Jeffrey Blustein

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.

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.

In this paper, we critically appraise institutions for people with disabilities, from residential facilities to outpatient clinics to social organizations. While recognizing that a just and inclusive society would reject virtually all segregated institutional arrangements, we argue that in contemporary American society, some people with disabilities may have needs that at this time can best be met by institutional arrangements. We propose ways of reforming institutions to make them less isolating, coercive, and stigmatizing, and to provide forms of social support the larger society denies many people with disabilities. Although these reforms far fall far short of abolition, they draw heavily on the work of disability scholars and advocates who call for the complete replacement of institutional arrangements with systems of supported living. The consideration of non-ideal-solutions is useful not only in reforming existing institutional arrangements, but in bringing disability scholarship and advocacy to bear on bioethics, which has paid little attention to institutions for people with disabilities. We intend this paper to redress the neglect within mainstream bioethics of the complex ethical problems posed by institutions.

Despite an explosion of studies on memory in historical and cultural studies, there is relatively little in moral philosophy on this subject. In this book, Jeffrey Blustein provides a systematic and philosophically rigorous account of a morality of memory. Drawing on a broad range of philosophical and humanistic literatures, he offers a novel examination of memory and our relations to people and events from our past, the ways in which memory is preserved and transmitted, and the moral responsibilities associated with it. Blustein treats topics of responsibility for one's own past; historical injustice and the role of memory in doing justice to the past; the relationship of collective memory to history and identity; collective and individual obligations to remember those who have died, including those who are dear to us; and the moral significance of bearing witness.

RÉSUMÉ: J'examine ici trois façons de défendre l'idée que les personnes ont individuellement une valeur. Je pars de la thèse selon laquelle la valeur des individus tient à la valeur de leurs qualités particulières. Je m'arrête alors sur l'objection que pour comprendre ce qui fait la valeur individuelle des personnes, il nous faut accorder une place distinctive à leurs conceptions d'elles-mêmes. L'approche par la conception de soi qui résulte de ces considérations se révèle problématique à l'examen, mais elle nous oriente vers une façon «kantienne», plus satisfaisante, de rendre compte de la valeur des individus. L'explication en question développe la doctrine des «deux points de vue» avancée par Christine Korsgaard et fait reposer ma valeur en tant qu'individu sur la dignité qui est la mienne en tant que maître d'œuvre de ma propre vie, un titre que personne d'autre ne peut avoir.

What is a disability? What sorts of limitations do persons with disabilities or impairments experience? What is there about having a disability or impairment that makes it disadvantageous for the individuals with it? Are persons with severe cognitive impairments capable of making autonomous decisions? What role should disability play in the construction of theories of justice? Is it ever ethical for parents to seek to create a child with an impairment? This anthology addresses these and other questions and is a valuable addition to a growing interdisciplinary literature exploring issues at the intersection of disability studies, philosophy, and bioethics. Most of the authors are well-known from their previous work in the disability field and have already made significant philosophical contributions to it