Michael Cholbi

Kant's claim that the rational will has absolute value or dignity appears to render any prudential suicide morally impermissible. Although the previous appeals of Kantians (e. g., David Velleman) to the notion that pain or mental anguish can compromise dignity and justify prudential suicide are unsuccessful, these appeals suggest three constraints that an adequate Kantian defense of prudential suicide must meet. Here I off er an account that meets these constraints. Central to this account is the contention that some suicidal agents, because they are unable to fashion a rational conception of their own happiness, are diminished with respect to their dignity of humanity, and as a result, lack the pricelessness that makes prudential suicide wrong on a Kantian view

This article addresses the question of whether the arguments for a duty to die given by John Hardwig, the most prominent philosophical advocate of such a duty, are sound. Hardwig believes that the duty to die is relatively widespread among those with burdensome illnesses, dependencies, or medical conditions. I argue that although there are rare circumstances in which individuals have a duty to die, the situations Hardwig describes are not among these.After reconstructing Hardwig's argument for such a duty, highlighting his central premise that ill, dependent, or aged individuals can impose unfair burdens upon others by continuing to live, I clarify precisely what Hardwig intends by his thesis that many of us have a duty to die. I then show that an important disanalogy exists between an uncontroversial example in which an individual has a duty to die and the situations in which Hardwig proposes individuals have a duty to die. More specifically, in situations where a duty to die exists, an individual's having a duty to die logically implies that those she burdens have a right to kill that individual in self-defense. I then suggest that the burdens that ill, dependent, or aged individuals impose on their families, loved ones, or caregivers do not constitute the kind of threat that warrants the latter killing the former in self-defense. Hence, the duty to die is much rarer than Hardwig supposes

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. Popular and academic discourse about assisted suicide paradigmatically focuses on individuals with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions.

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible.

Many participants in debates about the morality of assisted dying maintain that individuals may only turn to assisted dying as a ‘last resort’, i.e., that a patient ought to be eligible for assisted dying only after she has exhausted certain treatment or care options. Here I argue that this last resort condition is unjustified, that it is in fact wrong to require patients to exhaust a prescribed slate of treatment or care options before being eligible for assisted dying. The last resort condition effectively pits one right of patients, their right to refuse medical treatment or interventions, against another patient right acknowledged by advocates of assisted dying, the right to die. Drawing on an analogy with the legal notion of an unconstitutional condition, I argue that the last resort condition unjustly demands that an arguably more fundamental right—the right to refuse medical treatment or intervention—be foregone in order to acquire a less fundamental right—the right to die. I then address three rationales for the last resort condition and find that they subject individuals to arbitrarily stringent standards for exercising the right to die, standards to which those who seek to end their lives by voluntarily ending life-sustaining treatments are not subject. Subjecting those who seek assisted dying to the last resort condition therefore wrongfully infringes on their right to refuse medical treatment or interventions

Motivational internalism (MI) holds that, necessarily, if an agent judges that she is morally obligated to ø, then, that agent is, to at least some minimal extent, motivated to ø. Opponents of MI sometimes invoke depression as a counterexample on the grounds that depressed individuals appear to sincerely affirm moral judgments but are ‘listless’ and unmotivated by such judgments. Such listlessness is a credible counterexample to MI, I argue, only if the actual clinical disorder of depression, rather than a merely hypothetical example of such listlessness, is the source of this listlessness. However, empirical evidence concerning depression shows that, to the extent that the depressed are motivationally listless at all, they are abnormally listless only with respect to an important class of non-moral judgments, namely, their prudential normative judgments (i.e., those concerning their own happiness and well-being), not their moral judgments. Hence, depressed individuals do not constitute a counterexample to MI. This conclusion has important methodological implications concerning how supporters and opponents of MI can best defend their respective theses

abstract Ryan Tonkens proposes that my Kantian approach to suicide intervention with respect to the mentally ill (2002) wrongly assumes that the suicidally mentally ill are rational and are therefore rational agents to whom Kantian moral constraints ought to apply. Here I indicate how the empirical evidence concerning the suicidally mentally ill does not support Tonkens' criticism that the suicidally mentally ill are irrational. In particular, that evidence does not support the conclusion that such individuals are systemically practically irrational so as to undermine the attribution of at least minimal rational autonomy to them. A Kantian moral framework, albeit one developed in a non-ideal direction, remains applicable to such individuals.

T.M. Scanlon (1998) proposes that promise breaking is wrong because it shows manipulative disregard for the expectations for future behavior created by promising. I argue that this account of promissory obligation is mistaken in it own right, as well as being at odds with Scanlon's contractualism. I begin by placing Scanlon's account of promising within a tradition that treats the creation of expectations in promise recipients as central to promissory obligation. However, a counterexample to Scanlon's account, his case of the "Profligate Pal," will show that this view of promissory obligation, which I call the Expectations View, is incorrect. In its place, I propose an account of promissory obligation I call Promising as Accountability, according to which promising is a way of making oneself accountable to others for a future act. Not only is Promising as Accountability a more defensible approach to promissory obligation, it also better fits with certain general features of Scanlon's contractualism.

Philosophical discussions of the morality of suicide have tended to focus on its justifiability from an agent’s point of view rather than on the justifiability of attempts by others to intervene so as to prevent it. This paper addresses questions of suicide intervention within a broadly Kantian perspective. In such a perspective, a chief task is to determine the motives underlying most suicidal behaviour. Kant wrongly characterizes this motive as one of self-love or the pursuit of happiness. Psychiatric and scientific evidence suggests that suicide is instead motivated by a nihilistic disenchantment with the possibility of happiness which, at its apex, results in the loss of the individual’s conception of her practical identity. Because of this, methods of intervention that appeal to agents’ happiness, while morally benign, will prove ineffective in forestalling suicide. At the same time, more aggressive methods violate the Kantian concern for autonomy. This apparent dilemma can be resolved by seeing suicide intervention as an action undertaken in non-ideal circumstances, where otherwise unjustified manipulation, coercion, or paternalism are morally permitted.

T.M. Scanlon has recently proposed what I term a ‘double attitude’ account of blame, wherein blame is the revision of one’s attitudes in light of another person’s conduct, conduct that we believe reveals that the individual lacks the normative attitudes we judge essential to our relationship with her. Scanlon proposes that this account justifies differences in blame that in turn reflect differences in outcome luck. Here I argue that although the double attitude account can justify blame’s being sensitive to outcome luck, it cannot justify allocating blame differently when agents with the same attitudes differ only with respect to the luck-based outcomes of their actions. However, Scanlon’s own contractualist theory of morality can be invoked to show that the double attitude account is compatible with blame-based sanctions (e.g., compensation mandated when negligence or reckless result in harm) being sensitive to outcome luck. The resultant view of blame and luck remains desert-based while making sense of the common intuition that differences in outcome luck can matter to how lucky and unlucky individuals are justifiably treated

Much of the literature on the desirability of immortality (inspired by B. Williams) has considered whether the goods of mortal life would be exhausted in an immortal life (whether, i.e., immortality would necessarily end in tedium). However, there has been very little discussion of whether the bads of mortal life would also be exhausted in an immortal life, and more generally, how good immortal life would be on balance, particularly in comparison to a mortal life. Here I argue that there are compelling reasons to favor a mortal over an immortal life because a mortal life offers a higher ceiling for well-being and assigns our agency a greater role in how our lives turn out.

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the explanation of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis.

Consequentialism is often criticized for rendering morality too pervasive. One somewhat neglected manifestation of this pervasiveness is the obligatory self-benefit objection. According to this objection, act-consequentialism has the counterintuitive result that certain self-benefitting actions turn out, ceteris paribus, to be morally obligatory rather than morally optional. The purposes of this paper are twofold. First, I consider and reject four strategies with which consequentialists might answer the obligatory self-benefit objection. Despite the apparent consequentialist credentials of these answers, none of these strategies is adequate because each fails to justify agents failing to benefit themselves when benefiting themselves would be otherwise required by the imperative that overall good meet a certain threshold. Second, I argue that no plausible consequentialist response to this objection is forthcoming because consequentialism denies the central axiological fact propelling this objection, namely, that the self possesses a normative architecture relating the self as agent and self as patient. This architecture, I propose, justifies the option not to benefit oneself

The metatethical position known as motive internalism (MI) holds that moral beliefs are necessarily motivating. Adina Roskies (in Philosophical Psychology, 16) has recently argued against MI by citing patients with injuries to the ventromedial (VM) cortex as counterexamples to MI. Roskies claims that not only do these patients not act in accordance with their professed moral beliefs, they exhibit no physiological or affective evidence of being motivated by these beliefs. I argue that Roskies' attempt to falsify MI is unpersuasive because the evidence used to attribute the relevant moral beliefs to VM patients is insufficient: Contra Roskies, that VM patients are proficient moral reasoners does not establish the presence of these moral beliefs. In addition, the linguistic evidence Roskies cites (a) is vulnerable to methodological worries about its reliability or authenticity, (b) does not override counterevidence derived from the patients' nonlinguistic behavior, and (c) is undermined by VM patients' inability to correctly attribute moral beliefs to others. I conclude with a proposal about how MI should be interpreted, given that it is not falsified by empirical evidence of the sort put forth by Roskies.

Samuel Scheffler has recently defended what he calls the ‘afterlife conjecture’, the claim that many of our evaluative attitudes and practices rest on the assumption that human beings will continue to exist after we die. Scheffler contends that our endorsement of this claim reveals that our evaluative orientation has four features: non-experientialism, non-consequentialism, ‘conservatism,’ and future orientation. Here I argue that the connection between the afterlife conjecture and these four features is not as tight as Scheffler seems to suppose. In fact, those with an evaluative orientation that rejects these four features have equally strong moral reasons to endorse the existence of the collective afterlife

Suicide is a controversial ethical issue in large part because the reasonings of and above appear plausible but support contradictory conclusions. in effect asks: Why should we be granted an exemption to the prohibition on human killing when the person we kill is ourselves? What makes killing oneself so special? on the other hand starts from the intuition that there is something special or distinctive about the moral relationship we stand in to ourselves, a relationship that can at least sometimes morally justify suicide. The reasoning of and thus establishes the contours of the ethical debate concerning the permissibility of suicide and explains why suicide is one of the most hotly debated issues in bioethics

According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By appealing to these powers, my version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism.

Hazing is a widespread moral phenomenon that has attracted little theoretical discussion. Here are my purposes are two fold: First, I provide a characterization of hazing that captures the features relevant to analyzing and evaluating hazing from a moral point of view. Hazing is harmful or humiliating transaction between members of a coveted group and an individual seeking membership in said group where the transaction bears no intrinsic relationship to the group’s mission. Second, I provide an analysis of the moral wrongs of hazing that is broadly Kantian in spirit. The wrongfulness of hazing cannot be captured in terms of familiar categories of wrongdoing wherein individuals are treated as mere means (e.g., deception or coercion). However, hazing has no place in Kant’s Kingdom of Ends, for as a form of social interaction, it exploits and endorses an inequality between the hazer and the hazed that is antithetical to the equality of rational worth characteristic of social interaction in the Kingdom of Ends. In addition, hazing amounts to an invitation for a person to trade their humanity or self-respect in exchange for full inclusion in a group or organization. Issuing such an invitation, I claim, violates a Kantian duty to treat others’ humanity as an end in itself, violating a duty not to “give scandal” by tempting others to act in ways they will later have grounds to rationally regret.

Evidence from the Apology, Crito, Protagoras, and Gorgias is mustered in defense of the claim that for Socrates, dialectic typifies just punishment: Dialectic benefits the punished by making her more just, since it disabuses her of the false beliefs that stand in the way of her acquiring knowledge of justice. Though painful and disorienting to the interlocutor, having one’s opinions refuted by Socrates—who is wiser than his interlocutors due to his awareness of the vastness of his ignorance—is in fact a benefit. Socrates’ attitude toward his own pending death sentence, his claim that the virtues are unified around wisdom, and his opposition to vengeance or retaliation as a moral motive, all underscore how dialectical engagement is a paradigm instance of just Socratic punishment.

In “What is Wrong with Rational Suicide,” Pilpel and Amsel develop a counterexample that allegedly confounds attempts to condition the moral permissibility of suicide on its rationality. In this counterexample, a healthy middle aged woman with significant life accomplishments, but no dependents, disease, or mental disorder opts to end her life painlessly after reading philosophical texts that persuade her that life is meaningless and bereft of intrinsic value. Many people would judge her suicide “a bad mistake” despite its meeting “robust” conditions for rationality. Hence, Pilpel and Amsel conclude, even robust conditions for the rationality of suicide “fail to do their job: to exclude intuitively unacceptable suicides from being permissible.” I argue here that this counterexample fails to cast doubt on philosophical attempts to account for the moral permissibility of suicide in terms of its rationality

Kant's view that we have only indirect duties to animals fails to capture the intuitive notion that wronging animals transgresses duties we owe to those animals. Here I argue that a suitably modified Kantianism can allow for direct duties to animals and, in particular, an imperfect duty to promote animal welfare without unduly compromising its core theoretical commitments, especially its commitments concerning the source and nature of our duties toward rational beings. The basis for such duties is that animal welfare, on my revised Kantian view, is neither a conditioned nor unconditioned good, but a final and nonderivative good that ought to be treated as an end-in-itself. However, this duty to promote animal welfare operates according to a broadly consequentialist logic that both accords well with our considered judgments about our duties to animals and explains differences between these duties and duties owed to rational agents

Critics often charge that Kantian ethics is implausibly rigoristic: that Kantianism recognizes a set of perfect duties, encapsulated in rules such as ‘don’t lie,’ ‘keep one’s promises,’ etc., and that these rules apply without exception. Though a number of Kantians have plausibly argued that Kantianism can acknowledge exceptions to perfect duties, this acknowledgment alone does not indicate how and when such exceptions ought to be made. This article critiques a recent attempt to motivate how such exceptions are to be made, namely, the constitutive approach developed by Tamar Schapiro. I argue that the constitutive approach is vulnerable to the objection that it is too permissive, justifying many morally dubious exceptions to perfect duties. I conclude by briefly outlining an alternative ‘fine print’ approach to the rigorism objection that appears to avoid the objection leveled at Schapiro’s approach, focusing on how modifying the constituents of agents’ maxims can change the deontic status of an act of a generally impermissible kind