General but not useless or meaningless • Callahan considers some of the main objections against the WHO definition of health. • First objective: has to do with the link that WHO makes between health and peace. We do not have any historical evidence that health contributes to peace in any way. We have evidence to the contrary. 5 • Second objection: the WHO definition of health is too vague and too broad. • Essentially, it links “health” with “happiness”. For example, by including “social wellbeing” under the definition of “health”, we are turning the notion of human happiness (which WHO hasn’t defined either) into a medical problem to be dealt with scientific means. • Callahan sees this link as absurd for three reasons. First, medicine in all its forms has not proven yet that it has but only a very partial grasp on physical and mental ailments and their cures. • Second, there are such evils as social injustice, economic scarcity, food shortages, political tyranny, etc. which represent a far greater historical evidence of our failure to achieve social wellbeing than the lack of physical and mental health. • It is also self-serving and short-sighted to assume that all these social evils originated in bad physical and mental health. • Third, in practice, the lines between the appropriate authority and responsibility are blurred. • In other words, if we reduce all human – social, political, physical, mental, cultural, etc., problems to mental and physical problems (health), then there is no way to determine who (the authority) should be responsible for solving them. • One repercussion from putting the medical profession in charge of bringing social wellbeing, is that instead of sending criminals to prisons, we’ll be putting them in mental institutions • Another consequence of equating all social injustice with ‘sickness’: the whole world becomes ‘sick’in one way or another and since it often is not the fault of the sick person that they contracted the illness, we cannot blame anyone for any of the ‘sickness’of the world • The biggest problem with this line of thinking is that if we treat all social evil in the world, such as war, crime, social unrest, as illness, we turn ‘health’into a normative concept. • What does that mean? • Norms are things that need to be obeyed and sought after if we want to live in peace and happiness. • Then health becomes the norm, that is, it’s not optional anymore (examples: growing tendency of practicing eugenics, genetic disease screening practice during pregnancy, etc.). • Summary of Callahan’s criticism against the WHO definition (p32): • 1) Health is only a part of life; • 2) The role of medicine in our lives is important but limited; • 3) We should resist the tendency to place all criminal, deviant and harmful behaviour under the notion of ‘sickness’, thus setting those who exhibit such a behaviour free of responsibility; • 4) Medicine does not and should not have a normative power (medicine is not morality except in limited cases of epidemics and plague); • 5) We should keep the roles and responsibilities of different professions separate and clear. Medicine can save some lives but it cannot save the life of society. 6 • Despite that, the spirit of the WHO definition of health is very much alive. How? • We intuitively put a normative value in talking about health • There is an intimate connection between (physical and mental) health and happiness, and social rest. • We are a body and a mind and thus, health may not be a sufficient condition for happiness and social wellbeing, but it is a necessary one (a necessary condition; if the cause is not present, then the result is not present, either). • Two conclusions: • 1) a minimal level of health is necessary if there is a hope for happiness at all; • 2) one can be considered healthy without being in the state of ‘complete physical, mental, and social wellbeing’ • The second conclusion could be justified in two ways: • 1) some amount of infirmity and disease is perfectly normal for the normal functioning of individuals and societies; • 2) the complete physical, mental and social wellbeing is an ideal, it cannot be maintained as something permanent in practice • If we take the WHO definition at face value, we demand that life be perfect. • Callahan’s suggestion; we keep the definition of health under ‘a state of physical wellbeing” which definition does not have to be complete, but only adequate to prevent a significant impairment of its function. Targeting only the body • W. Miller Brown, “On defining ‘disease’”. • We need a definition of the concept of disease in order to be able to define health negatively (as a lack of disease). • Two approaches toward defining disease – objectivist and normative. • Objectivist approach: tries to fit the notion of disease within the theoretical framework of modern biological science. • This approach shows that we can define disease without appealing to non- scientific standards, norms or values. • This is a descriptive approach • Disease is then an impairment deviation from the normal functioning of the body, mal-adaptation, incapacity or dis-functioning. • It is upon the biological science to describe successfully normal bodily processes, as well as their deviations. • The objectivist approach developed by Boorse ignores ordinary language and relies on technical concepts such as biological function. • Boorse’s definition of disease: ‘a type of internal state which is either an impairment of normal functional ability, i.e, a reduction of one or more functional abilities below typical efficiency, or a limitation on functional ability caused by environmental agents.’ • Key concepts in Boorse’s definition: ‘function’and ‘normal’ • Function is goal-oriented. 7 • Brown’s criticism of ‘function’: there are many functions that are not goal- oriented (ex: human canines, man’s nipples). • Jan 22/13 1. IdentifyingArguments 2. Scope of argument 3. Editing out biases/degressions 4. Answering Questions An argument is a collection of premises (or at least one premise) followed by some conclusion (From excerpt from the Globe and Mail, Quebec Panel Recommends allowing physician- assisted suicide. Jan 15, 2013): 1. Whether the physician should have the last word 2. Whether the option should be available 3. Option should be open to people who are suffering from an incurable disease 4. Need to communicate the directive 5. What defines exceptional circumstances? 6. What is the panel of legal experts, and why them? 7. Source 8. Positive connotation 9. Dying is now a right (assistance) 10. Permitted to assist but not coerce Identifying an argument: -What is the excerpt from the Globe and Mail about? -Some panel, comprised by legal experts, is recommending that a certain category of patients receive assistance to die. -The types of patients are those who are suffering from a terminal or degenerative disease -The authority deciding whether someone ought to receive this type of assistance are the respective physicians of the patients. Scope of the argument: -Where is the line between where an argument begins and ends? -The scope refers to the content of an expression that is relevant to the argument "Physicians should not be the ones to decide whether a patient should be permitted to receive physician-assisted suicide. The duty 8 of physicians are to treat disease and not to determine when a persons life should end. If we do allow physicians to determine when a persons life should end, then we are allowing them to perform some act that is not part of their duty, and that neither arises from their training nor expertise as health care practitioners. Therefore either we introduce a new body of experts to determine cases where individuals should be permitted to receive physician assisted suicide (like an ethicist), or the act should not be permitted at all." Given the above argument, do you think the moral position presented here is tenable (acceptable, reasonable)? In our own words: Physicians should not be the sole deciders of assisted suicide. The physician’s role should not include suicide. Someone other than physicians should make decisions concerning assisted suicide, such as ethicists. Is it tenable? Answering Questions: 1. Clarify any aspects of the question you are not familiar with? (ie wording, terms, focus, clauses) 2. Rephrase the argument in our own terms, to see whether you’ve understood it or not. 3. Prepare a response. Jan 25/13 Health • Boorse understands normality as a statistical normality, what is typical in a population • Brown’s criticism: choice of target population unclear; also, unclear higher goal. • Boorse: survival and reproduction are the two highest goals for a species. • Brown: there are enough examples in biology where the species behaves in an ‘abnormal’way during or after reproduction (ex. Salmon). • So perhaps we should allow a normative element in our objectivist and purportedly descriptive definition of disease. • The normative approach considers what we, as a culture, etc. consider to be good, valuable etc. • Here ‘disease’means an undesirable disvalued or bad physical state or process of an organism 9 • The basic claim of the normative approach is that the concept of disease is bound up with the concepts of harm and benefit. • Caroline Whitback’s normative definition of disease (pp. 41-42): disease is a psycho-physiological state that people want to avoid • Brown: this definition is an improvement over Boorse’s defintioon in that it keeps disease limited to humans, and sees disease as a process. • One problem with Whitback’s definition: if the members of a human group decide that something they tried to avoid in the past (ex: diabetes), is not something they want to avoid any more, we are left with no definition of disease. • Brown’s conclusion: the problems with both Boorse’s and whitbecks’definitions of disease- they are working under the assumption that medicine is a theoretical discipline, and are looking for the perfect theoretical definition of disease. • But medicine is a practical discipline which has arisen from crisis and suffering, and its hypotheses emerge from a set of conditions and circumstances (such as doctor-patient communications (that lead to simple definitions of health and disease. • They may be incomplete at the moment but at least can be worked with • Thus, philosophical definitions may be helpful to medicine but they cannot be leading medicine. Abortion • Why abortion? • It deals, a part of the topic, with the status and rights of ‘border-line’entities such as fetuses. • In the discussion of embryonic stem-cell research, cloning, and genetic engineering, we encounter the same issue- the status and rights of entities such as cells, embryos, human vegetables, etc. • Why Sherwin and Warren together? • They present the feminist perspective, which we will juxtapose, to the non- feminist one. • Susan Sherwin,Abortion through a Feminist Ethics lens; maryAn Warren, On the moral and legal status of abortion. • Sherwin’s text was written after Warren’s and is complementary to it. • Sherwin focuses more on the social conditions and outcomes of abortion while Warren deals with the ethical side of the issue. • Abortion law in Canada. • Arguments against abortion.Abortion is killing an innocent human being, therefore we have to legally ban abortion unless it’s a therapeutic (threatens the life of the mother and/or the fetus). • Argument 1. Women are responsible for getting pregnant and therefore they have to be held responsible for bringing the human babies to life and safety. • Argument 2: If we allow abortions, then we encourage irresponsible behaviour in pregnant women. 10 • Both arguments are based upon an underlying premise that a human fetus is a human being with a right to live. • Fully reconstructed anti-abortion argument: i) it is wrong to kill (innocent) human beings, ii) foetuses (innocent) human beings, iii) therefore, it is wrong to abort foetuses. • Life starts at the moment of conception- this is the most rigid reading of the first statement and it originates from the Roman Catholic Church. • Other than more moderate readings—we have a live human form after the first week of pregnancy • Afetus is a potential human being with the right to life, safety, and happiness • In any of these cases, fetus is considered a human being and therefore abortion is considered morally wrong, and on the basis of morality it is considered also illegal. • Arguments from a pro-choice standpoint. Women have to have choice of abortion (in virtue of the basic right of freedom of choice). Therefore, we have to allow any type of abortion, not only the therapeutic ones. • The most mitigated pro-choice position: even if we agree that abortion is morally wrong, we should make it legal: illegal abortion leads to death or serious injuries of many women, which is equally wrong. • Support: stats on illegal abortion are always hard to come by, but we do know that between 1926 and 1947, 4000 to 6000 Canadian women died as a result of bungled, illegal abortions. • If we want to lower the numbers of abortions, here is what we can do: • -offer free consultation • -make sure that women fully understand the consequences of their actions • -make sure that women are fully aware of the options they have if they decide to become mothers or at least give birth to the child (child-support financing, options for adoption, etc.) • -ensure a better government child support system. • Full-fledged pro choice positions. To deny access to abortion is to deny a woman her right to control her own body. • Warren: this position is problematic because if we treat female body as her property, then we have to treat the body as something distinct from her (her self), since we treat every type of property as distinct from the people who own it. • Which is not the case with our bodies. Our bodies are an intrinsic part of us. • To think that women will be irresponsible if they had choice in the matters of abortion is to stretch things beyond reality. • Abortion: a traumatic experience both physically and emotionally. • Women do not enjoy having abortions! • Even if there are cases of irresponsible behaviour toward one’s pregnancy, they will be exceptions, which are not worth the prohibition of abortion as a basic right for women. • The case scenarios discussed by anti-abortionists are far-fetched and have no grounds in reality. 11 • Another part of this objection to the legal banning of abortion: even if women are fully responsible and extra careful, they cannot avoid unwanted pregnancies because the contraceptive devices do not guarantee full (100%) protection against pregnancy. • Many of the contraceptive devices are health hazardous for some women. Therefore they cannot be used all the time. • This makes abortion one of the legitimate options for preventing unwanted pregnancies. • If women are to enjoy freedom of sexual encounters as men do, they should have options to avoid unwanted pregnancy and safe abortion is one of them. • Warren tackles the moral side of abortion and leaves out the social and legal sides. • Her strongest objection against the argument against abortion: the concept of ‘human being’(in the argument that it is morally wrong to kill innocent human beings). • She answered: The status of fetus as human being is problematic • There are two different meanings of human being implicitly present in the definition of “human being” • First: Human beings • Second: it has to do with what we understand by “a moral agent”. • Human beings are ‘full-fledged members of the moral community’. • Ahuman being is considered every being which can make moral decisions and participate in the moral community. • The first premise of the anti-abortionist argument that is wrong to kill innocent human beings is acceptable only if we accept the second meaning of human beings. Why? • First, saying that human beings have certain genetic and physical structure doesn’t imply anything moral: it doesn’t imply that human beings’life is a precious thing. • Second, we have to explain why we justify the killing of human beings in certain cases (capital punishment, war, etc.). o This shows that the community of human beings operates with the concepts of morally right and morally wrong when it defends or convicts its members. o Therefore, we have t concede that “moral “agent” best describes what we mean by a “human” o Afull-fledged member of the moral community is a person. o Who is a person?  Five principles 1) Consciousness 2) Reasoning 3) Self motivated activity 4) Capacity to communicate 5) The presence of self-concept and self-awareness of ones own being. 12 -The minimum 2 criteria’s for being a moral agent is to have consciousness and reasoning 1) and 2 ) -The moral concept of good and bad are an intrinsic part of our cognitive apparatus ( reasoning) • The two main criteria have to be taken together, not separately • The fetus has none of these characteristics, hence, not a member of the moral community. • Human vegetables, normally incaputated • Sherwin adds: to be a moral agent is a relational concept and must be defined in terms of interactions and relationships with others • Amoral agent should be able to make moral decisions and to respond to the needs of other members of the moral community • The relationship between the full-fledged moral agents are presumably symmetrical • Moral agent expresses their needs, desires, etc. and expects a response from other moral agents. • By the relationship between fetus and the mother is clearly an asymmetrical one because the fetus is fully dependent on the mother for its survival. • Thus, the fetus cannot be considered in any way morally significant way a full-fledged moral agent or a person. • An important consequence: only persons, that are full-fledged members of the moral community, are entitled to full moral rights. (Moral rights come with moral obligations and responsibilities) • Two questions for women: 1) resemblance to personhood and 2) potentiality • Resemblance to personhood: a 7-month-old fetus resembles a person more than an embryo. • Warren: yes, a 7 month old fetus is somewhat like a person (it can feel pain) but this only means that it has somewhat of a moral status • Full fledged members of the moral community have full moral status, not somewhat of a moral status. • In virtue of this, it is not immoral to abort a fetus in the later stages of development (it may be indecent but is not immoral) • Potentiality: what about the fetus being a potential human being? • Warren: potential human being/person have some moral status and value (they are not mere objects) in the sense that we shouldn’t wantonly destroy them. • Ontologically speaking actually outweighs potentiality. • Potential Human beings do not enjoy the full moral rights (including the right to life) that a full-fledged member of the moral community enjoys. • So, if there is a conflict of rights, the full-fledged members moral value outweighs the moral value of a potential member. 13 • Athought of experiment ( p. 325): shows that the right to life of a full fledged moral agent outweighs the right to life of a potential one. • What is more, any of the basic human rights of a full-fledged moral agent outweigh the right to life of any potential moral agent. • Infanticide: Why, following the logic of personhood, isn’t infanticide automatically permitted on moral grounds? • Warren: two points • 1) the crucial difference between a baby in utera and one ex utera is that the ex utera baby (infant) is not fully dependent upon the mother for its survival • The newborn is an ontologically independent entity while the same cannot be said about a fetus. • So the mother cannot decide its fate because it is not an extension of her body. • 2) under reasonably humane conditions, it would be morally wrong to destroy an infant (on grounds of compassion, potentiality, and the fact that there might be other individuals willing to care for the infant) • The point is: we cant extend the argument concerning abortion for infanticide, we need to make a new argument on infanticide, taking into consideration the fact that infants are separate ontological entities from their mothers. • Sherwin adds: the moral issues concerning abortion should be discussed in a perspective, which doesn’t operate with absolute categories. • Personhood: is a social category and as such it appears in a complex web of concrete capacities, concrete desires and duties, performed by concrete individuals and not by abstract moral agents. • When discussing abortion, the right of the mother are forgotten • Potential points of criticism of Warren’s discussion 1) the five characteristics of personhood 2) The universal rights: are they all on a par? (Mills Definition of happiness: it is possible only if it doesn’t harm others). 3) question warrens notion of morality understand as a local community. • Don Marquis, “why abortion is immoral” • Marquis’thesis: abortion is, except in rare case (e.g., therapeutic abortion or rape), seriously immoral and it is in the same category as killing an innocent adult human being. • First premise/assumption: the decision whether abortion is moral or immoral seems to depend upon the decision whether the fetus is considered a human being whose life it is seriously wrong to take. • Both the standard anti-abortion and the standard pro-choice arguments suffer form the same argumentative flaws. Resulting in a standoff without the possibility of resolving the issue. • The standard anti-abortion position – ‘the sanctity of human life’position the standard pro-choice position – the ‘personhood’position. 14 • The ‘sanctity of life’position that all human life is sacred is too broad and leads to absurd conclusions such as that the human cancer-cell culture is sacred and should not be killed. • The ‘personhood’position is too narrow and leads to the conclusion that only rational (full-fledged) moral agents should not be killed, but it doesn’t whether it is permissible to kill the mentally ill, as well as infants and young children. • The ‘personhood’position uses psychological • characteristics to describe moral agent/person. • Pro-choicers demand that the anti-abortionists make the connection between the premise that (anatomical) human beings are precious and that it is morally wrong to kill human beings. • What we should demand, though, is that the pro-choicers justify the connection they’re making between a psychological definition of a human being (as a person with consciousness, etc.) ad the moral premise that it is wrong to kill only persons (moral agents). • For Marquis, the connections between the definitions of ‘human being’ and the assumption that is wrong to kill an innocent being, are arbitrary. • An additional point: the attempt of pro-choicers to define ‘human being’ or ‘person’as a moral agent leads to circularity of the argument about abortion. • (What the pro-choice argument says is that the fetus is not a moral agent and therefore, It is not morally wrong to kill it, and this argument is circular because it doesn’t define ‘moral agent’other than saying that foetuses are not moral agents). • This standoff between anti-abortionists and pro-choicers leads us to believe that the issue of abortion is not resolvable. • Marquis: the issue whether the fetus is a human being or not, is the wrong way to approach the problem of abortion. • We should approach it from the point of view of what it means to say it is wrong to kill an innocent human being. • It is wrong to kill a human being because the killing of someone inflicts the greatest of all possible losses on the victim (not on the family, friends, etc., but on the victim itself!) • This is the loss of one’s future. • The mere biological fact of death is not what is morally wrong with killing. • It is the fact that by killing someone I will deprive them of all the projects, activities, enjoyments, etc, that hey would have otherwise experienced, and which they value. • He calls this view ‘future-like-ours’view. • Four implications of the ‘future-like-ours’position: • It is incompatible with the anti-abortionist view that it is wrong to kill only biological human beings. 15 • It also allows for including the lives of some non-human mammals as valuable. • It does not automatically prohibit active euthanasia as the sanctity-of-life position does. • If one’s life is full of future pain and suffering, then it loses its value. • And last, the defenders of the personhood view cannot justify why it is wrong to kill infants and young children without adding ad hoc hypothesis which not always work (e.g., that we have other moral mechanisms that prevent us form killing infants). • But the future-like-ours theory accounts for all infants and young children and justifies why they are valuable human beings, which are not to be killed. • Thus, the future-like-ours theory avoids the flaws of both sanctity-of- human-life and personhood views, while at the same time bringing out their strengths. • An assumption that marquis makes and which has to be accepted for the argument to work: the future of a standard (normal) fetus is identical with that of a young child, and the future of a young child identical with that of an adult (which by default, is valuable). • Contraception: for Marquis contraception is not immoral because even though it prevents the future like ours form happening, it would be morally wrong only if one argues that we have a moral obligation to maximise all the futures- like-ours • But no such claim is made by his theory, so contraception is not on the same level as abortion. • Possible problems with Marquis’: • 1) his criticism of the pro-choice position doesn’t seem entirely fair on three main counts: • First, the two minimum characteristics that Warren proposes (consciousness, and reasoning) aren’t psychological but philosophical; • Second, if Warren’s characteristics are vague so are Marquis’s what are htose future experiences, projects, etc.? • Third, his criticism of ad hoc-ness is unfair since Warren has an argument why infants, young children, mentally incapacitated people are not moral agents. • 2) problems with his original position (future-like-ours): • apart from its intuitiveness it is not really justified philosophically/ethically. • There’s no explanation as to what makes the future experiences of any value (a discussion of value is needed) • One has to accept on faith that the future of a fetus is future like ours (but this is an empirical argument). Feb 12, 2013 Defence of commercial surrogacy – on 4 grounds” 16 1) shortage of children for adoption; legal cumbersomeness of the adoption process; 2) right to reproduce and freedom of contract; 3) the labour of the surrogate mother is a labour of love and her acts are altruistic; 4) surrogacy no different than the practices of day care, insemination by donor, adoption and wet nursing 5) Anderson refutes all of them as invalid grounds. • The biggest problem for Anderson with commercial surrogacy: children are treated as commodities. • Parents’rights over their children are trusts, which must always be exercised for the sake of the child (parent and child have shared interests). • Commercial surrogacy understands parental rights not as trusts but as property rights (to own and dispose of things owned). • Aresult of the commercial transaction of surrogacy—all the parties exhibit attitudes that undermine the norms of parental love. • Afew objections: • 1. What if we say that no matter how the child has come to a home, if the child is desired and loved, then the fact that the child is purchased doesn’t matter (e.g., adoption)? • Anderson: yes, it doesn’t matter if the child is purchased but the fact that the child is sold does matter- it is the transaction of sale that undermines the parental love and trust. • The unsold children of the surrogate mother are also affected by surrogacy (find out the answer- in the text) • 2. Surrogacy doesn’t sell children because the father already owns half of the genetic material. • Anderson: treating the child as a commodity is reflected in the way we treat the rights of the surrogate mother. • The surrogate mother is forced to relinquish her rights as a mother and the biological father pays for the exclusive right to own the child. • 3. How is surrogacy different from other practices such as adoption? • Anderson: surrogacy promotes the right to dispose of one’s children for profit while in adoption one pays for finding a new home for a child whose parents cannot or do not want to exercise their paternal rights. • Second problem with commercial surrogacy: mother’s labour is commodified. • Commercial surrogacy reduces labour that is unique to women to a mere product of use. • The application of commercial norms in reproductive labour reduces mothers form persons worthy of respect to mere objects of use. • And this, according to Kant’s deontology, is highly unethical. • Commercial surrogacy with its application of economic norms violates women’s claims for respect in 3 ways. • 1) Surrogate mothers have to repress parental feelings 17 • 2) the surrogate mother is degraded because he is denied legitimacy in her evolving views of her own pregnancy. (if she changed her mind.) • 3) surrogate mothers are open to exploitation because their non-commercial motivation is used and replaced by purely economic norms. • ForAnderson surrogate mother often operate according to the norms of gift relationship. • This attitude clashes with the economics norms imposed by the agency/contract. • Psychological effects of surrogacy: • -many women need to feel appreciated or adequate and special and surrogacy is a way of doing it • -many women experience grief after giving up their child which in 10% of the cases leads to serious depression, loss of self-esteem and even self-effacement. • Anderson defends the right to genetic and gestational rights. What does that mean? • If the surrogate mother is the genetic mother, she shouldn’t abandon her paternal rights over the born child. Why? • The involuntary ties such as the genetic ties at least secure a place of the chid in the world. The child is not left to the mercy of the adults’wills. • Anderson also believes that surrogate mothers should not be forced to give u their children if they have already formed emotional bonds with them. • What if the state interferes and regulates the transactions involved in surrogacy (the Canadian model)? • Anderson: as long as the surrogate mother is paid in any form for her labour, she is being treated as a commodity and is being treated as a commodity and is being exploited and manipulated. • What about the right to reproduce and the right of contract? • The right of contract forbids the sale of human beings. • ForAnderson the right to reproduce entails the right to sustain a family life with some integrity. • Surrogacy undermines such integrity: it denies the validity of emotional and other ties of the mother to her child. Euthanasia • As of 2008, active euthanasia is legally permissible in Belgium, Luxembourg, the Netherlands, Switzerland, the US state of Oregon, the autonomous community of Andalusia (Spain), and Thailand • The Oregon experiment • Euthanasia in Canada: euthanasia and assisted suicide still not decriminalized • The most recent bull proposal by a private MP, in 2010, defeated in the house of commons. • Here’s an example of such a bil: (Bill C-562, andAct to amend the criminal code.) o The bill would have required that the individual seeking assisted suicide: 18 o Be at least 18 yrs old o Be either experiencing “severe physical or mental pain without any prospect of relief” or terminally ill; o Have, while appearing to be lucid, made two requests more than 10 days apart stating his or her free and informed wish to die. o Have designated in writing someone to act for him or her “with respect to the person who aids him or her to die.. and with respect to any medical • The bill would also have required that the person who is assisting the death: o Be a medical practitioner or be assisted by a medical practitioner o Have received confirmation of the diagnosis from one or two medical practitioners (depending on whether the person assisting the death is a medical practitioner) o Be entitled by law to provide health services or be assisted by a team of people so entitled o Act as directed by the individual whose death is assisted, and o Provide the coroner with a copy of the diagnosis from one or two medical practitioners (depending on whether the person assisting the death Is a medical practitioner). • June 2007 – an ipsos reid survey of 1500 canadians found that 76% of respondents supported the right to die for patients with an incurable disease (this figure has remained unchanged for 14 urs) • The strongest support was in quebec with 87%, whie alberta had the lowest, with 66% • Some of the factors in the poll results: • Access and cost of palliative care (around 95% of deaths in Canada would benefit of palliative care, yet around 70% of Canadians lack access to hospice and palliative care); • Change in life expectancy (according to stats Canada’s 2007 report, there is a 2.3 increase in life expectancy at birth compared to a decade ago); • New methods of euthanasia and/or assisted suicide (such as dehydration and starvation, withdrawal or withholding of treatment, etc.) • James Rachels, “active and passive euthanasia” (repri
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