The ethics of separating conjoined twins: two arguments against

I argue that the separation of conjoined twins in infancy or early childhood is unethical (rare exceptions aside). Cases may be divided into three types: both twins suffer from lethal abnormalities, only one twin has a lethal abnormality, or neither twin does. In the first kind of case, there is no reason to separate, since both twins will die regardless of treatment. In the third kind of case, I argue that separation at an early age is unethical because the twins are likely to achieve an irreplaceably good quality of life—the goods of conjoinment—that separation takes away. Evaluation of this possibility requires maturation past early childhood. Regarding the second type, I point out that with conceivable but unrecorded exceptions, these cases will consistently involve sacrifice separation. I present an argument that sacrifice separation is unethical, but in some cases a moral dilemma may exist in which separation and refraining from separation are both unethical. Perhaps in such cases a decision can be made on non-moral grounds; however, the possibility of such a decision serves not to mitigate but to underscore the fact that the separation is unethical. My conclusion, which applies to all three types of cases, is that it is unethical to separate conjoined twins before their developing personalities give some reliable indication as to whether they desire separation and whether they will achieve those goods of conjoinment.     

Interactions between intrinsic principles of similarity and proximity and extrinsic principle of common region in visual perception

The interactions between intrinsic grouping principles (by proximity or by similarity in shape or luminance) and extrinsic grouping by common region were examined by presenting both principles acting alone or conjoined with another principle in visual patterns. The procedure used in our study closely mirrored that of Quinlan and Wilton (1998 Perception 27 417-430). However, in the present experiment, the intrinsic and extrinsic grouping principles involved had similar relative salience in order to avoid their possible effects on interactions. The results showed that the grouping effect of conjoined cooperating principles was greater than that of either principle acting alone, and the grouping effect of conjoined competing principles was lower than that of either principle operating alone. Compatibility of data with additive effects of grouping principles has been examined.     

Conjoined twins and Catholic moral analysis: extraordinary means and casuistical consistency

eThis article draws upon the Roman Catholic distinction between "ordinary" and "extraordinary" means of medical treatment to analyze the case of "Jodie" and "Mary," the Maltese conjoined twins whose surgical separation was ordered by the English courts over the objection of their Roman Catholic parents and Cormac Murphy-O'Connor, the Roman Catholic Cardinal Archbishop of Westminister. It attempts to shed light on the use of that distinction by surrogate decision makers with respect to incompetent patients. In addition, it critically analyzes various components of the distinction by comparing the reasoning used by Catholic moralists in this case with the reasoning used in other cases that raise similar issues, including women facing crisis pregnancies who prefer abortion to adoption and the Indiana "Baby Doe" case.     

Double Effect and the End-Not-Means Principle: A Response to Bennett

Proponents of double-effect reasoning — relying in part on a distinction between intention and foresight — assert that it is worse intentionally to cause harm than to cause harm with foresight but without intention. They hold, for example, that terror bombing is worse than tactical bombing in so far as terror bombing is the intentional harming of non-combatants while tactical bombing is not. In articulating the ethical relevance of the intended/foreseen distinction, advocates of double effect employ the Kantian end-not-means principle.
Jonathan Bennett has recently argued that this principle cannot ground the ethical relevance of the intended/foreseen distinction. He holds that the principle demands that one benefit others while double effect deals with acts that do not benefit others. Thus, he maintains, the intended/foreseen distinction does not have ethical import and double effect is not tenable. I argue for a reading of the end-not-means principle that grounds the ethical relevance of both the intended/foreseen distinction and double effect.     

Separated after birth

Bioethics has developed against a backdrop of increased concern for human and civil rights, including the rights of patients to decide about their own treatment. The recent case of Laleh and Ladan Bijani, the twenty-nine-year old Iranian conjoined twins who died in a Singapore hospital on Jul 8, after more than fifty hours of surgery aimed at separating them, highlights the tensions between respect for patient autonomy and professional medical judgment.     

The Double Life of Double Effect

The U.S. Supreme Court's majorityopinion in Vacco v. Quill assumes thatthe principle of double effect explains thepermissibility of hastening death in thecontext of ordinary palliative care and inextraordinary cases in which painkilling drugshave failed to relieve especially intractablesuffering and terminal sedation has beenadopted as a last resort. The traditionaldoctrine of double effect, understood asproviding a prohibition on instrumental harmingas opposed to incidental harming or harming asa side effect, must be distinguished from otherways in which the claim that a result is notintended might be offered as part of ajustification for it. Although double effectmight appropriately be invoked as a constrainton ordinary palliative care, it is not clearthat it can be coherently extended to justifysuch practices as terminal sedation. A betterapproach would reconsider double effect'straditional prohibition on hastening death as ameans to relieve suffering in the context ofacute palliative care.     

Double effect,all over again: The case of Sister Margaret McBride

As media reports have made widely known, in November 2009, the ethics committee of St. Joseph’s Hospital in Phoenix, Arizona, permitted the abortion of an eleven-week-old fetus in order to save the life of its mother. This woman was suffering from acute pulmonary hypertension, which her doctors judged would prove fatal for both her and her previable child. The ethics committee believed abortion to be permitted in this case under the so-called principle of double effect, but Thomas J. Olmsted, the bishop of Phoenix, disagreed with the committee and pronounced its chair, Sister Margaret McBride, excommunicated latae sententiae, “by the very commission of the act.” In this article, I take the much discussed Phoenix case as an occasion to subject the principle of double effect to another round of philosophical scrutiny. In particular, I examine the third condition of the principle in its textbook formulation, namely, that the evil effect in question may not be the means to the good effect. My argument, in brief, is that the textbook formulation of the principle does not withstand philosophical scrutiny. Nevertheless, in the end, I do not claim that we should then “do away” with the principle altogether. Instead, we do well to understand it within the context of casuistry, the tradition of moral reasoning from which it issued.     

Moralism and the good

It is often held that moral considerations take precedence over considerations of other kinds in determining what we ought to do. I contend that this claim is ambiguous and argue that objections to each interpretation of it can be met only by rejecting the other. One surprising consequence of my argument is that no deontic moral theory can effectively guide action unless it is conjoined with a theory of the good. Another interesting consequence is that the deontologists' favorite objection to teleological theories — the objection from injustice — does not go through.     

Non-heart-beating donors of organs: are the distinctions between direct and indirect effects & between killing and letting die relevant and helpful?

This essay analyzes the principle of double effect and, to a lesser extent, the distinction between killing and letting die in the context of the Pittsburgh protocol for managing patients who may become non-heart-beating donors or sources of organs for transplantation. It notes several ambiguities and unresolved issues in the Pittsburgh protocol but concludes that neither the principle of double effect nor the distinction between killing and letting die (with the prohibition of the former and the allowance of the latter under some circumstances) erects insurmountable obstacles to the implementation of the protocol. Nevertheless, the requirement of the principle of double effect that the intended good effects outweigh the unintended side effects necessitates careful attention to the probable overall impact of the proposed policy on organ procurement, particularly because public mistrust plays such a significant role in limiting the number of organ donations.     

EAS temperaments during the last half of the life span: twins reared apart and twins reared together

In this first behavioral genetic study of personality in the last half of the life span, results are reported using the powerful adoption/twin design that compares identical and fraternal twins reared apart and identical and fraternal twins reared together. Traits studied were the EAS temperaments (emotionality, activity level, and sociability), traits that show substantial genetic influence in childhood. It was hypothesized that the EAS traits would also show significant genetic influence later in life and that most of the environmental variation would be nonshared--that is, twins reared together would show no greater resemblance for the EAS traits than twins reared apart. Both hypotheses are supported.     

Deconstructing the Doctrine of Double Effect

This paper examines the doctrine of double effect as it is typically applied. The difficulty of distinguishing between what we intend and what we foresee is highlighted. In particular, Warren Quinn's articulation of that distinction is examined and criticised. It is then proposed that the only credible way that we can be said to foresee that a harm will result and mean something other than that we intend it to result, is if we are not certain that that harm will result. The ramifications of this are explored. The paper concludes with a moral evaluation of a variety of cases that have harmful outcomes. It is recommended both that we abandon the doctrine of double effect and that we cease to describe cases with harmful outcomes in a dishonest way.     

Interpreting conjoined noun phrases and conjoined clauses: Collective versus distributive preferences

Two experiments are reported that show that introducing event participants in a conjoined noun phrase (NP) favours a single event (collective) interpretation, while introducing them in separate clauses favours a separate events (distributive) interpretation. In Experiment 1, acceptability judgements were speeded when the bias of a predicate toward separate events versus a single event matched the presumed bias of how the subjects' referents were introduced (as conjoined noun phrases or in conjoined clauses). In Experiment 2, reading of a phrase containing an anaphor following conjoined noun phrases was facilitated when the anaphor was they, relative to when it was neither/each of them; the opposite pattern was found when the anaphor followed conjoined clauses. We argue that comprehension was facilitated when the form of an anaphor was appropriate for how its antecedents were introduced. These results address the very general problem of how we individuate entities and events when presented with a complex situation and show that different linguistic forms can guide how we construe a situation. The results also indicate that there is no general penalty for introducing the entities or events separately-in distinct clauses as "split" antecedents.     

Interpreting conjoined noun phrases and conjoined clauses: Collective versus distributive preferences

Two experiments are reported that show that introducing event participants in a conjoined noun phrase (NP) favours a single event (collective) interpretation, while introducing them in separate clauses favours a separate events (distributive) interpretation. In Experiment 1, acceptability judgements were speeded when the bias of a predicate toward separate events versus a single event matched the presumed bias of how the subjects' referents were introduced (as conjoined noun phrases or in conjoined clauses). In Experiment 2, reading of a phrase containing an anaphor following conjoined noun phrases was facilitated when the anaphor was they, relative to when it was neither/each of them; the opposite pattern was found when the anaphor followed conjoined clauses. We argue that comprehension was facilitated when the form of an anaphor was appropriate for how its antecedents were introduced. These results address the very general problem of how we individuate entities and events when presented with a complex situation and show that different linguistic forms can guide how we construe a situation. The results also indicate that there is no general penalty for introducing the entities or events separately—in distinct clauses as “split” antecedents.     

Business is not just war. Transferring the principle of double effect from war to business

Abstract

In this article the validity of transferring the Principle of Double Effect from the just war tradition to the domain of business is critically reviewed. If a case can be build for sufficient analogies between war and business, the principle of double effect can legitimately be transferred from war to business. If, on the other hand it can be shown that there are aspects in which business differ substantially from just war, then the transfer to business of a principle developed within the context of war becomes more problematic. After exploring the nature of arguments of analogy and fallacious arguments of weak analogy some important disanalogies between war and business are highlighted. Given these disanalogies it is then contended that the just war background of the Principle of Double Effect had some bearing on both the content and manner of application of the Principle of Double Effect. Finally it is argued that these disanalogies require some revisions to the Principle of Double Effect with regard to both its content and its manner of application before it can be applied meaningfully to foreseeable negative side-effects of business.     

Problems in Psychiatric Genetic Research: A Reply to Faraone and Biederman

This article examines evidence cited in favor of the operation of genetic factors in attention-deficit hyperactivity disorder (ADHD). Like other psychiatric conditions, a belief in the genetic basis of ADHD is derived from the results of family, twin, and adoption studies. Because family studies are widely believed to be confounded by environmental factors, primary emphasis is placed on twin and adoption studies. ADHD twin studies depend on the validity of the equal environment assumption (EEA), which holds that the environments of identical (MZ) and fraternal (DZ) twins are the same. Here it is argued that however the EEA is defined, it cannot be accepted. Therefore, the greater similarity or concordance of MZ twins when compared to DZ twins is plausibly explained by environmental factors. Adoption studies constitute a third method for investigating the role of genetic factors in ADHD. It is argued that these studies are greatly flawed by factors including non blinded diagnoses and the failure to study the biological relatives of adoptees. After an examination of the total weight of evidence in favor of a genetic basis or predisposition for ADHD, it is concluded that a role for genetic factors is not supported and that future research should be directed toward psychosocial causes     

Hedonic possibilities and heritability statistics

Several influential psychologists have attempted to estimate to what extent human happiness levels are directly controlled by genes by comparing the happiness levels of identical twins raised apart. If we discover that the happiness levels of identical twins raised apart tend to be closer than the happiness levels of fraternal twins raised apart, this is taken as evidence that average happiness levels are largely controlled by genes. However, if it turns out that identical twins' happiness levels tend to be substantially different, as different as fraternal twins raised apart, it has been argued that this implies that the environment largely determines happiness levels. I contend that this interpretation of the data rests on a set of questionable, closely related assumptions: a) that pairs of identical twins raised apart are raised in substantially different environments; b) that genetically identical twins aren't identical in other pertinent ways; and c) that average levels of affect that are correlated with certain sets of genes in the environments the twin studies were conducted in will be correlated with those genes in other relevant environments because those genes govern average affect levels. In this paper, I will show that these assumptions are false and explain how to properly go about investigating the contingent causal links between genes and happiness. In the end, I argue that there is no good evidence that our genes delimit our hedonic potential and that the fact that this misinterpretation of the data has been widely disseminated is potentially harmful to human well-being.     

An investigation of the use of linguistic probes “by” and “in order to” in assessing moral grammar

Proponents of the linguistic analogy suggest that methodologies originally developed for investigating linguistic grammar can also be fruitfully applied to the empirical study of moral grammar: the causal and intentional representations of moral events which – according to the linguistic analogy – drive moral judgements. In the current study, we put this claim to the empirical test. Participants were presented with moral dilemmas which previously have been shown to implement a central principle in moral judgements: the principle of double effect (PDE). Participants responded to by and in order to probes to assess causal and intentional representations of this principle. Results show that these linguistic probes do not relate to moral judgement in the manner predicted by proponents of the linguistic analogy and moral grammar. Although the linguistic analogy is a theoretically rich framework, the procedures posited to give it empirical traction require revision.     

Probabilistic reasoning in prediction and diagnosis: Effects of problem type,response mode,and individual differences

In prediction, subset relations require that the probability of conjoined events is never higher than that of constituent events. However, people's judgments regularly violate this principle, producing conjunction errors. In diagnosis, the probability of a hypothesis normatively is often higher for conjoined cues. An online survey used a within‐subjects design to explore the degree to which participants (n = 347) differentiated diagnosis and prediction using matched scenarios and both choice and estimation responses. Conjunctions were judged more probable than a constituent in diagnosis (76%) more often than prediction (64%) and in choice (84%) more often than direct estimation (57%), with no interaction of type of task and response mode. Correlation, regression, and path analyses were used to determine the relationships among individual difference variables and the diagnosis and prediction tasks. Among the correlation findings was that time spent on the task predicted higher conjunction probabilities in diagnosis but not prediction and that class inclusion errors predicted increased conjunction errors in choice but not estimation. Need for cognition and numeracy were only minimally related to reasoning about conjunctions. Results are consistent with the idea that people may misapply diagnostic reasoning to the prediction task and consequently commit the conjunction error. Copyright © 2010 John Wiley & Sons, Ltd.     

Accessing singular antecedents in conjoined phrases

Two experiments examined processing of singular pronouns when the antecedent (e.g., Mary) was a noun phrase (NP) in a conjoined phrase (e.g., Mary and John). Whole-sentence reading times showed an increase in processing time associated with splitting the conjoined phrase to access a single NP antecedent. The increase in processing occurred both when the antecedent was in the subject position and when it was in a nonsubject position. The source of the disruption was further investigated using eyetracking methods. Summing over regions of the text, the magnitude of the processing cost incurred by having to split a conjoined NP was closely comparable when there was and when there was not a gender-appropriate distracting potential antecedent. When there was no such potential antecedent, the increase in processing time occurred immediately in the pronoun region when eye movements were measured. In contrast, when there was a second discourse entity that matched the gender and number of the pronoun (but was not a plausible antecedent for the pronoun), eyetracking measures suggested that the processing difficulty was delayed until additional information was read that forced the antecedent to be one of the conjoined NPs. The results are interpreted in terms of Sanford and Garrod’s (1981) scenario-based model of text comprehension.     

Lifespan extension and the doctrine of double effect

Recent developments in biogerontology—the study of the biology of ageing—suggest that it may eventually be possible to intervene in the human ageing process. This, in turn, offers the prospect of significantly postponing the onset of age-related diseases. The biogerontological project, however, has met with strong resistance, especially by deontologists. They consider the act of intervening in the ageing process impermissible on the grounds that it would (most probably) bring about an extended maximum lifespan—a state of affairs that they deem intrinsically bad. In a bid to convince their deontological opponents of the permissibility of this act, proponents of biogerontology invoke an argument which is grounded in the doctrine of double effect. Surprisingly, their argument, which we refer to as the ‘double effect argument’, has gone unnoticed. This article exposes and critically evaluates this ‘double effect argument’. To this end, we first review a series of excerpts from the ethical debate on biogerontology in order to substantiate the presence of double effect reasoning. Next, we attempt to determine the role that the ‘double effect argument’ is meant to fulfil within this debate. Finally, we assess whether the act of intervening in ageing actually can be justified using double effect reasoning.