David DeGrazia

Edited by Thomas A. Shannon, this series provides anthologies of critical essays and reflections by leading ethicists in four pivotal areas: reproductive technologies, genetic technologies, death and dying, and health care policy. The goal of this series is twofold: first, to provide a set of readers on thematic topics for introductory or survey courses in bioethics or for courses with a particular theme or time limitation. Second, each of the readers in this series is designed to help students focus more thoroughly and effectively on specific topics that flesh out the ethical issues at the core of bioethics. The series is also highly accessible to general readers interested in bioethics

It might be appropriate to begin my commentary by disclosing the fact that Brad Lewis and I are good friends. “Oh, no,” you might think, “this will be one of those cozy, mutual back-patting, insider sessions that so often take place in the American Philosophical Association group meetings.” But never fear. For one thing, I’m no insider to the intellectual circles represented in Dr. Lewis’ bibliog- raphy. Indeed, I’ve read only two of the 32 works listed there. (Depending on how you look at it, that may make me either completely unqualified to comment on this paper or exceptionally well-qualified for reasons of critical distance.) Also, friendship and constructive criticism are entirely compatible in my book. And, to paraphrase a philosopher of some importance, “Brad is dear, but the truth is dearer.” I will begin my commentary by identifying some of Brad’s theses that I find interesting, important, and well-supported. The second part of my commentary will elaborate my major concerns about the paper. This part will be longer, not because my overall reaction is more critical than favorable, but because exploring different viewpoints generally takes more space and time than noting points of agreement. In my conclusion, I will suggest that many of the paper’s insights are likely to sail better if some of the baggage from postmodernism and cultural studies is thrown overboard.

From the late 1970s through the mid-1980s, a number of philosophers carefully worked out theories of justice in health care. Most of those still working on these issues have turned to clinical applications of the philosophical frameworks developed earlier. Although theories have not received much recent attention in this debate, this paper will offer a new theoretical framework for approaching issues of justice in health care. There are two reasons for thinking that returning to theory would be worth- while. One concerns the fact that our society remains very far from realizing justice in health care. While there are several well-argued theories of just health care whose implementation would take us into the neighborhood of justice, it would also seem - in pluralistic spirit - that adding to the arsenal is helpful. The more good arguments there are for a given conclusion, the more likely it is to be correct and, ultimately, to persuade. It will be contended that a limited right to health care can be grounded in self-respect. The argument will exploit Rawls' key insight that self-respect is a primary social good and will depend on the assumption that, at least in moderately affluent nations, one has a right to the primary social goods. This assumption is not defended here. But it should be noted that a right to the primary social goods is not of interest only to Rawlsians and other liberal deontologists; an enlightened utilitarianism might also vindicate it. The second reason for advocating a return to theory is that self-respect is especially fruitful as a focal concept for addressing issues of justice in health care (and other issues).

Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In light of persisting reasonable disagreement about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence.

This best-selling anthology of readings with case studies provides insightful and comprehensive treatment of ethical issues in medicine. Appropriate for courses taught in philosophy departments, bioethics programs, as well as schools of medicine and nursing, the collection covers such provocative topics as biomedical enhancement, clinical trials in developing countries, animal research, physician-assisted suicide, and health care reform. The text's effective pedagogical features include chapter introductions, argument sketches, explanations of medical terms, headnotes, and annotated bibliographies.

: Although nothing could be less fashionable today than talk of comprehensive health care reform, the major problems of American health care have not gone away. Only a radical change in the way the U.S. finances health care--specifically, a single-payer system--will permit the achievement of universal coverage while keeping costs reasonably under control. Evidence from other countries, especially Canada, suggests the promise of this approach. In defending the single-payer approach, the author identifies several political and cultural factors that make it difficult for Americans to obtain a clear view of this option. Finally, the author argues that much discussion of rationing is vitiated by bracketing more systemic questions to which the issue of rationing is inextricably linked

Regarding the sinking lifeboat scenario involving several human beings and a dog, nearly everyone agrees that it is right to sacrifice the dog. I suggest that the best explanation for this considered judgment, an explanation that appears to time-relative interests, contains a key insight about prudential value. This insight, I argue, also provides perhaps the most promising reply to the future-like-ours argument, which is widely regarded as the strongest moral argument against abortion. Providing a solution to a longstanding puzzle in value theory across species while illuminating the morality of abortion, the time-relative interest account proves worthy of sustained theoretical attention

_ Source: _Page Count 21 Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In light of persisting reasonable disagreement about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence

We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result — or perhaps take the form — of a variety of states including pain, anxiety, fear, and boredom. Third, pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states.

In the traditional fix-it model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.

_ Source: _Page Count 21 Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In light of persisting reasonable disagreement about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence

The following theses are defended in this paper: (1) The concept of autonomous action is centrally relevant to understanding numerous psychiatric conditions, namely, conditions that subvert autonomy; (2) The details of an analysis of autonomous action matter; a vague or rough characterization is less illuminating; (3) A promising analysis for this purpose (and generally) is a version of the "multi-tier model". After opening with five vignettes, I begin the discussion by highlighting strengths and weaknesses of contributions by other authors who examine the relationship between autonomy and autonomysubverting psychiatric conditions. I then present an analysis of the concept of autonomous action, before employing this analysis in a suggestive exploration of the conditions illustrated in the vignettes. Keywords: autonomy, multi-tier model, psychiatric conditions CiteULike Connotea Del.icio.us What's this?

: Those who are morally opposed to abortion generally make several pivotal assumptions. This paper focuses on the assumption that we have full moral status throughout our existence. Coupled with the assumption that we come into existence at conception, the assumption about moral status entails that all human fetuses have full moral status, including a right to life. Is the assumption about moral status correct? In addressing this question, I respond to several arguments advanced, in this journal and other venues, by Alfonso Gómez-Lobo. Gómez-Lobo's reasoning resolves into two basic arguments: (1) an appeal to the practical necessity of early moral protection and (2) an appeal to our kind membership and potentiality. I respond to these in turn before offering further reflections

In the literature on persons and their identity, it is customary to distinguish the issue of the nature of personhood—“What is a person?”—from the issue of per- sonal identity—“What are the persistence conditions of a person over time?” In recent years, Eric Olson and Lynne Rudder Baker have brought to the forefront of discussion the related, but often neglected, issue of our essence: “What are we, most fundamentally (essentially)—human animals, persons, or something else?” Attacking what he calls the Standard View of personal identity, according to which personal identity consists in some type of psychological continuity, Olson contends that this thesis has highly implausible implications. Attributing the claim that we are essentially persons to the Standard View, Olson defends the alterna- tive thesis that we are essentially (living) human animals, members of the species Homo sapiens, and that our persistence conditions are biological, having nothing to do with psychology. At the heart of his critique is the contention that the Standard View lacks a plausible account of the relationship between a person and the human animal associated with her. Defending “person essentialism” and defining persons as beings with first-person perspectives, Lynne Rudder Baker responds to Olson’s challenge with the Constitution View: We (human) persons are constituted by, but not identical to, human animals. After reconstructing Olson’s critique of the Standard View, I argue that Baker goes a long way toward meeting his challenge to account plausibly for the relationship between persons and human animals. Then I contend that her person-based Constitution View nevertheless has major difficulties: a “newborn problem”; a dubious ontology; and a problematic account of personal identity. I conclude with general reflections about this dialectic.