Stephen Napier

This project argues that arguments for the permissibility of killing—specifically, arguments in favor of abortion and euthanasia—fail to justify their conclusions. At best, these arguments form a merely coherent network, but ultimately evince a circular pattern of justification. This book traces the two principal arguments made in support of permissible abortion: arguments based on a time-relative interest account of wrongdoing; and arguments based on the non-personhood of what is killed. It also addresses the principal arguments made in support of permissible euthanasia, namely arguments based on the value of autonomy and compassion. For each argument, this book argues that it suffers from various defects. The book thus concludes that arguments for abortion and euthanasia are unjustified.

Intuitively, patients who suffer the permanent cessation of circulatory functioning—the cardiac criterion—are considered dead. As such, the cardiac criterion tells us what evidence counts as reliable evidence for determining death. The cardiac criterion is challenged by two principal arguments. The reversibility objection says that, for all we know, patients who suffer arrests could be resuscitated. Even so, for some donors who are declared dead by the cardiac criterion, they have their hearts transplanted and re-started. This challenges the idea that the donor’s circulatory functioning ceased permanently. The second argument is that donation-after-cardiac-death [DCD] donors undergo ante-mortem procedures that are only done to benefit the recipient of the organ. This looks like one is using the donor merely as a means and therefore is disrespecting the donor. This chapter argues that permanent cessation of circulatory functioning is a reliable indicator for death and that DCD protocols can be consistent with a fundamental respect for the donor.

A common justification for abortion rights is that the death of the fetus does not violate any of the fetus’s time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a necessary condition for harming someone is that his or her time-relative interests are frustrated. Regarding the justification for abortion, this account falls prey to impairment arguments. Impairment arguments entertain cases of prenatal injury, such as the mother using illicit drugs that disable the child. The intuition is that the child who is born with such disabilities is harmed by the mother’s drug use. But it is unclear what time-relative interest is violated in cases of prenatal harm. Typical responses to impairment arguments point out that the abortion case is different because the child does not exist to experience such harms; but in prenatal injury + survival cases, the child does live to experience those harms. Thus, the TRIA justification for abortion is not impugned by impairment counter-examples. This article argues that this response to impairment arguments is viciously circular. The response must say that so long as you kill the child, no harm is done. But this assumes that killing itself is morally inconsequential and is not itself a case of harm. The response to impairment arguments, then, assumes the permissibility of abortion.

The prevailing orthodoxy for competency assessment is to test for the presence of certain abilities. This article argues that the presence of certain abilities is not enough when a patient refuses a life-sustaining/lifesaving measure that promises to work and does not present obviously onerous burdens. In such cases, we need to know whether the patient has rendered a competent refusal of such measures. Whereas the former refers us to test for certain abilities, the latter refers us to assess the quality of one’s judgment. Although such a thesis has been entertained previously (for example, Freedman), I reformulate the argument by applying two well-accepted epistemological criteria for justified belief. I argue that a competent refusal of such measures requires that the judgment be based on reasons. This basing condition turns on (or kicks in) in what I refer to as high-stakes contexts—contexts in which the patient’s life will end by respecting the refusal, and, by not respecting it, the patient undergoes a lifesaving and minimally burdensome treatment.

Research on human subjects aims to obtain knowledge of vital importance for human health and functioning. Neuroscientific research specifically is understood as oriented towards three goals: the maintenance of neurological health, the treatment of neurological diseases or syndromes, and the enhancement of neurological functioning. Most guidelines or regulations for pediatric research (whether in the U.S. or elsewhere) require that if a research intervention exposes subjects to more than minimal risk, a prospect of direct benefit is required—along with some other important criteria. It is also required for any research project, that the methods and design will yield scientifically valid knowledge. This is typically met via placebo-controlled trials. This chapter presents an argument to the effect that more than minimal risk research on pediatric subjects cannot meet both ethical requirements. The basic idea is that either the subjects in the control or experimental arm will receive a prospect of direct benefit, but not both. This chapter also argues that the ethical weight or importance of this dilemma is very acute for neuroscientific research given the complexity of the brain’s functioning and the correlated difficulty of judging whether there is a “prospect” of direct benefit. The second half responds to this argument via a case study in neuroscientific research. The solution recapitulates a type of component analysis according to which different ethical principles apply to different activities of a research study.

Debates on moral enhancement focus legitimate attention on the questions of whether it is possible and/or what could count as a moral enhancement given deep ethical disagreement. I argue here that moral enhancements might not even be rational to consider—from the perspective of the agent. At issue is the assessment of whether the enhancement is truly reliable. Since we assess reliable belief forming processes by their outputs, whether they are true, an agent who is entertaining a putative moral enhancement faces a trilemma. If she already believes the promised outputs of the enhancement, the enhancement is obsolete. If she does not believe the promised outputs, it would be irrational from her current perspective to undertake the “enhancement.” If she is uncertain, she has no reason for thinking that the enhancement truly augments her moral beliefs. On any option, the agent has no reason for taking a putative moral enhancement.

Bioethics is a field of inquiry and as such is fundamentally an epistemic discipline. Knowing how we make moral judgments can bring into relief why certain arguments on various bioethical issues appear plausible to one side and obviously false to the other. Uncertain Bioethicsmakes a significant and distinctive contribution to the bioethics literature by culling the insights from contemporary moral psychology to highlight the epistemic pitfalls and distorting influences on our apprehension of value. Stephen Napier also incorporates research from epistemology addressing pragmatic encroachment and the significance of peer disagreement to justify what he refers to as epistemic diffidence when one is considering harming or killing human beings. Napier extends these developments to the traditional bioethical notion of dignity and argues that beliefs subject to epistemic diffidence should not be acted upon. He proceeds to apply this framework to traditional and developing issues in bioethics including abortion, stem cell research, euthanasia, decision-making for patients in a minimally conscious state, and risky research on competent human subjects. to traditional and developing issues in bioethics including abortion, stem cell research, euthanasia, decision-making for patients in a minimally conscious state, and risky research on competent human subjects.

The respect for one’s conscience is rooted in a broader respect for the human person. The conscience represents a person’s ability to identify the values and goods that inform her moral identity. Ignoring or overriding a person’s conscience can lead to significant moral and emotional distress. Refusals to respect a person’s conscientious objection to cases of killing are a source of incisive distress, since judgments that it is impermissible to kill so-and-so are typically held very strongly and serve as central moral commitments in one’s moral identity. I think it is wrong for a college basketball coach to pay his players, but I think it is really wrong to kill people. This article argues that any and all arguments for not respecting a conscientious objection to abortion commit a deontic fallacy. Briefly, arguments for the permissibility of abortion are structurally such that abortion is at best permissible, not obligatory. Now, arguments to justify overriding or ignoring a person’s objection to performing action (α) must understand action (α) as being obligatory. Thus, arguments for ignoring conscientious objections to performing abortion are incongruent with the actual philosophical justifications for abortion. Such arguments, then, commit a deontic fallacy.

I argue in this paper two theses. First, I argue that the internal consistency of the argument from evil demands that it take into account some form of EST. Thus, there is no ground for the atheist to chide the theist when the theist appeals to an expanded version of theism. Second, I show that it isprima facie probable that RST does in fact ential EST. I show this by capitalizing on the distinction between what is contained in a concept and what is entailed by a concept. What a term or concept means is different from what it may entail. What a concept or term entails is conceptually more robust than what it simply means. I call this the “containment objection” and if is true, then the restricted conjunction rule cannot apply since a version of theism sufficient to deflate the evidential argument would not be logically independent from RST,pace Rowe

Contemporary philosophical discussion on human embryonic stem cell research has focused primarily on the metaphysical and meta-ethical issues suchresearch raises. Though these discussions are interesting, largely ignored are arguments rooted in the secular research ethics tradition already informing humansubject research. This tradition countenances the notion of vulnerability and that vulnerable human subjects (of which human embryos are likely members)ought to be protected from research-related harms. This is the basic idea behind the argument from vulnerability, and it enjoys prima facie plausibility. This articlepresents the vulnerability argument and then focuses critically on several lines of attack including: (1) twinning and totipotency arguments, (2) embryo-rescuearguments, and (3) natural loss arguments. The article concludes that there is no good defeater for the vulnerability argument, and, therefore, we have undefeated reasons for protecting human embryos from research related harms.

It is common in bioethical discussion to present thought experiments or cases in order to construct an argument. Some thought experiments are quite illuminating, and ethical theorizing will often appeal at some point to one’s intuitions. But there are cases in which thought experiments are useless or do not contribute to the argument. This article considers cases presented in the context of stem cell research that are destructive of human embryos. I argue that certain popular cases that are meant to motivate the view that such research is permissible either are dialectically useless or do not contribute to the argument. By dialectically useless, I mean that the cases analyzed here yield intuitions in people who are already committed to the permissibility of such research. I end with some reflections that challenge the reliability of our intuitions on applied ethics issues by suggesting that thought experiments in this field are dubious from the start. My argument should not be read to support moral skepticism but to urge that our inquiries on applied issues requires certain intellectual virtues.

Ethical challenges to certain aspects of research on human subjects are not uncommon; examples include challenges to first-in-human trials (Chapman in J Clin Res Bioethics 2(4):1–8, 2011), certain placebo controlled trials (Anderson in J Med Philos 31:65–81, 2006; Anderson and Kimmelman in Kennedy Inst Ethics J 20(1):75–98, 2010) and “sham” surgery (Macklin in N Engl J Med 341:992–996, 1999). To date, however, there are few challenges to research when the subjects are competent and the research is more than minimal risk with no promise of direct benefit. The principal reason given for allowing research that is more than minimal risk without benefit is that we should respect the autonomy of competent subjects. I argue that though the moral intuitions informing respect for autonomy are sound, there is another set of intuitions regarding what we take to be just treatment of another when one agent knowingly causes or allows suffering on another agent. I argue that concerns generated by commutative justice serve as limitations on permissible research. I highlight our intuitions informing this notion of justice by appealing to work done on theodicy; what counts as a morally sufficient reason for God to allow suffering in humans is applicable also to the researcher-subject relationship. I conclude that all human subjects who are exposed to more than minimal risk research should enjoy the same actual protections (e.g., subpart D) as those given subjects who cannot consent