Christopher Cowley

By looking at the situations faced by the protagonists of two classic plays , I try to shed light on what it means to face an insoluble moral dilemma, what it might mean to deal with it, and how the dilemma can reveal certain crucial information about the decision-maker to us readers-spectators, to other characters in the play who witness, or are implicated by, the incident, as well as, and perhaps most importantly, to the protagonist himself. In so doing, I distinguish the above dilemmas from moral-prudential dilemmas and from apparent dilemmas constituted by the mere lack of epistemological access. Indeed, I generally resist the various reductive approaches characteristic of much analytic moral philosophy, and challenge the notion of a uniquely right answer to which all rational moral agents can be held accountable

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future

There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.

Most modern moral philosophy is what I call ‘Impersonalist.’ It claims, quite plausibly, that the particular identity of the moral agent has nothing to do with the rightness or bestness of a given course of action, with the overriding moral reasons supporting such an action, nor with the moral obligation placed upon the agent to perform it.In addition, the Impersonalist account assumes what I call a Humean model of practical reasoning, whereby perception, deliberation, decision, and action are all logically separate stages.I challenge both the alleged moral irrelevance of the agent and the logical separation of the reasoning stages by invoking Peter Winch’s metaphor of a ‘moral perspective’: my perception andmy deliberation are both shaped by the perspective from within which I experience – and must experience – the world.Different people have different moral perspectives, and so they will consider different moral options as available and different reasons as relevant when considering the same situation. This is relativism, but only a benign form, and I explain why

Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional's conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP's duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP's objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion.