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.

Williams's classic 1980 article ‘Internal and External Reasons’ has attracted much criticism, but, in my view, has never been properly refuted. I wish to describe and defend Williams's account against three powerful criticisms by Michael Smith, John McDowell and Tim Scanlon. In addition, I draw certain implications from Williams's account – implications with which Williams would not necessarily agree – about the nature and the role of the personal in ethics. Williams's insight, that a reason (including a moral reason) must find purchase in an agent's ‘subjective motivational set’ if it is to function as a reason at all, undermines a central assumption of many moral philosophers, realists and non‐cognitivists alike: that there exists a singular objective realm of moral facts and moral reasons supervening on the situation before the agent. According to this assumption, if two people facing that situation disagree about whether one of them has reason to Φ, then at least one of them must be mistaken. I reject this assumption and defend Williams's account, while pointing at ways in which the account might be developed. While the internalism‐externalism debate itself is well‐worn, there is still something new and important that can be gleaned from it.

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.

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.

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.