Abortion, value and the sanctity of life

In Life's Dominion Dworkin argues that the debate about abortion is habitually misconstrued. Substantial areas of agreement are overlooked, while areas of disagreement are, mistakenly, seen as central. If we uncover a truer picture, then hope of a certain accord may no longer seem vain. I dispute many of these claims.
Dworkin argues that both sides in the debate are united in believing that life is sacred, or intrinsically valuable. I disagree. I maintain that only in a very attenuated sense of intrinsic value will this be agreed upon. I consider how an account of such value might be further fleshed out, but suggest, if this is done on any plausible lines, agreement will fall away. Dworkin argues, also, that the issue of personhood, does not, contrary to widespread belief, keep the parties apart. Again I disagree. We need to distinguish the question of whether there is in fact dispute over this issue from that of whether there is, in truth, good reason for dispute. And I argue that, rightly or wrongly, the issue of personhood remains central. Dworkin suggests that the purported proximity between the two sides offers some hope of an eventual reconciliation. At least, they will agree to differ, accepting that in this area freedom of choice is paramount. I am sceptical. Even this measure of reconciliation depends upon conservatives giving up positions which, I argue, they will continue to maintain.
There is a further point. Dworkin appears to be, in many ways, cautiously optimistic. I appear, in contrast, to be pessimistic. I argue, however, that only so long as we do disagree over matters of substance is there much hope that our differences might be resolved.     

The Identity Objection to the future‐like‐ours argument

Some critics of Don Marquis's ‘future‐like‐ours’ anti‐abortion argument launch what has been called the Identity Objection. The upshot of this objection is that under a psychological theory of personal identity, a non‐sentient fetus lacks precisely what Marquis believes gives it a right to life – a future like ours. However, Eric Vogelstein, in a recent article, has argued that under this theory of personal identity a non‐sentient fetus, in fact, has a future like ours, which he believes dissolves the Identity Objection. But Vogelstein is mistaken. Even if he is correct that there is a sense in which a non‐sentient fetus has a future of value under a psychological theory of personal identity, the sense in which it has one is importantly different from the sense in which we have one, meaning that, under such a theory, a non‐sentient fetus does not have a future like ours.     

'Show me your original face before you were born': the convergence of public fetuses and sacred DNA

Embryology is an intensely visual field, and it has provided the public with images of human embryos and fetuses. The responses to these images can be extremely powerful and personal, and the images (as well as our reactions to them) are conditioned by social and political agendas. The image of the 'autonomous fetus' abstracts the fetus from the mother, the womb, and from all social contexts, thereby emphasizing 'individuality'. The image of 'sacred DNA' emphasizes DNA as the unmoved mover, the eidos, the soul of the human being. Since fertilization involves the forming of a new constellation of DNA in the zygote, the act of fertilization is being perceived as the secular and technical equivalent of ensoulment. This privileges fertilization above the other possible scientifically valued times when 'human life' begins.     

Harming the non-conscious

Peter Singer has argued that nothing done to a fetus before it acquires consciousness can harm it. At the same time, he concedes that a child can be harmed by something done to it when it was a non-conscious fetus. But this implies that the non-conscious fetus can be harmed. The mistake lies in thinking that, since existence can be intrinsically bad for a being only if it is conscious, it can be harmed only if it is conscious. In fact, its being harmed only implies that it could have been conscious (and led a good life).     

Two claims about potential human beings

It seems that at conception something is formed which, due to its genetic make-up, has the potentiality to develop into a full-blown human being. Many believe that in virtue of this potentiality, this organism, the human zygote or early embryo, has in instrinsic value which makes it wrong to use or produce it merely as a means to some end, e.g., some scientific end such as to produce embryonic stem cells. Against this it is here argued, first, that it does not follow from the fact that something has a potential to become a (fully developed) human being that it already is a human being (in a rudimentary sense). In fact, a human being begins to exist no earlier than a couple of weeks after conception, at the stage known as gastrulation. Thus, even granted the questionable assumption that something has instrinsic value in virtue of being a human being, the zygote will not have intrinsic value. Secondly, the value an embryo has in virtue of its potentiality to become a full-blown human being can only be instrumental, a value as a means. But of course it cannot be wrong to treat that which has merely instrumental value as a mere means or instrument to some end.     

The sanctity of life as a sacred value

The doctrine of the sanctity of life has traditionally been characterised as a Judeo-Christian doctrine that has it that bodily human life is an intrinsic good and that it is always impermissible to kill an innocent human. Abortion and euthanasia are often assumed to violate the doctrine. The doctrine is usually understood as being derived from religious dogma and, as such, not amenable to debate. I show that this characterisation of the doctrine is problematic in a number of ways, and I go on to rethink the doctrine. In doing so I follow in the footsteps of Ronald Dworkin, who offered a characterisation of the doctrine in his 1993 Life's Dominion, drawing on a conceptualisation of sacredness that is radically different from standard ones and not dependent on religious dogma. I'll argue that although Dworkin's efforts have much to recommend, his conceptualisation of sacredness is inadequate. Dworkin attempted to reconceptualise sacredness ‘from the armchair’. Here I explain how sacred values are thought of in anthropology and psychology and argue that the sanctity of human life should be understood in the same way. I'll explain how doing so allows us to resolve a number of conceptual problems that bedevil standard characterisations of the doctrine of the sanctity of life. I'll also consider the possibility of a compromise over the sanctity of human life, and as a consequence, compromise over the permissibility of abortion and euthanasia. I'll argue that such compromise is possible, albeit difficult to achieve.     

Academic Freedom,Public Reactions,and Anonymity

Academic freedom can be defined as immunity against adverse reactions from the general public, designed to keep scholars unintimidated and productive even after they have published controversial ideas. Francesca Minerva claims that this notion of strict instrumental academic freedom is supported by Ronald Dworkin, and that anonymity would effectively defend the sphere of immunity implied by it. Against this, I argue that the idea defended by Minerva finds no support in the work by Dworkin referred to; that anonymity would not in most cases effectively protect the kind of immunity sought after; and that in some cases it would not even be desirable to protect scholars from public reactions to their controversial claims.     

Gender context of personalism in bioethics

Personalism is one of the philosophical perspectives which hold that the reality in person and the human person has the highest intrinsic value. This paper makes reference to Louis Janssens' eight criteria in adequate consideration of the human person but further argues that there is need to consider people as situated agents especially within gender relational perspectives. The paper identifies gender as an important social construction that shapes the consideration of the human persons within socio-spatial spheres. The main crux of the paper is that there is a gender context of personalism and this has profound implications for bioethical agendas. Gender is part of the human condition, especially when we philosophically or sociologically engage the notion of equity and equality within the social system, because social realities in the relational perspective are not impartial, impersonal and equal. Gender does not determine morality but it plays a role in morality and expectations from moral agents. Women have been categorised as a sociological group because their integrity, freedom/autonomy and dignity (which are basic concerns of bioethics) are capable of being threatened. A gender perspective provides important incentives for moral theory which searches for possible conceptual imbalances or blind spots in ethical reflections. The paper refers to Sen's faces of gender inequality and expands on the notion that natality inequality is one of the fundamental levels of gender inequality, which in turn is the primary starting agenda in bioethics. The paper avers that the recognition of the fundamental importance of gender to the organization of social reality and the development of personal identities have important practical implications for bioethics.     

Pregnancy and Urinary Calculi

The possibility of upper urinary tract calculus disease is at least as great in pregnant as in nonpregnant women, and such disease if present carries greater risks during pregnancy. The well-being and even the life of both mother and fetus may depend on prompt diagnosis, the right kind of management and effective treatment. With adequate precaution, such essential procedures as urography and emergency surgical intervention can be carried out during pregnancy at little greater hazard than ordinarily attends them.     

Attitudes towards abortion in the Danish population

This article reports the results of a survey, by mailed questionnaire, of the attitudes among a sample of the Danish population towards abortion for social and genetic reasons. Of 1080 questionnaires sent to a random sample of persons between 18 and 45 years, 731 (68%) were completed and returned.
A great majority of the respondents were liberal towards early abortion both for social reasons and in case of minor disease. In contrast, there was controversy about late abortions for social reasons and in the case of Down syndrome. Further there was strong reluctance to accept late abortion in case of minor disease.
An analysis of the response patterns showed that most of the respondents had gradualist views on abortion, i.e. they would allow all early abortions, but only abortions for some reasons later in pregnancy. It was also found that the number who would find an early abortion acceptable in general was much higher than the number who would accept it in their own case. These findings suggest that a great part of the resistance towards abortion does not rest on a concern for the rights and interests for the fetus. Instead it may be explained on a view according to which fetal life is ascribed intrinsic moral value.     

Rights of and duties to non-consenting patients--informed refusal in the developing world

The principle of informed refusal poses a specific problem when it is invoked by a pregnant woman who, in spite of having accepted her pregnancy, refuses the diagnostic and/or therapeutic measures that would ensure the well-being of her endangered fetus. Guidelines issued by professional bodies in the developed world are conflicting: either they allow autonomy and informed consent to be overruled to the benefit of the fetus, or they recommend the full respect of these principles. A number of medical ethicists advocate the overruling of alleged irrational or unreasonable refusal for the benefit of the fetus. The present essay supports the view of fetal rights to health and to life based on the principle that an 'accepted' fetus is a 'third person'. In developing countries, however, the implementation of the latter principle is likely to be in conflict with a 'communitarian' perception of the individual -- in this case, the pregnant woman. Within the scope of the limitations to the right to autonomy of J.S. Mill's 'harm principle', the South African Patients' Charter makes provision for informed refusal. The fact that, in practice, it is not implemented illustrates the well-known difficulty of applying Western bioethical principles in real life in the developing world.     

Diseño y validación de las escalas de evaluación del impacto psicológico de sucesos vitales pasados: el papel del pensamiento rumiativo y el crecimiento personal

Introduction

Older people's emotional distress is often related to rumination processes focused on past vital events occurred during their lives. The specific coping strategies displayed to face those events may contribute to explain older adults’ current well-being: they can perceive that they have obtained personal growth after those events and/or they can show a tendency to have intrusive thoughts about those events. This paper describes the development and analysis of the psychometric properties of the Scales for the Assessment of the Psychological Impact of Past Life Events (SAPIPLE): the past life events-occurrence scale (LE-O), ruminative thought scale (LE-R) and personal growth scale (LE-PG).

Material and methods

Participants were 393 community dwelling elderly (mean age=71.5 years old; SD=6.9). In addition to the SAPIPLE scales, depressive symptomatology, anxiety, psychological well-being, life satisfaction, physical function and vitality have been assessed.

Results

The inter-rater agreement's analysis suggests the presence of two factors in the LE-O: positive and negative vital events. Confirmatory Factor Analysis (CFA) supported this two-dimensional structure for both the LE-R and the LE-PG. Good internal consistency indexes have been obtained for each scale and subscale, as well as good criterion and concurrent validity indexes.

Conclusions

Both ruminative thoughts about past life events and personal growth following those events are related to older adults’ current well-being. The SAPIPLE presents good psychometric properties that justify its use for elderly people.     

Consequentialism, reasons, value and justice

Over the past 10 years, John Harris has made important contributions to thinking about distributive justice in health care. In his latest work, Harris controversially argues that clinicians should stop prioritising patients according to prognosis. He argues that the good or benefit of health care is providing each individual with an opportunity to live the best and longest life possible for him or her. I call this thesis, opportunism. For the purpose of distribution of resources in health care, Harris rejects welfarism (the thesis that the good of health care is well-being) and argues that utilitarianism in general may lead to de facto discrimination against groups of people needing health care. I argue that well-being is a superior theory of the good of health care to Harris' opportunism. Harris' concerns about utilitarianism can be better addressed by: (i) relating justice more closely to reasons for action; (ii) by conceptualising the relationship between reasons for action and the value of the consequences of those actions as a plateau rather than scalar relationship. Justice can be understood as satisfying as many equally rational claims on resources as possible. The rationality of a person's claim on health resources turns on the strength of that person's reasons to promote certain health-related states of affairs. I argue that the strength of that reason does not track the expected value of that state of affairs in a fully scalar fashion. Rather a person can have most reason to promote some state of affairs, even though he or she could promote other more valuable states of affairs. Thus there can be equal reason for a distributor of public resources to save either of two people, even though one will have a better and more valuable life. This approach, while addressing many of Harris' concerns about utilitarianism, does not imply that doctors should give up prioritising patients according to prognosis altogether, but it does allow that patients with lower but reasonable prognosis should have a share of public resources.     

RETRACING LIBERALISM AND REMAKING NATURE: DESIGNER CHILDREN,RESEARCH EMBRYOS,AND FEATHERLESS CHICKENS

Liberal theory seeks to achieve toleration, civil peace, and mutual respect in pluralistic societies by making public policy without reference to arguments arising from within formative ideals about what gives value to human life. Does it make sense to set aside such conceptions of the good when it comes to controversies about stem cell research and the genetic engineering of people or animals? Whether it is reasonable to bracket our worldviews in such cases depends on how we answer the moral questions that the use of these biotechnologies presuppose. I argue that the moral language of liberal justice – of rights and duties, interests and opportunities, freedom and consent, equality and fairness – cannot speak to these underlying concerns about what the human embryo is, why the natural lottery matters to us, and whether ‘animal nature’ is worth preserving. I conclude that liberal theory is incapable of furnishing a coherent or desirable account to govern the way we use our emerging powers of biotechnology.     

Selection in plant populations of effectively infinite size VI. Overlapping generations

A selection model for iteroparous, monoecious, or hermaphroditic plant populations is considered which encompasses viabilities, pollen fertilities, ovule fertilities, and rates of self-fertilization which may arbitrarily depend on both age and genotype. The general conditions for establishment (which are also those for protectedness) of an allele are derived. The classical conjecture that the conditions of protectedness are the same for separated and overlapping generations if the intrinsic rates of increase are applied is discussed. For this purpose it is necessary to introduce two new intrinsic values: the intrinsic rate of self-fertilization and the intrinsic pollen-to-ovule ratio. The significance of the intrinsic values is demonstrated for complete self-fertilization, selection restricted to differential, partial self-fertilization, and sexual asymmetry (absence of proportionality between pollen and ovule production), including selection restricted to one sex. With the exception of asymmetric selection in both sexes, it turns out that the intrinsic values suffice to state the conditions for protectedness, but more information about the life histories is required to determine the exact speed of establishment. For asymmetric selection in both sexes, the concept of intrinsic value is inadequate for investigating the problem of establishment and thus the evolution of life histories. Since sexual asymmetry is rather the rule than the exception and selfing is common in plants, the consequences for finding optimal life histories are outlined.     

What does mental health have to do with well-being?

Positive mental health involves not the absence of mental disorder but rather the presence of certain mental goods. Institutions, practitioners, and theorists often identify positive mental health with well-being. There are strong reasons, however, to keep the concepts of well-being and positive mental health separate. Someone with high positive mental health can have low well-being, someone with high well-being can have low positive mental health, and well-being and positive mental health sometimes conflict. But, while positive mental health and well-being are not identical, there is an informative conceptual connection between them. Positive mental health usually contributes instrumentally to the living of a good human life, where a good human life includes (but is not limited to) well-being.     

Alcohol dependence associated with increased utilitarian moral judgment: a case control study

Recent studies indicate that emotional processes, mediated by the ventromedial prefrontal cortex (VMPC), are of great importance for moral judgment. Neurological patients with VMPC dysfunction have been shown to generate increased utilitarian moral judgments, i.e. are more likely to endorse emotionally aversive actions in order to maximize aggregate welfare, when faced with emotionally salient personal moral dilemmas. Patients with alcohol dependence (AD) also exhibit impairments in functions mediated by the prefrontal cortex, but whether they exhibit increased utilitarian moral reasoning has not previously been investigated. The aim of this study was to investigate moral judgment in AD patients (n = 20) compared to healthy controls (n = 20) matched by sex, age and education years. Each subject responded to a battery of 50 hypothetical dilemmas categorized as non-moral, moral impersonal and moral personal. They also responded to a questionnaire evaluating explicit knowledge of social and moral norms. Results confirmed our hypothesis that AD patients generated increased utilitarian moral judgment compared to controls when faced with moral personal dilemmas. Crucially, there was no difference in their responses to non-moral or impersonal moral dilemmas, nor knowledge of explicit social and moral norms. One possible explanation is that damage to the VMPC, caused by long term repeated exposure to alcohol results in emotional dysfunction, predisposing to utilitarian moral judgment. This work elucidates a novel aspect of the neuropsychological profile of AD patients, namely a tendency to generate utilitarian moral judgment when faced with emotionally salient moral personal dilemmas.     

The Substance View: A Critique (Part 2)

In my initial critique of the substance view, I raised reductio‐style objections to the substance view's conclusion that the standard human fetus has the same intrinsic value and moral standing as the standard adult human being, among others. In this follow‐up critique, I raise objections to some of the premises invoked in support of this conclusion. I begin by briefly presenting the substance view as well as its defense. (For a more thorough presentation, see the first part of my critique.) I then raise objections to three claims involved in the substance view's defense: the claim that the standard human fetus's intrinsic value and moral standing is a function of its potentiality; the claim that the standard human fetus's intrinsic value and moral standing is a function of its essential properties; and the claim that it is the possession of the basic potential for rational moral agency that best accounts for the wrongness of killing the standard human fetus, among others.     

肺癌生存质量量表在晚期肺癌中使用的研究进展

近几年来,肺癌的发病率呈现逐年上升的趋势,成为癌症中的头号杀手。临床上针对不同类型肺癌有不同的治疗策略,由于临床上大部分病人在确诊为肺癌时已经为晚期,对于常规治疗方法难以达到效果时,关注肺癌患者的生存质量就显地尤为必要。肺癌生存质量量表可以反映病人临床治疗后的生存质量状况,达到反馈治疗效果的目的。在临床实验中使用肺癌生存质量量表可以帮助临床医师制定最优化的治疗方案。国际上的研究大多不是以生存质量为主要终点的研究,生存质量也不能全面的反映病人预后的状况,希望在今后的研究中,肺癌生存质量量表能够在临床中的使用更加普及、更加全面。本文就肺癌生存质量量表在晚期肺癌中使用的研究进展作一综述,以期更加促进我们对于晚期肺癌患者生存质量的思考与关注,更有利于适合我国国情的生存质量量表的研究和发展。     

Bioethics for clinicians: 12. Ethical dilemmas that arise in the care of pregnant women: rethinking "maternal-fetal conflicts".

When a pregnant woman makes a decision or acts in a manner that may be detrimental to the health and well-being of her fetus, her physician may be faced with an ethical dilemma. Is the physician''s primary duty to respect the woman''s autonomy, or to promote behaviour that may be in the best interest of the fetus? The controversial concept of "fetal rights" or the "fetus as a patient" contributes to the notion that the pregnant woman and her fetus are potential adversaries. However, Canadian law has upheld women''s right to life, liberty and security of the person and has not recognized fetal rights. If a woman is competent and refuses medical advice, her decision must be respected even if the physician believes that her fetus will suffer as a result. Coercion of the woman is not permissible no matter what appears to be in the best interest of the fetus.