Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance. The requirement of contemporary competence is intended to ensure that PAD is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, (...) arguably the strongest objections to legalizing PAD.The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia. (shrink)

Is it wrong to bring children who will have serious diseases and disabilities into the world? In particular, is it unfair to them? The notion that existence itself can be an injury is the basis for a recent new tort known as "wrongful life" (Steinbock, 1986). This paper considers Feinberg's theory of harm as the basis for a claim of wrongful life, and concludes that rarely can the stringent conditions imposed by his analysis be met. Another basis for maintaining that (...) it is morally wrong to have children under extremely adverse conditions is suggested: a principle of parental responsibility. We also argue that having children under such conditions may be unfair to the children, even if they have not been (in Feinberg's sense) harmed. Finally, we consider when conditions are sufficiently awful that having children might be viewed as incompatible with being a good parent and unfair to the child. (shrink)

Most of us believe that we are entitled to treat members of other species in ways which would be considered wrong if inflicted on members of our own species. We kill them for food, keep them confined, use them in painful experiments. The moral philosopher has to ask what relevant difference justifies this difference in treatment. A look at this question will lead us to re-examine the distinctions which we have assumed make a moral difference.

Bonnie Steinbock presents The Oxford Handbook of Bioethics - an authoritative, state-of-the-art guide to current issues in bioethics.

Should people suffering from untreatable psychiatric conditions be eligible for physician-assisted death? This is possible in Belgium and the Netherlands, where PAD for psychiatric conditions is permitted, though rare, so long as the criteria of due care are met. Those opposed to all instances of PAD point to Belgium and the Netherlands as a dark warning that once PAD is legalized, restricting it will prove impossible because safeguards, such as the requirement that a patient be terminally ill, will inevitably be (...) eroded or discarded. However, some supporters respond that limiting PAD to those suffering from terminal illness, or physical illnesses generally, is arbitrary and illogical. In addition, precisely because such patients are not terminally ill, their suffering may last for years, even the rest of their lives. Finally, severe depression may not be treatable. If PAD is justifiable under some conditions—as I shall assume in this article—then why wouldn't it be justifiable for these patients? Why shouldn't psychiatrists who have nothing else to offer their suffering patients be able to help them to die, if that is what they want? (shrink)

Book reviewed in this article: Life Before Birth: The Moral and Legal Status of Embryos and Fetuses. By Bonnie Steinbock.

Suits that claim that a child would be better off never having been born often founder on conceptual and logical dilemmas. However, the correct interpretation of “wrongful life” does not require a comparison between existence and nonexistence. The New Jersey Supreme Court's decision in the Procanik case to limit damages to extraordinary medical expenses, barring recovery for pain and suffering, is a reasonable resolution.

This article begins with an introduction to the biology behind embryonic stem cell research. Next it presents briefly four views of moral status, based on four different criteria: biological humanity, personhood, possession of interests, and having a future-like-ours. On two of these views, embryos clearly lack moral status, but they most likely do not have moral status on the FLO account either. Only the biological humanity criterion combined with the view that life begins at conception results in the conclusion that (...) very early extracorporeal embryos have full moral status, making ESC research that destroys embryos morally wrong. This explains why even some who are anti-abortion are not against ESC research: they do not view the very early, extracorporeal embryo as having the same moral status as the fetus. (shrink)

Aid‐in‐dying laws in the United States have two important restrictions. First, only patients who are terminally ill, defined as having a prognosis of six months or less to live, qualify. Second, at the time the patients take the lethal medication, they must be competent to make medical decisions. This means that an advance directive requesting aid in dying for a later time when the patient lacks decision‐making capacity would be invalid. However, many people are more concerned about avoiding living into (...) severe dementia for years—a time when they will lack decision‐making capacity—than they are about preventing suffering or the loss of dignity or autonomy for a few months at the end of life.Gillian Bennett is an example of someone determined not to live into severe dementia. She opted for preemptive suicide in 2014, explaining why in a letter she posted online: “Every day I lose bits of myself, and it’s obvious that I am heading toward the state that all dementia patients eventually get to: not knowing who I am and requiring full‐time care.”A major problem with Bennett’s solution, however, is that the individual is likely thereby to be giving up some “good time.” A legal alternative to preemptive suicide is to create an advance directive stating the circumstances under which one wants not to receive any lifesaving or life‐sustaining treatment, even the most basic and noninvasive. This option is our focus in this paper: how to create effective advance directives to avoid living into severe dementia. To be relevant to progressive dementia, the directive would need to state what kinds of care should be withheld and when. At the same time, advance directives for severe dementia face serious challenges. Before addressing these, we review the normative force of directives themselves. (shrink)

Although sex selection calls for careful thought, it seems in many cases to be neither intrinsically objectionable nor likely to have bad consequences.

The legalisation of physician assisted suicide in Oregon and physician assisted death in the Netherlands has revitalised the debate over whether and under what conditions individuals should be able to determine the time and manner of their deaths, and whether they should be able to enlist the help of physicians in doing so. Although the change in the law is both dramatic and recent, the basic arguments for and against have not really changed since the issue was debated by Glanville (...) Williams and Yale Kamisar nearly 50 years ago. In this paper, the author argues in favour of Kamisar’s consequentialist framework. Any change in law and social policy should not be based solely on individual cases, heart wrenching though these may be. Instead, we need to assess the need for PAS, and weigh this against the risks of mistake and abuse. (shrink)

Applied ethics is relatively new on the philosophical scene, having grown out of the various civil rights movements of the 1950s and 1960s, as well as the student demand that college courses be relevant. Even today, there are those who think that there are no philosophically interesting practical ethical questions, and that applied ethics is not a branch of philosophy at all. This article rejects that view, both because some of the most interesting and respectable philosophers in the world have (...) worked in applied ethics and because applied ethics has been the source of many difficult conceptual questions in theoretical ethics and even metaphysics. These include the grounds for moral status, human identity, how to conceive rights in general and the right to life in particular, the question whether existence itself can be a harm (the nonidentity problem), and the nature of moral principles. (shrink)

Embryonic stem cell research is morally and politically controversial because the process of deriving the embryonic stem cells kills embryos. If embryos are, as some would claim, human beings like you and me, then ES cell research is clearly impermissible. If, on the other hand, the blastocysts from which embryonic stem cells are derived are not yet human beings, but rather microscopic balls of undifferentiated cells, as others maintain, then ES cell research is probably morally permissible. Whether the research can (...) be justified depends on such issues as its cost, chance of success, and numbers likely to benefit. But this is an issue for any research project, not just ES cell research. What makes the debate over ES cell research controversial is that it, like the debate over abortion, raises “questions that politicians cannot settle: when does human life begin, and what is the moral status of the human embryo?” This paper looks at several theories of moral status and their implications for embryo research. (shrink)

How reliable is a diagnosis of irreversible unconsciousness? In a unique case in New York, a state Supreme Court judge vacated an order allowing removal of life‐sustaining treatment after Carrie Coons showed signs of recovery from a diagnosed vegetative state.

This collection contains twenty-one thought-provoking essays on the controversies surrounding the moral and legal distinctions between euthanasia and "letting die." Since public awareness of this issue has increased this second edition includes nine entirely new essays which bring the treatment of the subject up-to-date. The urgency of this issue can be gauged in recent developments such as the legalization of physician-assisted suicide in the Netherlands, "how-to" manuals topping the bestseller charts in the United States, and the many headlines devoted to (...) Dr. Jack Kevorkian, who has assisted dozens of patients to die. The essays address the range of questions involved in this issue pertaining especially to the fields of medical ethics, public policymaking, and social philosophy. The discussions consider the decisions facing medical and public policymakers, how those decisions will affect the elderly and terminally ill, and the medical and legal ramifications for patients in a permanently vegetative state, as well as issues of parent/infant rights. The book is divided into two sections. The first, "Euthanasia and the Termination of Life-Prolonging Treatment" includes an examination of the 1976 Karen Quinlan Supreme Court decision and selections from the 1990 Supreme Court decision in the case of Nancy Cruzan. Featured are articles by law professor George Fletcher and philosophers Michael Tooley, James Rachels, and Bonnie Steinbock, with new articles by Rachels, and Thomas Sullivan. The second section, "Philosophical Considerations," probes more deeply into the theoretical issues raised by the killing/letting die controversy, illustrating exceptionally well the dispute between two rival theories of ethics, consequentialism and deontology. It also includes a corpus of the standard thought on the debate by Jonathan Bennet, Daniel Dinello, Jeffrie Murphy, John Harris, Philipa Foot, Richard Trammell, and N. Ann Davis, and adds articles new to this edition by Bennett, Foot, Warren Quinn, Jeff McMahan, and Judith Lichtenberg. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Fetal Sentience and Women’s RightsBonnie Steinbock (bio)A growing number of states have banned abortion after twenty weeks on the grounds that the fetus at that stage experiences pain. Such laws run contrary to current abortion law, and so are almost certain to be challenged in court. In Roe v. Wade the Supreme Court said that the constitutional right to abortion extends until the fetus is viable, between twenty-four and (...) twenty-eight weeks. After viability, states may ban abortion entirely except where continuing the pregnancy would threaten the woman’s life or health. The viability threshold was upheld in Planned Parenthood v. Casey.Why viability? The Roe court said that this is “the ‘compelling’ point... because the fetus then presumably has the capability of meaningful life outside the mother’s womb.” Some commentators point out that this is no justification; the capacity for independent life does not explain the significance of viability. It merely gives the meaning.Another problem with viability is that it seems to depend on medical technology. What if fetuses under twenty-three weeks could be placed in an artificial uterus and brought to development there? Would we then say that even a first-trimester fetus was viable? This focuses on one aspect of viability only—namely, the capacity for independent existence. Another aspect is development. The justification for viability is that a fetus of twenty-four to twenty-eight weeks is so substantially developed, so similar to a newborn, that it has a claim to societal protection—so long as this does not threaten the pregnant woman’s life or health. Any attempt to ban abortions much earlier in pregnancy—as in a bill passed by the Ohio state legislature in June that would ban abortion after a fetal heartbeat is detectable, which can occur as early as six weeks—would be so restrictive as to vitiate the right to abortion altogether.It could be argued that sentience is a more rational threshold than viability because of the connection between sentience and moral considerability. If, as many experts believe, sentience and viability occur around the same time, then from a practical standpoint, it does not matter whether sentience or viability is chosen. But if sentience is the standard, and if it occurs earlier than viability, then abortion rights are restricted. Thus, much of the debate has turned on when fetal sentience occurs. Some are adamant that fetal sentience prior to twenty-four weeks is impossible, but other researchers do not rule it out. The development of neural networks necessary for the experience of pain might be present as early as seventeen weeks.Opposition to these laws should not be based on when sentience occurs, since this might change with more evidence. All we can say now is that the fetus almost certainly cannot feel pain during the first trimester and almost certainly can during the third. The exact onset of sentience in the second trimester is not just unknown; it may even be unknowable. It depends on the development of neural connections, which is a process, not an event. Drawing any exact line within a process is likely to be arbitrary.The choice between sentience and viability to justify the prohibition of late abortions is not the real issue. What really matters—and what pro-choice advocates should stress—is that late abortions are not denied to women who need them to preserve their own lives or health. Roe makes this clear, and subsequent cases have affirmed it.That is what is so upsetting about the story of Danielle Deaver. Deaver was at twenty-two weeks in a wanted pregnancy when her water broke, and the amniotic fluid did not rebuild. Her doctors said that fetal development had stopped and that the fetus stood only a remote chance of being born alive. Deaver also faced a risk of serious infection. She and her husband opted for inducing labor. But because inducing labor, if not done to save the life of the fetus, is legally defined as abortion, and Nebraska law prohibits abortion after twenty weeks, doctors and hospital lawyers concluded that the procedure would be illegal.After ten days, Deaver went into labor... (shrink)

This paper seeks to contextualize Lycurgus' use of the historical example of King Codrus' self-sacrifice within Athenian social memory and public discourse. In doing so, it offers a solution to the puzzle of Lycurgus' calling Codrus one of the ἐπώνυμοι τῆς χώρας . I make the case that Codrus was one of the forty-two eponymous age-set heroes who played an important role in the Athenian military and socio-political system. I contend that devotion to the city's gods and heroes and knowledge (...) of their mythology were essential parts of the religious and ideological instruction of Athenian ephebes. Consequently, Lycurgus' citation of the Ephebic Oath, the self-sacrifices of King Codrus and the daughters of Erechtheus, as well as his repeated invocation of the city's gods and shrines, must be seen as integral elements of his indictment of Leocrates for cowardice and treason, behavior that is diametrically opposed to the hoplite ethos and religious devotion that were instilled into young ephebes. Lycurgus thus brings the jurors' memories of their own ephebate into the courtroom and taps into emotions and values that lie at the heart of Athenian collective identity. (shrink)

The prelims comprise: Introduction Better Alternative Than Abortion? The Morality of Prenatal Diagnosis Prenatal Genetic Testing as Prevention The Line‐drawing Question Conclusion Note.

This chapter contains sections titled: Abortion and Mother‐Fetus Conflict Moral Obligations to the Unborn The Obstetrical Cases: Forced Cesareans Fetal Surgery Conclusion References Further reading.

John Robertson, Children of Choice: Freedom and the New Reproductive Technologies Princeton, NJ: Princeton University Press, 1994, 281 pp.

The questions and dilemmas of bioethics touch everyone. Should people who refuse to be vaccinated be treated for COVID-19, even if that displaces vaccinated patients with other serious conditions? What restrictions on abortion should there be, if any? Should women be paid to donate eggs? Bioethics: What Everyone Needs to Know ® discusses these and other similar questions facing the public today--as well as providing a way for thinking deeply about them. Steinbock and Menzel first examine major moral theories and (...) how they can be used to analyze bioethical issues. They then provide historical background to the birth of bioethics and explain how it shifted from a paternalistic doctor knows best approach to respect for autonomy, a fundamental value in contemporary bioethics. Subsequent chapters cover advance directives, experimentation on human subjects, the definition of death, physician-assisted dying, abortion, disability, just healthcare systems, the allocation of scarce resources, pharmaceutical drug pricing, assisted reproductive technology, egg donation, surrogate motherhood, sex selection, and the genetic modification of humans. Race and gender are considered throughout, as are the ethical issues raised by pandemics. Steinbock and Menzel consider the controversial questions that surface in the public sphere, explaining the facts, and then evaluating different approaches to resolving them. (shrink)

This article includes a short history of bioethics and the major issues surrounding bioethics. At its inception, the central issues in bioethics were research with human subjects, genetics, organ transplantation, death and dying, and reproduction. These continue to be important issues today. Methodology has been a central theoretical issue since the very beginning of bioethics. While some hoped that bioethics would generate a single correct normative theory, that idea has been given up by most practitioners. Indeed, bioethics reflects a wide (...) range of theoretical approaches in normative ethics, including utilitarianism, deontology, natural law, contractarianism, virtue ethics, communitarianism, pragmatism, and feminist ethics. (shrink)

On 27 September 2002, the Bush administration issued final rules allowing states to define a fetus as a child eligible for government‐subsidized health care under the Children's Health Insurance Program. CHIP does not cover any illegal immigrants and only covers legal immigrants who have been in the country for five years. Babies born in the United States, however, are citizens and therefore eligible for assistance. The response from women's groups and pro‐choice advocates was swift and unanimously negative.