Gerald Dworkin

The moral issues involved in doctors assisting patients to die with dignity are of absolutely central concern to the medical profession, ethicists, and the public at large. The debate is fuelled by cases that extend far beyond passive euthanasia to the active consideration of killing by physicians. The need for a sophisticated but lucid exposition of the two sides of the argument is now urgent. This book supplies that need. Two prominent philosophers, Gerald Dworkin and R. G. Frey present the case for legalization of physician-assisted suicide. One of the best-known ethicists in the US, Sissela Bok, argues the case against.

Simon Rippon believes that a certain argument is not sound.1 I agree. I do not agree with the role he assigns the argument in the debate about organ sales. Nor do I agree with the much stronger argument he puts forward that organ sales should be forbidden.The argument he believes unsound, which I shall use his terminology to refer to as the Laissez-Choisir or LC argument, has three premises. The one be believes false says, “If we take away what some regard as their best option, we thereby make them worse off, at least from their own perspective”.Applied to the case of a market for organs, this says that if we take away what the potential organ seller regards as his best option, that is, there being a market for his organs, we make him worse off as judged by him. The reason Rippon thinks this argument is false is that, as I have argued and have been cited by Rippon, adding an option can, in addition to merely adding a choice, have adverse effects on the agents, can harm the agent by his own lights. Thus, says Rippon, if the argument is unsound, then it does not follow that if we deny the agent the option to sell his organs, we must be acting paternalistically. The option we are taking away is one that the agent himself regards as harmful.This is correct as far as it goes, but it might leave the reader thinking that the premise is never true. This would be to overlook the fact that even if the additional option …

In recent years, there has been renewed interest in the question of when, if ever, the state may use coercion to enforce majority views about what types of conduct are right or wrong, noble or base, decent or indecent. Such interest has been generated by both political and philosophibal pressures. In recent political history, controversies over such issues as abortion, homosexuality, pornography, textbooks in schools, new reproductive technologies such as surrogate parenting and in vitro fertilization, and faith healing have focused attention on the role of the state in supporting or opposing various moral views. In political philosophy, often a theoretical reflection of the political debates of the time, we have seen renewed attempts to provide a satisfactory foundation for traditional liberal views of the legitimate scope of state power. In particular, there has been an emphasis on the neutrality of the liberal state and the right of individuals to be treated as equals by the state.

This is a study of the question of whether moral principles, as justified by a contractualist scheme, such as Scanlon's, are binding on persons, i.e., give them reasons to act in accordance with such principles. I argue that for those agents who meet the motivational conditions that Scanlon lays down, i.e., those who seek to reach agreement with others on principles that are not rejectable, such principles are binding. But on those who do not meet the motivational condition the principles are not binding.