Two years ago in two articles in a thematic issue of this journal the three of us engaged in a critique of principlism. In a subsequent issue, B. Andrew Lustig defended aspects of principlism we had criticized and argued against our own account of morality. Our reply to Lustig's critique is also in two parts, corresponding with his own. Our first part shows how Lustig's criticisms are seriously misdirected. Our second and philosophically more important part picks up on Lustig's challenge (...) to us to show that our account of morality is more adequate than principlism. In particular we show that recognition of morality as public and systematic enables us to provide a far better description of morality than does principlism. This explains why we adopt the label “Dartmouth Descriptivism.”. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the concept of malady (...) is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

After surveying and criticizing some earlier definitions of "disease", we propose that a general term--malady--be used to represent what all diseases, illnesses, injuries, etc., have in common. We define a malady as the suffering, or increased risk of suffering an evil in the absence of a distinct sustaining cause. We discuss the key terms in the definition: evil, distinct sustaining cause, and increased risk. We show that the role of abnormality is to clarify these terms rather than to be used (...) directly in the definition of malady. (shrink)

Book reviewed in this article: Philosophy in Medicine: Conceptual and Ethical Problems in Medicine and Psychiatry. By Charles M. Culver and Bernard Gert. Psychiatric Ethics. Edited by Sidney Block and Paul Chodoff. Man, Mind, and Morality: The Ethics of Behavior Control. By Ruth Macklin.

Studies of the association between wealth and fertility in industrial populations have a rich history in the evolutionary literature, and they have been used to argue both for and against a behavioral ecological approach to explaining human variability. We consider that there are strong arguments in favor of measuring fertility (and proxies thereof) in industrial populations, not least because of the wide availability of large-scale secondary databases. Such data sources bring challenges as well as advantages, however. The purpose of this (...) article is to illustrate these by examining the association between wealth and reproductive success in the United States, using the National Longitudinal Study of Youth 1979. We conduct a broad-based exploratory analysis of the relationship between wealth and fertility, employing both cross-sectional and longitudinal approaches, and multiple measures of both wealth (income and net worth) and fertility (lifetime reproductive success and transitions to first, second and third births). We highlight the kinds of decisions that have to be made regarding sample selection, along with the selection and construction of explanatory variables and control measures. Based on our analyses, we find a positive effect of both income and net worth on fertility for men, which is more pronounced for white men and for transitions to first and second births. Income tends to have a negative effect on fertility for women, while net worth is more likely to positively predict fertility. Different reproductive strategies among different groups within the same population highlight the complexity of the reproductive ecology of industrial societies. These results differ in a number of respects from other analyses using the same database. We suggest this reflects the impossibility of producing a definitive analysis, rather than a failure to identify the “correct” analytical strategy. Finally, we discuss how these findings inform us about (mal)adaptive decision-making. (shrink)

Prohibition on sex selection may well be unnecessary and oppressive as well as posing risks to women’s lives The urge to select children’s sex is not new. The Babylonian Talmud, a Jewish text completed towards the end of the fifth century of the Christian era, advises couples on means to favour the birth of either a male or a female child.1 The development of amniocentesis alerted the public in the mid-1970s to the scientific potential for prenatal determination of fetal sex,2 (...) and progressive decriminalisation of abortion afforded choice about continuation of pregnancy. The more recent emergence of preimplantation genetic diagnosis (PGD) obviates resort to abortion, and improved techniques of sperm sorting and diagnosis permit creation of zygotes that will ensure the sex of a future child. Growth of biomedical means to select the sex of future children has been accompanied by fear that such means will be employed to favour births of sons, and so perpetuate devaluation of girl children and women’s inferior family and social status. A reaction to this fear has been the demand for legal and medical professional prohibition of sex selection techniques. For instance, the Council of Europe’s Convention on Human Rights and Biomedicine3 provides in article 14 that: The use of techniques of medically assisted procreation shall not be allowed for the purpose of choosing a future child’s sex, except where serious hereditary sex-related disease is to be avoided. Legislation has been enacted in a number of countries, and proposed in others, to prohibit sex selection on non-medical grounds, such as the Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 in India. In Canada, for instance, government draft legislation introduced in May 2002 proposes to make it a crime for any person, for the purpose of creating a human …. (shrink)

In his article 'Specifying, balancing and interpreting bioethical principles' (Richardson, 2000), Henry Richardson claims that the two dominant theories in bioethics - principlism, put forward by Beauchamp and Childress in Principles of Bioethics , and common morality, put forward by Gert, Culver and Clouser in Bioethics: A Return to Fundamentals - are deficient because they employ balancing rather than specification to resolve disputes between principles or rules. We show that, contrary to Richardson's claim, the major problem with principlism, either (...) the original version, or the specified principlism of Richardson, is that it conceives of morality as being composed of free-standing principles, rather than as common morality conceives it, as being a complete public system, composed of rules, ideals, morally relevant features, and a procedure for determining when a rule can be justifiably violated. (shrink)

This article provides somephilosophical ``groundwork'' for contemporary debatesabout the status of the idea(l) of critical thinking.The major part of the article consists of a discussionof three conceptions of ``criticality,'' viz., criticaldogmatism, transcendental critique (Karl-Otto Apel),and deconstruction (Jacques Derrida). It is shown thatthese conceptions not only differ in their answer tothe question what it is ``to be critical.'' They alsoprovide different justifications for critique andhence different answers to the question what giveseach of them the ``right'' to be critical. It is arguedthat (...) while transcendental critique is able to solvesome of the problems of the dogmatic approach tocriticality, deconstruction provides the most coherentand self-reflexive conception of critique. A crucialcharacteristic of the deconstructive style of critiqueis that this style is not motivated by the truth ofthe criterion (as in critical dogmatism) or by acertain conception of rationality (as intranscendental critique), but rather by a concern forjustice. It is suggested that this concern should becentral to any redescription of the idea(l) ofcritical thinking. (shrink)

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.

The Genetic Information Nondiscrimination Act of 2008 prohibits most forms of discrimination on the basis of genetic information in health insurance and employment. The findings cited as justification for the act, the almost universal political support for it, and much of the scholarly literature about genetic discrimination, all betray a confusion about what is really at issue. They imply that genetic discrimination is wrong mainly because of genetic exceptionalism: because some special feature of genetic information makes discrimination on the basis (...) thereof wrong. I suggest, to the contrary, that the best arguments against genetic discrimination assume that health care is an entitlement . I do this by examining two different exceptionalist arguments for genetic nondiscrimination, showing that they do not furnish good reasons for prohibiting genetic discrimination unless one supposes that health care is an entitlement. (shrink)

Professor Kemp Smith in providing a new edition of Hume’s Dialogues Concerning Natural Religion , embodying all the author’s additions and corrections, has given expression to the perennial interest and fascination which this work has possessed for many minds during the odd one hundred and fifty years since it was first published by Hume’s nephew. The editor himself has performed a great service by contributing an Introduction and a clear and concise summary of the Dialogues , in both of which (...) he expounds his own view as to how Hume’s discussion is to be interpreted. Hume employs three characters—Demea, Philo, and Cleanthes; and. (shrink)

The Acarnanian chrēsmologos Amphilytos spoke the verses to Peisistratos just before the battle of Pallene in 546 b.c. They contain a prediction of imminent victory for Peisistratos and total defeat for the Athenians. The Athenians will be routed and deprived of political self-determination, while the victory will restore to Peisistratos the tyranny from which he was twice forced, ‘rooting’ it once for all. Of course, all of this appears quite evident from the narrative. But as the verses form part of (...) Herodotos' account of Peisistratos' ascent to power they amount to much more, for they constitute penultimate proof of Peisistratos' irresistibility , a recurrent theme in Herodotos' logos, but one which was undoubtedly encouraged by his Athenian sources as a means of explaining how the Athenians were forced to yield the tyranny. Indeed, the theme of irresistibility helps to excuse the Athenians for being overcome; as much of the logos, which is historically quite vague, it is a reaction to fact, not factual itself. (shrink)

I defend the following version of the ought-implies-can principle: (OIC) by virtue of conceptual necessity, an agent at a given time has an (objective, pro tanto) obligation to do only what the agent at that time has the ability and opportunity to do. In short, obligations correspond to ability plus opportunity. My argument has three premises: (1) obligations correspond to reasons for action; (2) reasons for action correspond to potential actions; (3) potential actions correspond to ability plus opportunity. In the (...) bulk of the paper I address six objections to OIC: three objections based on putative counterexamples, and three objections based on arguments to the effect that OIC conflicts with the is/ought thesis, the possibility of hard determinism, and the denial of the Principle of Alternate Possibilities. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

Various meanings of “rational” implicitly and explicitly suggested in this issue's articles are abstracted and stated. Two accounts of rationality are shown to be able to explain most uses of “rational”: the “cool moment” account and a more objective account. The former is examined and modified, but still found inadequate. The objective account of rational is developed, taking “irrational” as the basic concept. “Irrational” is given content in terms of a list, and “rational” is subsequently defined as “not irrational”. Reasons (...) and motives are defined and distinguished. The advantages of the objective account are explored and some challenges to it are answered. (shrink)

In Alfred Ayer's article, philosophy is sharply counterposed to science, is denied the status of a science. This is the leitmotif of his entire paper. Moreover, the defense of this conception is characteristic of many representatives of neopositivism who go along with Ayer. However, Ayer has certain distinctive ideas of his own, which require critical analysis. Fundamental among them is his acknowledgment of the extremely general character of the concepts and principles with which philosophy, as distinct from the special sciences, (...) operates. This universality which is the distinguishing characteristic of philosophy is then transformed into an argument against the recognition of philosophy as a science. In replying to Ayer we shall attempt to demonstrate that his acknowledgment by no means necessitates the elimination of philosophy from the list of the sciences, but merely emphasizes its distinctive, that is, its general character, in contrast to all other sciences, which are particular in nature. This is the theme of the present article. (shrink)

Unrecognized presuppositions about patient appearance have become increasingly important in medicine, medical ethics and medical law. Symptoms of these historically conditioned assumptions include common ageism, aesthetic surgery, and litigation about ‘wrongful life’. These phenomena suggest a societal intolerance for what is considered an ‘abnormal’ appearance. Among others, eighteenth-century artists and anatomists helped to set these twentieth-century precedents, actually measuring deviations of external traits to analogous deformations of the soul, and drawing moral conclusions from physiognomic measurements. Other eighteenth-century artists countered with (...) pathognomy, recognizing that uneven physical features may indicate humanity, instead of character flaws. We suggest that there is an important and as yet unrecognized role played by visual and perceptual preferences in our judgments concerning normalcy and anomaly. We further suggest a shift away from our current fashion-magazine, youth-oriented aesthetic, and towards an aesthetic of imperfection. Physicians and medical students can be made aware of their historically conditioned reactions to ‘abnormal’ appearing patients by studying the understandings and methods with which artists have portrayed those who are considered deformed in appearance. (shrink)