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1 Contents in Brief PREFACE xiii CHAPTER 1 Arguments and Methodology 1 CHAPTER 2 Philosophical Ethics: An Introduction 16 CHAPTER 3 Our Philosophical Approaches 66 CHAPTER 4 Euthanasia 90 CHAPTER 5 Autonomy and the Right to Refuse Treatment 121 CHAPTER 6 Abortion 164 CHAPTER 7 C-Section by Choice 216 CHAPTER 8 Two-Tier Health Care 247 CHAPTER 9 Microallocation of Scarce Resources 289 CHAPTER 10 Alternative Medications and Professional Relationships 323 GLOSSARY 359 INDEX 369

2 Contents PREFACE xiii CHAPTER 1 Arguments and Methodology 1 Introduction 1 Arguments 2 What Is an Argument? 2 Evaluating Arguments 3 Philosophical Methodology Counterexamples and Thought Experiments 8 Common Fallacies 11 Circularity (a.k.a. Begging the Question) 11 False Dilemma 12 Equivocation 13 Appeal to Emotion 13 Straw Man 13 Ad Hominem 14 Conclusion 14 Review Questions 15 CHAPTER 2 Philosophical Ethics: An Introduction 16 Introduction 16 Three Types of Ethical Inquiry 17 Skeptical Concerns: Ethical Relativism 21 Normative Ethical Theory 24 Classical Act Utilitarianism 25 Objections to Utilitarianism 27 Utilitarian Responses 31 Rule Utilitarianism 33 Non-consequentialism and Deontology 35

3 Contents vii Kant s Ethics 35 The Idea of Moral Worth 36 The Categorical Imperative 37 The Universal Law Formulation of the Categorical Imperative 37 The Humanity Version of the Categorical Imperative 40 Objections to the Universal Law and Humanity Tests 42 Pluralistic Deontology 45 Difficulties with Ross s Theory 47 Social Contract Theory 49 Hobbes s Social Contract Theory 49 Objections to Hobbes s Social Contract Theory 51 Rawls s Social Contract Theory: Justice As Fairness 52 Difficulties with Rawls s Social Contract Theory 54 Aristotle s Virtue Theory 57 Objections to Virtue Theory 59 Feminism and the Ethics of Care 60 The Ethics of Care 61 Difficulties with the Ethics of Care 62 Conclusion 64 Review Questions 65 CHAPTER 3 Our Philosophical Approaches 66 Introduction 66 Doran s Pluralistic Approach to Ethics 67 Leading Ethical Theories and Their Problems 68 Moral Pluralism 70 Patrick s Virtue-Based Approach to Ethics 72 Metaethics 73 Normative Ethics 75 Some Objections and Responses 77 Warren s Approach to Ethics: Practical Social Contract Theory 80 The Main Contractarian Ideas for Warren s Purposes 80 The Committee Metaphor 82 The Video Game Metaphor 84 Warren s Use of Social Contract Theory 85 Cultural Relativism 85

4 viii Contents Ethics Regarding Non-humans 85 Social Contract Theory beyond Ethics 87 Warning 88 Conclusion 88 Review Questions 89 CHAPTER 4 Euthanasia 90 Introduction 90 Drama 92 Debate 95 Clarifying the Case and Identifying Relevant Facts 95 What Is Euthanasia? 95 Different Kinds of Euthanasia 98 Deciding Which Issues to Debate 101 The Morality of Voluntary Active Euthanasia 102 The Autonomy and Best Interest Argument for VAE 103 The Revised Autonomy and Best Interest Argument 104 The Sanctity of Life Objection to the Morality of VAE 106 Hare s Lorry Driver A Counterexample to the Sanctity of Life Principle 108 An Argument That the Moral Reasons against Killing Do Not Apply to VAE 110 An Argument That Euthanasia Is Wrong Because It Destroys What Belongs to God 110 The Morality of Non-voluntary Active Euthanasia 112 The Best Interest Argument for NAE 113 Philippa Foot s Objection to NAE 115 The Never-Best-Interest Objection to NAE 117 Summary 119 Review Questions 120 CHAPTER 5 Autonomy and the Right to Refuse Treatment 121 Introduction 121 Drama 123 Debate 129 Clarifying the Case and Identifying Relevant Facts 129

5 Contents ix Moral Issues Raised by the Case 133 Stating Our Positions 133 An Argument for the Right to Ignore Experts 135 Clarifying Premise (3) 136 Assuming Mrs. Edwards Was Competent, Did the Hospital Staff Err in Releasing Her from the Hospital When They Did? 140 Objections to Premise (5) 143 Was Mrs. Edwards Competent? 143 The Gangrenous Foot Example 145 Incompetence to Refuse Medical Care: Skepticism without Reason 146 Competence and Psychiatric Evaluation 149 Did Mrs. Edwards Give a Valid Refusal? 152 Objections to Premise (7) 156 Virtue Overpowers the Right to Refuse 156 Doubt Justifies Delay 158 Summary 162 Review Questions 163 CHAPTER 6 Abortion 164 Introduction 164 Drama 166 Debate 169 Clarifying the Case and Identifying Relevant Facts 169 Moral Issues Raised by the Case 172 Stating Our Positions 173 Leading Arguments against the Morality of Abortion 174 Noonan s Argument 174 Marquis s Argument for the Wrongfulness of Abortion 177 The Moral Significance of Potential 182 Potential and Rights 182 Potential and Value 183 Warren s Reasons for Thinking the Fetus s Potential Can Give the Fetus Value 185 Patrick s Reasons for Thinking That Fetuses Have Value 187 Patrick s Virtue-Based Argument for Why Deb Acted Permissibly 192 Patrick s View That Abortion May Be Permissible Even If the Fetus Has Value 192

6 x Contents Patrick s View That Abortion May Be Permissible Even If the Fetus Has a Right to Life 193 Deb s Alleged Lack of Integrity 194 The Right to Life Weighed against Deb s Virtues 195 Thomson and the Case of the Famous Violinist 196 Doran s Argument That Deb s Decision to Abort Was Morally Permissible 201 The Rationality Criterion for a Right to Life 202 The Life Criterion 203 The Sentience Criterion 204 The Addition of Rationality to Sentience 205 Objections to Doran s Sentience-Based Criterion of a Right to Life 207 Summary 215 Review Questions 215 CHAPTER 7 C-Section by Choice 216 Introduction 216 Drama 218 Debate 222 Clarifying the Case and Identifying Relevant Facts 222 Moral Issues Raised by the Case 227 Stating Our Positions 228 Doran s Argument for Why Wendy s Decision Is Morally Permissible 229 Do Potential Harms Make Wendy s Autonomous Choice Wrong? 230 Harms to the Baby 231 Harms to the Mother 239 Harms to Others besides the Baby and the Mother 242 Summary 245 Review Questions 246 CHAPTER 8 Two-Tier Health Care 247 Introduction 247 Drama 249 Debate 251 Clarifying the Case and Identifying Relevant Facts 251 Moral Issues Raised by the Case 256 Stating Our Positions 257

7 Contents xi A Libertarian Argument 259 The Wilt Chamberlain Example 260 Is Redistributive Taxation Inherently Unjust? 262 The Complicity Objection to the Second Premise 266 The Compassion Objection to the Libertarian s Second Premise 268 An Egalitarian Argument 269 The Self-Respect Argument 272 Two-Tier Arguments 274 Is Two-Tier MRI Permissible If It Does Not Harm the Public Health Care System? 274 Is Two-Tier MRI Permissible If It Benefits the Public Health Care System? 275 Warren s Social Contract View on When Two-Tier MRI Is Justified 276 Patrick s Virtue-Based View on When Two-Tier MRI Is Justified 278 Comments on Canada s Current Public Health Care System 282 From the Political to the Individual 283 Closing Arguments 285 Summary 287 Review Questions 288 CHAPTER 9 Microallocation of Scarce Resources 289 Introduction 289 Drama 291 Debate 295 Clarifying the Case and Identifying Relevant Facts 295 Moral Issues Raised by the Case 296 Stating Our Positions 296 Microallocation Rules: Clinical Considerations 297 Warren s Argument for Fair Microallocation Rules: Worst First, First Come, and Hopeless Second 297 Doran s Objection to the Sympathy Metarule 300 Patrick s Objection to the Sympathy Metarule 304 Objection to the Sufficiency of Hopeless Second 306 Minimize YPLL (Minimize Years of Potential Life Lost) 307 Substantial Benefit 308 Fair Turn 309

8 xii Contents Microallocation Rules: Non-clinical Considerations 312 Moral Responsibility 312 Innocents First 314 Third-Party Interests 315 Public Interest 316 Medical Interests 318 Collecting Our Thoughts 320 Summary 321 Review Questions 322 CHAPTER 10 Alternative Medications and Professional Relationships 323 Introduction 323 Drama 325 Debate 329 Clarifying the Case and Identifying Relevant Facts 329 Moral Issues Raised by the Case 332 Stating Our Positions 333 The Best Interest Principle 334 Patrick s Venom Counterexample to the Best Interest Principle 336 The Ample Discretion Principle 337 Doran s Indeterminacy Objection to Warren s Principle 338 The Ample Discretion Principle Revised: Valid Consent of Competent Patients Only 340 Ample Discretion, Patient Competence, and Valid Consent 341 Ample Discretion and Patient Autonomy 344 The Ample Discretion Principle Revised (Again): Harm Avoidance 346 Against the Revised Ample Discretion Principle: The Division of Labour Objection 350 The Psychic Surgery Counterexample 351 More Counterexamples to the Ample Discretion Principle: Prayer and Other Unconventional Treatments 353 Final Thoughts 354 Summary 357 Review Questions 358 GLOSSARY 359 INDEX 369

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