Bioethics Notes For Learning Community Fall 2011 Bioethics Potter ethics with the biosphere Now ethics having to do with the medical fields and professions A branch of applied ethics Introduction to ethics. I. II. To what extent is reasoning possible in ethics? One assumption: ethics is subjective A. If subjective then no disagree: Paul I like my coffee sweetened, Helen unsweetened: no disagreement B. If Paul “drs should sometimes assist their patient’s death, Helen: No (then real disagreement) C. There is a point here about disagreement A characteristic of ethics and ethical argumentation consistency: A. It is always wrong to kill a human being B. Abortion is not always wrong C. I am committed to holding that abortion isn’t always the killing of a human being a. This sets a limit on the subjectivity of ethics b. Another such limit: factual accuracy c. One can enjoy a taste without knowing what it is d. In ethics we have to understand the facts of the matter: patient’s prognosis, wishes etc in regards to resuscitation (2) Ethical relativism A. Similarity to subjectivism: B. Ethics depends upon a group, a culture etc. a. Darius: eat or burn one’s dead b. Herodotus each culture things its custom best c. Nomos vs. Phusis d. Anthropology: no superior morality which should be imposed on another culture C. An implication: moral reformers are always wrong; no basis to criticize a practice say enslavement after defeat in war. D. No way of resolving conflict between two cultures (strictly speaking there is no disagreement between them) An alternative to subjectivism and relativism: R.M. Hare’s universal prescriptivism A. A characteristic of an ethical judgment: universalizability

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B. Ethical judgments must be phrased without reference to individuals and must be able to hold in relevantly similar circumstances a. Example: everyone must do what is in Mick Jagger’s interest or my interest: neither of these are universalizable b. I should frame my ethical principle taking into consideration others potentially effected; for example I’m a small factory owner and want to dump waste in a stream that others use; I must take these others into consideration (3) c. Hare’s view leads to a type of consequentialism: what is morally relevant is the consequences of an action d. Bentham and Mill’s Utilitarianism: actions are right just in case they lead to a greater surplus of happiness over their available alternatives. Utilitarianism A. A single principle to decide moral dilemmas B. Bentham: each count for one and no one as more than one. C. Preference consequentialism: nothing is good except in so far as it is desired a. More strongly held preferences are weighed more strongly D. An objection to Consequentialism: Dostoevsky’s Karamazov: promote the greatest happiness by torturing just one innocent Exceptionless rules (Church and State) A. Ten Commandments etc B. Kant’s categorical imperative a. Act on that maxim which you can make a universal law b. Treat rational beings never merely as means but also always as ends in themselves (4) c. Can’t tell lies Consequentialists: suffering of the one for the benefit of the many A. There can be no architect for the whole world: too large B. Flexible rules? C. Aristotle: human nature as a source for moral rules D. Natural to seek: knowledge, friendship, health, love, procreation etc E. Natural; descriptive or prescriptive; what of violence, war (are these equally natural?) F. The Aristotelian universe everything has an end (telos). a. Post Darwin view of nature: we don’t exist for any purpose but we are the result of natural selection operating on random mutations for millions of years (5) Intuition and morality A. Match with our intuitions or most of them B. Problems of bias: against non-­‐human animals, women etc Morality as a function of a good person, nurse, doctor etc A. Moral education teaching the virtues relevant to a particular role. 2

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B. In moral conflicts a question of rightness of action reemerges: a patient asks a nurse to help them die; a question of the virtues of a nurse doesn’t definitively answer the question here. An ethics of care A. Previous philosophy too male and reason orientated not relational and emotion based enough B. Problems: based on stereotypes of women as more caring, more emotion: institutionalize the disproportional role of women as providing care. Religion and ethics A. Ethics as prior for a conception of the good: “God is good” requires and account of the good if it isn’t a meaningless tautology (6). B. Wealth of experience in a religious tradition a. Need to judge the moral pronouncements independently of the tradition Ethics and Law A. Legality has relevance to morality (particularly in a democracy) B. Legality affects the consequences of an action C. Laws are subjected to moral appraisal (unjust laws etc) D. Public policy vs. private conduct

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Part I. Before Birth I. Introduction A. The ethics of personhood B. Mother-­‐fetus relationship Abortion A. Fetus will, if everything goes normally, develop into persons B. Is abortion the killing of a person? (11) Finnis “Abortion and Health Care Ethics” A. Argument is based not on faith but reason B. The one celled zygote already has the capacity within its genetic structure for supporting specifically human functions: self-­‐consciousness, rationality and choice. C. You or I have the capacity to speak Tibetan or Icelandic though we don’t D. According to this “active potentiality or capacity” even the zygote is already a person and not merely a potential person. E. Given that zygotes, embryos, and fetuses have the same status as person, killing a one-­‐celled human organism has the same moral status as killing a person (12). F. Finnis is aware that our imaginations balk at equating the full grown human with the single zygote but argues that we can’t find any criterion by which to judge that the human is anything else but one and the same human person as the one-­‐cell zygote. Tooley “Abortion and Infanticide” A. To have a right to life an entity needs to possess a concept of self: “to be capable of desiring to continue existing as a subject of experiences” a. A consequence of this is that fetuses and very young infants aren’t persons while animals and extraterrestrials who do have it are persons. b. Humans who are asleep were conscious before and will be after they awake; fetus have never been awake or self-­‐conscious in this sense. c. The crucial distinction in both these articles is the issue of personhood Judith Jarvis Thomson “A Defense of Abortion” A. Thomson grants the conservative position that the fetus is a person but denies that every person has a right to life. B. You have been kidnapped by the society of music lovers and a famous violinist has been plugged into your circulatory system for 9 months to keep them alive; after 9 months you can go your separate ways. Unplugging him now will amount to killing him. C. For Thomson the fetus only has the right to use the woman’s body if it was explicitly given to it. D. A right to life also includes a right for positive aid so Thomson’s argument is inconclusive. Do Marquis “Why Abortion is Immoral”

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A. It is wrong to kill the fetus not because it is a person or a potential person but because by doing so one deprives it of a future (13). B. Marquis’ position doesn’t rule out euthanasia because depriving those who are terminally ill and want to die doesn’t deprive them of a valuable future. C. His view is not speciesist because it would be wrong to kill non-­‐human animals or extra terrestrials if it turns out that they have futures like ours. D. Marquis points out that those like Tooley have the embarrassing position that their view seems to sanction the killing of infants (since they don’t meet the criteria of personhood). E. Does Marquis’s view equally apply to contraception because its use prevents the egg and the sperm from enjoying a valuable future. Mother-­‐Fetus Conflict A. Laura M. Purdy “Are Pregnant Women Fetal Containers?” B. If fetal rights trump women’s rights, this could lead to coercion forced cesareans etc C. The importance of social conditions and the future of the fetus

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Article One “Abortion and Health Care Ethics” (John Finnis) A. If unborn are human persons then the principles of justice and non-­‐maleficence prohibit every abortion B. Most people begin at fertilization a. Persons are living human individuals b. Tooley argues that personhood is gradually acquired; thus unborn and newborns are not persons. i. He begs the question: abortion is morally acceptable, and any potential which is not being actively exercised cannot be a defining property of personhood. ii. Donceel: personhood dependent of sense organs and brain: the preperson is ensouled suddenly when the brain begins to develop. iii. The basis of this position (medieval biology) has been surpassed iv. The fertilized human ovum is specifically human. v. Like our capacity to speak Tibetan or Icelandic the youngest human embryo already has the biological capacity to support specific human operations such as self consciousness etc. C. Ford’s account a. At fertilization a zygote begins b. This is not the same individual with the same genetic constitution and gender that will begin 16 days later c. The zygote is replace at the first mitotic division by two beings, then four, eight, 12, 16, 32, 64 etc; then these thousands cease to exist when God forms them into ‘one living body’ (19) d. Ford’s account is unintelligible because it can’t account for twinning which occurs somewhere around day 6 or 7 when on his account there is not one being to become two but hundreds to become how many? D. Any entity which remaining the same individual, will develop into a paradigmatic instance of a substantial kind already is an instance of that kind (19). a. Organic integration is what is important and this is found from inception of fertilization. b. Imagination balks at equating the full grown adult with the one cell zygote c. Reason can find no principle by which to differentiate the full grown adult from the one cell zygote. d. Every living human individual must be regarded as a person. E. Justice, Beneficence and Non-­‐Maleficence for Mother and Child a. Every attempt to harm and innocent human violates non-­‐maleficience and justice b. Every such attempt is wrong c. Every procedure attempted to kill an unborn child is wrong d. Even if there is reluctance or regret. 6

e. What is directly done is directly willed f. Side effects are indirectly willed g. Directly killing as an end or as a means is wrong h. Some indirect killing is not always wrong F. Distinctions a. Direct killing as an end or means is wrong b. Every living individual equally has a right to life c. The unborn child can never be regarded as an aggressor; aggression requires action; the unborn is not there of its own choice d. Provided that bring the death or injury is not chosen as a means of preserving life; an action which preserves a life can be permissible even if it should result in the taking of another innocent life. e. Not every indirect killing is permissible; for instance if there is another non-­‐ deadly alternative. G. Exceptions a. An exception “to save the life of the mother” can’t be a part of a just law and medical ethics. 1) It suggests killing as means 2) By referring only to the mother it suggests that the mother’s life should always be preferred which is unfair. b. If the life of either the mother or child can be saved only by a procedure which will adversely affect the other, then such a procedure can be undertaken with the intention to save a life provided that the procedure is the most effective one available. c. The mostly likely application: some pathology threatens the life of both woman and child; it is not safe to wait; there is no way to save the child; an operation to save the woman will kill the child (ectopic pregnancy) d. Abortion to “save the life of the mother” because she is threatening to commit suicide or her family is threatening to kill her are not instances of that above principle. H. Rape a. A women the victim of rape has a right to defend herself including a right to protect her ovum from conceiving through the aggressors sperm. b. Once an unborn child is involved termination is not permissible because the child is not responsible for its father’s wrong. c. Taking a post-­‐coital pill to prevent fertilization even when this has a possible side effect of causing an abortion is permissible; because of the direct intention. I. Prenatal Screening and Genetic Counselling a. Tests for the health of the fetus etc are permissible

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b. Tests with the intention of abortion if they turn out with a particular result are already willing (conditionally) an abortion; and thus is already a violation of non-­‐maleficence and justice. c. Health care providers who respect these principles have a duty to indicate which tests are permissible and which aren’t J. Participation a. Anyone who encourages an immoral act is a participator in the immorality b. Material and formal participation 1. Formal direct participation, intentional 2. Material: a nurse who is opposed to abortion but who is required by her terms of employment to perform certain activities in preparation of abortion: cleaning, shaving etc 3. The surgeon who performs the action, even if only because of his terms of employment must directly will the success of the activity (the abortion) and thus is a formal participant of the activity 4. Health care professionals have a duty not to participate in immoral actions K. Embryo Experimentation a. What has been said about abortion applies to in vitro activities; if any action is taken without an eye to the successful implantation and maintenance of the embryo is immoral. L. Benevolence and Autonomy a. Resistance of abortion in a culture of permissible killing requires a sense of one’s moral autonomy and beneficence for the unborn and for the mother.

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Article Two “Abortion and Infanticide” (Michael Tooley)(p. 25) Tooley considers the characteristics which are required for a ‘right to life’ concluding that the unborn and some infants don’t possess these characteristics and thus abortion is morally permissible; he also considers that these characteristics suggest that our treatment of non-­‐human animals is on the basis of this principle not morally permissible. Abortion and Infanticide A. The conservative position against abortion basically holds that if one permits the killing of a zygote of some stage intermediate to birth of the mature human infant one must be able to specify the morally relevant distinction in virtue of which on is justifying this action (the issue of arbitrariness); since they claim that the liberal position can’t specify an non-­‐ arbitrary basis to make this distinction, abortion is not permissible. B. This argument also has baring on infanticide as well C. Infanticide requires one to be very clear on what characteristic gives say an adult human moral consideration while not granting that same moral consideration to the infant. D. The abortion debate is characterized by Tooley as extreme; if the fetus is a person then it can only be killed to save the life of the mother; if the fetus is not a person how can it be wrong to destroy it? E. Infanticide is an important issue to consider a. It helps to define what it is that makes on a person and thus when there is a right to life b. Most would rather not raise a child with severe mental, emotional physical handicaps so an account of the permissibility of infanticide could have a bearing on human happiness in these cases c. The reaction to infanticide is visceral like the reaction to incest and cannibalism; when philosophers respond viscerally without offering arguments it may be that we are in the presence of a taboo rather than a rational prohibition. F. Terminology: “person” versus “human being” a. “person” for Tooley is not descriptive but moral; to say X is a person means that X has a moral right to life. b. The usual use of person suggests that someone has rights c. Rights and right to life are not coextensive 1. Most adults would rather be tortured for one hour then killed 2. A kitten doesn’t have a right to life but it would be wrong for the kitten to be tortured for an hour 3. One has a right when if one wants that thing it is wrong for others to deprive them of that thing. d. Some have taken “person” and “human being” as synonymous. e. This lends support to the antiabortionist 9

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1. The fetus is a human being then perhaps but not a person on Tooley’s account 2. If the question turns on whether a fetus is human being then it seems it is a matter of fact; for Tooley it is a moral question whether the fetus is a person The basic issue: when is a member of the species Homo Sapiens a person? A. What properties must some one have to be a person? That is a right to life (a moral issue) B. Does the fetus have such properties (a factual issue) C. Compared to the issue of slavery; no similar clear principles? D. Development gradual so how does one draw the line? Arbitrariness. E. An organism possesses a right to life if it possesses the concept of a self and a subject of mental experiences. F. A has a right to X; If A desires X, then others are under a prima facie obligation to refrain from actions that would deprive him of it G. Desire has a link to states of consciousness: thus ruling out machine’s desiring a. ‘right to life’ is an unhappy phrase for there are instances where one continues to live but where one is not the subject of one’s own experiences: the case of reprogramming b. For one to have certain desires requires that one have certain concepts (29) c. The connection between desire and right is tenuous because of 1. the individual’s desires are due to states of emotional disturbance 2. situations of temporary unconsciousness 3. Cases of indoctrination

d. Depression etc.

e. Cases of being unconscious yet in some sense having desires

f. Indoctrination H. A’s right to X can be violated not only when he desires x but when he would desire x but for the following: emotional disturbance, unconsciousness, indoctrination I. Such a condition is necessary for having a right to life on Tooley’s account

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Some critical comments on alternative proposals A. Conception B. Human form C. Move about spontaneously D. Viability E. Birth All of these yield moral principles A. It is seriously wrong to kill a zygote, and organism with human form, capable of spontaneous movement, viable, no longer in the womb. B. In the first principle membership to homo sapiens doesn’t seem morally relevant; it is acceptable to abort a cat; one will need to specify what homo sapiens possesses that cats don’t possess. C. To rule out viability what if one could learn a language in the womb; a Siamese twin isn’t viable on its own does it have a right to life? D. Dependence upon another organism may clash with the rights of that organism to do what it likes with its body (Thomson) E. Mobility as sign of agency; this won’t do one wants to maintain a right to life for adults who are paralyzed. Is it a sufficient but not necessary condition; then animals and some machines have a right to life. F. Human form doesn’t seem adequate; what if we encountered other intelligent species of another form? Refutation of the conservative position A. The conservative position has been held to be stronger than the liberal position because they can show the continuous development as it changes from zygote to adult human being. B. All cut off points seem arbitrary. C. Both positions can’t identify the properties which give the organism a right to life on Tooley’s account D. Differences in species is not in itself a morally relevant basis E. The conservative can defend the right to life; the adult has a property which gives it a right to life; any member of the species which has the property potentially then has such a right. F. The liberal can’t mount such a defense without specifying what the morally relevant property is. G. Tooley attacks thus: an adult human has a right to life while an adult ape doesn’t is because the adult has certain psychological states that the ape lacks. Now even if one is unsure what these properties are it is clear than an early stage zygote lacks these properties. H. There are no differences between the human fetus and the ape fetus in terms of ascription of mental states (only perhaps different potentialities). I. Thus it seems that the conservative position is defensible if the potentiality principle is right. 11

a. To argue against the principle one can invoke the self-­‐consciousness requirement b. A separate concern which is related to potentiality is the value of a life; but one’s right to life is different from one’s value c. Is there a property J

possessing the following conditions 1) there is a property K such that an individual possessing K has a right to life and there is a scientific law L to the effect that organisms possessing J will normally in the course of events come to possess K at some later time and 2) given the relationship between J and K, anything possessing J has a right to life and 3) If J were not related to K in the way indicated , it would not be the case that possessing J would give one a right to life. d. Tooley next invokes a distinction between negative and positive duties (the difference between non-­‐interference not to harm or kill and the positive duty to save or support life) 1. The basis for this distinction is that someone who kills seems to have a motivation to do so; while someone who doesn’t save a life may just be lazy, selfish, amoral etc. 2. The way to defeat this distinction is to show that both cases actually have the same motivation 3. Tooley’s example Jones sees that Smith will be killed by a bomb unless he warns him (he says to himself “how lucky, it will save me the trouble of killing Smith myself”) and the case where Jones wants Smith dead so he shoots him. According to Tooley there is not a significant difference in the motives of Jones in these two cases; and thus the actions are morally indistinguishable? The difference here comes from first drawing the distinction between negative and positive duties and then imposing it here rather than actually judging the two cases on their own merits (35). The morally interesting difference between giving aid and non-­‐ interference has to do with a difference of motives and not a difference in terms of negative and positive duties. 4. There is another difference between action and inaction in terms of expenditure of energy: how much is one required to sacrifice in terms of energy expended? 5. Saving a life may require a large expenditure of energy. 6. Where the positive action requires very little expenditure the positive and the negative cases seem symmetrical and thus Tooley’s moral symmetry principle 7. Now Tooley can defend his argument against potentiality: suppose in the future a chemical is discovered which when injected into the brain of a kitten will make the kitten develop into a cat with all the typical human abilities: self-­‐consciousness etc; if one were to say that a

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member of homo sapiens has a right to life, one would also have to say that such a cat has a right to life as well (36). 8. Before the injection it is not seriously wrong to kill the kitten even though by receiving the injection to would have a right to life; to not inject but instead kill is not seriously wrong 9. According to the symmetry principle if it is not seriously wrong not to initiate the process it is not seriously wrong to interrupt the process; if the kitten was injected accidentally it would not be wrong to interrupt the process just as long as it didn’t currently possess those characteristics which give it a right to life; thus whether one injected a neutralizing chemical or killed the kitten would be equal morally speaking. 10. If it is not wrong to interrupt the process in a kitten neither is it wrong to interrupt the process with a human fetus; the only difference is that the human fetus possessed the potentiality from the beginning the kitten only later after being injected. 11. It is reasonable to think that an adult has properties which give it a right to life and also that a normal human fetus will come to possess those properties but the argument has shown that it isn’t simply wrong to kill the fetus because it has the potential for possessing those properties. 12. The conservative then needs to defeat the moral symmetry principle or needs to argue that in the case of a kitten that could be transformed it is wrong to kill kittens before the transformation. 13. Tooley has not provided a thorough defense of the symmetry principle but he has tried to show that the tradition response to it using the difference between positive and negative duties is inadequate. Summary and Conclusions A. Tooley’s main claim has been the self-­‐consciousness requirement B. His defense has been two fold: direct and indirect by showing that the traditional liberal and conservative rejection of it are incorrect. C. If it is morally moral acceptable that a human be tortured for an hour than to be killed but it is not serious wrong to kill a kitten but it is to torture it for an hour, how do we explain the difference? D. How is it that kittens have a right not to be tortured but not a right to life? a. It can be killed because it is not self-­‐conscious b. It can’t be tortured because it has an awareness of pain; an awareness of pain doesn’t presuppose a self-­‐consciousness; the kitten can desire that a certain sensation not exist. E. The last question has to do with the factual point as to when an infant or fetus has a concept of self a. For Tooley a newborn lacks such a concept just as a kitten lacks it b. What is the cut off point? 13

c. If concept formation requires language acquisition then infanticide would be morally permissible up to this point; Tooley rejects this cut off though d. Some organisms may have concepts without the ability of expressing them e. To discover this may take subtle experimentation f. Infanticide is only usually desirable early on; early on there is no serious question of having the basis of forming concepts of self; so infanticide when desirable is generally not morally questionable(!)(37) g. Psychologist could modify when infanticide is permissible by proving that the infant is a subject of the concept of self etc. F. The more troubling worry to Tooley is whether or not other adult organisms not of the species Homo sapiens also have a concept of self without having the ability to express this awareness; once on specifies the relevant moral principle which affords beings the status of person we may find that are moral treatment of animals is tragically mistaken(38).

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Article 3 “A Defense of Abortion” (Judith Jarvis Thomson) A. Most opposition to abortion makes use of the premiss that the fetus is a person form the moment of conception B. The development from conception to birth is continuous C. To draw a line is arbitrary: thus from the moment of conception the fetus is a person D. The conclusion doesn’t follow: the development of an acorn into an oak can be said to be continuous but that doesn’t mean that the acorn is an oak a. This is a slippery slope type of argument (a fallacy) b. It is dismaying that foes of abortion so heavily rely on such types of arguments c. Jarvis agrees that the prospects of drawing a line are not very good (40). d. And holds that it is likely the fetus is a person well before birth e. She denies that it is a person from conception though f. The problem for her is the step from that premise to the impermissibility of abortion E. Granting that the fetus is a person; a person has a right to life; this right to life is more stringent than the mother’s right to her own body; so abortion is impermissible (41) F. This sounds plausible but what if: one wakes up back to back in bed with an unconscious violinist; you have been kidnapped by Music lovers because of your blood type; the violinist has been plugged into your circulatory system to use your kidneys. a. We’re sorry this has happened but to unplug now would be to kill the violinist b. It’s only for nine months c. What if it was for nine years; or the rest of your life; d. Everyone has a right to life and that right outweighs your right to do with your life what you like. e. Is there less of a right to life if one is a result of rape? f. There is no exception if the mother has to lay in bed for nine months, what if nine years, what if the rest of her life? G. Some hold that abortion is wrong even if it will save the mother’s life (the extreme view) a. Say the mother has a cardiac condition; carrying the baby to term will threaten her life b. The fetus has a right to life as does the mother: should we flip a coin to decide? c. Does the mother’s additional right to decide what happens to her body outweigh the fetus’ simple right to life?

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d. Killing the fetus is direct killing and so impermissible whereas letting the mother die is not direct killing. e. Thomson objects to the claim that the mother who is imperiled would be killing; she compares it with the violinist case; if the violinist is endangering your life because of the added strain on your kidney it wouldn’t be impermissible killing for you to unplug them. H. The focus has been on what a third person can do; the woman’s rights have been read off of this as an afterthought I. Suppose you are trapped in a very tiny house with a growing baby; you will be killed but the baby only hurt if you are left in the house with the rapidly growing baby a. If one says we can’t do anything for you we can’t kill the baby; then this is discounting your rights as a person to decide what to do b. Thomson is not saying that one has a right to doing anything in one’s self defense for instance one is not permitted to torture another person even if to do so would save one’s life (43) c. In this case only two people are involved both are innocent so others perhaps feel that they can’t intervene; but the person threatened can. d. A women has a right to defend herself even if this involves death; thus the extreme view is incorrect J. The extreme view can be weakened to say that while abortion is permissible it can only be performed by the woman a. This is incorrect; the case is not like that of the house where both happen to be renting the house; the woman, in the case of abortion owns her body; thus it adds to the offensiveness of denying the woman’s ability to do anything which has been inferred from the impermissibility of the third party doing anything. b. It is not impartiality in the third party to say I can’t do anything c. Compare the situation where Jones has put on a coat to keep from freezing but the coat is owned by Smith who also needs it to keep from freezing; it isn’t impartiality in the third party to say I can’t decide between them because Smith owns the coat. d. One can personally refuse to decide between Smith and Jones but it isn’t necessary that everyone so refuse. e. Someone might claim that the woman’s body is on loan to her; that strictly speaking she doesn’t have a right to it; Thomson doesn’t treat this case further K. The more common case is not one in which the woman’s life is threatened in such cases it seems rather more clear that the fetus’s right to life overrides the woman’s right to do what she likes with her body a. Thomson denies this; for her the right to life is problematic L. What does it mean to have a right to life? 17

a. It may mean that one has a right to the bare minimum to keep one alive b. What if what is required is the touch of Henry Fonda’s cool hand on my fevered head? c. I don’t have a right to this though d. Nor does the violinist have a right to use your kidneys though this is what is required to keep him alive e. If you give him the right it is a kindness but not something that he or anyone else can demand of you as a right in itself f. Some treat a right to life as purely negative that is one doesn’t have any right to anything positive that is needed for life but only negatively that one can’t permissible kill another g. Thus one can’t slit one’s throat or shoot one or if the violinist is plugged into to you unplug him h. The violinist doesn’t have a right to the continued use of your kidneys only if you grant it as a kindness. i. For Thomson people do have a right to life but that right doesn’t mean that one can use or have use of another person’s body if to do so would support the person’s life; thus the right to life won’t serve the opponents of abortion in the way that they think it will M. Ordinarily to deprive someone of what they have a right to is to treat them unjustly a. For instance, two boys are given a box of Christmas chocolates and one boy takes them all for himself: he is here treating the other unjustly b. In the case of unplugging the violinist though you are not treating him unjustly even though you kill him by doing so (44). c. The right to life then must mean that one is not permitted to be killed unjustly; this will satisfy the requirement of the violinist d. Applied to the case of abortion it is not enough to show that abortion is killing but rather we have to show that it is unjust killing (45) N. In the case of rape the mother has not given the fetus a right to food and shelter a. In the case of any pregnancy it doesn’t seem that the mother has given such a right; for it is not as if there are unborn fetuses ranging around the world and the mother invites this particular one in (what of the case of in vitro fertilization etc?) b. But in the case of the woman willingly participating in intercourse with the knowledge that to do so would likely result in pregnancy, in this case it seems that to abort the fetus is more like the case of the chocolates then the case of the violinist; that is the fetus has a right to life and to kill it would be unjust. c. Likewise to kill it in self defense seems to be undermined because she called it into existence voluntarily.

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d. This is a new point in the debate; abortion opponents have been eager to establish the independent rights of the fetus; however, the mere fact of the fetus’s dependence on the mother seems to establish a special responsibility of the mother for the fetus; rights that are not like those claimed by the violinist who is a stranger to the mother. e. The fetus would have a right to use the mother’s body only in the case of a voluntary act not in the case of rape f. In the case of opening the window because it is stuffy and a burglar climbing in it is not right to say that you voluntarily allowed the burglar in. g. Likewise if ‘people plants’ float in the air and you open your window and one comes through the screen and plants itself; you are not, in this case, responsible for its implantation h. Likewise one could avoid being raped by having a hysterectomy or having one’s own personal army (46) i. The argument seems to show that there are some cases in which an unborn person has a right to the mother’s body and in such cases abortion would be unjust killing O. Suppose the violinist needs to only use your body for one hour; even though you’ve been kidnapped it seems that you should let him use your body for that one hour a. Likewise suppose pregnancy lasted only one hour; even in the case of rape it seems that the woman should let the baby use her body for that one hour b. Some think that because you ought to allow the use of one’s body that then the person has a right to use your body even though they haven’t been given a right by any one. This is a loosening of the term right c. Suppose the box of chocolates was given only to the older boy who stolidly eats through it by himself; one could say you ought to give your brother some of those. It does not follow from this though that he has any right to the chocolates and thus the boy doesn’t act unjustly if he doesn’t give his brother any d. He may be stingy, greedy, callous but not unjust e. Previously when the box was given to both of them the other boy had titled to half f. If one needs the touch of Henry Fonda to live but it requires that he flies from the West Coast one doesn’t have a right to it; but does one have a right to it if it just requires that he walk across the room? It seems strange that one’s rights would fade away and disappear the harder it gets to accord them to one g. Likewise though you ought to let the violinist use your body for one hour he doesn’t have a right to it; this case is like the boy with the chocolates (47); the same holds in the case of rape. P. The Good and the minimally decent Samaritan

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a. The Levite and the Priest in the story weren’t even minimally decent (Luke 10:30-­‐35) b. The case of Kitty Genovese: killed while 38 people watched or listened; someone should have at least called the policy c. In no state in the country are people required to call the policy in a case like the Genovese one; but in most states women are required to be good Samaritans to their unborn; these states should enact good Samaritan laws as well (48) d. Minimally good Samaritan laws are one thing good Samaritan laws another e. Third party interventions: one can’t extricate oneself from the violinist and they ask for help; should they be extricated? There is no injustice to the violinist if we help Q. We have followed the language of the abortion opponent’s that the fetus is a person: does it prove that a fetus has a right to life? Not necessarily. a. The fetus is not just a person but a person to whom its mother has a special responsibility b. You don’t have that kind of relationship to the violinist or to Henry Fonda; people do, on the other hand, have a responsibility to their children c. If the parents have taking the child home then they’ve assumed responsible for it; if they’ve done everything to prevent pregnancy then they haven’t assumed responsibility. d. A good Samaritan would assume responsibility in all the cases perhaps R. Abortion proponents will fault Thomson’s account because it doesn’t always give a yes answer a. A sick raped fourteen-­‐year-­‐old can have an abortion; any law which prevents this is insane (49) b. In some cases abortion is indecent: a woman in her seventh month who now wants an abortion to avoid the nuisance of postponing a trip c. Thomson is not arguing for the right to the death of the unborn child should it survive and abortion attempt; nor is she arguing that one can slit the throat of the violinist should he be detached from you and miraculously survive d. Though she has been arguing that the fetus is a person; a very early abortion is not the killing of a person

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4 “What Abortion is Immoral” (Don Marquis) A. The anti-­‐abortion position has not received many philosophical defenders: a. Some see it as a result of religious dogma b. Or poor philosophy B. Marquis seeks to correct this to show that abortion except in possibly rare cases is seriously immoral; that it is in the same category of killing an adult human being (51) a. Most of the serious writers on this topic assume that the morality of abortion turns on whether the fetus is the sort of being whose life it is seriously wrong to end b. This article will not argue the hard cases; its aim is to argue that the vast majority of deliberate abortions are seriously immoral. C. (part I) D. Strategies of argumentation a. Anti abortionist argue in the following ways: b. Life is present from the moment of conception c. The fetus looks like a human d. Fetus have human genetic code e. Anti-­‐abortions hold that these are obviously true and that establishing the true of any of these is sufficient for showing that abortion is akin to murder (52) E. Abortionists strategies a.

Not persons, rational beings, or social beings b.

Likewise true and sufficient for showing abortion is not wrongful killing F. How can the standoff be resolved? G. As logics is: a view must have some fact and some moral principle a. The anti abortionist principle: it is prima facie wrong to take a human life b. Pro choice: being a person is what gives a human being intrinsic moral worth c. Again a standoff d. The anti abortionist have a broad principle: does it embrace to much: they can’t kill a living human cancer cell: it is living and it is human e. Problems of counter examples and arbitrariness in drawing lines f. The anti abortionist has problems because human being is either a biological category and so irrelevant of if not question begging g. The pro choice advocates has a problem with establishing person with psychological characteristics (why should they make a difference): Feinberg 1. Psychological personhood: commonsense personhood 2. It is because of consciousness that people have values and thus rights and duties 3. Because they have a sense of self and expectations for the future they have rights and duties 4. There is nothing arbitrary about these linkages h. It is clear that having a duty requires consciousness but not clear that having a right requires it

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The severally retarded and mentally ill have rights though some are not conscious; likewise the temporarily unconscious have rights according to a supreme court decision (54) j. It wouldn’t make sense to afford rights to one who never had any psychological states in their history: but such a view would go against the intentions of Feinberg (for fetuses have psychological states in their future) k. If psychological personhood is taken as a moral category it can’t be established non-­‐ circularly l. The generalizations of both camps are not quite right; they are accidental generalizations holding for the most part m. We need a better account of why killing is wrong. H. Part II I. Starting from our own case a. It is wrong to kill us 1. Killing brutalizes: but it brutalizes because it is immoral 2. It deprives society of a benefit: what about killing hermits? 3. What makes it wrong is neither its effect on the murderer nor the victims friends but on the victim himself 4. The loss of life is the loss of one’s experiences, activities, projects, enjoyments (55) 5. It is the loss of what I value now and what I would come to value in the future 6. This explains why killing is such a serious crime 7. It explains the attitudes of those who die prematurely 8. This also shows that what is important is not biologically being human; other non-­‐human beings with a similar future would also find death to be bad b. Loss of future is the wrong making feature of killing c. This implies that non-­‐human animals with similar futures also shouldn’t be killed (Marquis doesn’t argue for this position but treats his position as indeterminate regarding these other species) d. This wrong making feature, unlike sanctity of life theories, doesn’t imply that active euthanasia is wrong (56) (there may be other reasons against it) e. This wrong making feature also shows why it is wrong to kill infants and little children; personhood theories can’t always do so (thus they have to provide ad hoc measures to correct their account) f. Fetuses have the same feature (a valuable future) which adults have g. This argument doesn’t depend on the claim that since it is wrong to kill persons it is wrong to kill potential persons as well J. The structure of the argument can be illuminated by comparing with an argument about the wrongness of inflicting pain on animals a. The natural property of inflicting pain which is morally significant is that it causes suffering and suffering is a misfortune b. The wanton infliction of pain on me is wrong, on others and on animals as well 22

i.

K. Similar of structures of the pain argument and the abortion argument a. Starts with me b. Looks for a wrong making feature of the act c. Shows that the wrong making feature also applies in the case of non-­‐human animals d. Thus showing why abortion is wrong as well e. In neither argument is the category of person essential L. This the arguments analysis of the wrong making feature of wanton causing of pain to animals correct? M. The competitor theory: Kant (57) a. In the first cause, the account seems plausible b. Kant’s didn’t believe that animals were persons so he doesn’t believe that it is directly wrong to harm animals for their own sakes but only because if one is hard on animals one will also be hard on human beings. c. Kant’s account doesn’t explain why one who would be hard on an animal (a non-­‐ person) would be hard on a person; what is the relevant similarity of the two which would make one move from the one to the other? d. Thus the alternative account (namely that infliction of pain causes suffering and suffering is a misfortune) is more plausible; if this is so and this argument has the same form as the abortion argument, then that argument is more plausible too. N. The argument shows that abortion is prima facie wrong; there may be some exceptional causes where it would be right (where the loss would be greater if there wasn’t an abortion) O. (Part III) P. How thorough does the future as valuable have to be to be an account of the wrongness of killing? a. It needn’t be a necessary condition: some in nursing homes may not have a valuable future but it may still be wrong to kill them. b. The account doesn’t have to be the sole reason that killing is wrong c. It is a sufficient reason when it is present that killing is wrong d. One can overturn this account if one finds at least as intelligible contenders Q. Some other accounts a. Value of the experience of living (the discontinuation account) b. People strongly desire to live (the desire account) 1. The desire account must supply a necessary condition; what would make abortion wrong would be that the fetus has a strong desire 2. The problem with this account is we still think it is wrong to kill those who don’t have a desire to live or have a desire not to live; in these cases the value of a future account provides a better interpretation 3. Life is desirable because of the goods it offers; if the desire account was true a premature death could be overcome by the reorganization of one’s desires 4. If this account is modified to provide not a necessary but a sufficient account then it will be quite similar to the value of a future account 23

R. S. T.

U.

5. The discontinuation account doesn’t yield and anti abortion ethic; because fetuses don’t have projects, experiences to continue 6. The discontinuation account must make reference to the value of the experiences (or it would be wrong to kill someone terminally ill who doesn’t value their very painful experiences and wishes to die) 7. Similarly with the valuable future account; the value of that future must be brought in to make it persuasive in the above case 8. It doesn’t matter what the patients past experiences are for the value of the future account; thus it seems that the continuation view is otiose. Part IV The alternative accounts don’t work like the account of the value of a future How might one defeat this argument a. Some might argue that a necessary condition for have a valuable future is that one actually value it (59); since fetus don’t value their futures it could be said that their futures are not valuable b. One’s future can be valuable to one even if one doesn’t value you at a particular time (the attempted suicide’s case) c. Tooley argues that an entity doesn’t have the right to life unless it has the capacity to desire its continued existence d. It can be formulated as if an individual is incapable of caring about X, then one can’t have a right to X, or X can’t be a benefit to someone e. One can have a right to a procedure that one can’t understand; also one as Tooley points out could be indoctrinated not to care; Tooley’s account is undermined by counterexamples f. Bassen has argued that fetuses can’t be victims because they lack sentience (60) g. Plants and the permanently unconscious don’t have prospects (the future value account) h. Paradigm cases of victimization are case where we can empathize; empathy requires mentation i. Bassen’s account is undermined by one of his own examples: the posthumous obliteration of an authors work; Bassen says this only constitutes victimization if the author valued its continued reputation; but the author can have a low self esteem so that he doesn’t recognize its merits but it could have such merit (this would be an instance of victimization without empathy; we can’t feel for the author because the author doesn’t feel for himself j. Bassen actually requires mentation but his examples don’t make this point k. The mentation requirement is subject to counterexamples: after a severe accident I am unconscious for a month after which time I recover; it would be wrong to kill me during that month though I lack mentation (61). Part V.

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a. Perhaps one could argue that contraception similarly undermines future value and so it as well is prima facie wrong; this would only be the case if there was a value of maximizing futures b. What could be the subject of harm through contraception: some sperm, some ovum, a sperm and an ovum separately or together; the future value account doesn’t rule contraception as wrong V. Part VI. a. This paper sets out a wrongness criterion for abortion: the property in virtue of which abortion is wrong; it doesn’t require religious dogma, or a use of the concept “person”; nor does it rule out euthanasia and contraception

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Article 5 “Are Pregnant Women Fetal Containers?” (Laura M. Purdy) Part I. A. Women like men want to control what happens to their bodies B. Some have argued that women’s ability to do this is subordinated to the welfare of fetuses within them (65) a. Control of bodies is a keystone of liberal society (for both men and women) b. Pregnancy as happening only to women have been treated as a special question c. The fact that it has entered the legal domain brings up issues such as coercion and punishment which make this a serious issue d. Legal cases have been accumulating: women charged with child abuse for giving birth to drug addicted babies; cases of forced caesareans to give a marginally viable fetus the chance to life for a women terminally ill with cancer; if the same things were being done to middle class white men there would be moral outrage; what is the relevant moral difference in these cases? C. The Fetus’s Place a. Fetuses live in women’s bodies this means that what harms a woman can harm the fetus b. This has consequences for women’s life style choices: drugs, alcohol, tobacco, diet and for her work and home environment, medical advice and treatment c. This list shows how intertwined and how potentially divergent the interest of the mother and the fetus are d. Some writers refuse to see the potential divergences of interest by conflating the fetus with a child; they fail to see that women’s rights sometimes trump the rights of a fetus e. Women have forgone medical treatment to protect the fetus or a woman could give up a job because it endangers the fetus; the cocaine addict goes “cold turkey” for the fetus. f. Some have seen the relationship between the fetus and the mother as colored by the ideology of patriarchy g. It isn’t just an illusion though in the case of Siamese twins; the surgery may cause the loss of one or both; is the loss an illusion? h. Choices which benefit the mother may harm the fetus; society tries to minimize these losses i. The fact of being one flesh now doesn’t preclude two different fates D. The Social Context of Conflict a. We start with the assumption that women have at least the same level of rights as others b. What do we owe others (and others who don’t yet exist)? c. The closest relationship seems to be that of relatives

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d.

e. f. g.

h. i. j.

k.

1. The courts have refused to force Shimp to have bone marrow surgery to increase the probability of his cousin McFall’s survival 2. The relationship between the mother and fetus is closer than that of cousins 3. No mother has been forced to undergo surgery to save the life of her child (67) 4. It would be ironic if a mother were forced to undergo more invasive procedures for the sake of her fetus 5. Annas argues that a woman’s duty to her fetus be no more demanding than it is to her child 6. The mother fetus relationship has been taken as special; but this status hasn’t provided arguments on other side Special characteristics of the case: 1. Dependence is a pervasive characteristic of human society 2. Because of location and state, fetuses are dependent on women in a fundamental and continuous way 3. Fetuses are not moral persons 4. They will probably become such persons some time after birth We can have moral duties towards those who are dependent on us The morally relevant feature of fetuses are not that they are persons know but that they will be affected after birth by what happens now. We ought to prevent disease or handicap in our children so the same duty holds for our fetuses; if parents are not required to sustain invasions to save a dying child the same holds for fetuses Personhood is relevant where death is an issue; because fetuses are not persons it may be permissible to abort them; one cannot kill a child The fetus’s possibility of survival is somewhat lower; the effects of the actions on the mother are uncertain as to their effects on the fetus Judges have refused to give leukaemic adoptee children the names of their father (In re George) to find a good bone marrow donor; however, caesareans have been ordered for women). Women seem to be denied the sorts of procedural rights afford to the unconscious, criminal and individuals with mental problems 1. Judges at hospitals are more like lay people: women can easily be described as hysterical 2. Of the 21 cases since 1987, involuntary treatment was obtained in 86 percent of the cases (treatment was received within 6 hours in 88 percent of them); especially powerless women were affected by the additional fact that 81 percent of the women were black, Asian or Hispanic (69). 3. Overturning an adult’s decision about how to use her body legally requires meeting an exacting standard of proof 4. Review of the actual cases shows that such standards are not met.

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5. There is serious debate about whether caesarean is indicated with triplets; rate of these procedures vary widely suggesting that the decision to cut are influenced by non medical factors. 6. Some conditions like placenta previa are not total and so don’t required caesareans 7. In cases where the predications have been dire, normal birth occurred 8. Nevertheless, judges have ordered that women be picked up by the police in certain cases and transferred to the hospital to have whatever procedure was deemed medically necessary (70) 9. The unreliability of fetal monitoring has led to skepticism about physicians recommendations 10. Apgar scores are plagued with false positives 11. Some treatments have the tendency to precipitate further intervention (laying prone) l. Doctors make value judgments; most have not received ethical training a. They make decisions based on the worst case scenario being the death of the fetus rather than material mortality of morbidity m. The social context is not always just a. Poverty and lack of insurance can lead to low birth weight and inadequate prenatal care b. Medicaid is often cut and even women with it may not have access to a physician. c. Under these circumstances, invading women’s bodies to impose last minute, heroic care is stupid mean and unfair (71). d. A women may be denied life saving care yet later subjected to life-­‐threatening risk to save her fetus e. It is less expensive to provide prenatal care than to provide Caesareans, , neonatal intensive care, and lifetime care for damaged babies. n. Toxic exposure in the work place also brings up similar issues 1. This would be solved if employers cleaned up their work places; some have claimed that to do so would be prohibitively expensive but this just passes the cost on to pregnant women, who often least able to bear the cost because they earn the least. 2. Alleged concern for fetuses ring hollow when society passes the cost of doing so entirely on to women 3. Reproductively damage plaintiffs have limited redress from their employers through the courts 4. Odder still is that more men than women have filed legal charges of reproductive damage o. Women who drink smoke and take drugs affect the health of their children 1. Non addicted women can reasonably be expected to quit

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2. We depend on moral exhortation; we don’t ban these substances or their advertisement 3. Why is addiction growing: US is among the lowest in terms of social services 4. The growth of drug use in the 1980s corresponds with the reduction in those programs 5. Poverty is growing; the philosophy of individualism, egoism and self-­‐sufficiency coupled with a system of hierarchy and privilege, which for the most part excludes women and people of color is singularly hostile to human wellbeing 6. People at the bottom are blamed for their problems 7. Few drug treatment programs for pregnant women 8. There will need to be wide societal changes if women’s plight is to be remedied 9. There are cases for forced caesareans without court orders and procedures performed with the knowledge and consent of the women affected. 10. A fetal harm law could make nearly every action potentially criminal 11. Studies show that 46 percent of fellows think that women should be forced against their will if they refuse medical advise 12. 47% want further life saving procedures ordered by courts if women refuse them 13. 26% want state surveillance of women in the third trimester who remain outside of the hospital system 14. Only 24% consistently supported a woman’s right to refuse medical advice 15. This practice constitutes a legal double standard 16. Many people have more control over their body after death than women do while alive 17. It is unjust to subject women to the treatments forced upon them especially since there is not much care shown for the health and the welfare of existing mothers and children 18. Purdy believes that it is seriously wrong to knowingly bring a diseased or handicapped child into the world 19. Not all are persuaded that the marital prerogative of privacy does not justify wife-­‐beating or rape (73) p. Because women’s interests are constantly at danger of being undervalued Purdy thinks they should be given priority q. If society was fair and humane we would have a legitimate right to expect more of each other morally and legal): we could expect people to be willing to sacrifice expendable parts of their bodies (pair organs, bone marrow etc); a still more demanding sacrifice would be to have people make sacrifices to prevent serious illness and handicaps (this latter would fall disproportionately on pregnant women r. A more humane world would invite many fewer conflicts of interest between women and their fetuses s. We may reject imposing these requirements legal as they would be counterproductive

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t.

A more caring society would be desirable; in the meantime the contrast between this vision and our own society should be enough to fuel the fight against invasion of women’s bodies occurring.

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