Jeffrey Blustein

This paper is a response to particularist critics of the normative force of moral principles. The particularist critique, as I understand it, is a rejection not only of principle‐based accounts of moral deliberation and justification, but also of accounts of character in which principles play a central role. I focus on the latter challenge and counter it with a view I call character‐principlism. I begin by discussing in a general way what motivates the particularity objection to principles and then contrast two views – both of which insist on the importance of attentiveness to particularity – about the relative normative status of principles and particular cases. I present some reasons for believing that we need a more normatively robust conception of the role of moral principles than the particularists provide. In the main portion of the paper, I discuss how character‐principlism sees principles functioning in our lives and the lives we lead with others. I contrast this with some other accounts of desirable character that particularists can embrace, and argue that these are seriously flawed because, unlike character‐principlism, they cannot satisfactorily explain how a person could possess the constancy of character that moral integrity requires.

This paper examines the concept and moral significance of “childhood interests.” This concept is important in medical decision-making for children and more broadly in the field of pediatric ethics. The authors argue that childhood interests are identifiable components of childhood well-being that carry moral weight. Parents have a special role in protecting and promoting these interests and special obligations to do so. These parental obligations are grounded by the independent interests of the child, as well as the good of society more generally. Because parents have these child-rearing obligations, they must also have the authority and wide discretion necessary to fulfill them. However, while parental discretion is wide, it is not unlimited, for it must be used to safeguard and advance childhood interests.

No profession has undergone as much scrutiny in the past several decades as that of medicine. Indeed, one might well argue that no profession has ever undergone so much change in so short a time. An essential part of this change has been the growing insistence that competent, adult patients have the right to decide about the course of their own medical treatment. However, the familiar and widely accepted principle of patient self-determination entails a corollary that has received little attention in the growing literature on the ethics of physician-patient relations: if patients are to direct the course of their own medical treatment, then physicians are at least sometimes to be guided in their actions on behalf of patients by values that are not, and may even be incompatible with, their own values. Unless it is supposed that it would be best if physicians were simply to accommodate any and all patient requests, a possibility I consider and reject in this paper, there are bound to be numerous instances of legitimate moral conflict between the preferences of physicians and patients. In this paper, I examine the implications of this sort of moral conflict from the standpoint of the integrity of the physician. Critical to a proper appreciation of the significance of this conflict is a distinction that the literature on biomedical ethics has largely failed to draw: that between medical paternalism and physician integrity.

The recent child custody case Weisberger v Weisberger raises a number of ethical issues concerning the rights and responsibilities of parents. Chavie Weisberger, thirty‐five, and her husband, both members of an ultraorthodox Hasidic community, appeared before a religious court in 2008 to obtain a divorce. There are two sharply contrasting legal rulings in this case. Setting aside the legally significant fact that Chavie had signed the divorce agreement with the clause requiring her to raise her children Hasidic, which decision is ethically more defensible and why? Were Chavie's parental rights violated when the court removed her children from her care? Should her ex‐husband have been awarded full custody on the ground that this was in the children's best interest, and is this the right standard to use in making custody decisions? What parental responsibilities did Chavie and her ex‐husband have, and were they satisfactorily discharging them? A theory of the moral foundations of parenthood should provide answers to these questions among others. Joseph Millum, in his excellent new book The Moral Foundations of Parenthood, does this and more. His theory encompasses accounts of the foundation and content of parental rights and responsibilities, the acquisition of parental responsibilities, and the standards governing parental decision‐making.

This essay is written in the belief that questions relating to the treatment of impaired and imperiled newborns cannot be adequately resolved in the absence of a general moral theory of parent-child relations. The rationale for treatment decisions in these cases should be consistent with principles that ought to govern the normal work of parenting. The first section of this paper briefly examines the social contract theory elaborated by John Rawls in his renowned book A Theory of Justice and extracts from it normative principles that can guide us in our attempt to lay a rational foundation for parenthood. The second section clarifies the implications of a Rawlsian theory for the problem at hand by examining several standards that have been proposed for the treatment of impaired newborns: the strict right-to-life standard, the medical decision standard, and the quality-of-life standard. A Rawlsian standard, by contrast, is autonomy-based. That is, it would have us base our treatment decisions on consideration of the child's capacity for developing critical rationality in making decisions on his or her own. This standard, it is suggested, avoids morally objectionable features of the others.

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else.