David K. Chan

In "After Anscombe," I argue that, although Bratman's account of intention "has provided a conceptual tool for many directions of research in philosophy and cognitive psychology," it cannot do the work in ethics that moral philosophers, especially Kantians, use it for. This can be shown by considering the problems in using intention to make a moral distinction in cases of double effect. If so, Bratman's is not the same concept of intention that Anscombe had in mind when she wrote her book. I show that Ancombe's account of intention is a much broader concept, with deeper historical roots. This does not mean that Bratman's concept of intention should be abandoned. Rather, we need to make a distinction between desire and intention that is implicit in Anscombe's account. That is, the aspects of intention that make her concept suited for ethics do not belong to Bratman's narrower concept and should be attributed to a concept that can be distinguished from intention. Evidence for what the latter concept is can be found in Aquinas' account of intentio from which the concept of intention has borrowed its name. Intentio for Aquinas is an act of will in regard to the end, whereas Bratman's intention is of the means that are chosen in practical reasoning. Intentio seems to be an intrinsic desire for the end. If this is right, then it is desire that is relevant for ethics, and not intention in its modern use. Recognition that desire and not intention is the relevant concept for ethics, in both Anscombe's and Aquinas' accounts of human agency, dovetails perfectly with their ethical theories, for it is Aristotle's ethics that has guided both philosophers in their ethical writings. After all, Aristotelian virtue ethicists are concerned with moral evaluation of the agent's character, which consists in a set of dispositions to seek ends that are desired for their own sake.

This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52.4%) valid responses were completed and returned. The survey is the first of its kind in Singapore. Questions were framed around issues of medical paternalism, consent and patient autonomy. As the doctors were exposed to Western ethical concepts in their training, we were not surprised to find that they would mostly allow patients some say in decision-making and keep patients reasonably informed. In respecting patient autonomy, they would usually seek to influence patient choice by persuasion. However, the residual "Asian-ness" of doctors in Singapore gives rise to some inconsistencies between values and practices. Many doctors still believe that a number of their patients are incapable of rational choice. There is some lack of openness in telling patients the whole truth. When patients choose to refuse treatment, many doctors are prepared to involve family members in making a consensus decision. Doctors were also asked how they made ethical judgements in the face of dilemmas, and how they would like disputes with patients to be resolved. By and large, the doctors prefer to make their own judgements rather than to rely on rules. They also wish to keep the law courts out of disputes with patients, preferring less public ways of settling disputes.

This book brings together in one volume some of the very latest developments in moral psychology that were presented at a major American conference in 2004. Moral psychology is a broad area at the intersection of moral philosophy and philosophy of mind and action. Essays in this collection deal with most of the central issues in moral psychology that are of interest to a large number of philosophers today, including important questions in normative ethical theory, meta-ethics, and applied ethics.

An extrinsic desire is defined as a desire for something, not for its own sake, but for its supposed propensity to secure something else that one desires. I argue that the notion of ‘extrinsic desire’ is theoretically redundant. I begin by defining desire as a propositional attitude with a desirability characterization. The roles of desire and intention in practical reasoning are distinguished. I show that extrinsic desire does not have its own motivational role. I also show that extrinsic desire is not needed for other roles besides motivation to carry out the means, and is not generated by reason. Finally, I argue that an account of extrinsic motivation in terms of intention is preferable to an account in terms of extrinsic desire. Because of the fundamental differences between extrinsic desire and intrinsic desire, it is more advantageous to distinguish between them as different kinds of mental states: intention and desire.

In this paper, I examine the conflicts between autonomy and justice. The problem of justice in healthcare concerns both micro-allocation and macro-allocation. The latter has to do with distributive justice: who should get what healthcare resources at whose expense. The current debate about healthcare reform brings up two competing models of distributive justice from political philosophy. The libertarian theory holds to the ideal of individual responsibility and choice, viewing taxation for the purpose of providing goods to those who cannot afford them as a form of unjustified coercion. The liberal theory holds that society should ensure that all members are provided with basic goods that correct for inequalities that deprive them of human dignity. Even though both theories value individual choice, these theories provide opposing answers to the question of whether taxes should be collected and used for the purpose of ensuring universal access to healthcare. In my paper, I show that neither theory can respect patient choice in healthcare and achieve distributive justice. Libertarians ignore the realities of the healthcare system and why a free market where patients choose and pay for what they want cannot exist. Liberals face the problem that the choices that patients make can lead to over-consumption of healthcare at the expense of other goods important to society.

I argue that the moral distinction in double effect cases rests on a difference not in intention as traditionally stated in the Doctrine of Double Effect (DDE), but in desire. The traditional DDE has difficulty ensuring that an agent intends the bad effect just in those cases where what he does is morally objectionable. I show firstly that the mental state of a rational agent who is certain that a side-effect will occur satisfies Bratman's criteria for intending that effect. I then clarify the nature of the moral distinction in double effect cases and how it can be used to evaluate the moral blameworthiness of agents rather than the moral status of acts. The agent's blameworthiness is reduced not by his lack of intention but by his desire not to bring about the side-effect, and the 'counterfactual test' can be used to determine whether he desires the effect in acting. In my version, the DDE has its rationale in virtue ethics; it is not liable to abuse as the traditional version is; and it makes more plausible distinctions when applied to standard examples.

My paper critiques the comparability requirement that practical reason is limited by the possibility of comparing alternatives. I describe methods of reasoning that are compatible with choice between incomparable options, and discuss a mistake about intention that supports the view that comparing alternatives is the only way to choose rationally. I then explain how a model of rational choice that prescribes the comparison of alternatives invents unacceptable concepts to make comparability possible. Finally, I criticize the assumption of the unity of practical reason that requires that prudential and moral choices are both made by comparing alternatives. It turns out that moral conflicts that are intractable for those who reason with a method of comparison may be resolvable by using moral reasoning that does not involve the comparison of alternatives in terms of a comprehensive value. Making room for such forms of reasoning is preferable to denying incomparability.

In Chinese Confucian medical ethics, the principle of autonomy has not been recognized. Instead, the basic values of medical practice are compassion and humaneness. Patient autonomy however lies at the foundation of Western medical ethics in general and research ethics in particular. In the modern world of biotechnology, what happens when medical research is carried out in an East Asian society? Should the society adopt principles of Western medical ethics? Or can resources to ensure ethical research be found in Confucian ethics? I consider answers to these questions in the context of a recent case of unethical research in Singapore.

There are two contrasting paradigms for dealing with terrorists: war and law enforcement. In this paper, I first discuss how the just war theory assesses the military response to the 9/11 terrorist attacks on the United States. I argue that the ethical problems with the U.S. attack on Afghanistan in response to 9/11 concern principles of jus ad bellum besides just cause. I show that the principles of right intention, last resort, proportionality and likelihood of success were violated. Furthermore, both jus in bello principles of proportionality and discrimination were not satisfied in targeting terrorists in places where civilians not linked to them live. The law enforcement that takes place in liberal democracies is fully respectful and protective of innocent lives. Crime is dealt with by apprehending lawbreakers and putting them on trial if possible, and by keeping criminal elements on the loose away from potential victims. Good law enforcement also includes acting to remove causes of crime. I examine how this model applies to the problem of terrorism and address objections concerning the impossibility ofeliminating terrorism, the slowness of success, and the possibility that there are “nut cases” who hate America no matter what.