Hugh V. McLachlan

In their account of passive euthanasia, Garrard and Wilkinson present arguments that might lead one to overlook significant moral differences between killing and letting die. To kill is not the same as to let die. Similarly, there are significant differences between active and passive euthanasia. Our moral duties differ with regard to them. We are, in general, obliged to refrain from killing each and everyone. We do not have a similar obligation to try to prevent each and everyone from dying. In any case, to be morally obliged to persist in trying to prevent their deaths would be different from being morally obliged to refrain from killing all other people even if we had both obligations

Rather than to focus upon a particular ‘right to life’, we should consider what rights there are pertaining to our lives and to our living. There are different sorts. There are, for instance, rights that constitute absences of particular duties and rights that correspond to the duties of other agents or agencies. There are also natural and non-natural rights and duties. Different people in different contexts can have different moral duties and different moral rights including rights to life. The question of the moral rights there are to and pertaining to life is considered with reference to James Griffin’s account of human rights. Also considered is the question of who or what can be a bearer of them.

Various authors, for instance Elizabeth Anderson, Rosemary Tong, Mary Warnock and Margaret Brazier have argued that commercial surrogate motherhood is exploitative and that it should be prohibited. Their arguments are unconvincing. Exploitation is a more complex notion than it is usually presented as being. Unequal bargaining power can be a cause of exploitation but the exercise of unequal bargaining power is not inevitably or inherently exploitative. Exploitation concerns unfair and/or unjust strategies - rather than the exercise of power as such. Commercial surrogate motherhood is not necessarily exploitative. Furthermore, not all transactions which are exploitative should be made illegal.

David Shaw presents a new argument to support the old claim that there is not a significant moral difference between killing and letting die and, by implication, between active and passive euthanasia. He concludes that doctors should not make a distinction between them. However, whether or not killing and letting die are morally equivalent is not as important a question as he suggests. One can justify legal distinctions on non-moral grounds. One might oppose physician- assisted suicide and active euthanasia when performed by doctors on patients whether or not one is in favour of the legalisation of assisted suicide and active euthanasia. Furthermore, one can consider particular actions to be contrary to appropriate professional conduct even in the absence of legal and ethical objections to them. Someone who wants to die might want only a doctor to kill him or to help him to kill himself. However, we are not entitled to everything that we want in life or death. A doctor cannot always fittingly provide all that a patient wants or needs. It is appropriate that doctors provide their expert advice with regard to the performance of active euthanasia but they can and should do so while, qua doctors, they remain hors de combat

The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies

This is a continuation of and a development of a debate between John Keown and me. The issue discussed is whether, in Britain, an unpaid system of blood donation promotes and is justified by its promotion of altruism. Doubt is cast on the notions that public policies can, and, if they can, that they should, be aimed at the promotion and expression of altruism rather than of self-interest, especially that of a mercenary sort. Reflections upon President Kennedy's proposition, introduced into the debate by Keown, that we should ask not what our country can do for us but what we can do for our country is pivotal to this casting of doubt. A case is made for suggesting that advocacy along the lines which Keown presents of an exclusive reliance on a voluntary, unpaid system of blood donation encourages inappropriate attitudes towards the provision of health care. Perhaps, it is suggested, and the suggestion represents, on my part, a change of mind as a consequence of the debate, a dual system of blood provision might be preferable

In his paper , Culyer talks about “values” and “value judgments” in relation to equity.1 He says: “The focus is on equity in the allocation of health care resources .... These are value laden questions because any idea of “equity” must embody value judgments about what it is that makes for a good society”. He says too: “Equity in health care policy, as in other arenas of policy, is a question of ethics and therefore of values”.I disagree with this way of talking: it suggests a sort of “postmodernist” moral relativism. It sounds as if there might be, say, socialist beliefs which were vouched for by socialist values while …

The current UK policy for the distribution of scarce vaccination in an influenza pandemic is ethically dubious. It is based on the planned outcome of the maximum health benefit in terms of the saving of lives and the reduction of illness. To that end, the population is classified in terms of particular priority groups. An alternative policy with a non-consequentialist rationale is proposed in the present work. The state should give the vaccination, in the first instance, to those who are at risk of catching the pandemic flu in the line of their duties of public employment. Thereafter, if there is not sufficient vaccine to give all citizens equally an effective dose, the state should give all citizens an equal chance of receiving an effective dose. This would be the just thing to do because the state has a duty to treat each and all of its citizens impartially and they have a corresponding right to such impartial treatment. Although this article specifically refers to the UK, it is considered that the suggested alternative policy would be applicable generally. The duty to act justly is not merely a local one

Le Grand describes a situation where a drunk driver, who has medical insurance, is the cause of an accident in which he and a sober pedestrian, who has no medical insurance, are both equally and seriously injured. At the private hospital to which they are both taken, there is available emergency treatment for one of them only. Who should receive it? The issues raised by Le Grand's example are shown to be more interesting, more complex and less clearcut than Le Grand suggests and implies. In particular, it is not the case that, unequivocally, the drunkenness of the driver establishes that the pedestrian rather than he should be treated nor that, unequivocally, the driver's possession of health insurance is morally irrelevant

In his discussion of ethics and abortion, Prof. Richard Dawkins makes the provocative claim that: ‘The Great Beethoven Fallacy is a typ ical example of the kind of logical mess we get into when our minds are befuddled by religiously inspired absolutism.’ (Dawkins, p. 339) This supposed fallacy is presented as if it exemplified not only a particular view of abortion held, for instance, by certain fundamentalist Christians but as if it revealed some flaw that is characteristic of the thinking of theists. I shall examine his claim

Wardrope argues against my proposed non-consequentialist policy for the distribution of scarce influenza vaccine in the face of a pandemic. According to him, even if one accepts what he calls my deontological ethical theory, it does not follow that we are required to agree with my proposed randomised allocation of doses of vaccine by means of a lottery. He argues in particular that I fail to consider fully the prophylactic role of vaccination whereby it serves to protect from infection more people than are vaccinated. He concludes that: ‘The benefits and burdens of vaccination are provided impartially and far more effectively by targeted vaccination than impartial lotteries.’ He has shown convincingly that this conclusion can be established in the case of his particular envisaged scenario. However, Wardrope gives no reason to suppose that, in the circumstances that we actually face, targeted vaccination would constitute impartial treatment of citizens in the UK. I readily agree with Wardrope that if it should treat its citizens justly and impartially, it does not necessarily follow that the state should distribute vaccinations of the basis of a lottery. That will be a reasonable thing to do only if certain assumptions are made. These assumptions will not always be reasonable. However, they are reasonable ones to make in the actual circumstances that currently apply

Marquis’s account of the ethics of abortion is unsatisfactory but not as Christensen implies baseless. It requires to be amended rather than abandoned. It is true, as Marquis asserts that murder and abortion both might deprive people of something of value to them, in particular, the life of a sort that might have been to them worth living. However, it is mistaken to conclude, as Marquis does, that murder and abortion are thereby morally equivalent. Not all deprivation is wrongful. Not all that is wrongful is wrongful because it deprives someone of something. Contrary to what Christensen asserts, and Marquis seems to accept, it is not solely those discernible people who currently exist who might be deprived by our current actions. It is not only towards and concerning such living discernible people that we can have moral duties. It is not only such living discernible people who can be the beneficiaries of our generosity. Hence, contraception and the emission of greenhouse gases are, like abortion, issues that raise significant moral questions; however, they might each be properly answered. Nonetheless, it does not follow that is morally equivalent to each other far less than they are all morally equivalent to murder. If and when they are morally wrong, they can be different wrongs.

The literature concerning the possibility and desirability of using new pharmacological and possible future genetic techniques to enhance human characteristics is well-established and the debates follow some well-known argumentative patterns. However, one argument in particular stands out and demands attention. This is the attempt to tie the moral necessity of moral enhancement to the hypothesised risks that allowing cognitive enhancement will bring. According to Persson and Savulescu, cognitive enhancement should occur only if the risks they think it to poses are mitigated by moral enhancement. By this they mean the compulsory and universal amplification of the disposition of altruism and the inflation of our sense of fairness, by chemical and/or genetic means. Their claim is important, intriguing and unsettling. This paper focuses on three central, but relatively neglected, features of their argument. First, there is a pernicious ambiguity in the language of ‘risk’ used by Persson and Savulescu where they tend to conflate ‘risk’ and ‘uncertainty’. Second, their use of the lottery analogy to render their position more plausible is unconvincing. It tends to distort rather than illuminate the relevant considerations. Third, Persson and Savulescu do not adequately take into account the social and individual benefits that enhancing cognition could have. If they did, it would be apparent that those benefits alone would outweigh the considerations used to justify accompanying CE with ME

Coggon’s remarks on a previous paper on active and passive euthanasia elicit a clarification and an elaboration of the argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not the same as to let die is based upon a rejection of consequentialism

The status of human embryos is discussedparticularly in the light of the claim by Fox,in Health Care Analysis 8 that itwould be useful to think of them in terms ofcyborg metaphors.It is argued that we should consider humanembryos for what they are – partiallyformed human bodies – rather than for what theyare like in some respects (and unlike inothers) – cyborgs.However to settle the issue of the status ofthe embryo is not to answer the moral questionswhich arise concerning how embryos should betreated. Since persons rather than bodies haverights, embryos do not have rights. However,whether or not embryos have rights, people canhave duties concerning them. Furthermore, thepersons whose fully developed bodies embryoswill, might (or might have) become can haverights. Contrary to what is often assumed, itis not merely persons who have (or have had)living, developed human bodies who have moralrights: so it is argued in this paper

In a recent article in Health Care Analysis (Vol. 8, No. 1),Campbell misrepresents our specific arguments about commercialsurrogate motherhood (C.S.M.) and our general philosophical andpolitical views by saying or suggesting that we are `Millsian'liberals and consequentialists. He gives too the false impressionthat we do not oppose, in principle, slavery and child purchase.Here our position on C.S.M. is re-expressed and elaborated uponin order to eliminate possible confusion. Our general ethical andphilosophical framework is also outlined and shown to be otherthan Campbell says that it is. In particular, a moral philosophythat it is based on neither consequentialism nor Kantianism ispresented. C.S.M., it is argued, is not child purchase. It is like it insome respects and unlike it in others. It is unlike it in therespects which, relative to the present discussion, matter