Using Cases with Contrary Facts to Illustrate and Facilitate Ethical Analysis

There has been increasing interest in developing practical, non-theoretical tools for analyzing ethical problems in public health, biomedicine, and other scientific disciplines so that professionals can make and justify ethical decisions in their own research or practice. Tools for ethical decisionmaking, together with case studies on ethics, are often used in graduate education programs and in continuing professional education. Students can benefit from opportunities to further develop their analytical skills, to recognize ethical issues, and to develop their moral sensitivity. One practical approach for illustrating and facilitating ethical analysis uses cases with contrary facts and circumstances, an approach which complements rather than replaces theoretical approaches to moral reasoning. Cases with contrary facts and circumstances are presented in two or more alternative ways so that the facts, circumstances, or framing of one version runs counter to that of the other version (s). Cases with contrary facts, together with practical steps for identifying and analyzing ethical issues, are likely to be useful tools for illustrating and facilitating ethics analysis and stimulating the moral imagination. The findings and conclusions in this article are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Fischer’s Way: The Next Level

I present an analogy between analytic philosophy and a particular sort of computer game, and analyze some aspects of John Martin Fischer's My Way in the light of this analogy. I set out the different levels of the free will question, and explore how well Fischer does on them. On the compatibility level, he succeeds, in my view, in confronting the "metaphysical challenge" and the "manipulation challenge", but does less well with the "moral arbitrariness challenge". The compatibilist perspective captures only part of the moral and personal truth on the compatibility issue, and is shown to be inherently shallow. On the next levels we see that Fischer confronts particular dangers: the very virtues that make his minimalist position so resilient on the second (compatibility) level, render it too impoverished when it comes to the third, which asks about the very importance of taking moral responsibility seriously. Connecting to other positions (such as P.F. Strawson's version of naturalism) may be an imperative, but would also be risky. Likewise, on the fourth level, where we confront the difficulty of deciding how to deal with the previous conclusions, it is doubtful how well Fischer can do, given his previous philosophical commitments.

Infant feeding and HIV in Sub-Saharan Africa: what lies beneath the dilemma?

The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally in other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities.

Third party assisted conception: an African perspective

The central importance of reproduction in all human cultures has given rise to many methods and techniques of assisting reproduction or overcoming infertility. Such methods and techniques have achieved spectacular successes in the Western world, where processes like in vitro fertilization (IVF) constitute a remarkable breakthrough. In this paper, the author attempts to reflect critically on assisted reproduction technologies (ART) from the background and perspective of African culture, a culture within which human reproduction is given the highest priority but which also exhibits a highly ambivalent attitude to modern technology-assisted methods of reproduction. The author considers the ethical crux of reproductive technologies to be linked to the issue of the moral status of the human embryo and argues that a morally significant line of demarcation cannot be drawn between embryos and other categories of humans.     

The Great Apes and the Severely Disabled: Moral Status and Thick Evaluative Concepts

The literature of bioethics suffers from two serious problems. (1) Most authors are unable to take seriously both the rights of the great apes and of severely disabled human infants. Rationalism—moral status rests on rational capacities—wrongly assigns a higher moral status to the great apes than to all severely disabled human infants with less rational capacities than the great apes. Anthropocentrism—moral status depends on membership in the human species—falsely grants all humans a higher moral status than the great apes. Animalism—moral status is dependent on the ability to suffer—mistakenly equates the moral status of humans and most animals. (2) The concept person is widely used for justificatory purposes, but it seems that it cannot play such a role. It seems that it is either redundant or unable to play any justificatory role. I argue that we can solve the second problem by understanding person as a thick evaluative concept. This then enables us to justify assigning a higher moral status to the great apes than to simple animals: the great apes are persons. To solve the first problem, I argue that certain severely disabled infants have a higher moral status than the great apes because they are dependent upon human relationships for their well-being. Only very limited abilities are required for such relationships, and the question who is capable of them must be based on thick evaluative concepts. Thus, it turns out that to make progress in bioethics we must assign thick evaluative concepts a central role.

Moral phenomenology: Foundational issues

In this paper, I address the what, the how, and the why of moral phenomenology. I consider first the question What is moral phenomenology?, secondly the question How to pursue moral phenomenology?, and thirdly the question Why pursue moral phenomenology? My treatment of these questions is preliminary and tentative, and is meant not so much to settle them as to point in their answers’ direction.     

Addressing moral problems through practical reasoning

In this paper, following the work of Hare, we consider moral reasoning not as the application of moral norms and principles, but as reasoning about what ought to be done in a particular situation, with moral norms perhaps emerging from this reasoning. We model this situated reasoning drawing on our previous work on argumentation schemes, here set in the context of Action-Based Alternating Transition Systems. We distinguish what prudentially ought to be done from what morally ought to be done, consider what legislation might be appropriate and characterise the differences between morally correct, morally praiseworthy and morally excusable actions. We also describe an implementation which simulates this reasoning and discuss some issues arising from the simulation.     

Moral disagreement and procedural justice: Moral mandates as constraints to voice effects

Procedural voice is a widely used and effective means to reduce or eliminate conflict. Moral disagreements, however, are particularly inflammatory, divisive, and difficult to manage. The current article reports two studies that demonstrated the unique challenge that moral disagreements pose. Specifically, the studies tested the extent to which procedural voice affected justice judgements, group climate, and decision acceptance when people perceived decisions to have moral implications. Results indicated that when people's outcome preferences represent strong moral convictions, outcomes were the primary determinant of perceived fairness and related judgements, irrespective of whether people had voice in the decision‐making process.     

Pursuing moral outrage: Anger at torture

Moral outrage—anger at violation of a moral standard—should be distinguished from anger at the harm caused by standard-violating behavior. Recent research that used experimental manipulation to disentangle these different forms of anger found evidence of personal and empathic anger, but not of moral outrage. We sought to extend this research by assessing anger at a more extreme moral violation: torture. If the person tortured is a member of one’s group (nationality), anger may not be over the moral violation but over the harm done to one of “us.” In an experiment designed to create the necessary appraisal conditions, we found clear evidence of identity-relevant personal anger (anger when a person from one’s nationality is tortured) but little evidence of moral outrage (anger even when a person from an identity-irrelevant nationality is tortured). Implications for understanding moral emotion and moral motivation are discussed.     

Possessing Moral Concepts

Moral discourse allows for speakers to disagree in many ways: about right and wrong acts, about moral theory, about the rational and conative significance of moral failings. Yet speakers’ eccentricities do not prevent them from engaging in moral conversation or from having (genuine, not equivocal) moral disagreement. Thus differences between speakers are compatible with possession of moral concepts. This paper examines various kinds of moral disagreements and argues that they provide evidence against conceptual-role and informational atomist approaches to understanding our moral concepts. Conceptual role approaches fail because they cannot account for shared concepts among speakers with different commitments to the practical and conative ramifications of moral judgments. Informational atomist views fail because speakers need not be locked on to the same moral properties to share moral concepts.