Torbjörn Tännsjö

This interview explores the relationship between moral theory and medical reality through an in-depth conversation with Torbjörn Tännsjö, one of the most influential contemporary utilitarian philosophers. Moving between normative ethics and concrete bioethical challenges, the dialogue addresses healthcare priority setting, triage in pandemics and war, euthanasia, disability, distributive justice, and global existential threats. Central attention is given to Tännsjö’s methodological approach – described as “applied ethics turned upside down” – which relies on considered moral intuitions tested through crucial thought experiments and subjected to cognitive psychotherapy. The interview examines the practical relevance and limits of philosophical abstraction in real clinical contexts, particularly under conditions of scarcity, uncertainty, and moral distress. Special emphasis is placed on overlapping consensus among competing moral theories, the role of counterfactual reasoning in utilitarianism, and the ethical implications of aging, mental illness, and end-of-life decisions. Situating these discussions against the background of the COVID-19 pandemic and russia’s full-scale war against Ukraine, the conversation highlights how extreme circumstances expose latent ethical assumptions embedded in healthcare systems. The interview concludes by reflecting on the place of bioethics as applied ethics, its educational mission, and its capacity to inform morally responsible decision-making without claiming privileged principles of its own.

This chapter asks the question of whether it is permissible for human beings to raise animals for food and clothing. In deontology, animals are left out of moral consideration. In moral rights thinking, there exists a strand that grants animals roughly the same moral standing as the one given to human beings. Finally, according to utilitarianism, most humans and many non-human animals share moral standing. Yet for reasons to do with side effects, it is not permissible to kill and eat human beings (in ordinary circumstances), while it is in fact considered morally acceptable to kill and eat non-human animals.

Utilitarianism has fared better than the competing theories. Yet there is one intuition it cannot cater for: it is wrong to kill a person, even if it is in his own best interest, where he knows everything about his bleak future and still wants to stay alive. An attempt is made to construct a common sense morality that can cater for this and the other considered intuitions. The attempt fails. The recalcitrant intuition is then reconsidered and debunked. In the final analysis, utilitarianism has proved to be the only theory in the competition that is intuitively adequate, i.e., consistent with all our considered intuitions within the field of the ethics of killing. And we may _conclude_ from utilitarianism that it is indeed right to kill the person in his own best interest.

In this chapter the focus is on the ethics surrounding war. The laws of armed conflict regulate how warfare can legitimately be conducted. In particular, there are laws regulating what you can do in war (_jus in bello_), regardless of whether the war you take part in is just or unjust. It is argued that these laws are roughly as they should be. How do the three theories put to test deal with the question of killing in war? Deontology cannot provide a rationale behind them, however. The moral rights theory is consistent with them. Utilitarianism can explain _why_ they should look roughly in the way they do.

Survival lotteries play a considerable role in philosophers’ thinking on the ethics of killing. They have also entered popular culture. The lotteries are not widely accepted, yet they seem to be reasonable, if only we can set some of our taboos to one side. In this chapter, deontology, the moral rights theory, and utilitarianism are confronted with famous ‘survival lotteries’. Here this chapter examines cases such as John Harris’s organ lottery, John Taurek’s rescue lottery, and Gilbert Harman’s ‘organ’ thought experiments. In the final analysis, it is argued that utilitarianism can best explain our considered intuitions in relation to these lotteries. It is possible to debunk intuitions commonly held to the opposite effect, once they are submitted to cognitive psychotherapy.

This chapter starts off by asking the question of whether it is morally permissible for a woman to have an abortion when she feels that she doesn’t want to take care of her unborn child. The two deontological strands give rise to different verdicts on this issue. On the Sanctity-of-Life Doctrine abortion is wrong. On Kantianism abortion is all right. In this Kantian verdict the moral rights theory concurs. Utilitarians have a hard time telling in the individual case whether an abortion is right or wrong. Utilitarianism also implies what Derek Parfit has nicknamed the repugnant conclusion. It is argued that the repugnant conclusion is in fact acceptable, and this sheds light on the moral issue of abortion.

This chapter defines assisted death as an active and intentional killing of a person suffering from a terminal and painful disease in order to spare this person further suffering. According to deontology, assisted death is wrong, period, even if the principle of double effect permits a merely foreseen but not intended hastening of death. With regard to the moral rights theory, assisted death is permitted given that it is voluntary. Concerning utilitarianism, positive and negative externalities must be taken into account. It is noted that much of the extant discussion about legalization of assisted death is in fact conducted in utilitarian terms, and it is argued that utilitarianism seems to offer the best explanation of our considered intuitions about assisted death.

The focus of this chapter is the sensitive subject of suicide. This chapter brings to light the importance of cultural variations in forming opinions on suicide, reminding us to not rely on gut feelings and, instead, attempt to move beyond our own narrow cultural horizon. However, while the startling cultural differences on the view of suicide are rather clear, interpreting them is far from easy. As with other topics, our three theories are again brought forth and applied. According to deontology, suicide is wrong, period. According to the moral rights theory, suicide is right if it is voluntary. According to utilitarianism, both positive and negative external effects must be taken into account. It is then argued that utilitarianism can best explain our considered intuitions about suicide.

Does the extensive use of capital punishment for murder mean fewer homicides and violent crime in general? Has a murderer, by committing his crime, forfeited his own right to life? Is it possible for murderers to compensate their victims? These are some of the key questions tackled in this chapter. Here, as in others, we apply each of our three theories to capital punishment, seeing what role, if any, the aforementioned questions play in each theory. If capital punishment has a superior deterrent effect, it gains support from utilitarianism. Deontology recommends capital punishment in one (retributive) version and condemns it in another (Sanctity-of-Life) version, regardless of its deterrent effects. The moral rights theory does not support capital punishment, but according to the theory, people can contract and adopt capital punishment if they see a point in doing so.

This chapter goes in search of thought experiments that elicit a consistent pattern of responses, irrespective of one’s traditions or cultural background. Since it is believed that the three standard trolley cases (the Switch, the Footbridge, and the Loop) elicit precisely such a response, This chapter discusses these three cases in relation to deontology, the moral rights theory, and utilitarianism. How do we react intuitively to each of the cases? Do our intuitive responses survive cognitive psychotherapy (our knowledge about their origin)? The Sanctity-of-Life Doctrine and utilitarianism can both explain our considered intuitions about the cases. Kantianism and the moral rights theory, on the other hand, are at variance with them. No intuition about the Footbridge survives cognitive psychotherapy, with all our intuitions in relation to it debunked.

In murder we meet with a kind of killing where the death of the victim is _intended_. Does this mean that murder is always wrong? This chapter tackles the implications of deontology, the moral rights theory, and utilitarianism for this question. In addition, the chapter highlights a particular complication in regard to this topic: the difficulty of making a distinction between whether an individual act of murder is morally permissible and whether murder should ever be legal. This distinction, however, is real, and it remains so for all three theories. One claim of this chapter is that the _intention_ portion of murder does not play the crucial role we may have thought, once our intuitions are submitted to cognitive psychotherapy. In fact, none of the examined theories are able to explain all of our considered intuitions about murder.

Three ethical theories, to be tested in relation to killing, are characterized: deontology, a libertarian moral rights theory, and utilitarianism. The idea is to find the best versions of each one in relation to the problem discussed: when should we, or should we not, kill, and why? These three theories are chosen specifically for their intuitive plausibility, their ability to offer a definitive answer to all of the problems raised in the various chapters, and their promising explanations of various conflicting intuitions people claim to have in the area. Interestingly, the three theories offer, in many cases, different (inconsistent) answers to the questions posed.

The preliminary chapter to this book begins with a description and defence of the methodological approach used throughout this book. The vindication of the method is, in the final analysis, pragmatic in nature. While it is not known whether a comprehensible true moral theory exists in the first place, it is only through employment of the method the book advocates that whether it exists will be able to be unraveled. In order to test out the book's moral theories, the text arranges crucial thought experiments where different theories yield conflicting answers. It then confronts the answers with considered moral intuitions. The theory that gives the best explanation of the content of the considered moral intuitions gains inductive support. An intuition is considered if it has been exposed to, and survived, cognitive psychotherapy.

The film _Sophie’s Choice_ has been seen to represent in a vivid manner how a human being in extreme circumstances is faced with a true moral dilemma. This interpretation is questioned in the present paper. It is argued that the best way of making philosophical sense of Sophie’s choice is to see it as a case of blameful right-doing, rather than a dilemma. By doing, in her situation, the right thing, or at least not clearly doing anything wrong, Sophie exhibits a trait of character we do not expect to find in a good mother. She was in a situation where a good parent is not supposed to be able to do the right thing, and yet she does this. Even if we cannot _fully_ explain it, her choice to commit suicide, rather than becoming a parent once again, makes sense when viewed from her own subjective perspective and given her personality as we know it.

The expressivist theory of truth (TETT) is stated and defended. According to TETT, to state such things as that it is true that snow is white is to express one's assent to the proposition that snow is white. In contexts where we refer to propositions with the aid of definite descriptions (“What Peter said”) or quantify over them (“Everything Peter says”), in order to say that they are “true”, the word “true” is essential, however. But it does not stand for any genuine property. According to TETT, as here understood, it expresses our readiness or willingness to assent to these propositions. It is argued that TETT, even if still more of a reseach program than a full‐fledged theory, means an improvement over more elaborate minimalist theories of truth put forward by Crispin Wright and Paul Horwich.

In principle, there seem to be three main ways in which society can react when people commit crimes under influence of mental illness. (1) The standard model. We excuse them. If they are dangerous they are detained in the interest of safety of the rest of the citizens. (2) The Swedish model. We hold them responsible for their criminal offence, we convict them, but we do not sentence them to jail. Instead, we sentence them to psychiatric treatment. (3) My model. We sentence them to jail, but offer them (voluntary) psychiatric treatment. The advantages of my model are obvious. We get a clear delineation of roles. We allow the psychiatrist to be just a doctor, not a warden. We liberate psychiatry of the objective of deciding whether people who were mentally ill when they committed criminal offences ‘could have acted otherwise’— a hopeless task. We allow that psychiatrists live up to their professional ethical code (the Hawaii Declaration). We treat psychically ill persons as ‘normal’, we allow them to repent their crimes, which renders easier their recovery. However, two objections to my model come to mind. First of all, is it not unfair to sentence people to jail who could not help doing what they did? And, secondly, the question of fairness set to one side, is it not inhumane to sentence mentally ill persons to jail? Is it not inhumane to the mentally ill persons themselves, and does it not mean that they will be a burden to other prisoners? In my paper I show that, if our system of criminal punishment takes a civilised form, neither of these objections carries any weight.

In the Fall of 1997 the leading Swedish newspaper, Dagens Nyheter, created a media hype over the Swedish policy of compulsory sterilisation that had been in operation between 1935 and 1975. In the discussion that followed the moral condemnation of our medical past was unanimous. However, the reasons for rejecting what had gone on were varied and mutually inconsistent. Three strands of criticism were common: the argument from autonomy, the argument from caution, and the argument from biological scepticism. In the paper it is argued that what point of departure you choose in your criticism of the past should be of consequence also for your ideas about present and future medical practice. In particular, if you rely on the argument from autonomy, you should be prepared to accept a liberal (present and future) use of reproductive techniques.

The final chapter reviews the results of the book and adds a reflection on pessimism and hope. It is clear that the book is highly pessimistic. Does that mean that it sends the message that our human predicament is hopeless? It is sometimes claimed that hope presupposes optimism. This is not so. If the stakes are high enough, pessimism and hope go well together. Even if the probability that you can change the world is almost negligible, it is rational to make an attempt, when such a thing as the continued existence of humanity is at stake.

The problem I want to solve in this book is easy to formulate: How can we best save human civilization, and even all sentient life on earth, from imminent global existential threats? I will argue that we need to resort to a world government. It would have been terrific if it could have been established in the form of a global democracy. This is not possible, however. Therefore, we must put our hopeHope (in desperate situation) in a despotic world government capable of laying the ground for a future global democracy.