Withholding and Withdrawing Life-Sustaining Treatment: Ethically Equivalent?

Withholding and withdrawing treatment are widely regarded as ethically equivalent in medical guidelines and ethics literature. Health care personnel, however, widely perceive moral differences between withholding and withdrawing. The proponents of equivalence argue that any perceived difference can be explained in terms of cognitive biases and flawed reasoning. Thus, policymakers should clear away any resistance to accept the equivalence stance by moral education. To embark on such a campaign of changing attitudes, we need to be convinced that the ethical analysis is correct. Is it? In this article, I take a closer look at the moral relation between withholding and withdrawing. My conclusion is that withholding and withdrawing are not in general ethically equivalent. Thus, medical guidelines should be rewritten, and rather than being “educated” away from their sound judgments, medical professionals and patients should have nuanced medico-ethical discussions regarding withholding and withdrawing treatment.     

Monitoring and meta-metacognition in the own-race bias

Although there is a great deal of research focused on identification issues related to own-versus other-race faces very few experiments have explored whether metacognitive monitoring contributes to the own-race bias. In the current experiment the typical own-race bias paradigm was modified so that type-2 signal detection measures (e.g.  and ) could be used to directly measure metacognitive monitoring at retrieval. A second goal of the experiment was to explore whether self-reported confidence ratings differed depending on whether they were directed at answer accuracy (e.g., judging a face as “studied”) versus at decisions about that answer (e.g., volunteering vs. withholding that answer). Overall the results demonstrated that monitoring does contribute to the own-race bias, in that participants were better at monitoring their memory for own-race faces. Further, there was a significant difference between the two confidence measures, and the pattern of this difference depended on whether responses had been volunteered or withheld.     

Vicarious dishonesty: When psychological closeness creates distance from one’s moral compass

In four studies employing multiple manipulations of psychological closeness, we found that feeling connected to another individual who engages in selfish or dishonest behavior leads people to behave more selfishly and less ethically themselves. In addition, psychologically connecting with a scoundrel led to greater moral disengagement. We also establish that vicarious justification is the mechanism explaining this effect: When participants felt psychologically close to someone who had behaved selfishly, they were more likely to consider the behavior to be less shame-worthy and less unethical; it was these lenient judgments that then led them to act more unethically themselves. These vicarious effects were moderated by whether the miscreant was identified with a photograph and by the type of behavior. Importantly, we establish a general process of vicariousness: psychological closeness produced both vicarious generosity and selfishness depending on the behavior of the person one feels psychologically connected to. These findings suggest an irony of psychological closeness: it can create distance from one’s own moral compass.     

Axiological Absolutism and Risk1

Consider the following claim: given the choice between saving a life and preventing any number of people from temporarily experiencing a mild headache, you should always save the life. Many moral theorists accept this claim. In doing so, they commit themselves to some form of ‘moral absolutism’: the view that there are some moral considerations (like being able to save a life) that cannot be outweighed by any number of lesser moral considerations (like being able to avert a mild headache). In contexts of certainty, it is clear what moral absolutism requires of you. However, what does it require of you when deciding under risk? What ought you to do when there is a chance that, say, you will not succeed in saving the life? In recent years, various critics have argued that moral absolutism cannot satisfactorily deal with risk and should, therefore, be abandoned. In this paper, we show that moral absolutism can answer its critics by drawing on—of all things—orthodox expected utility theory.     

The morality of scientific openness

The ideal of scientific openness — i.e. the idea that scientific information should be freely accessible to interested parties — is strongly supported throughout the scientific community. At the same time, however, this ideal does not appear to be absolute in the everyday practice of science. In order to get the credit for new scientific advances, scientists often keep information to themselves. Also, it is common practice to withhold information obtained in commissioned research when the scientist has agreed with his or her employer to do so. The secrecy may be intended for ever, as in the military area, but also temporarily until a patent application has been made. The paper explores to what extent such secrecy is undesirable, as seems to be suggested by the ideal of scientific openness. Should this ideal be interpreted as having certain exceptions which make the above-mentioned practices acceptable? Are there, on closer inspection, good arguments for the ideal of scientific openness, and for officially upholding it? Possible versions of the ideal of scientific openness are explored and the issue is found to be rather complex, allowing for wide variations depending on the acting parties, beneficiaries, types of information and moral requirements involved. We conclude that the arguments usually given in favour of this ideal are weaker than what seems to be generally believed, and that, on closer inspection, they leave plenty of room for exceptions to it. These exceptions only partly cover the actual practice of withholding scientific information, and there may still be good reason to advocate, teach and enforce the ideal of scientific openness within the scientific community.     

Acting rightly: Three dimensions of moral conduct

Philosophical literature in normative ethics has tended to concentrate on (1) what we should do—what acts we should perform—or (2) virtues of character, understood as leading to the right deeds or (3), as most notable in Kant, the importance of motivation appraising agents and actions. All these elements—actions, virtues, and motives—are ethically significant. But there is a dimension of moral responsibility that should be given a place beside obligations to act, virtues of character, and appraisability of actions in relation to their motivation. It is the manner in which actions are performed. This can be right or wrong, an object of intention, and behavior for a reason; and it is important for assessing moral virtue. This paper explores manners of action, shows why they apparently do not reduce to kinds of actions, and proposes an account of their importance. The result is a wider conception of acting rightly than the common understanding on which it simply doing the right thing, a partial account of how acting rightly figures in the content of intention, and a sketch of the moral dimensions of the manners in which we act.     

TOPICAL EPISTEMOLOGIES

Abstract: What is the point of developing an epistemology for a topic—for example, morality? When is it appropriate to develop the epistemology of a topic? For many topics—for example, the topic of socks—we see no need to develop a special epistemology. Under what conditions, then, does a topic deserve its own epistemology? I seek to answer these questions in this article. I provide a criterion for deciding when we are warranted in developing an epistemological theory for a topic. I briefly apply this criterion to moral epistemology and argue that some approaches to moral epistemology should be abandoned. I also argue that we can develop an epistemology for a topic without committing ourselves to a specific substantive theory of justification, such as reliabilism or coherentism, if we work within a suitably neutral framework.     

Moral Self-Licensing: When Being Good Frees Us to Be Bad

Past good deeds can liberate individuals to engage in behaviors that are immoral, unethical, or otherwise problematic, behaviors that they would otherwise avoid for fear of feeling or appearing immoral. We review research on this moral self-licensing effect in the domains of political correctness, prosocial behavior, and consumer choice. We also discuss remaining theoretical tensions in the literature: Do good deeds reframe bad deeds (moral credentials) or merely balance them out (moral credits)? When does past behavior liberate and when does it constrain? Is self-licensing primarily for others’ benefit (self-presentational) or is it also a way for people to reassure themselves that they are moral people? Finally, we propose avenues for future research that could begin to address these unanswered questions.     

Blind ethics: Closing one's eyes polarizes moral judgments and discourages dishonest behavior

Four experiments demonstrate that closing one’s eyes affects ethical judgment and behavior because it induces people to mentally simulate events more extensively. People who considered situations with their eyes closed rather than open judged immoral behaviors as more unethical and moral behaviors as more ethical. In addition, considering potential decisions with closed eyes decreased stated intentions to behave ethically and actual self-interested behavior. This relationship was mediated by the more extensive mental simulation that occurred with eyes closed rather than open, which, in turn, intensified emotional reactions to the ethical situation. We discuss the implications of these findings for moral psychology and ethical decision making.     

The Concept of Harm and the Significance of Normality

Many believe that severe intellectual impairment, blindness or dying young amount to serious harm and disadvantage. It is also increasingly denied that it matters, from a moral point of view, whether something is biologically normal to humans. We show that these two claims are in serious tension. It is hard explain how, if we do not ascribe some deep moral significance to human nature or biological normality, we could distinguish severe intellectual impairment or blindness from the vast list of seemingly innocent ways in which we fail to have as much wellbeing as we could, such not having super‐intelligence, or not living to 130. We consider a range of attempts to draw this intuitive normative distinction without appealing to normality. These, we argue, all fail. But this doesn't mean that we cannot draw this distinction or that we must, implausibly, conclude that biological normality does possess an inherent moral importance. We argue that, despite appearances, it is not biological normality but rather statistical normality that, although lacking any intrinsic moral significance, nevertheless makes an important moral difference in ways that explain and largely justify the intuitive distinction.     

Traversing boundaries: clinical ethics,moral experience,and the withdrawal of life supports

While many have suggested that to withdraw medical interventions is ethically equivalent to withholding them, the moral complexity of actually withdrawing life supportive interventions from a patient cannot be ignored. Utilizing interplay between expository and narrative styles, and drawing upon our experiences with patients, families, nurses, and physicians when life supports have been withdrawn, we explore the changeable character of boundaries in end-of-life situations. We consider ways in which boundaries imply differences – for example, between cognition and performance – and how the encounter with boundaries can generate altered meanings important for understanding decisions and actions in these contexts. We conclude that the reliance on mere roles to support the moral weight of withdrawing medical interventions is inadequate. Roles that lead us to such moments are exceeded by the responsibility encountered in such moments. And here, we suggest, is the momentous character of withdrawal: it presents the grave astonishment, the trembling awe, in the not-being-there of the other in death.     

Betting Against Compatibilism

Some argue that libertarianism represents the riskier incompatibilist view when it comes to the free will problem. An ethically cautious incompatibilist should bet that we are not free in the sense required for moral responsibility, these theorists claim, as doing so means that we no longer run the risk of holding the morally innocent responsible. In this paper, I show that the same reasoning also advises us to bet against compatibilism. Supposing that we are unsure about whether or not the causal order of the world is compatible with the kind of freedom that is required for moral responsibility, an ethically cautious approach would once again bet that hard incompatibilism is true.     

Modelling the Moral Dimension of Decisions

In this paper we explore the connections between ethics and decision theory. In particular, we consider the question of whether decision theory carries with it a bias towards consequentialist ethical theories. We argue that there are plausible versions of the other ethical theories that can be accommodated by “standard” decision theory, but there are also variations of these ethical theories that are less easily accommodated. So while “standard” decision theory is not exclusively consequentialist, it is not necessarily ethically neutral. Moreover, even if our decision‐theoretic models get the right answers vis‐à‐vis morally correct action, the question remains as to whether the motivation for the non‐consequentialist theories and the psychological processes of the agents who subscribe to those ethical theories are lost or poorly represented in the resulting models.     

The moral behavior of ethics professors: Relationships among self-reported behavior,expressed normative attitude,and directly observed behavior

Do philosophy professors specializing in ethics behave, on average, any morally better than do other professors? If not, do they at least behave more consistently with their expressed values? These questions have never been systematically studied. We examine the self-reported moral attitudes and moral behavior of 198 ethics professors, 208 non-ethicist philosophers, and 167 professors in departments other than philosophy on eight moral issues: academic society membership, voting, staying in touch with one's mother, vegetarianism, organ and blood donation, responsiveness to student emails, charitable giving, and honesty in responding to survey questionnaires. On some issues, we also had direct behavioral measures that we could compare with the self-reports. Ethicists expressed somewhat more stringent normative attitudes on some issues, such as vegetarianism and charitable donation. However, on no issue did ethicists show unequivocally better behavior than the two comparison groups. Our findings on attitude-behavior consistency were mixed: ethicists showed the strongest relationship between behavior and expressed moral attitude regarding voting but the weakest regarding charitable donation. We discuss implications for several models of the relationship between philosophical reflection and real-world moral behavior.     

Group moral discount: Diffusing blame when judging group members

People lie more when they work as a group rather than alone. However, do people suspect and morally evaluate groups and individuals differently when they are suspiciously successful? In four experiments, we examine whether (a) suspiciously successful individuals and groups are judged and punished differently and (b) individual group members are judged differently from the group as one unit. Results suggest that people suspect successful groups and individuals to the same extent. However, group members are less likely to be suspected, judged negatively, punished, and reported on, when they are judged as separate individuals compared with as a group. The findings demonstrate a bias in judgment of group members, stemming from the method of evaluation—holistic or separate. We suggest that in order to minimize bias when judging misconduct by a group, the moral evaluation and punishment of all group members should be considered simultaneously.     

Frankfurt in Fake Barn Country

It is very widely held that Frankfurt‐style cases—in which a counterfactual intervener stands by to bring it about that an agent performs an action but never actually acts because the agent performs that action on her own—show that free will does not require alternative possibilities. This essay argues that that conclusion is unjustified, because merely counterfactual interveners may make a difference to normative properties. It presents a modified version of a fake barn case to show how a counterfactual intervener can make the difference between an agent knowing a fact or merely truly believing that fact, by eliminating veretic epistemic luck. If counterfactual interveners can make this kind of difference to the epistemic status of agents, the essay argues, there is no reason why they can't make an analogous difference to agents' moral responsibility. It concludes that reflection on these cases reveals that despite the mountains of words spilled on the topic, we still don't fully understand what role access to alternative possibilities plays in whether or not agents are morally responsible for their actions.     

A Single Counterexample Leads to Moral Belief Revision

What kind of evidence will lead people to revise their moral beliefs? Moral beliefs are often strongly held convictions, and existing research has shown that morality is rooted in emotion and socialization rather than deliberative reasoning. In addition, more general issues—such as confirmation bias—further impede coherent belief revision. Here, we explored a unique means for inducing belief revision. In two experiments, participants considered a moral dilemma in which an overwhelming majority of people judged that it was inappropriate to take action to maximize utility. Their judgments contradicted a utilitarian principle they otherwise strongly endorsed. Exposure to this scenario led participants to revise their belief in the utilitarian principle, and this revision persisted over several hours. This method provides a new avenue for inducing belief revision.     

Taking human life

Alan Donagan's position regarding the morality of taking innocent human life, that it is impermissible regardless of the wishes of the victim, is criticized by Brock who argues for a rights-based alternative. His argument appeals to the nature of persons' actual interest in life and gives them an additional element of control which they lack if a nonwaivable moral duty not to kill prevails. The author rejects Donagan's view that stopping a life-sustaining treatment, even when a competent patient has consented, is morally wrong and that there is no moral difference between killing and allowing to die. A rights-based position permits stopping treatment of incompetent patients based on what the patient would have wanted or what is in his or her best interest, and allows the withholding of treatment from a terminally ill person, with the patient's consent and for a benevolent motive, to be evaluated as morally different from killing that patient.     

Seeing Like a Geologist: Bayesian Use of Expert Categories in Location Memory

Memory for spatial location is typically biased, with errors trending toward the center of a surrounding region. According to the category adjustment model (CAM), this bias reflects the optimal, Bayesian combination of fine‐grained and categorical representations of a location. However, there is disagreement about whether categories are malleable. For instance, can categories be redefined based on expert‐level conceptual knowledge? Furthermore, if expert knowledge is used, does it dominate other information sources, or is it used adaptively so as to minimize overall error, as predicted by a Bayesian framework? We address these questions using images of geological interest. The participants were experts in structural geology, organic chemistry, or English literature. Our data indicate that expertise‐based categories influence estimates of location memory—particularly when these categories better constrain errors than alternative (“novice”) categories. Results are discussed with respect to the CAM.