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.     

The Guise of the Bad in Augustine’s Pear Theft

In the second book of his Confessions, Augustine of Hippo presents his famous juvenile Pear Theft as an apparent case of acting under the guise of the bad. At least since Thomas Aquinas’ influential interpretation, scholars have usually taken Augustine’s detailed discussion of the case to be dispelling this “guise of the guise of the bad”, and to offer a solid “guise of the good”-explanation. This paper addresses an important challenge to this view: Augustine offers two different “guise of the good”-explanations in his text rather than just one, and the two explanations seem to be mutually exclusive. A number of more recent attempts to reconcile Augustine’s two lines of explanation are discussed and found wanting, and a new suggestion is made. The proposed solution focuses on the Pear Theft as a joint action, and it departs from the Aquinian interpretation in that it accounts for a way in which the “guise of the bad”-hypothesis survives the explanation.     

Contractualism,Person-Affecting Wrongness and the Non-identity Problem

A number of theorists have argued that Scanlon's contractualist theory both "gets around" and "solves" the non-identity problem. They argue that it gets around the problem because hypothetical deliberation on general moral principles excludes the considerations that lead to the problem. They argue that it solves the problem because violating a contractualist moral principle in one's treatment of another wrongs that particular other, grounding a person-affecting moral claim. In this paper, I agree with the first claim but note that all it shows is that the act is impersonally wrong. I then dispute the second claim. On Scanlon's contractualist view, one wrongs a particular other if one treats the other in a way that is unjustifiable to that other on reasons she could not reasonably reject. We should think of person-affecting wronging in terms of the reasons had by the actual agent and the actual person affected by the agent's action. In non-identity cases, interpersonal justifiability is therefore shaped both by the reason to reject the treatment provided by the bad suffered and the reason to affirm the treatment provided by the goods had as a result of existing. I argue it would be reasonable for the actual person to find the treatment justifiable, and so I conclude that Scanlon's contractualist metaethics does not provide a narrow person-affecting solution to the non-identity problem on its own terms. I conclude that the two claims represent a tension within Scanlon's contractualist theory itself.     

Violence,research, and non-identity in the psychiatric clinic

Violence in psychiatric clinics has been a consistent problem since the birth of modern psychiatry. In this paper, I examine current efforts to understand and reduce both violence and coercive responses to violence in psychiatry, arguing that these efforts are destined to fall short. By and large, scholarship on psychiatric violence reduction has focused on identifying discrete factors that are statistically associated with violence, such as patient demographics and clinical qualities, in an effort to quantify risk and predict violent acts before they happen. Using the work of Horkheimer and Adorno, I characterize the theoretical orientation of such efforts as identity thinking. I then argue that these approaches lead to epistemic imperceptiveness and a subtle form of conceptual restraint on patients. I suggest a reorientation in psychiatric research, away from identity thinking and toward a more productive and just approach to the problem of violence in psychiatric clinics.     

Narrative,Self-Realization,and the Shape of a Life

Velleman, MacIntyre, and others have argued for the compositional view that lives can be other than equally good for the person who lives them even though they contain all and only the same moments, and that this is explained by their narrative structure. I argue instead for explanation by self-realization, partly by interpreting Siegfried Sassoon’s exemplary life-narrative. I decide between the two explanations by distinguishing the various features of the radial concept of narrative, and showing, for each, either that self-realization is just as good an account, or that we should prefer the self-realization account, of the composition it is supposed to explain. I conclude that, if the shape of a life matters, it matters because some shapes are self-realizations, not because they are narratives.     

Evolution and the meaning of being: Heidegger,Jonas and Nihilism

Hans Jonas accuses Heidegger of “never bring[ing] his question about Being into correlation with the testimony of our physical and biological evolution.” Neither the early nor later Heidegger has a “philosophy of nature,” Jonas charges, because Naturphilosophie demands a new concept of matter, a monistic account of cosmogony and evolution, and the grounding of ethical responsibility for future generations in an ontological “first principle.” Jonas’s ontological rethinking of Darwinism allows him to overcome the nihilism that a mechanistic interpretation of evolution forces upon us: a nihilism allegedly shared by Heidegger. I imagine a Heideggerian response to Jonas, and ask whether the dream of recovering a synthesis between cosmogony and moral insight has been irrecoverably shattered by modern natural science.     

The joy of Desire: Understanding Levinas’s Desire of the Other as gift

In this paper, I argue that if we understand Levinas’s Desire of the Other as gift, we can understand it as joyful—that is, as celebratory. After presenting Levinas’s conception of Desire, I consider his claim, found in Otherwise than Being, that the self is a hostage to the Other, and I contend that, paradoxical as it may seem, being a hostage to the Other is actually liberating. Then, drawing on insights Richard Kearney offers in Reimagining the Sacred, I argue for understanding Desire as a gift that is the condition of possibility for joy. If I offer hospitality to the Other, I thereby accept the gift that makes joy possible, and this joy is not egoistic but is the proper response to the gift. Finally, I ask whether Desire can be joyful in practice, given that the pure gift is an originary condition and never a historical one, and I conclude that imperfect joy remains possible. Moreover, this imperfect joy is better than any solitary enjoyment I might experience in the total absence of the Other.