Christopher Cowley

In a recent thought-provoking piece, Peter Roberts argues against the central role of happiness as a guiding concept in education, and argues for more attention to be paid to despair. This does not mean cultivating despair in young people, but allowing them to make sense of their own natural occasional despair, as well as the despair of others. I agree with Roberts about happiness, and about the need for more attention to despair, but I argue that focusing too much on despair is dangerous without paying simultaneous attention to goodness. Roberts argues that students must be helped to face the despair born of the realisation that we can never be sure of the moral grounds on which our actions are based, we can never fully know ourselves, and that education should make us more appreciative of what we don't know. I argue against all three claims: there are some moral truths that we can know; we can know enough of ourselves in certain contexts; education should not only teach intellectual humility, it should also give us confidence in appreciating the sources of meaning that are ordinarily available, e.g. personal relationships. The paper concludes with a response to the objection that my position is little more than old-fashioned moralism and conservatism.

In a recent thought-provoking piece, Peter Roberts argues against the central role of happiness as a guiding concept in education, and argues for more attention to be paid to despair. This does not mean cultivating despair in young people, but allowing them to make sense of their own natural occasional despair, as well as the despair of others. I agree with Roberts about happiness, and about the need for more attention to despair, but I argue that focusing too much on despair is dangerous without paying simultaneous attention to goodness. Roberts argues that students must be helped to face the despair born of the realisation that we can never be sure of the moral grounds on which our actions are based, we can never fully know ourselves, and that education should make us more appreciative of what we don't know. I argue against all three claims: there are some moral truths that we can know; we can know enough of ourselves in certain contexts; education should not only teach intellectual humility, it should also give us confidence in appreciating the sources of meaning that are ordinarily available, e.g. personal relationships. The paper concludes with a response to the objection that my position is little more than old-fashioned moralism and conservatism.

In 1965 Peter Winch published ‘The Universalisability of Moral Judgements’. I feel that the argument in this paper has never been successfully refuted, and that it remains relevant to many contemporary debates in moral philosophy. Winch argued against the widespread assumption that a moral judgement, if true, ought to be universalisable for all people in relevantly similar situations. He considers the example of Captain Vere in Melville’s ‘Billy Budd’: Vere managed to condemn a man he considered innocent, while Winch concludes that in the same situation he could not have done it. Many contemporary moral realists would demand that at least one of them was incorrect, probably because of misperceiving the situation . Instead, says Winch, there is a sense in which one action legitimately ‘struck’ Vere, but not Winch, as correct, and that this is the end of the ‘dispute’ between them. However, this requires a robust defence against counter-charges of relativism. Part of the problem with Winch’s article, I argue, is his ambiguous use of the concept of ‘moral rightness’, but I remedy this, and defend Winch against two further sympathetic criticisms

This is a slim, user friendly volume designed to introduce medical students and practicing clinicians to some basic issues of medical law and ethics, as well as to the ways in which lawyers and philosophers characteristically think. The book is divided into two parts: the first adumbrates the main ethical theories, some central ethical concepts, the role of law in society, and the English legal system ; the second part comprises chapters about key issues such as “consent”, “reproductive medicine”, and “mental health”.This integration of ethics and law into such an accessible and tidy package is the main strength of the book. More weighty tomes have aimed for the same integration , but their scholarly density makes them more appropriate for reference than overview. The integration is important because there will always be certain students and practitioners who do not see …

In Dostoyevsky's Crime and Punishment, Rodion Romanovich Raskolnikov is an impoverished university student who commits a brutal double-murder of an old money-lender and her sister, and then for much of the novel manages to evade detection.1 He is racked by guilt and anxiety from the act. Sonia is a young woman who lives with her parents and several siblings. Her father is an alcoholic, unable to hold down a job, and Sonia has therefore become a prostitute to support the family. What is remarkable about Sonia is that she feels no bitterness, either to her father, or to her family, or to her clients, or even to fate itself.The novel traces an arc from the murders in part I to Raskolnikov's confession to the police ..

A lot of medical procedures can be justified in terms of the number of quality-adjusted life-years (QALYs) they can be expected to generate; that is, the number of extra years that the procedure will provide, with the quality of life during those extra years factored in. QALYs are a crude tool, but good enough for many decisions. Notoriously, however, they cannot justify spending any money on terminal care (and indeed on older people in general). In this paper I suggest a different way of construing ‘quality’ (as meaningfulness rather than physical comfort) and ‘life’ (as both backward-looking and forward-looking), so that the terminal patient's efforts to find meaning in his life could in principle generate plenty of ‘retrospective QALYs’ to justify funding

Next SectionThe dominant conception of medical ethics being taught in British and American medical schools is at best pointless and at worst dangerous, or so it will be argued. Although it is laudable that medical schools have now given medical ethics a secure place in the curriculum, they go wrong in treating it like a scientific body of knowledge. Ethics is a unique subject matter precisely because of its widespread familiarity in all areas of life, and any teaching has to start from this shared ethical understanding and from the familiar ethical concepts of ordinary language. Otherwise there is a real risk that spurious technocratic jargon will be deployed by teacher and student alike in the futile search for intellectual respectability, culminating in a misplaced sense of having “done” the ethics module. There are no better examples of such jargon than “consequentialism”, “deontology”, and the “Four Principles”. At best, they cannot do the work they were designed to do and, at worst, they can lead student and practitioner into ignoring their own healthy ethical intuitions and vocabulary

Five proposals for admitting better applicants into medical school are discussed in this article: An A level in a humanity or social science would be required, to supplement—not replace—the stringent science requirement. This would ensure that successful candidates would be better “primed” for the medical curriculum. Extra points in the applicant’s initial screening would be awarded for an A level in English literature. There would be a minimum age of 23 for applicants, although a prior degree would not be required. This is to ensure that the applicants are mature enough to know themselves and the world better, to make a more informed and motivated choice of career, and to get more out of the humanities components of the curriculum. A year’s full-time experience in a healthcare or charity environment would be desirable. Applicants would be given two lists of interview discussion topics to prepare: works of literature and topics in healthcare politics

In Kimberly Brownlee’s book, Conscience and Conviction, she argues that Thomas More’s paradigmatic ‘personal objection’ successfully meets the 4 conditions of her ‘Communicative Principle’. In this article I want to challenge Brownlee’s ‘universality’ condition and the ‘dialogical’ condition by focusing on a counter-example of a British GP conscientiously objecting to authorizing an abortion. I argue that such an objection can be morally admirable, even though the GP is not politically active, even though she is not open-minded to the possibility that she might be wrong, and even if she refuses to condemn her non-objecting colleagues. I suggest that this particular counter-example can tell us more general things about the nature of ethical disagreement and ethical incomprehension.

In this article I consider the case of the surgical separation of conjoined twins resulting in the immediate and predictable death of the weaker one. The case was submitted to English law by the hospital, and the operation permitted against the parents’ wishes. I consider the relationship between the legal decision and the moral reasons adduced in its support, reasons gaining their force against the framework of much mainstream normative ethical theory. I argue that in a few morally dilemmatic situations, such a legalistic–theoretical approach cannot plausibly accommodate certain irreducible and ineliminable features of the ethical experience of any concrete individual implicated in the situation, and that this failure partly undermines its self–appointed role of guiding such an individual's conduct. For example, the problem as experienced by the judge and by the parents might not be the same problem at all, and some of their respective reasons may be mutually unintelligible or impotent. I certainly do not argue for a rejection of law or of moral theory; I merely challenge their implicit claim to comprehensiveness and their fixation with an idealised and putatively universal rationality modelled on converging scientific enquiry. Finally, I claim that at least in the twins’ case there may be insufficient normative robustness to the conclusions reached, or indeed reachable, by the court in a situation where intuitions and moral reasons pull in fundamentally incommensurable directions; as such, there may be room for an acknowledgement of the spiritual, through a humble abstention from making a decision – which is not to be confused with deciding to do nothing.

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.

Most discussions in ethics argue that a certain practice or act is morally justified, with any underlying theory taken as supporting a guide to general action by aiding discovery of the objectively and singularly right thing to do. I suggest that this oversimplifies the agent’s own experience of the moral dilemma, and I take the recent English case of Diane Pretty’s request for assisted suicide as an example. Here the law reacted one way, despite the obvious sympathy many felt for her. This only appears paradoxical, I suggest, because too much is expected of the concept of justification, and because moral understanding of a particular case is too often reduced to the legalistic search for general justificatory reasons. The starting point should be, I conclude, a full awareness of the phrase “there but for the grace of God go I”

The big issues of medical ethics are more in the news than ever before. And yet they remain as stubborn and often as incendiary as ever. This book claims that in an effort to deal with the issues, mainstream philosophers have arbitrarily omitted many ethically relevant features in order to reduce the central problems to more tractable technical puzzles. The most gratuitous omissions have been the patient's point of view on the problem; the patient's ordinary life, which provides the wider context for his point of view; and the ordinary language and concepts by which the patient tries to make sense of the problem.

In a recent issue of Bioethics, Bernard Gesang asks whether a moral philosopher possesses greater moral expertise than a non-philosopher, and his answer is a qualified yes, based not so much on his infallible access to the truth, but on the quality of his theoretically-informed moral justifications. I reject Gesang's claim that there is such a thing as moral expertise, although the moral philosopher may well make a valid contribution to the ethics committee as a concerned and educated citizen. I suggest that wisdom is a lot more interesting to examine than moral expertise. Again, however, moral philosophers have no monopoly on wisdom, and the study of philosophy may even impede its cultivation.

Charles Griswold’s 2007 book Forgiveness argues that genuine forgiveness of an unexcused, unjustified and unignored offence must be normgoverned and conditional. In the same way that gift-giving is governed by norms of appropriateness, so too is forgiveness; and the appropriateness of forgiving is centrally dependent on the offender’s repentance. In response, I claim that genuine forgiveness must always be elective and unconditional, and therefore genuinely unpredictable, no matter how much – or how little – the offender repents. I consider and reject one defence of unconditional forgiveness, that of Garrard and McNaughton. I then develop my own account, which builds on Bernard Williams’ notion of practical necessity

Richard Brandt, following Hume, famously argued that suicide could be rational. In this he was going against a common ‘absolutist’ view that suicide is irrational almost by definition. Arguments to the effect that suicide is morally permissible or prohibited tend to follow from one’s position on this first issue of rationality. I want to argue that the concept of rationality is not appropriately ascribed – or withheld – to the victim or the act or the desire to commit the act. To support this, I explore how the concept is ascribed and withheld in ordinary situations, and show that it is essentially future-oriented. Since the suicide victim has no future, it makes no sense to call his act rational or irrational. The more appropriate reaction to a declared desire for suicide, or to the news of a successful suicide, is horror and pity, and these are absent from Brandt’s account, as is a humble acknowledgement of the profound mystery at the heart of any suicide.

Contemporary moral philosophy assumes an account of what it means to legitimately change one’s mind in ethics, and I wish to challenge this account by enlarging the category of the legitimate. I am just as eager to avoid illegitimate mind-changing brought on by deceit or brainwashing, but I claim that legitimacy should be defined in terms of transparency of method. A social reformer should not be embarrassed to admit that he acquired many beliefs about justice while reading Dickens. As such, appeals to the heart and the imagination are just as legitimate, within limits, as appeals to the mind; and showing can be as legitimate as telling. To demonstrate this, I consider the example of a vegetarian trying to ‘convert’ a carnivore. I then ask what it means when the carnivore claims to have been previously mistaken.

In a recent Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious objection in publicly-funded healthcare systems, at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access

I claim that the dominant moral-realist understanding of action and moral responsibility cannot provide a comprehensive account of morality since it neglects the irreducibly personal component of the individual’s moral experience. This is not to embrace non-cognitivism, however; indeed, I challenge the whole realist framework of most contemporary moral philosophy. To this end I explore the phenomenon of moral necessity, exemplified by Luther’s declaration that he “has to” continue his protests against the church. I am careful to distinguish this kind of necessity from physical or psychological necessity, from means-end necessity and from the Categorical Imperative, and I suggest that it is far more widespread and far more complex than the realist or non-cognitivist would allow. Thesedeclarations are personal in that they do not entail any necessary universalisability of the judgement; however, their personal nature does not mean that they must collapse into the merely personal realm of whim and preference. Instead, Luther can be said to experience a legitimately objective demand that he behave thus and so, even though others would not experience such a demand in a relevantly similar situation. This irreducible heterogeneity of the moral, I suggest, lies at the heart of the intractability of many moral arguments. My argument can be derived as broadly Wittgensteinian (without being exegetical), and draws on the work of Peter Winch and Bernard Williams.

Forgiveness is one possible response by a 'victim' to a specific act of wrongdoing, especially when the 'wrongdoer' apologises and invites joint condemnation of the act , perhaps explaining the source of misjudgement or ignorance that brought it about. In this paper, however, I will ask what the victim can do when faced with an unrepentant wrongdoer, perhaps some-one who even refuses to acknowledge that a wrong act was committed or that the victim 'really' suffered . Importantly, I will ask if it is possible to forgive some-one just for being who they are - for example, estranged parents - without necessarily implying an attempt to resume a broken relationship. This will involve a conceptual analysis of the term as used in the situation, in parallel to a phenomenological analysis of how the victim is to come to see the wrongdoer and her act in order to forgive her. My account will stress two aspects of the 'wrongdoing situation' in order to relocate the problem rather than attempt to solve it - first, the wrongdoer's unique narrative history, and the more or less intelligible role played by the wrong act within such a self-understanding; second, the fundamental uncertainty of motive that lies at the heart of all human action and thus impedes one's ability to ever fully understand a wrong act, whether committed by others or by oneself