David K. Chan

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.

In this paper, I examine the difference between decision-making by soldiers and commanders, compared with leaders of the nation. Decision-makingin the armed forces is prudential reasoning concerned with the best means to achieve given military objectives. I argue that those in the military cannot rationally make the moral choice to risk the lives of their own soldiers or jeopardize their mission in order to protect the lives of enemy civilians. This does not vindicate the realists who deny that morality applies to war. Moral constraints set out in war conventions foster the illusion that by following rules of war, soldiers and their leaders have done all anyone needs to do in terms of moral choice concerning war. Political leaders should instead engage in moral reasoning by considering other means besides war, even the option of changing objectives. Such reasoning differs from prudential reasoning not in scope but in type.

In this paper, I discuss an example from Buchanan of active voluntary euthanasia (AVE). I first refute objections to the intuitive permissibility of the killing described in the example. After explaining why the killing is intentional, I evaluate Buchanan's solution to the ‘problem of intending death’. According to Buchanan, what justifies a physician in intentionally bringing about a patient's death by AVE is a principle that embodies the values of patient self-determination and well-being. I argue that these two considerations are not sufficient for justifying AVE. The motive of the physician matters, but it is his desire rather than his intention that is relevant. An ethical physician may bring about intentionally the death of his patient if in forming his intention, he began with an appropriate desire to keep the patient alive as well as a legitimate desire to prevent prolonged suffering, with the latter outweighing the former. The ethical physician also desires to respect the choice of his patient wherever possible. On my account, the physician should be guided by the virtues and goals of his profession rather than by strict ‘all-or-nothing’ principles. I defend my account by describing the advantages of my account, and dismissing possible objections.