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  • Vaughn Ch2

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    Cayla Kass
    4 vues20 pages
    Bioethics

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    Bioethics

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    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    4 vues20 pages

    Vaughn Ch2

    Transféré par

    Cayla Kass
    Bioethics

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 20
    Bioethics and Moral Theories As we have seen, the moral life is dynamic, omplet and inescapable. Init we wrestle with thormentous questions of moral value and moral Tignes, Weasset challenge, acept.and eet nora statements, We make moral judgments out the rightness of ations, the goodness of persons or thei character andthe moral quality End worth of our lives. Through general mora orm of principles, we direct our actions and form ove choices, We formulate and critique tora arguments, thereby esting what we Know tr think we know about moral realities. We do Ait sand one thing more: We naturally and Ciewvodably venture nto the realm of mors theory, trying to see the larger moral meaning behind particule situations and precepts. In this chapter we explore this realm and try to {Usecrn bow it it into the moral fe in general nd Into Bioethics in partial in science, theories help us understand the em ikl word by explaining the causes of events, ‘hy things re thew hey ate The germ theory Uedisease explains how particular diseases arise fin spread ins human population. The helio ‘Ena oun centered) theory of planetary motion pins why the planets t9 Our solar syste tehave the way they do, In ethics, mora theories fave similar explanatory role. A moral theory txplains not why ane event causes another but ‘ohn action sight orweong or why person ri person's character is good or bad. A moral ‘heory tellus what iis about an action that snakes tight ot what is about a person that Frakes hin oF her good. The divine command theory of morality, for example, ys that right tctions are those commanded o willed by God ‘radtionalulitaranism says that ight actions dre thove that produce the greatest happiness tral concerned, These ad other moral theories tre atempts to define rightness or goodness. In this ay, they are both more general and more thule than moval principles or eter general norms ‘Moral theoriingthat i, making sing oF assessing moral theories or pars of theories tormal and pervasive in the moral if, though Tris ovfen dane without mich recognition that theory is plying 2 part inthe deliberations Whenever we try to understand what a moral Jroperty such a ihtness or goodness met, Ee justiy a moral principle or other norm oF solve a confit between two credible principles, Srcplain why a particular action or practic is Tight or wrong or evaluate the plausibility of ‘pecife moral inkons or assumptions, we do ‘poral theoriing In fet, we must theorize if tear to make headway in such investigations We must stand back fom the stuation at han nd try to grasp the larger pattern that only theory ean reveal ‘Moral theres that concentrate on right nd rong actions are known a theories of oblige von (edly) o simply as heois of rit cto. The divine command theory ad wiitarianism ur theories of right ation. Philosophers often “istingulsh het fram mocal theories that focus Gn good and bad persons a character—so-clled sire tased theories Vito ethics covered later inthis chapter fa prime example low do moral theories Rt into our everyday moral reasoning? In answering tat let’ Fou ‘theories of Fight atin, probably the most Fynenl pe blobs. First, moral the: Hae para ncurorlepuents Mac omer, orl seamen contain BURR eed econ prem A col Psceanconst ono princi moral atc pecr ar dered rm ox bane) fina principle ora claim expressing ental tenet of a rnoral theory. Using such a tenet fomeone might arge, for example that stem fal revarch shold be fully Funded eather than Tuled altogether because such a step would ‘entunlly lead to a greater benefit for more people and right actions (acording to ita tris are thse that result nthe greatest over fi benefit forthe greatest number. Thus the fundamental moral standard of utilitarianism becomes premise in an argument fora specie ction na particular case. Second, theories can have an indict impact fon moral arguments because peinciples ap pesled to are een supported in turn bya moral theory, The principles can be either derived from or supported by the theory’ accouat af right and wrong action, Consider the prohii thon ageinse murder, the Basie precept that itis verong to take the life of an thnocent person This principe canbe dawn from theories bul around the fundamental notion of respect for Persons As one ach theory would have i Iurder is wrong because it treats people ot 25 persons with inherent woth bt 8 mere chings tobe used or dispensed with sone wishes. Some people are tempted to deduce from all his thot moral theories ae the dominant oral reasoning ae well sin the moral ie This view would be an overimplifcaion. By Aesign, moral theories ave certainly more gen feral in scope than moral principles, rules, oF judgments. But from this fact it doesnot flow ioral delierations. For one thing, to be truly Useful, moral theories must be Billed outwith details about howto apply them in real life and the kinds of casesto which they aerelevant. For Another thers more to morality than what can be captured in the general norms of & theory. Theresa the testimony ofthe particular the evidence of individual mora judgments ‘Our moral deliberations then vee both the general and the particular. Suppose we embrace moral theory that sens to fr ura plausible txplanation of what makes an action right oe wrong, When we mst decide which action Is morally right ine pertclar station, we lock to ‘ur theory for general guidance From our theory wwe may geen set of moral pines that sem to {ply to the cse at hand the principles lead us tocomfting choices, we lock agin to the theory for insight in vesaving the cone. But we also ‘must ae nt account or consdeed judgments houtthe case (Wem ao formulate considered udgents aout the relevant princes or rules) Tour considered judgments and the deiverances of our theory ate consistent with one another, wwe have sonal esrance that our ddson in the case is correct. (Four pidgin clash with fur theory oF principles, we must decide which 0 fevise or discard for ric reasoning demands hat our Beliefs be coherent that they dono harbor contractions Ife lieve ou jadgents to be more credible than the implications of eur theory (or principles) we may modify the theory sccotdngly (ar arly repr the theory aires Table and give ip But the theory seems more Credible inthis ese, we may concade that our judgment untrustworthy and sett ie Sova moral theory can show us what is im portant and easonabe in morality guiding our Judgments through overarching insights that Inay help us with specific cases andres some times correcting erring judgments along the ‘way Or considered judgments are allie ind ‘tors of moral common sense and are checks Sgainst wayward theory or faved principl Inbioethies, both ofthese moral resources are ighiprespectd and widely used Several moral theories have played major roles imbioethis and they contnset influence how ople think about oethisl sues. Theories of right ection in contrast to virtue based theories) have dominate the eld, exch usually based on ‘ne of two broad views about the essensal char ctor of right actions. Consequentalst moral hearies insist thatthe rightness of actions ‘epends solely on thelr consequences or results The key question ie what or how much good the actions produce, however good is defined Deontlogical for nonconsequentiais) theories Say thatthe rightness of actions is determined hot soley by thee consequences bat party OF Entirely by their intrinsic nature. For some oral action, rightness depends on the kind of actions they are, not on how much god they produce ‘A-conseguentnlist theory, then, may sey that Stealing is wrong becuse le cases more harm than good. Buta deontlogical theory may con tend that sealing is inherently wrong regardless ofits consequences, good of bad Utlitarianism The leading consequentialist theory ewilitar anism, the view that right actions are those ha result in the most beneficial balance of good ‘ver bd consequences for everyone involved Says we should maximize the noamoral good (the wlio everyone affected regardless ofthe contrary urgings of moval rules or unbending ‘moral principles Varios forms of titariansm Alife in how they define tility, with some equt, ing it with happnes or pleasure (Oe hedonistic ‘view, eters with station of preferences or {esresorsome other intrinsically valuable things or sates suchas knowledge or perfection Inapplyingtbe utilitarian mera standard (he sreates god, everyone considered) some mora Plilloophers concentrate on specie ats and fomecon rulescovering kinds of acts. The former spproach ie called acttlitaranism, the ies athe rightness of etions depends solely onthe relive good produced by individual actions An act sight a particular situation i pr ducer grester balance of good over bad then any alleratve acts determining righines i ma of weighing the elect of exch possible act, The ater approsch, known ae rule-utlitarianis, voids judging rightness by specific acts and Focuses instead om rules governing caegris of nets tsaysaright action one that confomsto 2 ral that, followed consstenly would create Toreveryone involved the most beneficial balance of good aver bad. We ae 0 adhere tothe rules because they maximize the good for everyone onsietedeven though » given act may Pro ‘ducebad effects in partial situation “he classic version of uiltarianis was de vised by English phawoperfrcoy 2 48-1832) and given more detail and plas ity by another English philosopher, John Stet Mil (1805-1879, Clase wtltarianism is he tonic im that the tity to be maximized is pleasure, broadly teri happiness, the only Intrinsic good. Aight action produces more net happiness (amounts of appinese minus unhap- pines) than any alternative ation, everyone Considered. Ae Mil put [Raton] ar sightin ogortion as they end to promote happiness wreng ae they fend to intended plensure, andthe sbaeneof pl: by unppiness” pin a the pivation of pleseure Bentham and Mill, however, had deren eas about what happnes enale, a do many pllsophers oda. Benthem thinks that hap esis one-dimensional: I pleasure, pore and Simple something that varesonly inthe amount that am agent can experience. On this scheme. seems thatthe mora ia! would be to expe fence maximum amounts of pleasure a des the lation or the debaucee. But Mil thinks that pleasores can vary in qulty aswel as quantity. For him, there ae lower and higher pleasures he lower and inferior ones indulged in by the tluton and his ilk andthe higher and more Sstsfying one found in sich experiences asthe search for knowledge and he appreciation of art fd muse Mil famously sume up this contrast bysaying “Is beter tote a human being de sited than pig satis beter to be Socrates ‘ietified than a fool sas Like all forms of utilitarianism, the classic formulation demands 2 strong sense of impar fully When promoting happiness, we must no Ebi take into account the happiness of evry Gre afected but alto give everyone’ needs 0 meres equal weight Mil explains [the hapinese which forms the iain an Udo whet ight conduc ent he agents freentisown happiness nda ef thers il eran requis him tobeas sty inpertialaeadsererted an benevolent In classic uiltasanism, the emphasis is on maximizing the total quantity of net happiness, ot ensring that ts rationed in any particular inounts among the people invobed This means that an action resulting in 1,000 units of hap es for 10 peopl is eter than an action yell jing onl 909 units of happiness fr those same TO peore repulse of hve the units of hap res are distributed among them, Csi uta Line do want to alloeate the total amount of happiness among as any people spose hs thet moto the greatest happnes forthe greatest umber? But maxinzing total hapines isthe Fundamental concer whether everyone ges an {qu portion or one person gets the bo'share. ovr might urlitaranian appytsboeticl suet Conse this scene: ohn sa 10-year (boy with eral palsy, emaciated and bed Fier, hooked to feeding tubes and monitors, hsb wid in pin thats almest impossible to control hls days measured out by one agoni ing surgical operation afer another, lcked inthe mental hf ofan infant and acknowiedged by all the experts to be without hope His anguished parents wanting desperatly to end his sufering beg the physician to give Jonny a lethal inj tion What should the physian dot Suppose in this cate there are only two options indetely matntaning johnny n is present condition or carrying out the parents wishes An atuttarian might reason like this Allowing the curen station to continue would cause enormous unheppiness—Tohnny/s own physial agony, the unimaginable misery ofthe Eiatraught parent, the anslety of ether family members and fends, snd te distress and us ration ofthe physan and nurses who can do tle more than stand by as Johnny withers ahay-On te other an, ministering the lethal injection would immediately end Johnny’ pain tnd prevent future fering The parents would few fr Johany but would at leat find some Feet and perhapepence—in knowing that is torture was over The nedial staf would probs Sly also be relieved fer the same eeason, There would, ofcourse, aloe possible negative con Sequences fo take inte account. In administer ing the lethal injection, the physician would be Faking both professitalcensre and ciminal prosecution her atane were tobecame public, people might Bein to mistrst physicians who fret severely impaired children, undermining the whole medical preesin. Perhaps the phy ial action woul lad oa general devaluing ofthe ves of dsalel or elderly people evry Iver, These dire consequences, however, would probaly nthe very likey ifthe physician acted Aiscretly. On balance, the act-utlitaian might Say greater nethappinss the last uhappines) ‘vould esl fromthe ery king which wou therefore be the moalypermisable course. ‘A eule-utiltarian might judge the situation Aiferenty The key question would be which ful if consistently fallowed would produce the Ely two rales consider. One says ‘Do not kill Seriously impaired children, regardless of thie Sulfering or the wishes of their parents” The bother on is"Killing seiusly impaired children is permissible i they are sfering severely and limprovement ishopeless” The eule-utlitarian might reason that consistently folowing the Second ule would fave terible consequences It would cause widepread suspicion about the ously impaired and disabled children. People ‘woul come to distr physicians, which in turn trovld damage the elie health care system, fac) Ramee isl? Feroneet a UTicd John Stare Mil deended hs ada doctrine of ‘estar by arguing cht was encom tent wih fundamental Cartan acing ‘he complee spirit athe ethies af wy. To do one would be done by and o love one's rey wal enjoin fst tht as 2d ee Society might begin to devalue the lives of dis abled people generally a well ae the eldery and fother vulherable populations. The rule would ko appeat toenail a blatant violation of the Cardinal priniple of medical protie -do 0 harm Adhering to it might therefore cause an crsion fall ethical codes nd profesional stan ards in medicine. Bur following the fst rule wouldhave no sich consequences woul permit the sufering of some impaired children, but this oneeguence seems no tobe a catastrophic 36 thse produced by consistent conforming to the second role, For therule-utitaria, then the morally right ation would be not to administer the lethal injection, dete the parents ples, Kantian Ethics From the great German philosopher Immanuel Kant (724-180) coms what widely regarded as probably the most sophisticated and inf ental deontologial theory ever devised. Its the very antithesis of utteianim, holding that right actions do not depend inthe least on consequences the macilzation of uty the (es apeing practi oma be cle) he tery with comducroppored othe general production ofhappiness, or the desires and needs Shuman beings For Kan, the core of morality Consists of following »raltonal and universally applicable moral rule pd doing so solely out of 2 sense of duty. An actin right only fico: forme to sucha rule and we are morally praise worthy oni ifwe perform it for diy sake alone In Kant system, all ovr moral dates are ex pressed in the form of eaegoricl inperatves, fn imperative i command todo something ite categorical if applies without exception and without gard for particular needs or pur poses A categoria imperative say,"Do this fegardless”Incontac,shypotheialnnperative ia command to do something if we want to techie particular ais, asin If you want good pay work ard” The moral lathe, ete on solute directives that do not depend on the contingencies of desire or tity. ‘Kant say that through reason and reletion ‘we ean derive our dates fom 8 single moral Principle, what he calle the categoria impers: tive He formulates iin diferent ways, the irs tone being "Act only on that maxim through eich you can at the same time will that it Thad become a universal law: For Kant, oor sake tive logical impliatlons—they imply aera, maxims, of conduct. Ifyou tell Bie nancial gin, you are in effect acting Hlording to 4 maxim like “T's okay to lie 10 ‘Fpequstion i whether the maxim correspond ington etion se legitimate moral a. To nd fuze st ask we could consistently wil that themavim become a universal lw applicable 0 trerjore thats everyone could consistently Seon be maxim and we would be ling to have them dss If we could do this then the action drt bythe maxim is morally permissible ifnot is probed, Thus moral laws embody two cbiecterisics thought to be essential to morality itself universality and impartiality. To tow us how to apply tis formulation of the catigorial imperative ta speci stuation, Kant wis the example ofa ying promise, Sup pose yeu need to borrow maney from a frend Fratyr know you could never pay her back. So togettb lan, you deve tli faltely promising to repay the money. To find out if such lying promis is morally perteuible, Kant woul have You ash ifyu could consistent wilthe maxim Of your action to become a universal law ask, In effet, "What would happen if everyone di thie?" The maxim is "Whenever you need to borrow money you cannot pay back, make alying promise to repay” So what would happen fe ryonein need of oan acted in secordance with this maxim? ple would ak ying promises to obtain loans, but everyone would also know that sich promires were worthless, and the ‘uston of loaning money on promises would Aisapper.So wig the maxim to bea universal law involves a contradiction: I everyone made Jying promises, promise making tself would be no more: you cannot consistently wll the azine tobecome a univers lav, Therefore, your Ahty lear: Making lying promise to borow ‘mone s morally wong ‘Kant st formulation ofthe categoria in peratve yields several other dais, some of which ate particulary elevant to bioethics. Notably ergs that here isan absolute moral pro bition sgaine killing the innocent, ing. com ritting suid, and failing to help others when feasible Petheps the most renowned formulation of the categorical imperative the principle ofr spect for person (a formation dstne from the frstone, though Kant hought them equiva lent Ashe pate i “ACin suc a way that you sways treat humanity, whether In your own person or inthe pesson of ny other, neve simply Erameans, but always atthe same ime a6 an nd" People must never be treated as if they were mere instruments fer achieving sme fur ther end. for people are ends in themsehes, possesors of ultimate inherent worth. People ave ultimate value because they are the ite Source of value for other things. They bestow ‘ale; they do not have itbestowed upon them So we should treat bath ourselves and other persons with the respect that all inherently aluale beings deserve “According to Kant, te éaherent worth of persons derives from the nature as fe, rato fal beings capable of directing their own lives, Setermining their own ends, and decrecing their own ulesby which olive. Ths, the inher tnt value of persons doesnot depend in any way fon ther social stats, wealth talent race, oF cl ture, Moreover, inherent values something that All persons possess equily. Each person de ferves the same measure af espect anyother. Kent explains that we teat people merely 26 a means instead ofanendin themseesif we dis regard these characteris of personhood —ifwe thwart people’ fel chosen actions by enecing them, undermine tei rational decision-making by Ivng to them, or doune thee equality by Alserminatingsgaine them. ln bioethies, cer fut cases of ot respecing persons in Kant’ Sense would normally include experimenting Gi people without ther Enowledge ana consent ping to them about thelr medial condtion and Prognosis and forcing tens fo receive treat tentagainst thee wl Notice that this formulation ofthe catego calimperative does na ctusly prob treating Spero a «mies but forbids treating a pee fen spy, or mere a8 a means—as nothing but a means. Kent recognizes that in daly ie rer fen must se peopl to achieve our various tres. To buy milk we use the cashier Yo find bok, we ae the ibrarian; to get well, we use the doctor. But because their ations ate feely tlosen and we donot undeemine thei status a5 ‘eons, we do not use them sly asinstruments ‘Stour will Medial researchers ue thir aman Subjects as a means to an end—but not merely 4 means to an endif the subject give thie informed consent to participate in the research [Natural Law Theory From ancient times to the presen day, many pple hve thug thatthe ones of he moral at plain tose cae they ae writen large tnd true in natare feel This base notion has ten developed over the centuries ino what is Kyown as natural aw theory, the view that ight action ate thowe tht canorm to moral andards discerned in nature through human reason. {Undergirdng this doctrines the bel that all of nate (ineiadng hurnarkind) i leologicl, bat it i somehow directed towatd particular pols or ens, and that humans achive thee Fighest good when the follow their tre, natural islinaion leading to these goal or ends. Tere lsimother words, 3 ay things are—natural pro Ccese and fetions that accord withthe natural Tew-and how things are shows howe things should (The prime duty of amans, then, isto guide ir Hives toward these natural ends, acting i ‘ccoxdance with the requirements of tual a Implicit in all thi is the element of rational: iy, According natural law theory, man ase ftional beings enpowered by reason to perceive the workings of nature, determine the natural nclinatonscf humans, end recognize te inp tations therein for morally permisible actions That reason enables human beings to acetain the moral law implicit in nature and to apply that objective universal standard to tei live, Though natural theo has both eligous nd nonreligious frm, the thsi Foemaltion of theologian pilosopher Thnas Aquinas (1225 Iara) has been the theorys dominant version, 8 no only the ofl mera outlook of the oman Catholic Church, butt has also been the ntllecual starting point fr many cotemporary ‘ariations of the theory, secular and otberwis. For Aquinas, God isthe author ofthe natural soho gave humans the gif of reason to discern the law for themselves and lve accordingly ‘Agus arges tat aman ings natal ter toward—and therefore ave a daly of—presrving human lie and health and so shut not il the innocen). producing an ring children, sek ing knowiedge Gncloding knowledge of God) and culating cooperative social reatioships. Imall this Aquinas sys the overarching sims todo and promot god and wold evi ‘Natura law theory does et rovidea relevant moral ate covering every stuetion butt dos ter guidance through oneal moral principles, Some of which ae thought fo apply universally fd absolutely admitting noaxception) Among hee princpcs are aboltst prohibition agaist Aiectlyklling the innocert, lying, and using ontraceptines, In his list of acts considered wrong ne mater wha, Aqtinat includes al tee. blgpheny ard sodomy ‘GF course, moral princes or rules ofen conf, demanding that we ull wo oF more incompatible duties. We may be forced, fr ex mpl to ihe ell le and save people’ ives, Orel the truth and emse their denth—bu we Cannot do both. Some moral theories address, these problemsty ying thal tes prima face: When darics confit, we must decide which tones ovecide the others. Tories that posit ab Solute duties natural aw theory being 2 pine ‘rample ten do rot have this option How does the natural av tradition reselve such dilemmas? Among oter resources, tases the doctrine of double effect. This principle, a cornerstone of Roman Catholic ethics. airs tha performing 2 bad ction to bring about a good eflect is never moral acceptable but that performing 2 good on may sometimes be acceptable even ff Produces bad effect. Mor precisely, the pin Ep soys tiaras wrong 0 intentionally per form a bad action to predce a good eect, ba Going «good action tha results ina bad eet nay be permissible the bad effect isnot in fended though foreseen Inthe former case 2 td thing is ad 0 be decty tended in the Inte, aed thing snot directly intended Beclreguietents ‘ave been detailed in fates" that an actor mus pas to be judged ‘motlly petmissible, We can express trad onal esion ofthese ets like his The action itself must be morally permis 2, Causing aba effec: must not be used to obtain a good efect the end doesnot justify the means. 4. Whatever the outceme ofan action, the Intention must be a cause only 3 good effect (he bad elec: can be foreseen but never intended) 4: The bd effect ofa action must not be {ftir in importance than the good effect Consider the appliaton ofthese est 0 eu anata, Suppose sn BD year-old hopelesy il patient js in continuous unbearable pain and begs to be put out of er misery. Is morally Permissible o grant her equst (ether by giving 2 lethal Injetion or ending all ordinary ie Sustaining messurs? I we apply the doctrine of double eet a just outlined, we mist conchde thatthe answer eno Ethanasi—cither active ot passive not a monly permissible option here. (Inthe Roman Cathole view all forms of ‘euthanasia ce wrong, al ought permisble mot to treat a hopeless ill perso for whom ‘rdinary life-sustaining etmente are useless) Falling even one ofthe tert would render an ction impermissible, bit in thi case et ws ron ‘through ll four a natral la theorist might 1 Tung steps to terrinate someone ie dea vioation of sts, Whatever ts effects the action of taking ein itself immoral, a violation ofthe cardinal dat to preserve innocent ie Ending the womans life sve her from terrible suffering isan instance of causing ttbad eect the womans death) 82 means of achieving a god efec, (cessation of pain) fale of test 3 The death ofthe woman intends tis not merely a tragic side eect ofthe sttempr soley to eae her pain Sothe 4 Causing the death of an innocent person is 2 great evil that cannot be counterbalanced by the good of pain rit So the ston les not pasts ‘The verdit in such case would be diferent, however ifthe patient’ death were not inten ionally caused. but uninertionally brought shout Suppose, for example ta the physician Sees thatthe woman isin agony and so gives her 1 large injection of morphine to minimize her Suffering—knowing fll well that the dose wil leo probably sped her death. In this scenri, the act of eating the woman's pun is itself mor ally permisable test I, Her dethis nota means to achieve some greater good; he gol isto ease her suffering (est 2, Her deat’ i nt intended the intention ist alleviate her pin, though the unintended (but foreseen side effect is her has tened death (et 3) Finally, the good eect of an easier death seems mote or less equivalent in importance to the bad effet of «hastened death Therefore, unintentionally butknowingly bringing about the womans death in his way ‘morally permissible, ‘We get similar results if we apy the double effect principle inthe tatinal way to abor tion. We find tata the intentional destruction ff an innocent human life (o-clled direct) ‘horton i aeays immoral st) Moreover, wrong even (or especialy) fits performed to being about some good result, sucha saving. the mothers hfe or preventing serious harm to er (ests and 3), On the ofr hand, actions leading tnintntonally tothe death of «fetus {so-called indirect abortion) may be permissible in are cases, Sy a pregnant woman hasan in Fectious disease tha wil il her nles she gets nections of powerful dug. But the drug will hort the fetus, According t the doctrine of Sout eect, receiving the injections may be ‘morally permissible ifthe action itself is morally petmissble, which itis et) ifthe death ofthe Fetus is ot used to rescue the woman (est 2: if the injections are given with the intention of ‘uring the woman’ disease, not of inducing an horton (est 3) and ifthe death ofthe ets i Balanced by the life ofthe woman (test Reve Contract Theory Ins broadest sense, conteactatlanism refers {mora theories based on the idea of social Contract or agreement, among individuals for mutual edvantage. The most influential conten: porary frm of tontactarianiam i that of Pi Fesopher fon Raves (1921-2002), who uss the notion ofa social contrac to generate and defend moral principles governing how members of society etould reat one another He askin ec by what principe should just society struct isl toensure afar ditibation of ight, dais, tnd advantage focal cooperation? His anever is thatthe requlted principles sentially principles of ustice—are those that people would agre to under hypothetical con Eitions that ensure fir and unbiased choices. He belive that f the stating point for the soci contac ie fir—if the inital conditions find bargaining proces for producing the pin Clples ate fir=then the principles themselves willbe jst and wil define the essential makeup Uf ajostsociety As Rae sys, [the guiding ide isha the pines fst forte base stature of soit arethe ajc tv orpnal agreement They arte places at ie nd atonal eons onceroed fares their own interests weal cept arial postion Fandmentl ernst their asociation Thee principles ate to esta farther sreements They pei the Kind of sci cooperation that an be eneedinsoand the forms of goverment thatcon be else [At the hypothetical starting_point—what Rawls calls the "orginal postion” group of hotmal selPinereted, rational individuals Come together to choose the principles that will ‘etermine their basic rights and duties and their Share of soity’s benefits and burdens. But to nau tha their desions areas airand impar {alas possible, they must meet behind a meta phoriel "vel of ignorance” Behind the vil, no {ne knows his okn socal or economic status, las ace Se, bili tales, level of itll fence, or paychologeal makeup. Since the pat Teipans are rairal and selfinterested bur ignorant of ther station in society. they will Not ages to principks that will put any particu Tar group ata disarantage because they might ‘very well be members ofthat group. They wil ‘Choose principles tht are unbiased and noni Sriminatory. The assumption i that since the hegotiating condition in the original position fe fir the agreements reached wl also be far—the principles wil be ust Rawis contends that given the original pos: tion the particpunts woud agree to arange thei socal ration hips according these fur dainental principles: 1s Each person eto have an equal ight 10 the mort extersive otal system of equal ‘esc iberties 2omparible with similar system af iby fr all. 2 Soeil and ecenomic inequalities ae tobe arranged s thet they ae both (a) tothe retest benai ofthe least advantaged. --and (by attached to ofces and positions ‘pen toal under conditions of fir ‘hualityofepportunity® The first principle—the equal_iberty riniple—says tht everyone is ented to the Fost redom posable in exercising basi rights an duties (or example, the right to vote and ai ice and freedom of speech, assembly pehoughe) Each person should get maximum gece of tos ibetesbut no more than anyone Ge this principle takes precedence overall fer conserations (including the second pri {plese that basic liberties cannot reduced or ‘Greed justo improve economic wel- being The second principle concerns social and connie goods suchas income, wealth, oppor. uals and postions of authority: Part (says [Dat everyone is ented to an equal chance to tay toscquie these basi goods, No ones guar srteedan equi shareof them, but opportunites tobtain these benefits mast be open tal gudless of social standing awis knows that socal and economic In equates wil patraly ree in society. Butas he assersin pat they are not unjust they werk toeveryoes bene, especial othe benefit of {he east well off in society. "Thee sno inus tice e sys “in the greater Benefits earned by 2 few provided tha the stuation of persons not 3 Fortunate thereby improved” For Ra, such «polly ifr more just than one in which some pope are made to ser forthe greater god of ters) sno jst hat ome could have ess norte that others may prosper Th Rave scheme, the demands ofthe fist principle must be satisfied before satisfying the Second, and the requirements of par () must be met before those of part a In any ast dist bution of benefits and burdens, then, the Best Priority is to ensure equal baie betes forall oncered then equality of opportunity then the Arrangement of any inequalities tothe Benefi of ‘he least advantaged ‘Asa theory of distelbutive justice, Ral con- ‘tsctarianism seems to have signifiant impli tions fr the allocation of society's health care resources, For example, one prominent line of arguent goes ike this: As Ras claims every fone ie entitled to fair equality of opportunity, and adequate (basic) health care enables fir ‘quality of opportunity (by ensuring "normal species functioning" Therefore, everyone is enti to adsquate heath care, which incades SI approprie: measures for liminating oF Compensating forthe dsadvantages of disease nd imparment.*Tn sch ystems tere woul beuniversl cesta bic level of healthcare, tile more eaborat or elective services woul be svallable to anyone who could afford the ‘nother implication: Suppose that to provide asic levee health are to everyone (and meet the equality opportunity reguiement, sci tty wouldve to spend 90 percent of its health fave resourees But say that in the cucen "tem, 50 percent of the resources are being Spent on act cre for the elderiy—that i x pensive measures to extend the lives of people tno have alieady lived ong time. According to Rawls principe, the curent system of healthcare nos Vistue Ethie Most moral theores—incuding all those just discussedste theories of obligation. Tey em phnsize the ghtness of ationsand the duties of nora agenss"Their main concern is knowing hd doing what igh, and their clef guide to these aims is mor principles or directives Virtue ethics, however, i radically diferent kindof motl theory fcuses onthe develop ment of vituous character According virlue ties, characte is the key tothe moral if, for itis fom a virtuous character that moral con fuct and vlues naturally are. Vitus are i fined. dispositions to act by standards of cellene, shaving the proper virtues lads as mater of course to right actions propery mo- tivated. Thecentral tsk in morality then, not Knowing and applying principles but being and becoming » good person, someone possessing he virtues that define moral excellence. In ‘rte etic, someone determines right action ot by commiting rules but by asking what 2 truly virtuous person would do or whether an tetion woul accord with the relevant vets Aristotle (384-22 nC) isthe primary in spitation for contemporary versions of virtue thies For him, as for many modern virtue ethics, the highest goal of humanity isthe food lie or"husan fouriehing” hat Aristotle fills eudainonc, oe happiness), and developing jstues i the way t0 achieve such a eich and tateying life. Thus wietues are both the tits hat make ws goed persons and the dispositions hat enable us a le good lives. The god life isthe virtuous fe Unlike many theories of obligation, virtue tics askew todo more than just observe min inl moral roles—it insists that we aspire fo moral exellcey tha we cuit the virtues that will make us beter persons In this sense virtue ethics is gol-direted, not rule-guded ‘The moral virus benevolence, honest. yay compassion, fairness, nd the ike—are ideals that ve must ever steivetoattan. (There arealso hhonmoral virtues sch as patience, pradence and reasonableness, which need not concer us hete) By theligts ofboth Aristotle and modern ‘itu ethicists, character i not ttc, We can become more vituousby reflecting on our lives and thos of obs practicing vituousbeavin, or imitating meral exemplars such as Gand Rudd, Jesus, uhammad, and Socrates. We ‘anand shouldbe better than we ae "fo the virt ehiest, possessing the right virtues means saving the proper motivations that naturally accompany those virtues, To et morally we must at from virtue, and sting ftom virtue meins acting with the appropriate motives. tis not enough to-do right, we must do righ for the eight motivating reasons. If we fave 8 drowning fend, we should do 50 out of fenuine flings of compassion, kindness, or Toyalty—notberause of the prodding of moral rules or socal expectations. In conta, some nora theories (notably Kant’) maintain that Acting morally is solely « matter of acting for duty sake—performing an action simply be toute duty requires it, Virtuous motives are ieelevant; west morally i we do our duty ee fatdlese of our motivatons. But this notion Seems to many to offer a barzenpictre ofthe moral life Suey, they say, motivations for cting are often elevant to our evaluations of peoples character and actions, The friend we $aved fom drowning would probably be appalled fe declared that we saved er out of duty even ‘thogh we di not ell care whether she ved ‘ordied. Many morl philosophers agre that 0 tivation are inded important considerations i ‘moral judgments, and they have incorporated vires int their theories obligation ‘Virto ethic fits wll with the emphasis on ines that has alwys been part ofthe heling rts Physicians and nurses ae expected topos: {ese particular virtues, inching compassion, trustworthiness, justice, and honesty. They are expected tobe more than just echnical skilled tnd knowledgeable and to do more than merely fellow the rule of conductor proce, They ate obliged tod right by ther patents snd this ‘bligtion ie mos key met through the cult vation and possesion of virtues The vite ethics approach to blethicl asus is distinctive. On abortion, for example, the virtue ethics might argue that woman's dec ton to have an abortion should be judged by the virtue (orlick thereof tht se drs it Aiding what todo. If he decides to have an abortion just because shes afraid ofthe respon: ibis of parenthood, she shows cowardice. Ir. $Shewantsto go through with anaborton merely because pregnancy would disrupt her vacation plans, se shows self centeredness and callous fess. in neither ease ste vetue ethics likely (cll the womans decision virtuous" “The Ethie of Care he ethic of care sa ditnctive moral perspec: tive that arose out of feminist concerns and stew to challenge core elements of mest other moral theories. Generally tote theories emp Size abstract principles, general duties, individ taleght, impartial jadgmentsand deliberative feazoning. But the ethics of eat shits the focus tothe unique demands of pecfistuations and tothe virtues and fing thatare central to cose personal relationships~empathy, ompssion Tove, sympathy, and fidelity. The heat ofthe moral if fing for nearing fo thase with PreMed efehingyoucan learn by mere studing them, Tiegh pact, by hing te vrwer, Ase sp, whom you havea speci ntimste connecto approach that epecalyresastes with phy Sane and nurses. Tarly on the ethics ofeare drew inspiration from the notion that men and women have Arataticlly diferent styles of moral decision naling with men sing on principles, duties, fhe rights and women foming in on personal ‘ehaionships, caring, and empathy. This die feces highlighted in -esearch done by poy- ‘hloit Cal Gligan ae plished in er 1982 Beck Ina Different Voice Typically men recog ize an ethic of justice ard right, se say, and women are guided by ax ethic of compassion Ane cae Inher view the ter sas lgitimateas the former and both have thei place n ethics. (Othe research has suggested thatthe dif aces between menand women n styles of moral thinking may not be as great as Gilligan sug sts. But the credibility ofthe empiial claim ‘oes noe the age insight hatte esearch secmed to some writers suggest Caring isan ‘rset part of moray andthe most "earies have not fully ake tito account hese points get support along several lines. First virtue ethics reminds us that vitues are part of the moc life I arin i viewed as a ‘tue in he form of compassion, empathy. or Kindness—then caring bo must bean element ‘Sent ifit made no room fr exe, Moreover many arguethat unlike the ethics of care, most moral theorie push the principle of oral views comes abou a8 rest of [Bloc ene vues we ot by firm veriing [Sel For the thnge we have lec before tne can do therm, we lotr bye them. 2, tren become bers by aun md yrepiayers Tr plying theyre sot we Sacome sy impart to fat, Recall that impartiity in morality requires ut consider everyone 2s qa Counting everyone’ interest the same. The principle applies widely, specally in matters of Public jusie butless20in perl eltionships love ami fiiendship ane ike. We seem to have special obligations (putiaity) to close Friends family members, and thers we care fr, tes that we do ot hat to stangers ort uni ‘esl humanity. A some pilosopers explain it the cre perspective epeily meaingul for tube cues and deepening speci latoasips trelikl tobe more portant meal than foxy own ren and fei een his nea ignoring the needs fhe people whom ould lop rom 28 inpartal pit of| ‘ews our daly sto promote the ers of ‘ery alike Bat few of accep ht ve re confrmsthe pry that we tually ie oo fay nd ends, and 0 [tesa move plnble moral ceneption.” Most moral theories emphase duties and dowaploy the role of emotions, attodes, and motivations Kan, for example would have ws do Sur dat fr ny sake, whateve our Feelings. For him, to Bea morally good parent, we ned only at from duty, But taking ee of our chil dren asa matter of moral obliga alone seems an empty exercise, Surely being « mocly good parent alo involves having flings of lve and atitudes of caring The ethics of care eagerly {akes these emotional elements nt account Many philosophers, ineluding several we ng roms feminist perspective, have lodged Sich erfcsms againot the most fuera moral theories while suggesting that» mature moray should accommodate both an ethic of| ‘obligation and an ethic of cae, Annette Bale, for examples bas taken this proach (eich thin, hatte best oral theory hae hast harmonize jesticeand care The moray mend for women and will ed tei com. bined A ila sai, what we eed row isa mariage ofthe od tale and the ‘newly atc eae night: Formany nies, the this afar scems ike ating, natural approach o morality in nursing sctie After all caring hs always been an ential part whacnarees do and hw they think ‘Shout their jobs. When the fcus of oncera i, sy, avery ck patient ad her fay. traitonal moral theories would have those ave attend to relevant moral principles, strive fr an im Portia stance, emphasiae individual rights snd ngage impassive moral deliberations Bt the tic of cae insets tht medial ere providers ay more attention to the specie nee ofthe Patient and he amily eavere ofthe pei re Ietionships they have witheach eter understand the attudes and feelings at work mong them, and act wth compassion, sympathy. and respect. Feminist Ethics Feminitt ethics is an approach to morality timed at advancing women's interests and cor fectng injustices Infcted on women through tocial oppression and inequality Ire dened by ‘sintive focus on these issues, rather than bya setf doctrines or common ideology among feminists, many of whom may disagree onthe nature of feminist ethics or an particular morl ieses.A varity of divergent perspectives have been identified a5 examples of feminist ethics, including the eis of cre. Feminist ethics enealy downplays therle of moral principles and traditional ethical concep, ining instead thal moral election mus ake practices, reatonships, institutions, and power Etrangements. Many feminists think thatthe familia principles of Westen ethicatonomy uli, freedom, equality, ad s0 forth—are 10 trod and abstract to elp us make moral ud mens about spetie persons who are enmeshed in concrete soca situations, eis not enough for ‘ramp to respects womaris decison tohave an Shorion i she is oo oor to have ne, oi er alto iso oppressive fr oppressed) as to mke orion impose wo obtain. o soci cond tioning leads her to baieve that she has no choice or that ber views dont count. Theoretical ton tomy doesnot mean much iit ss thoroughly undermined in ali ‘Many theorists in feminist ethics also reject the traditional concept ofthe moral agent. Jan CCosthwste says thatthe od notion ie that of sbetact individuals as fundamentally uton0 mous agents aware oftheir own preferences and ‘als, and motivated by rational self interest hough not necessarily sesh" But, se say, resent richer oncegton of persons ahr {sly and curly lose scaly ete nd an formas by speci retionshis(ehoen and cnchoen and ie flim and espns iy Such conception of tle sete vefocues thinking ab shiing the emphasis fom relatedness. Respecting autonomy becomes Ie mate of protecting indivi from cre econ poor’ ntedepenence and sipping india development he ‘Though ll adherents of feminist ethics sup portnretion and equality or women, thy dis Peron these vais apply to specif mor Fe. Mist support wnimpeded acest bor on but some do not As ater chapters show 71 femnits also diverge on sur Gpinons among ferinists also diverge on Geney and reproductive technologies such 38 invite Ferlzaton. Carsieury Ganstry isa method of moral reasoning that (rphasires cases and analogy rather han un Sel principles and theories from which ronal judgments are supposed t be deduced, CCauists sy reasonable oral judgments are feived at not by applying theories, sights, and ules, but by paying careful attention to spe (Gf cases and creumetances. In casuisty judgments about new cases are made by ans ‘gy with similar or paradigm cases; an a asvistry operates by consulting precedent CCasuists pont out that problems in moral res foning te especially Ukely when theories of principles aestrcly applied without regard to the relevant details ates. They also note that vee are often far more confident of specific Iroral judgments than we are of decisions based on general principles, Moral. philosophers, however, have voiced several concerns about the method. For one thing it seems that caultry is dependent on rules ot prineples just ae moral theories ae, Consider suns sometimes write asf paradigm cates speak fo thems or nem moral jedgmenk ptt facts stone an laste. Fr the ‘recognized ond oly eleanor mast onc the eet Te norm at pat of the wsyotnerpeting eating, nd Heking ie lamin easing ne sequence of eens ir morally ke or ule nvclevant cespects Some rte also question the bility of est ta paradigm cate, Catusts bold that justi Cation comes fom a society's traditions aes, Sr conventions Buti aeem that a solid se of Principles or standards would be necessary 10 ounteract the bias abirainess, or vagueness ‘ofthese influences CCasuistry has made valuable contributions 0 our understanding sd use of moral reasoning ‘But ints pret for iacers problematic. More recent scholarship, however, has demonstrated ‘vay that eapistey can take into account some ‘moral principles or norms As you can see as explanations of what makes fctions right or character good, moral theories an difer dramatically in both content and quality In thei own fzhion, they ty entfy the true determinant of rightness or goodness, nd they vary in how else they seem to gett the mark. Mast moral philosophers would res iy agree Some moral theories are beter than thers and a vital takin etic is 0 ty 10 tll which is which. Moral theores can be useful nd valuable 10 us only User ae rer for judging their worth-—aed fortunately there ate buch standards Th several ways, moral theories areanalogous to scien theories, Scientists devise theories to explain the causes of events. The germ theory 13 ofered to explain the cause and spread of infectious diseues, The Big Bang theory is wsed to explain the strctute and expansion ofthe tniverr The "preehouse fet” spt forth to “lain climate change. For each phenomenon to be explained, scientist usually have several possible theories to consider, and the challenge to determine which one i best (and is there foremost likely tobe correc). The superior theory the one that fares best when judged by gener sly accepted yandsticks known as the sletfic ls fafulnese—ohether the theory makes sue cessful predictions of previously unknown phe homens All things being equal, «theory that ‘makes sccesful predictions af nove phenomens iSrmore likey tobe true than one tat does not Another important eriteron is coker how well theory fe with estalished facts, with what scientists already know. Al things bring equal theory that confit ith what seienttslredy have good reason: to believe les likey tobe true than 8 theory that has no such conflicts, OF course, an urzonservatve theory ean tur out tobe correct, and a conser ‘ative theory wrong, but the odds are against this outcome. Analogoasly, moral theories sre reant to explain what makes an action right or person good, and to try to determine which nora theory is most likely covet, we apply Conceptual jardstcks-the mor! criterla of que. Ay plausible mocl tory mist mes Sure up to these critical standard ‘Animportant criterion of adequacy for moral theories Criterion I consistency wit our con Sideed moral judgments, Any Plusible scien tic theory must be consistent withthe data that the theory i supposed to explain; there shoul bono confit between the theory an the ree vant facts. A theory put frth fo eplain plane tary mation, for example, must acount for he relevant datascenifi obserations ofthe ‘movements ofthe planets and rented object, Likewise a motal theory must also e consistent with the data ti supposed to expan: ou con ‘dered morl jadgment, what sume call our moral common sense. We arrive a these judg nents fer careful deliberation thet ia free of bias self ners, and other distortinginfences 2s possible Mora philosophers gram these ud ments considerable respect and tyto take them Into eccount in their moral theoaing, As we have sen, these judgments ae fallble, and they areoften revised under presure fon trustworthy Principles o theories But we are eile to rust them unless we have good reseon te doubt ther. “Therefore, any moral theocy that seriously In consent with our considered judgments must be regarded oe badly awed, peshaps fatally so, and in need of radial revision. Our considered judgments, for example, tell us that slavery, ‘murder rape, and genocide are wrong, A mor theory that implies other fis hiseriterion and ea candidate for rejection. n applying this standard, we must keep in sind that in both seience and ethics, thee is tension between theory and data. good theory explains the ate, which in ven influence the shape ofthe theory Particularly strong data can Compel scientists to alter theory to account for heinformation bata good theory an alo give Scientist reasons to question o eject particular ata the same way, thee iakind of give and take between & morl theory andthe relevant dt Our considered moral dgments ray ive tus good reasons for altering or even rejecting fir mors theory. But our torel chery su herent and wel Supported, it may oblige us to rethink or rect our considered judgments, In both science and ethics, the goal isto ensure thatthe fi between theory and das is a ight te possible, The fit aceeplaby close when no farther changes in the theory or the data are necesiry--when there isa kind of balance be {heen the two that moral philosophers cal fective equilibria Another test of adequacy it Crilrion I om sistency withthe fcts of the mora fe In nce good theories ate consistent with cent background knowledge, with what scientists already have good reasons to believe, They are {5 mentioned earlier, conservative. This back round knowledge includes other well founded theories, highly eible findings, and scenic {natural} laws. Moral theories should also be consistent with background. knowledge—the ‘moral Background knowledge, the bas, ines ‘Capable experiences of the moral fe, Thse ex evinces incide making, moral jadgmens, Aisagreeing with others on moral sues, being mistaken in our moral belies, and giving rea sons for accepting moral belies That we do in fact experience these things from time lie isa matter of moral common senae—seersingly ine Vie Ws Evaluating Moral Theories: Criteria of A Cieror I oneiteey wit our considered moral judgments vious facts ofthe moral ifeThs, any moral theory that i inconsistent wh these aspects of the moral life is deeply p-oblematle. It possble that we ace delided about the moral Te—that we, for example, merely think we ate Adsgreving with others on moral issues bat are Seu jt venting our feslings But our expe Hence gies ut good grounds for taking the commonsense view uit we given good tes sons to believe otherwise. Finally, we have Criterion If: esourcfulses i moral problem-solving. IF ascienifc theory helpless answer questions sole problems 2nd contol facts of the natural worl, dem entratesboth ts plausibility ard usefulness, All things being equal, such a resourceful theory is boiler than one that has none ofthese advan tages: Mich the same s true fr moral theories, ‘Aresoutceful moral theory bes us solve moral problems Itcanelp us ident morally televant ‘specs of conduct, judge the rightness cins, resolve conflicts among moral principles and judgments test and correct our moral imitions 2nd undertand theunderyngpoint of morality ie Any mal theory that cs proble- sling resourcefulness is neither useful nor credible. Tnthis section, we apply the thee moral eriteria of adequacy wo two theares wediscussed ear (one consequentialist the other deontolopc) As we do, keepin mind that ealsting moral "theories using thet yardsticksis nota rote pro trax. There leno standard procure for applying the criteria to theory and no eof instructions for assigning conceptual weigh 0 ech criterion 5 we judge a theory’s worth. But the clea do help us make broad jadgments on ational {rounds about a theory’ strengths and weak esses, We must use them as guides, relying on ‘ur best judgment in appiying the, jst tits rot use their ow eat judged in wielding ther kind oferteria of adequacy In ‘either case fe tere a nea algorithms for theaxy ‘sessment, but nonetheless in both arenas te process is objective, reaonabl, ad eset "Weshoul alo remember tht no moral thery is pertec, and none i ily to get the hight marks on every test. But there is much to lea ven from flawed theories. If we look closely, ne ‘an at that each ofthe most influential theoree fof past centuries, even with its fas apparent seems to have grasped atleast modest, gleam ing piece ofthe trth abou the moral ie Uuitarianism Fo simplicity sake, et sry wo aply the criteria to classe actatilitasianism, the view that rit fecons are thse that resin the gentest over happiness for everyone involved. Fist, note tat the theory semsto pas the est suggested by Ci terion If (consistency with the facts ofthe mont If Usitarianiam assumes that we cen indesd. make morsl judgments, have mor disngree ‘ents, be mistaken nour moral bel, and po vide supporting reson for our ord judges “Thetheory. however, hasbeen accused ofa lc: of wefulness—falling Citron I (esourcefu ‘ess in moral problem calving), The wal chage isthattitarianism sa poor guide tothe mor Ife beease the theory demands too much of us and blurs the datinction between oblige and Ssupererogstry actions Utlitaranis sys tat sve should always try to matieize happiness fo MRetyone considered, to d> our utmost (0 in SIee vera uty. But some say tis require then woul lead us to extreme beneficence—t0 ee tatiale, ge avay mot of our possessions, id mest of our time in charity work and “Beth mandatory many ac that we would nr. thally consider above ané beyond the call of {Tty Some defenders ofthe theory have sug eset canbe modified cay 0 case te Seetands that it places onus A fe titarians ave ss that contrary to the popular ew the commonsense distinction between obi thay amd supererogatory ats is mistaken and 1a oat does demard the kindof scrifce thatutartanisen impli. “ihe most serious accusation against classic tltrtanis i that i les in the face of oor aeeiored moral judgments (Criterion spe ‘Sully concerning ites ofjstice and rights Cabdigerthe case ofa medical researcher trying fcadrlopacoeforAlhiersdsesse. To devise thiscare tht would sve countess ives se needs Daly to conduct a single, secret experiment in omnes gives lethal drug to 10 cal-stage Mluhiaer patents (without thee knowledge) et goes a postmortem examination on thei ‘rans By ncesing the anhaprines of 10 pepe (aad depriving them of all possible happiness in the future, she can maximize happiness for thousands Should she conduct the experiment? Teton to classic witarianis, fer ations nGaldpotndeteted ard have notional un Mapp ales the anever sys. The experiment rT be justified bythe enormous amount of werapoines it woul generate. But the util Ten Nerdct seems 0 conti strongly with rar conadered judgments about osie Taking Ser ints af fev people to Benefit many aters sppears unjust, regardless ofthe good conse atepcc that would fw from the esd Cris Bein thatenses ike this shove that iltarinism {sa seriousyinadequte theory ‘Now consider the ase ofa competent patient wth seriousness who refuses medica treat wae on icigious grounds. He Knows that he ‘paul safer much xs pala and havea longer ae happee fe fhe were treated, but be still ‘Sbjct Buispiyscian wants to maximize the Fepines and well-being of al er pants. sarProrepeiousy teats the patent anyway rthout hs consent (Let us assume that noo “tonal lea proflsionl or psychoogieal on sence ensue) Does the Phyisan do Fgh? ‘a Sitaram seems obliged to sy es. But our TBhimonsense judgment would likely be that ‘he physician vated her patent's autonomy Specialy hsright fs determination. Shin vlitarians have replied to sch Cit rion sicisms by ying that cearios ike hose woe prevented are unrealistic and misleading TA eal word they say, ations that seem to nf with our mora intuitions almost alors

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