Tom Beauchamp

In lieu of an abstract, here is a brief excerpt of the content:The Mettle of Moral Fundamentalism: A Reply to Robert Baker*Tom L. Beauchamp (bio)AbstractThis article is a reply to Robert Baker’s attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.Robert baker’s imaginative and incisive articles on international bioethics (Baker 1998a & b) are rich in history and philosophy, but they are as profoundly misguided as they are misdirected. In this comment, I will concentrate both on a pivotal interpretation and criticism that he offers of the Report of the Advisory Committee on Human Radiation Experiments (ACHRE 1996) and on his philosophical thesis that a moral fundamentalism of principles and rights is bankrupt. Baker seriously misinterprets the ACHRE report, distorts and fails to refute moral fundamentalism, and ultimately embraces a form of the very fundamentalism that he declares bankrupt. These three topics are connected in that Baker’s misconceptions of the ACHRE report launch his critique of moral fundamentalism and his mistaken understanding of moral fundamentalism drives his critique of the ACHRE report. 1 [End Page 389]Some Misunderstandings of the Human Radiation CommitteeBaker proclaims a conflict between ACHRE’s moral fundamentalism and multiculturalism. He presents this conflict as primarily a factual issue regarding whether different cultures and eras accept different moral principles—“the difference claim,” in his vernacular (Baker 1998a, pp. 208–9). This interpretation eventuates in a critique of the work of both ACHRE and Ruth Macklin:[W]hen Macklin and the Radiation Committee consider the challenge of multiculturalism, they construe this challenge, not as dispute about anthropological fact, but as a dispute about philosophical theory. More specifically, they treat any assertion of the difference claim as a form of “ethical relativism.”... They thus respond to the multiculturalist’s factual observations—even to factual observations by anthropologists—as if they were philosophical analyses.(Baker 1998a, p. 209)Baker thinks that a factual question has been fallaciously transformed into a philosophical one. However, this false dilemma is a figment of his fancy. He provides no citation to ACHRE to show that it holds this view, and for an understandable reason: This position is neither stated nor presumed in the Report. ACHRE is quite clear that relativism involves both an anthropological (I would prefer to say historical) dispute about fact and a philosophical dispute about value—and that they are not the same.The Committee and its staff proceeded as follows: They first collected a large body of historical documents and facts about the practices, policies, and values that prevailed during the period they were studying. Chapters 1 through 3 and 5 through 13, 12 of the Report’s 18 chapters, display the results of this empirical work. The Committee concluded, on this basis, that research investigators and government officials were aware of the obligations generated by universal principles. The ACHRE report specifically lists six “basic” moral principles and maintains that these principles were pervasively recognized at the time of the radiation experiments (ACHRE 1996, pp. 114ff, 124). ACHRE received testimony, conducted interviews, and compiled documents that indicated how deeply these principles were woven into the fabric of American culture at the time, so deeply that no responsible research investigator could have been unaware of them. ACHRE did not move beyond its list of six principles to a broader thesis about the (factual) universality of other principles and did not examine other cultures or periods of history; such work would [End Page 390] have exceeded ACHRE’s mandate and would have done more to obscure than to further its arguments.ACHRE also found that some government officials had attempted to hide their wrongdoing—a clear indication that these officials were aware of the relevant moral principles and knew that they should not have been treating persons as they did (ACHRE 1996, pp. 152–53; Chapman 1946). These factual findings were not armchair philosophy or empirical guesswork...

In lieu of an abstract, here is a brief excerpt of the content:36. A DISCUSSION ON PERSONAL IDENTITY Jane L. Mclntyre's original paper "Is Hume's Self Consistent?" was presented at the MoGiIl Hume Conference; it will be published in the forthcoming volume devoted to those preceedings. Tom Beauchamp" s paper is presented here as delivered. John Biro's paper has been revised since its original presentation. 37. SELF INCONSISTENCY OR MERE SELF PERPLEXITY? Professor Mclntyre's imaginative and constructive paper has three primary parts (despite its division into six sections). First, she offers an interpretation of Hume's view of the self in Book I of the Treatise. Second, she explains why his own reservations in the Appendix create problems not only for this theory of self identity but for other parts of his philosophy as well. Finally, she tries to ease him out of these difficulties with her overlap interpretation of the bundle theory. My comments follow exactly this outline, though my conclusions, for the most part, do not coincide with hers. My reservations do not derive from her attempt to render Hume consistent. Rather, I question the foundations of the entire enterprise in which she, Robison, Nathanson, et. al. are engaged. That is, I remain unconvinced that the alleged problem, as presently framed, is more than a pseudo-problem. I. Hume's Theory in Book I In Book I Hume offers a variety of arguments about the nature of the self, most of which rely on other theories, such as those of causation, the association of ideas, and substance. Whatever the exact arguments and positions he may be advancing, at least the following six propositions are integral to his theory of personal identity: 1)The self is entirely reducible to a collection of perceptions. 2)The self is not characterized by strict identity. 3)There is nothing simple in which the collection of perceptions inheres. 4)Both identity and simplicity are attributed to the self because of relations between perceptions--the relations of causation and resemblance. 5)The relations of resemblance and causation unite these perceptions. 38. 6) There are no real (non-associational) connections or relations among these perceptions which unite them. Half of these six claims are critical denials of other philosophical claims; the other half are constructive philosophical theories. Hume's entire philosophical program in Book I is tied up with these claims. The criticisms are directed at numerous metaphysical theories of mind, substance and causation; and the constructive account of personai identity requires his theories of perception and association of ideas. I mention these obvious points only because it is so important to note that if_ the interpretation is correct which Professor Mclntyre and others give to (roughly) five sentences in the Appendix, where Hume mentions a possible inconsistency, then Hume is not only questioning his theory of personal identity in Book I, he is calling Book I itself into question. To be convinced that this strikingly implausible turnabout occurs in five sentences of the Appendix, we must be given a most compelling argument—one which I doubt is forthcoming. II. Hume's Alleged Inconsistency The alleged problem of inconsistency arises because Hume says in the Appendix that he does not know how to render his own former opinions consistent (T633, 636). However, when he comes to a formal statement of the inconsistency, as everyone is agreed, the propositions said to be inconsistent are not inconsistent. In the attempt to grasp Hume's meaning, a general consensus has emerged in recent Hume scholarship, including Professor Mclntyre in its company, that we ought both to move backward and forward a sentence or two in Hume's text. Hume says in those passages that his hopes for his theory are diminished because he is unable to explain the principles, that unite our successive perceptions in our thought or consciousness (T636) ; and he then indicates that i_f perceptions could be shown to inhere in something simple or to be really connected, these prob- 39. lems would vanish. It is this textual setting which Robison, Nathanson, and Professor Mclntyre turn into the claim that "the concept of a self which is affected by experience, and therefore must persist through experience— is precisely the concept of the self that...

In lieu of an abstract, here is a brief excerpt of the content:Refusals of Treatment and Requests for DeathTom L. Beauchamp (bio)It would be hard to overestimate the importance of two decisions on physician-assisted suicide delivered recently by the Ninth and Second Circuit Courts (Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc), aff’g 850 F.Supp. 1454 (W.D. Wash. 1994), rev’g 49 F.3d 586 (9th Cir. 1995); Quill v. Vacco, 80 F.3d 716 (2nd Cir. 1996). They are the highest courts yet to render an opinion on this subject, and their decisions have set the stage for the U.S. Supreme Court to take one of two paths: It will either say that (1) all citizens have a liberty interest in physician-assisted suicide, or that (2) each state may set its own policy on such matters. Whichever path is elected, a right to request physician-assisted suicide is a virtual certainty, at least in some states.These opinions are later segments of an evolving legal history in which courts have held that no criminal liability exists for withholding or withdrawing a life-sustaining treatment when physicians are directed to do so by a patient or an authorized surrogate (see Alan Meisel 1992). The decriminalization of suicide and the right to refuse a life-sustaining treatment now appear to be evolving into a rule that a patient has a legal right to control his or her death, or at least to obtain a lethal prescription. We are at a delicate point in this evolving history. Neither in law nor in bioethics is the justification of physician assistance in suicide the received opinion at the present time, but support for physician assistance in dying could soon become the received opinion in both disciplines.The leading edge of the wedge producing these changes has been widespread acceptance of an extensive right to refuse treatment. This right is today axiomatic in even conservative quarters of bioethics, but 20 years ago it was far from axiomatic that all patients have a right to refuse treatment. Few at that time judged that it would be both immoral and illegal for a physician not to forgo treatment in the face of a competent, authoritative refusal of any form of medical service or treatment.The justification for assistance in bringing about death in medicine is an extension of the justification for letting patients die. Letting a patient die by accepting a valid refusal to continue in life is directly analogous to helping a patient die by accepting a valid request for help. The high value we place on [End Page 371] rights of autonomy thereby spills over from the right to refuse to the underexplored right to request active assistance. 1 As the autonomy interest in this choice increases, denial of help to the patient becomes more burdensome.Those who defend the view that euthanasia and physician-assisted suicide are morally prohibited typically assume that assistance involves an act of killing, that acts of killing are impermissible, and that a defensible distinction exists between killing and letting die. However, this distinction has proved difficult to explicate, and the category of killing often seems distant from the problem at hand. For example, it is an eccentric view that a physician who prescribes a lethal medication to a patient thereby kills the patient (or, for that matter, lets the patient die) when the patient voluntarily ingests the medication and dies. So poor are the conceptual understandings of “killing” and “letting die” that conceptual confusion abounds as to which term to use in almost all morally difficult and controversial cases.A common view is that “letting die” is a matter of “ceasing useless treatments” after which patients die (Gaylin, Kass, Pellegrino, and Siegler 1988). This account is attractive, but too narrow. “Letting die” occurs in medicine under at least two circumstances: cessation of treatment because it is useless and cessation of treatment because it has been refused (which can occur even with useful treatments). Neither conceptually nor morally is “ceasing useless treatment” the proper way to state the condition under which many “letting-die” cases occur. It follows that the type of action—killing or letting...

In recent years, the right of employees to know about health hazards in the workplace has emerged as a major issue in occupational health policy. A general consensus has gradually evolved that there is a right to know, and correlatively that there is a moral obligation to disclose relevant information to workers. For example, the National Institute for Occupational Safety and Health, and several other U.S. federal agencies, informed the U.S. Senate as early as July 1977 that ‘workers have the right to know whether or not they are exposed to hazardous chemical and physical agents regulated by the Federal Government.’ In 1980, the Occupational Safety and Health Adminstration promulgated regulations guaranteeing workers access to medical and exposure records.

Robert Baker and Laurence McCullough argue that the "applied ethics model" is deficient and in need of a replacement model. However, they supply no clear meaning to "applied ethics" and miss most of what is important in the literature on methodology that treats this question. The Baker-McCullough account of medical and applied ethics is a straw man that has had no influence in these fields or in philosophical ethics. The authors are also on shaky historical grounds in dealing with two problems: (1) the historical source of the notion of "practical ethics" and (2) the historical source of and the assimilation of the term "autonomy" into applied philosophy and professional ethics. They mistakenly hold (1) that the expression "practical ethics" was first used in a publication by Thomas Percival and (2) that Kant is the primary historical source of the notion of autonomy as that notion is used in contemporary applied ethics.

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or theories, these approaches are consistent with and should not be considered adversaries of a principle-based account.

: Phenomena of moral conflict and disagreement have led writers in ethics to two antithetical conclusions: Either valid moral distinctions hold universally or they hold relative to a particular and contingent moral framework, and so cannot be applied with universal validly. Responding to three articles in this issue of the Journal that criticize his previously published views on the common morality, the author maintains that one can consistently deny universality to some justified moral norms and claim universality for others. Universality is located in the common morality and nonuniversality in other parts of the moral life, called "particular moralities." The existence of universal moral standards is defended in terms of: (1) a theory of the objectives of morality, (2) an account of the norms that achieve those objectives, and (3) an account of normative justification (both pragmatic and coherentist).