•  112
    Precedent Autonomy, Advance Directives, and End-of-Life Care
    In Bonnie Steinbock (ed.), The Oxford Handbook of Bioethics, Oxford University Press. 2007.
    Bioethicists are widely agreed that patients have a right of self-determination over how they are treated. Our duty to respect this is said to be based on the principle of respect for autonomy. In end-of-life care the patient may be incompetent and unable to exercise that right. One solution is to exercise it in advance. Advance directives, which include living wills and powers of attorney for health care, enable people to decide what medical treatment they will receive later, when they become i…Read more
  •  4
    The 14 chapters in _Ethics at the End of Life: New Issues and Arguments_, all published here for the first time, focus on recent thinking in this important area, helping initiate issues and lines of argument that have not been explored previously. At the same time, a reader can use this volume to become oriented to the established questions and positions in end of life ethics, both because new questions are set in their context, and because most of the chapters—written by a team of experts—surve…Read more
  • Advance directives and other forms of advance medical decisionmaking provide ways for people to decide now what medical treatment they will receive later when they are incapacitated and unable to decide. Both critics and supporters of advance directives tend to agree that a directive's moral authority, if any, has two sources. The first source of support is a "surviving interest," where a patient's interest in, for example, dignity or certain religious practices, survives into a period of dement…Read more
  •  8
    Surviving Interests and Living Wills
    Public Affairs Quarterly 20 (1): 17-30. 2006.
  •  503
    An Alternative to Relativism
    Philosophical Topics 38 (2): 17-37. 2010.
    Some moral disagreements are so persistent that we suspect they are deep : we would disagree even when we have all relevant information and no one makes any mistakes. The possibility of deep disagreement is thought to drive cognitivists toward relativism, but most cognitivists reject relativism. There is an alternative. According to divergentism, cognitivists can reject relativism while allowing for deep disagreement. This view has rarely been defended at length, but many philosophers have impli…Read more
  •  47
    Discussions of life extension ethics have focused mainly on whether an extended life would be desirable to have, and on the social consequences of widely available life extension. I want to explore a different range of issues: four ways in which the advent of life extension will change our relationship with death, not only for those who live extended lives, but also for those who cannot or choose not to. Although I believe that, on balance, the reasons in favor of developing life extension outwe…Read more
  •  79
    Subjectivity, Judgment, and the Basing Relationship
    Pacific Philosophical Quarterly 90 (1): 21-40. 2009.
    Moral and legal judgments sometimes depend on personal traits in this sense: the subject offers good reasons for her judgment, but if she had a different social or ideological background, her judgment would be different. If you would judge the constitutionality of restrictions on abortion differently if you were not a secular liberal, is your judgment really based on the arguments you find convincing, or do you find them so only because you are a secular liberal? I argue that a judgment can be b…Read more
  •  94
    Applying Principles to Cases and the Problem of Judgment
    Ethical Theory and Moral Practice 15 (4). 2012.
    We sometimes decide what to do by applying moral principles to cases, but this is harder than it looks. Principles are more general than cases, and sometimes it is hard to tell whether and how a principle applies to a given case. Sometimes two conflicting principles seem to apply to the same case. To handle these problems, we use a kind of judgment to ascertain whether and how a principle applies to a given case, or which principle to follow when two principles seem to conflict. But what do we d…Read more
  •  110
    Life-extension and the malthusian objection
    Journal of Medicine and Philosophy 30 (1). 2005.
    The worst possible way to resolve this issue is to leave it up to individual choice. There is no known social good coming from the conquest of death (Bailey, 1999). - Daniel Callahan Dramatically extending the human lifespan seems increasingly possible. Many bioethicists object that life-extension will have Malthusian consequences as new Methuselahs accumulate, generation by generation. I argue for a Life-Years Response to the Malthusian Objection. If even a minority of each generation chooses l…Read more
  •  124
    For now, the best way to select a child's genes is to select a potential child who has those genes, using genetic testing and either selective abortion, sperm and egg donors, or selecting embryos for implantation. Some people even wish to select against genes that are only mildly undesirable, or to select for superior genes. I call this selection drift– the standard for acceptable children is creeping upwards. The President's Council on Bioethics and others have raised the parental love objectio…Read more
  •  68
    Conscientious refusal and a doctors's right to quit
    Journal of Medicine and Philosophy 29 (1). 2004.
    Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide obj…Read more
  •  86
    Precedent autonomy and subsequent consent
    Ethical Theory and Moral Practice 7 (3): 267-291. 2004.
    Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her precedent autonomy by giving her what she used to want? There is a similar problem with subsequent consent: How can we justify interfering with someone''s autonomy on the grounds that she will later consent to the interference, if she refuses now?Both problems arise on the assumption that, to respect someone''s au…Read more
  •  113
    Relativism and contextualism are the most popular accounts of faultless disagreement, but Crispin Wright once argued for an account I call divergentism. According to divergentism, parties who possess all relevant information and use the same standards of assessment in the same context of utterance can disagree about the same proposition without either party being in epistemic fault, yet only one of them is right. This view is an alternative to relativism, indexical contextualism, and nonindexica…Read more