No abstract
Analogies come in several forms that serve distinct functions. Inductive analogy is a common type of analogical argument, but critical thinking texts sometimes treat all analogies as inductive. Such an analysis ignores figurative analogies, which may elucidate but do not argue; and also neglects a priori arguments by analogy, a type of analogical argument prominent in law and ethics. A priori arguments by analogy are distinctive, but--contrary to the claims of Govier and Sunstein-they are best understood as deductive, rather than a special form of non deductive reasoning.
This essay explores some concerns about the quality of informed consent in patients whose autonomy is diminished by fatal illness. It argues that patients with diminished autonomy cannot give free and voluntary consent, and that recruitment of such patients as subjects in human experimentation exploits their vulnerability in a morally objectionable way. Two options are given to overcome this objection: (i) recruit only those patients who desire to contribute to medical knowledge, rather than gain access to experimental treatment, or (ii) provide prospective subjects the choice to participate in standard double-blind study or receive the experimental treatment. Either option would guarantee that patients in desperate conditions are given a more meaningful choice and a richer freedom, and thus a higher quality of informed consent, than under standard randomized trials.
An examination of the powerful social and psychological factors that hold the belief in moral responsibility firmly in place. The philosophical commitment to moral responsibility seems unshakable. But, argues Bruce Waller, the philosophical belief in moral responsibility is much stronger than the philosophical arguments in favor of it. Philosophers have tried to make sense of moral responsibility for centuries, with mixed results. Most contemporary philosophers insist that even conclusive proof of determinism would not and should not result in doubts about moral responsibility. Many embrace compatibilist views, and propose an amazing variety of competing compatibilist arguments for saving moral responsibility. In this provocative book, Waller examines the stubborn philosophical belief in moral responsibility, surveying the philosophical arguments for it but focusing on the system that supports these arguments: powerful social and psychological factors that hold the belief in moral responsibility firmly in place. Waller argues that belief in moral responsibility is not isolated but rather is a central element of a larger belief system; doubting or rejecting moral responsibility will involve major adjustments elsewhere in a wide range of beliefs and values. Belief in moral responsibility is one strand of a complex and closely woven fabric of belief, comprising threads from biology, psychology, social institutions, criminal justice, religion, and philosophy. These dense interconnections, Waller contends, make it very difficult to challenge the belief in moral responsibility at the center. They not only influence the philosophical arguments in favor of moral responsibility but also add powerful extraphilosophical support for it.
Autonomy is good for you. A strong sense of competent self-control and effective choice-making promotes both physical and psychological well-being. Loss of autonomous control-and a sense of helplessness-causes depression, increased sensitivity to pain, greater vulnerability to disease, and death. Well established by a wide range of psychological and physiological studies, the positive effects of patient autonomy (and the harms of autonomy deprivation) are well known to competent physicians, nurses, and therapists. Conscientious caregivers are thus moving beyond grudging acceptance of informed consent toward clinical respect for patient autonomy. But as vitally important as autonomy is for both physical and psychological health, promoting autonomy carries a serious risk: the danger that along with increased autonomy will come increased emphasis on the just-deserts (or "moral") responsibility that supports blame and punishment. Autonomy is salubrious, but just-deserts responsibility-the responsibility that justifies awarding differential treatment, including special benefits or detriments-is hazardous to your health. Fortunately, autonomy does not carry just-deserts responsibility in its wake, and the therapeutic benefits of autonomy need not be weighted down by the baleful effects of just deserts. Many regard the close link between autonomy and just-deserts responsibility as so obvious that it requires neither comment nor argument. Thus the noted psychiatrist and bioethicist Willard Gaylin wrote (and the entire paragraph is included in the quote): "Freedom demands responsibility; autonomy demands culpability." 1 The same assumption was more recently voiced by John Hardwig: "But with autonomy comes responsibility. Indeed, the effects of our choices on the lives of others is the very cradle of moral responsibility." 2 And Walter Glannon has confidently asserted: "Autonomy and responsibility are mutually entailing notions." 3 Thus by both common wisdom and philosophical principle autonomy is inseparably joined to moral (just-deserts) responsibility. If patient autonomy flourishes, then just-deserts responsibility must increase along with it. Linking autonomy and just-deserts responsibility has profound implications. The patient is encouraged to exercise greater autonomy in considering and choosing; but if she makes the wrong choices, she must suffer the consequences. If she chooses a less than optimum treatment plan, she should grit her teeth and accept a less than optimum outcome, and not expect the medical community-or her insurer or health maintenance organization or government-to ameliorate the bad effects of her autonomous choices. Clear examples of this view are Leon Kass' recommendation that any national health insurance plan should "build both positive and negative inducements into the insurance plan,
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