Hastening death and respect for dignity: Kantianism at the end of life

Suppose that a young athlete has just become quadriplegic. He expects to live several more decades, but out of self‐interest he autonomously chooses to engage in physician‐assisted suicide (PAS) or voluntary active euthanasia (VAE). Some of us are unsure whether he or his physician would be acting rightly in ending his life. One basis for such doubt is the notion that persons have dignity in a Kantian sense. This paper probes responses that David Velleman and Frances Kamm have suggested to the question of whether participating in PAS or VAE to benefit oneself, as the young man might, respects the dignity of persons, specified in an orthodox Kantian way. Velleman claims that it does not, while Kamm insists that, in certain circumstances, it does. I argue against Kamm's position. I go on to contend that while orthodox Kantianism might provide a basis for moral concern regarding the case of the young quadriplegic, it suffers from two serious shortcomings. First, it implies that terminally ill patients are wrong to request VAE or engage in PAS to avoid intense suffering, at least when this suffering has not yet overwhelmed their reason. Second, orthodox Kantianism implies that it is wrong for physicians to withdraw such patients from life‐sustaining treatments, even if they request it. To remedy these shortcomings, I sketch an unorthodox Kantian account of respect for the dignity of persons. This account promises to capture the idea that it would be morally problematic for doctors to help the young quadriplegic to die, but to avoid the shortcomings of an orthodox Kantian account.     

A Defence of Conscientious Objection in Medicine: A Reply to Schuklenk and Savulescu

In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu's 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious objection in publicly‐funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end‐of‐life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk's point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access.     

Genesis of phenotypic and genotypic diversity in land plants: The present as the key to the past

The evolutionary history of vascular plants is reviewed by extrapolation back through time from a wide range of data recently derived from the present flora, using as the central theme evolutionary inferences gained from phylogenies reconstructed as cladograms. Any region of the genome can be used to infer relationships, but only a combination of knowledge of morphology and the developmental genes that underpin morphology can allow evolutionary interpretation of macroevolutionary transitions; this in turn is necessary to identify bona fide evolutionary radiations and any putative causal key innovations. Such studies require clades to be delimited not by the inclusion of particular extant ‘crown’ species but rather by specific apo‐morphies, thereby giving important phylogenetic roles to extinct as well as extant species. Dating phylogenetic divergences via molecular clocks remains seriously inaccurate, and ultimately relies primarily on fossil benchmarks. First principles suggest that evolution of most regions of the genome is fundamentally gradual, whereas evolution of regions especially prone to strong selection pressure, and of the many facets of the phenotype, is punctuational, being characterized through time dominantly by stasis. Sequence data have proved valuable for inferring monophyletic groups, but within the now widely accepted context of monophyly the taxonomic hierarchy should primarily reflect degrees of morphological rather than molecular divergence. Incongruence among contrasting data sets is best explained by understanding the biological constraints operating on each type of phylogenetic information. The conventional ‘uniformitarian’ view of evolution has only limited applicability as one traces the history of land plants through time. Diversity increased in stepwise fashion, reflecting either attainments of complexity and/or fitness thresholds by the lineage (intrinsic) or the availability of unusually permissive environments, often following major perturbations (extrinsic). The Quaternary period demonstrates especially well the resilience, and ease of migration, of the Earth's vegetation. A higher frequency of generation of novel phenotypes in the deep past is possible, but a far higher frequency of their establishment is certain; together, these factors generate an evolutionary pattern of nested radiations that is fractal, as saturation of the resource space rendered the environment decreasingly permissive through time. In the immediate future, evolutionary‐developmental genetics will have increasing value for testing homology, interpreting homoplasy and elucidating evolutionary constraints, and will become easier to pursue as whole‐genome sequences of additional ‘model’ species further invigorate comparative genomics. Complexity of gene regulation, both by other genes and by the cellular and extra‐cellular environment, appears a particularly fruitful area for further research. Nonetheless, environmental filtering of evolutionary novelties (whether instantaneously isolated mutant ‘prospecies’ or classic neoDarwinian ‘selfish genes’ selectively spreading through panmictic populations) can only be effectively understood by longer term monitoring of populations in the wild, to better capture rare evolutionary and ecological events and to better assess the efficacy of traditional microevolutionary processes. We believe that the resulting renaissance in macroevolutionary studies will encourage a broader systematic perspective ‐ one that better encompasses the remarkable diversity of evolutionary processes that together generated the present diversity of life.