This article addresses the question of whether the arguments for a duty to die given by John Hardwig, the most prominent philosophical advocate of such a duty, are sound. Hardwig believes that the duty to die is relatively widespread among those with burdensome illnesses, dependencies, or medical conditions. I argue that although there are rare circumstances in which individuals have a duty to die, the situations Hardwig describes are not among these.After reconstructing Hardwig's argument for such (...) a duty, highlighting his central premise that ill, dependent, or aged individuals can impose unfair burdens upon others by continuing to live, I clarify precisely what Hardwig intends by his thesis that many of us have a duty to die. I then show that an important disanalogy exists between an uncontroversial example in which an individual has a duty to die and the situations in which Hardwig proposes individuals have a duty to die. More specifically, in situations where a duty to die exists, an individual's having a duty to die logically implies that those she burdens have a right to kill that individual in self-defense. I then suggest that the burdens that ill, dependent, or aged individuals impose on their families, loved ones, or caregivers do not constitute the kind of threat that warrants the latter killing the former in self-defense. Hence, the duty to die is much rarer than Hardwig supposes. (shrink)

In contemporary debates on euthanasia, physician assisted suicide and withholding and withdrawing life prolonging treatments, besides commonly used reasons, which are based on presumption of freedom and avoidance of pain, there is also an idea of a duty to die. Given that individuals are also members of society, and that they have families and loved ones, it is necessary to discuss cases when illness causes severe burdens for lives of loved ones. We consider that patient’s just assessment of (...) class='Hi'>duty to die can be legitimate candidate for justification of procedure of acceleration of death, taken care of necessary conditions of justified social support for patients and necessary aliment from family and society. In this paper we examine main features of duty to die thesis, extract objections, and offer guidelines for continued discussion. We also want to express the importance of establishing social circumstances and preconditions for protecting the individuals.U suvremenim raspravama o eutanaziji i liječnički potpomognutom samoubojstvu, te odustajanju od tretmana, osim uobičajenih razloga koji se temelje na slobodi i izbjegavanju patnje osobe koja traži ubrzavanje smrti, postoji i teza o dužnosti umiranja. S obzirom na to da je pojedinac ujedno i član zajednice, odnosno da ima obitelj i voljene, nužno je raspraviti o slučajevima kada bolest izaziva značajne teškoće za život njegovih bližnjih. Smatramo kako i pacijentova pravedna prosudba o dužnosti umiranja može biti legitiman kandidat za opravdanje postupaka ubrzavanja smrti, uz nužne preduvjete pravedne društvene podrške pacijentu i dužne skrbi od strane obitelji i društva. U ovom tekstu razlažemo osnovne značajke teze o dužnosti umiranja, izdvajamo prigovore i dajemo smjernice za nastavak rasprave te izražavamo važnost ustanovljavanja društvenih okolnosti i preduvjete za zaštitu pojedinaca. (shrink)

When Richard Lamm made the statement that old people have a duty to die, it was generally shouted down or ridiculed. The whole idea is just too preposterous to entertain. Or too threatening. In fact, a fairly common argument against legalizing physician-assisted suicide is that if it were legal, some people might somehow get the idea that they have a duty to die. These people could only be the victims of twisted moral reasoning or vicious social pressure. It (...) goes without saying that there is no duty to die. (shrink)

This paper aims to explore and offer different hypotheses that could account for an adequate understanding of the duty to die and its relation to biopolitics from two neglected approaches. First, death will be analysed from a biopolitical perspective to understand the crucial role it has in biopower. Second, the focus lies on the two-folded implication that death has in biopower, for it could be either a defiance of it or the final sublimation of its control. Similarly, the next (...) section addresses the relations between death and neoliberalism from a biopolitical perspective, exploring the possibility of understanding the duty to die as resistance to economic mandates or, on the contrary, as the fulfilment of neoliberal interests. Finally, as a continuation of the relations between the duty to die and neo-liberalism, the paper analyses a similar two-folded view of the former from a psychopolitical perspective. (shrink)

This paper straightforwardly addresses one of the strongest, from an ethical perspective, objections presented to the duty to die, the one concerned with the lack of a normative theory to support it, offered by Seay in his paper Can there be a “duty to die” without a normative theory? The aim of the paper is to provide strong metaethical grounds to support the duty to die without the need of a moral normative theory. First, the definition and (...) main argument for the duty to die will be presented. Second, Seay’s objection will be described and clearly explained. Third, our metaphysical assumptions and a preliminary metaethical discussion will be offered to situate and understand the context. Finally, we will show how the duty to die can be integrated within the metaethical approach previously presented, defending that there is no need of a normative theory to provide good justification and strong ethical grounds for the duty to die, because they will have already been provided by our metaethical argument. (shrink)

Amid the controversies surrounding physician-assisted suicides, euthanasia, and long-term care for the elderly, a major component in the ethics of medicine is notably absent: the rights and welfare of the survivor's family, for whom serious illness and death can be emotionally and financially devastating. In this collection of eight provocative and timely essays, John Hardwig sets forth his views on the need to replace patient-centered bioethics with family-centered bioethics. Starting with a critique of the awkward language with which philosphers argue (...) the ethics of personal relationships, Hardwig goes on to present a general statement on the necessity of family-centered bioethics. He reflects on proxy decisions, the effects of elder care on the family, the financial and lifestyle consequences of long-term care, and physician-assisted suicide from the perspective of the family. His penultimate essay, "Is There a Duty to Die?" carries the idea of family-centered ethics to its logical, controversial, conclusion; comments upon this essay from Daniel Callahan, Larry Churchill, Joanne Lynn, and journalist Nat Hentoff offer differing views on this highly charged subject. As advances in medicine prolong patient's lives, the welfare of those ultimately responsible for medical care-the family-must be addressed. Hardwig's courageous and illuminating essays set forth a new direction in bioethics: one that considers the welfare of everyone concerned. (shrink)

In recent years, there has been a great deal of philosophical discussion about the alleged moral right to die. If there is such a moral right, then it would seem to imply a moral duty on others to not interfere with the exercise of the right. And this might have important implications for public policy insofar as public policy ought to track what is morally right.

When considering our own death, we normally weigh its impact on the people we love and care about, as well as worrying about the way in which our life might end, hoping that not too much suffering precedes it. However, such view, despite necessary, is a passive understanding of death, interpreted as something that merely happens to us, where we would have some control over timing if physician-assisted dying were legal in our countries. But what if our relation to death (...) would not end there? What if special medical needs, such as the emergency situation resulting from the Covid-19 pandemic, could have a direct impact on us creating a moral duty to end our lives? That is the thesis that will be advocated for in this paper: a moral duty to die will arise in some people to save resources that will help others get through Covid-19. It is important to indicate that the duty to die is personally acknowledged and self-imposed, thus nobody can be coerced to carry it out; for autonomy would be lost and such action should be considered an instance of incitement to die, therefore being morally blameworthy. (shrink)

Unlike many philosophers who write on biomedical ethics, John Hardwig is not primarily concerned to test our intuitions about the limits of normative theories by thought experiments or problematic borderline cases. Rather, he presses us to accept the conclusions to which our most firmly held principles commit us. But these conclusions, if Hardwig is right, turn out to be quite startling claims about moral duty that would undermine much of contemporary bioethical theory regarding end-of-life decisions. On his view, we (...) must face squarely the moral implications of our present arrangement of healthcare funding in the United States, where more and more of the financial responsibility of care is being shifted onto the families of patients, often with disastrous results. Yet, in the context of this increasingly unstable arrangement, our chief principle of medical decisionmaking also holds that their interests are not morally relevant at all in deciding what should be done for the patient, and only the patient's wishes count. Now Hardwig thinks that this rule is irrational in the present circumstances, and that it would make more sense to admit the moral relevance of the interests of family members, but also that if we do give appropriate weight to their concerns, we shall be led in some cases to the conclusion that the patient has a duty to die. (shrink)

Cooley's argument that persons with pre‐dementia have a Kantian duty to die has led to much debate. Cooley gives two reasons for his claim, the first being that a person with pre‐dementia should end his/her life when he/she will inevitably and irreversibly lose rationality and be unable to live morally as a result. This paper argues that this reason derives from an unsubstantiated premise and general confusion regarding the condition for a Kantian duty to die. Rather, a close (...) reading of Kant reveals that such a condition occurs when a person confronts an external handicap that does not undermine his/her rational ability but deprives him/her of the possibility of living the way a person should. People do not confront this experience with progressive dementia. The other reason Cooley proposes is that a person should not allow their continued existence to become a burden to others. This claim partly stems from a radical interpretation of a case discussed by Kant and is partly based on a misuse of Kant's formulation of humanity. Based on a prudent inference from Kantian ethics, this article argues against Cooley that persons with pre‐dementia have no Kantian duty to die. (shrink)

Thanks to recent scholarship, Kant is no longer seen as the dogmatic opponent of suicide he appears at first glance. However, some interpreters have recently argued for a Kantian view of the morality of suicide with surprising, even radical, implications. More specifically, they have argued that Kantianism requires that those with dementia or other rationality-eroding conditions end their lives before their condition results in their loss of identity as moral agents, and requires subjecting the fully demented or those confronting future (...) dementia to non-voluntary euthanasia. Properly understood, Kant’s ethics has neither of these implications. wrongly assumes that rational agents’ duty of self-preservation entails a duty of self-destruction when they become non-rational. further neglects Kant’s distinction between duties to self and duties to others and wrongly assumes that duties can be owed to rational agents only during the time of their existence. (shrink)

Argument about euthanasia in Australia intensified following the world's first legal euthanasia death of Bob Dent under the Northern Territory's short-lived Rights of the Terminally Ill Act 1995. This paper takes stock of the implacably opposed positions on euthanasia following Bob Dent's death, which provides a focus for the controversy, and identifies the key doctrines which separate adversaries in the euthanasia debate and their associated incommensurable intuitions.

As of 2019, ten jurisdictions in the United States—Oregon, Washington, Montana, Vermont, California, Colorado, the District of Columbia, Hawaii, New Jersey, and Maine—have authorized physicians to...

Kant on Duty to Oneself and Resistance to Political Authority SVEN ARNTZEN in ms DOCTRI~tE OF Law and related writings? Kant denies the subject's right to resist political authority in the strongest terms. His argumentation to sup- port this denial is conceptual in character. The denial of a right of resistance follows from the relevant legal concepts of civil society, of the people as sub- ject, of the head of state as the supreme power in civil society, as having (...) only rights but no duties that he may be coerced to fulfill, and of a right as an authorization to use coercion. Civil society is the coexistence of persons as subject to a central authority, a supreme power, which is not itself subject to some other coercive authority. For the people as subject to have a right to resist the supreme power in civil society would be for it to have an authorization to use coercion to restrain that power, which would not, then, be the supreme power. In other words, a people's right to resist the supreme power would imply that the power is both supreme and not ' By Kant's Doctrine of Law I mean his Die metaphysische Anfangsgriinde der Rechtslehre, the first part ofD/e Metaphysik der Sitten, hereafter MdS . The other available translation of the Doctrine of Law is by John Ladd, and is rendered as The Metaphysical Elements of Justice (Indianapolis: The.. (shrink)

This essay focuses on the purported duty—defended by Walter Benjamin but widely assumed in much political theory and practice—of the living to redeem the suffering of those who died as a consequence of oppression, exploitation, and political violence. I consider the cogency and ethical value of this duty from the perspective of a politics grounded in the equal life-value of human beings. For both metaphysical and ethical reasons I conclude that this duty does not obtain, first because (...) the dead cannot experience redemption, and secondly because it is politically counterproductive: it personalizes a pathological form of political resistance which may easily incite further violence and thus perpetuate human suffering and oppression. (shrink)

On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont's law pertaining to patients' rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an (...) end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient–provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID. (shrink)

At the heart of this book is the idea that we would all be better off were we able to recognise the harder, slower, more expensive and more unjust dying which the continued development of modern medicine offers. The proposal is perhaps not so much a duty to die as a duty to refrain from unfair or excessive use of health care resources and to refrain from imposing excessive burdens at the end of one's life on family or (...) friends. On the global scale, Battin invites us to consider a huge international deal to be struck between the wealthy First World and the developing Third World. Backed by figures on …. (shrink)

Kant behauptet, daß wir nur indirekte Pflichten haben können, von Grausamkeiten und Gewalt gegen Tiere abzusehen. Pflichten dieser Art seien direkte Pflichten gegen uns selbst, um unseren moralischen Charakter nicht zu verderben, aber könnten nicht direkte Pflichten gegenüber den Tieren sein, weil Tiere keine rationalen Wesen sind. Diese Sichtweise erscheint unbefriedigend, da die Tiere die Opfer einer solchen Mißhandlung sind, wenn sie stattfindet, und die Vorstellung, daß wir keine direkten Pflichten ihnen gegenüber haben sollen, erscheint merkwürdig. Ich plädiere dafür, daß (...) Kant, durchaus in Übereinstimmung mit seiner allgemeinen Moralphilosophie, hätte ein Konzept von direkten Pflichten gegenüber Tieren entwickeln können. Ein solches Konzept wäre weitaus plausibler und hätte Kant geholfen, mit allfälligen Problemen umzugehen, die sich im Hinblick auf die Behandlung von zurechnungsunfähigen Personen ergeben, die ebenfalls keine rationalen Wesen sind, sondern allenfalls potentiell. Zwar kann Kant durchaus plausibel machen, daß es die von ihm behaupteten indirekten Pflichten im Hinblick auf Tiere gibt, aber nicht, daß unsere Pflichten gegenüber Tieren auf derartige indirekte Pflichten beschränkt sind. Kant claimed that we could only have indirect duties to abstain from cruelty and violence to animals; such duties were directly duties to ourselves not to degrade our moral character, but could not be direct duties to animals because animals are not rational beings. This view seems unsatisfactory because animals are the victims of such mistreatment when it occurs, and the idea that we have no direct obligations to them seems odd. I urge that Kant, consistent with his general moral philosophy, could have developed a view of DIRECT duties to animals. Such a view would have been more plausible and would also have helped him deal with lurking problems concerning the treatment of incompetent humans, some of whom are also not rational beings, even potentially. Kant can plausibly claim that there are such indirect duties to animals, but not that our duties to them are limited to such indirect duties. (shrink)

Letters commenting on Hardwig, J "Is There a Duty to Die?" with a reply to those letters by the author.

BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

As the single most important experience in the lives of all people, the process and event of death must be handled carefully by the medical community. Twentieth-century advances in life-sustaining technology impose new areas of concern on those who are responsible for dying persons. Physicians and surrogates alike must be ready and willing to decide not to intervene in the dying process, indeed to hasten it, when they see the autonomy and dignity of patients threatened. In addition, the very ways (...) we talk about death and dying need to come under scrutiny, and it is likely that our technical advances should be parallelled by equally arduous advances in the semantic and rhetorical approaches we take to death. (shrink)

What would make it the right time for you to die, or the wrong one? In particular, could it be the right time for you to die even if your loved ones want to make the sacrifices needed to prolong your life, because that would cost them too dearly? The worry is that it would be selfish to permit these sacrifies, and wrong for that reason. I think it matters that the sacrifies would occur within a relationship of mutual devotion, (...) and I try to say how it matters. In particular, I argue against some fairly simple views of what constitutes impermissible selfishness in this context, and in favor of approaching such decisions in a different way. (shrink)

In this short paper I will discuss the ambiguous and, even, controversial term ‘right to die’ in the context of the euthanasia debate and, in particular, in the case of passive euthanasia. First I will present the major objections towards the moral legitimacy of a right to die, most of which I also endorse myself; then I will investigate whether the right to die could acquire adequate moral justification in the case of passive euthanasia. In the light of the Kantian (...) tradition I will argue that since rights are understood as based upon duties, the right to die should also presuppose a corresponding duty, which to me could be either an imperfect, solidarity-related duty, or an autonomy-related one, at least as far as the unwanted prolongation of life is concerned. I will conclude with the view that the right to die could actually be considered a legitimate one in the case of passive euthanasia, when the application of life-supporting techniques is against the wishes and the best interests of the patient. (shrink)

Is there is a moral obligation to militarily intervene in another state to stop a genocide from happening (if this can be done with proportionate force)? My answer is that under exceptional circumstances a state or even a non-state actor might have a duty to stop a genocide (for example if these actors have promised to do so), but under most circumstances there is no such obligation. To wit, “humanity,” states, collectives, and individuals do not have an obligation to (...) make such promises in the first place or to create institutions that would impose a legal obligation of intervention upon them. Nor do states or persons or humanity “collectively” have – originally, without specifically creating such duties by contracts or promises – any pro tanto or special duties to save strangers at considerable cost to themselves or their own citizens (including their soldiers). That is, these costs do not merely override a duty to intervene, but rather there is no such duty to begin with – as shown by the fact that in such cases of non-intervention agents would not owe those they let die any compensation: if I do not save someone’s life because saving him would have cost me my arm or would have come with a high risk of losing my own life or would have forced me to kill innocent bystanders, I do not owe this person compensation. Thus the point of this chapter is that there is no “natural” or “general” or “original” duty to militarily intervene (or to create a legal obligation) to stop a genocide. I will consider and refute a number of arguments to the contrary, for example by Lango, Tan, and Pattison. (shrink)

Euthanasia and the duty to die have both been thoroughly discussed in the field of bioethics as morally justifiable practices within medical healthcare contexts. The existence of a narrow connection between both could also be established, for people having a duty to die should be allowed to actively hasten their death by the active means offered by euthanasia. Choosing the right time to end one’s own life is a decisive factor to retain autonomy at the end of our (...) lives. However, there is no definitive consensus on why physicians should be the ones performing the medical procedure to end a person’s life. The moral problems arising from such assertion are not to be taken lightly, for medical tradition has long regarded the duty not to kill, not to actively end a patient’s life, as the core moral obligation that gives meaning to the medical profession. Our concern is to question the moral justifiability of the arguments offered by physicians not to actively help patients die. (shrink)

David Shaw's response to Hugh McLachlan's criticism of his proposed new perspective on euthanasia is ineffectual, mistaken and unfair. It is false to say that the latter does not present an argument to support his claim that there is a moral difference between killing and letting die. It is not the consequences alone of actions that constitute their moral worth. It can matter too what duties are breached or fulfilled by the particular moral agents who are involved.

Despite the undeniable ethical dimensions of paid occupations — trades and services — other than the traditional professions, it is still natural to associate courses of professional ethics with medicine, law, nursing or teaching, rather than auto‐repair, supermarket assistance or window‐cleaning. Indeed, it seems plausible to hold that if there is anything more to the traditional distinction of professions from trades or other services than considerations of social and economic status, it might well reside in the distinctive ethical or moral (...) character and implications of such occupations as medicine, law and education. This paper undertakes to explore, via examination of some of the commonly suggested criteria of professionalism, the nature of such implications and the extent to which they justify continued deployment of a distinctive occupational category of ‘profession’. On the assumption that they do, however, the paper is also concerned to examine critically the consequences for education in professional ethics of any such distinctive ethics of profession. (shrink)

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many (...) were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Major considerations of disability studies—such as provision of care, accommodation for disabled people, and issues surrounding institutionalization—have been consistently marginalized in American bioethical discourse. The right to die, however, stands out as a paradigmatic bioethical debate. Why do advocates for expanding the volition and self-direction of disabled people emerge from the periphery only to help those disabled people who choose death? And why do the majority of people assume an unrealistically low quality of life for those with disabilities? This paper (...) will argue that the dominance of the Western liberal tradition in American culture motivates both these phenomena: by emphasizing individual rights over duties and responsibilities, assuming the isolated and independent rights-bearer as the prototypical person, and evoking an unrealistically atomistic view of human interaction. As an alternative, I offer a framework rooted in feminist ethics that emphasizes context, gives moral weight to human relationships, abandons the problematic ideal of a lone rights-bearer, and emphasizes the mutual vulnerability of embodied individuals. (shrink)

The prohibition on administering lethal medication to a patient can be found in the first code of medical deontology (450 BC), which calls on doctors to practice their art with purity and piety. Today, in some countries, doctors are faced with an ethical and deontological dilemma: patients or their relatives request deep and continuous sedation in the name of the “right to die”, believing their life to be inhuman and unworthy! The very concept of the “right to die” is a (...) complex and delicate subject, undefined and un-framed by law. However, it is often discussed in the context of individual rights and medical ethics, often leaving the physician torn on one side by compassion and a sense of medical duty to alleviate a patient’s unnecessary suffering. The “right to die” is an ethical and legal concept that supports the freedom of a human being who is incurably ill or “tired of living” to end his or her life, or to obtain the necessary assistance to do so, by refusing treatment. Yet the universal Hippocratic law that underpins medical practice formally prohibits doctors from assisting suicide. This prohibition is based on the physician’s commitment to defending and preserving life until its natural end. The aim of this study was to see in what sense we can speak of a “right to die” in the philosophy of medicine, so that death can be experienced with humanity and dignity, even by means of deep and continuous sedation. The subject is all the more topical as this right is claimed in the name of human dignity and individual rights and freedoms. (shrink)

Authority is an important feature of military life. Political and military superiors claim the power to give binding orders to their subordinates. If they have the authority they claim (and that many citizens and soldiers take them to possess), then the subordinates are morally required to do as commanded. Tadros’ To Do, To Die, To Reason Why challenges the authority claims that political and military superiors make in giving orders: the kinds of considerations ordinarily thought to underpin their authority – (...) in particular, the instrumental benefits of authoritative decision-making in politics and military life – cannot justify it. Tadros’ claim is not that subordinates are never required to do what their superiors order. Trivially, superiors may order subordinates to do what they are anyway required to do. (The captain orders the privates not to kill the prisoners.) Less trivially, superiors’ orders may change the subordinates’ factual or epistemic circumstances, which results in their having duties that they would otherwise have lacked. (The captain orders a private to jump into the sea. His order startles a child on the shore so it loses its balance and plunges into the water. The private may now have a duty to jump in to save the child, and he may have that duty because the superior gave the order.) Yet this way of changing the subordinates’ duties is not, for Tadros, a genuine exercise of authority: authority brings about normative change directly, rather than by changing the subordinate’s factual or epistemic circumstances. It is authority so understood that, according to Tadros, military and political superiors claim and yet lack. Tadros offers two complementary arguments for this anarchist conclusion. First, he argues that superiors have practical authority over subordinates only if the subordinates have duties to obey (or follow) the superiors’ orders, rather than merely to conform with them (by doing something which happens to be what they were ordered to do). There must be a suitable link between order and action. But, Tadros argues, soldiers don’t have a duty to obey their superiors’ orders. (Call this the Obedience Claim.) So military superiors lack practical authority vis-à-vis their subordinates. (Call this the Authority Claim.) Second, Tadros argues that authority is either unjustified or otiose. Exercises of practical authority, by imposing duties, restrict their subjects’ freedom. Moral duties are difficult to justify precisely because they are freedom-restricting in this way; and only certain kinds of considerations suffice to make an action morally obligatory. Tadros argues that there are sufficient reasons for a superior to have and exercise the power to make ving morally obligatory by issuing a directive only if there are already sufficient reasons for ving being independently morally obligatory. (We call this the No Duty, No Authority Claim.) We challenge both arguments. Sections 2 and 3 show that, even if the Obedience Claim is true, it does not entail the Authority Claim. Section 4 casts doubt on the No Duty, No Authority Claim. (shrink)

The preceding Preface, which Professor William Frankena had the great kindness to write as an introduction for the readers of the present English translation of my major work, still requires several supplementary com­ ments on my part. Professor Frankena rightly considered it to be an advan­ tage to introduce the English-speaking world to my moral philosophy through its presentation in this book. As an introduction to my moral philosophy, Professor Frankena provided a concise formulation of the fun­ damental ideas of (...) my ethics by quoting from an article I had just recently published. Several points worth mentioning remain. Firstly, it is necessary to distinguish the two editions of the text here translated. The first edition was published in 1951 by Anton Hain in Meisenheim am Glan, under the title Pflicht und Neigung (Duty and In­ clination), with the subtitle Die Grundlagen der Sittlichkeit, erOrtert und neu bestimmt mit besonderem Bezug auf Kant und Schiller (The Fun­ damentals of Morality, Discussed and Redefined with Special Regard to Kant and Schiller). In 1974, a revised and enlarged second edition was published by the same publisher and was entitled Die Grundlagen der Sitt­ Iichkeit (The Fundamentals of Morality). Of this second edition, the first four chapters have been translated in the present volume, along with four more recent essays. (shrink)

On May 15, 2006, 34 year-old mountaineer David Sharp died in a small cave a few hundred meters below the peak of Mount Everest in the aptly named “death zone”. As he lay dying, Sharp was passed by forty-plus climbers on their way to the summit, none of whom made an effort to rescue him. The climbers’ failure to rescue Sharp sparked much debate in mountaineering circles and the mainstream media, but philosophers have not yet weighed in on the issues. (...) This is surprising, since Sharp’s case raises interesting puzzles about the duty to rescue. Commonsense morality suggests that it was wrong for the climbers to put their summit bids ahead of saving a human life. But rescuing Sharp was extremely risky. If you and I are not required to assume significant risks to rescue others, why think the climbers had a moral duty to do this? My primary focus is on a new principle of rescue, which I dub the comparable risk principle, that has not been discussed in the duty-to-rescue literature. More generally, I explore the limits of the duty to rescue not just in Sharp’s case, but in relevantly similar high-risk environments common in action sports. (shrink)

Die allogene Transplantation von Blutstammzellen aus dem Körper von Kindern, die der Spende nicht selbst zustimmen können, in den Körper eines kranken Geschwisterkindes wirft schwierige ethische Fragen auf. Wie kann ein risikobehafteter, fremdnütziger medizinischer Eingriff ethisch gerechtfertigt werden? In dieser Arbeit werden Argumente kritisch untersucht, nach denen das Spenderkind eine Pflicht habe, bei der Transplantation mitzumachen. Die Idee der Pflicht ist nachvollziehbar aus der Perspektive der Eltern, die zwar in einem Fürsorgekonflikt sind (ein Kind zu Gunsten der Rettung des anderen (...) verletzen zu müssen), aber selbst eine Pflicht haben, für das Leben des kranken Kindes zu kämpfen. Eine Analyse des Pflichtbegriffs zeigt jedoch, dass die Erfüllung einer Pflicht daran gebunden ist, entscheidungskompetent zu sein. Drei Wege werden untersucht, eine solche Pflicht dennochzuzuschreiben: i) die Eltern übertragenihre Pflicht auf das Kind; ii) die Interessen des Spenderkindes implizieren eine Pflicht; iii) Geschwisterkinder haben aufgrund ihrer vertrauten Familienbeziehungen Pflichten untereinander, die auch die Pflicht zu spenden beinhalten. Alle drei Zuschreibungsstrategien werden als unhaltbar kritisiert. Das Ergebnis lautet, dass die Pflicht, einem Geschwisterkind Körpergewebe zu spenden, einem nicht-einwilligungsfähigen Kind nicht zugeschrieben werden kann. Andere philosophische Ansätze zur Stammzellspende von Kindern an Familienangehörige müssten entwickelt und geprüft werden. (shrink)

In late 2021, tennis star Chris Evert learned new genetic information about her sister, who died from ovarian cancer in January 2020. As Evert has explained in posts published by ESPN, her sister had a variant in the BRCA1 gene that was reclassified—upgraded—from a variant of uncertain significance (VUS) to pathogenic. Hearing about the variant’s reclassification likely saved Evert’s life. After getting genetic testing that showed she also carried the variant, Evert underwent prophylactic surgery. Clinical testing associated with the procedure (...) revealed she already had stage 1c ovarian cancer. The Wall Street Journal reported on a different variant reclassification story in 2019. Seven female relatives had prophylactic surgeries after cascade genetic testing indicated they each carried the same pathogenic variant in BRCA2. However, there was significant distress and confusion when one of the women received notice that the variant had been downgraded from pathogenic to a VUS. As these cases illustrate, reclassification of the clinical significance of genetic variants—which ranges from pathogenic, likely pathogenic, uncertain, likely benign and benign—can have profound impacts on individuals and families. Although genetic testing often provides valuable information, many identified variants are of uncertain significance, even in genes associated with disease. Many of these VUS will be reclassified as genomic data …. (shrink)

Coggon’s remarks on a previous paper on active and passive euthanasia elicit a clarification and an elaboration of the argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not the same (...) as to let die is based upon a rejection of consequentialism. (shrink)

In this chapter, we seek to offer a fresh perspective on whether or not doctors should be “licensed to kill”. As that phrase indicates, we metaphorically refer to the adventures of fictional spy James Bond, although we hope, in doing so, that readers will not think that we are belittling the serious topic with which the chapter is concerned. Having surveyed some of the familiar arguments for and against allowing medically-assisted dying, we advance a new proposal, which seeks to strike (...) a compromise between such arguments. Our exploratory model builds on an analogy with armed response police units as they operate in England, and specifically with situations in which such officers are found to have killed someone in the course of their duties. Rather than confer immunity prospectively (as proponents of assisted dying often seek) or deny immunity completely (as opponents insist), our policy would provide a potential retrospective excuse. (shrink)