for each question answer with 2 to 3 sentences max 1. What is the difference between 'descriptive' versus 'normative' claims? 2. What are the key features of moral claims or norms, according to Vaughn

Moral , of course, pertains to morality as just defined, though it is also sometimes employed as a synonym for right or good, just as immoral is often meant to be equivalent to wrong or bad.

Ethics , as used in this text, is not synonymous with morality . Ethics is the study of morality using the tools and methods of philosophy. Philosophy is a discipline that systematically examines life’s Any serious and rewarding exploration of bio ­ ethics is bound to be a challenging journey.

What makes the trip worthwhile? As you might expect, this entire text is a long answer to that question. You therefore may not fully appreciate the trek until you have already hiked far along the trail. The short answer comes in three parts. First, bioethics— like ethics, its parent disci ­ pline— is about morality, and morality is about life. Morality is part of the unavoidable, bitter ­ sweet drama of being persons who think and feel and choose. Morality concerns beliefs regarding morally right and wrong actions and morally good and bad persons or character. Whether we like it or not, we seem confronted continually with the necessity to deliberate about right and wrong, to judge someone morally good or bad, to  agree or disagree with the moral pronounce ­ ments of others, to accept or reject the moral outlook of our culture or community, and even to doubt or affirm the existence or nature of moral concepts themselves. Moral issues are thus inescapable— including (or especially) those that are the focus of bioethics. In the twenty ­first century, few can remain entirely untouched by the pressing moral questions of fair distribution of health care resources, abortion and infanti ­ cide, euthanasia and assisted suicide, exploitative research on children and populations in devel ­ oping countries, human cloning and genetic en ­ gineering, assisted reproduction and surrogate parenting, prevention and treatment of HIV/ AIDS, the confidentiality and consent of patients, the refusal of medical treatment on religious grounds, experimentation on human embryos and fetuses, and the just allocation of scarce life ­ saving organs. 01-Vaughn-Chap01.indd 3 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 4 PART 1: PRINCIPLES AND THEORIES some or all of these as proper guides for our ac ­ tions and judgments. In normative ethics, we ask questions like these: What moral principles, if any, should inform our moral judgments?

What role should virtues play in our lives? Is the principle of autonomy justified? Are there any exceptions to the moral principle of “do not kill”? How should we resolve conflicts between moral norms? Is contractarianism a good moral theory? Is utilitarianism a better theory?

A branch that deals with much deeper ethical issues is metaethics. Metaethics is the study of the meaning and justification of basic moral be ­ liefs. In normative ethics we might ask whether an action is right or whether a person is good, but in metaethics we would more likely ask what it means for an action to be right or for a person to be good. For example, does right mean has the best consequences , or produces the most happi - ness, or commanded by God ? It is the business of metaethics to explore these and other equally fundamental questions: What, if anything, is the difference between moral and nonmoral be ­ liefs? Are there such things as moral facts? If so, what sort of things are they, and how can they be known? Can moral statements be true or false— or are they just expressions of emotions or attitudes without any truth value? Can moral norms be justified or proven? The third main branch is applied ethics, the use of moral norms and concepts to resolve practical moral issues. Here, the usual challenge is to employ moral principles, theories, argu ­ ments, or analyses to try to answer moral ques ­ tions that confront people every day. Many such questions relate to a particular professional field such as law, business, or journalism, so we have specialized subfields of applied ethics like legal ethics, business ethics, and journalistic ethics.

Probably the largest and most energetic subfield is bioethics. Bioethics is applied ethics focused on health care, medical science, and medical technology.

( Biomedical ethics is often used as a synonym, and medical ethics is a related but narrower term used most often to refer to ethical problems in big questions through critical reasoning, logical argument, and careful reflection. Thus ethics— also known as moral philosophy — is a reasoned way of delving into the meaning and import of moral concepts and issues and of evaluating the merits of moral judgments and standards. (As with morality and moral , we may use ethics to say such things as “Kant’s ethics” or may use ethical or unethical to mean right or wrong, good or bad.) Ethics seeks to know whether an action is right or wrong, what moral standards should guide our conduct, whether moral prin ­ ciples can be justified, what moral virtues are worth cultivating and why, what ultimate ends people should pursue in life, whether there are good reasons for accepting a particular moral theory, and what the meaning is of such notions as right , wrong , good , and bad . Whenever we try to reason carefully about such things, we enter the realm of ethics: We do ethics.

Science offers another way to study morality, and we must carefully distinguish this approach from that of moral philosophy. Descriptive ethics is the study of morality using the meth ­ odology of science. Its purpose is to investigate the empirical facts of morality— the actual be­ liefs, behaviors, and practices that constitute people’s moral experience. Those who carry out these inquiries (usually anthropologists, sociol ­ ogists, historians, and psychologists) want to know, among other things, what moral beliefs a person or group has, what caused the subjects to have them, and how the beliefs influence behav ­ ior or social interaction. Very generally, the dif ­ ference between ethics and descriptive ethics is this: In ethics we ask, as Socrates did, How ought we to live? In descriptive ethics we ask, How do we in fact live? Ethics is a big subject, so we should not be surprised that it has three main branches, each dealing with more or less separate but related sets of ethical questions. Normative ethics is the search for, and justification of, moral standards, or norms. Most often the standards are moral principles, rules, virtues, and theories, and the lofty aim of this branch is to establish rationally 01-Vaughn-Chap01.indd 4 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 5 about art; norms of etiquette about polite social behavior; grammatical norms about correct use of language; prudential norms about what is in one’s interests; and legal norms about lawful and unlawful acts. But moral norms differ from these nonmoral kinds. Some of the features they are thought to possess include the following.

Normative Dominance. In our moral practice, moral norms are presumed to dominate other kinds of norms, to take precedence over them.

Philosophers call this characteristic of moral norms overridingness because moral consider ­ ations so often seem to override other factors.

A maxim of prudence, for example, may suggest that you should steal if you can avoid getting caught, but a moral prohibition against stealing would overrule such a principle. An aesthetic (or pragmatic) norm implying that homeless people should be thrown in jail for blocking the view of a beautiful public mural would have to yield to moral principles demanding more humane treat ­ ment of the homeless. A law mandating brutal actions against a minority group would conflict with moral principles of justice and would there ­ fore be deemed illegitimate. We usually think that immoral laws are defective, that they need to be changed, or that, in rare cases, they should be defied through acts of civil disobedience.

Universality. Moral norms (but not exclusively moral norms) have universality: Moral princi ­ ples or judgments apply in all relevantly similar situations. If it is wrong for you to tell a lie in a particular circumstance, then it is wrong for everyone in relevantly similar circumstances to tell a lie. Logic demands this sort of consistency.

It makes no sense to say that Maria’s doing action A in circumstances C is morally wrong, but John’s doing A in circumstances relevantly similar to C is morally right. Universality, how ­ ever, is not unique to moral norms; it’s a charac ­ teristic of all normative spheres.

Impartiality. Implicit in moral norms is the notion of impartiality— the idea that everyone medical practice.) Ranging far and wide, bio ­ ethics seeks answers to a vast array of tough ethical questions: Is abortion ever morally per ­ missible? Is a woman justified in having an abor ­ tion if prenatal genetic testing reveals that her fetus has a developmental defect? Should people be allowed to select embryos by the embryos’ sex or other genetic characteristics? Should human embryos be used in medical research? Should human cloning be prohibited? Should physicians, nurses, physicians’ assistants, and other health care professionals always be truthful with patients whatever the consequences? Should severely im ­ paired newborns be given life ­prolonging treat ­ ment or be allowed to die? Should people in persistent vegetative states be removed from life support? Should physicians help terminally ill patients commit suicide? Is it morally right to con­ duct medical research on patients without their consent if the research would save lives? Should human stem ­cell research be banned? How should we decide who gets life ­saving organ trans­ plants when usable organs are scarce and many patients who do not get transplants will die?

Should animals be used in biomedical research? The ethical and technical scope of bioethics is wide. Bioethical questions and deliberations now fall to nonexpert and expert alike— to pa­ tients, families, and others as well as to philoso ­ phers, health care professionals, lawyers, judges, scientists, clergy, and public policy specialists.

Though the heart of bioethics is moral philoso ­ phy, fully informed bioethics cannot be done without a good understanding of the relevant nonmoral facts and issues, especially the medi ­ cal, scientific, technological, and legal ones. ethics and the moral life Morality then is a normative, or evaluative, enter ­ prise. It concerns moral norms or standards that help us decide the rightness of actions, judge the goodness of persons or character, and prescribe the form of moral conduct. There are, of course, other sorts of norms we apply in life— nonmoral norms.

Aesthetic norms help us make value judg ments 01-Vaughn-Chap01.indd 5 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 6 PART 1: PRINCIPLES AND THEORIES the moral life— is to do moral reasoning. If our moral judgments are to have any weight at all, if they are to be anything more than mere per ­ sonal taste or knee ­jerk emotional response, they must be backed by the best of reasons. They must be the result of careful reflection in which we arrive at good reasons for accepting them, reasons that could be acknowledged as such by any other reasoning persons. Both logic and our commonsense moral ex ­ perience demand that the thorough sifting of reasons constitutes the main work of our moral deliberations— regardless of our particular moral outlook or theory. We would think it odd, per ­ haps even perverse, if someone asserted that physician ­assisted suicide is always morally wrong— and then said she has no reasons at all for believing such a judgment but just does. What­ ever our views on physician ­assisted suicide, we would be justified in ignoring her judgment, for we would have no way to distinguish it from personal whim or wishful thinking. Likewise she herself (if she genuinely had no good reasons for her assertion) would be in the same boat, adrift with a firm opinion moored to nothing solid. Our feelings, of course, are also part of our moral experience. When we ponder a moral issue we care about (abortion, for example), we may feel anger, sadness, disgust, fear, irritation, or sympathy. Such strong emotions are normal and often useful, helping us empathize with others, deepening our understanding of human suffering, and sharpening our insight into the consequences of our moral decisions. But our feelings can mislead us by reflecting not moral truth but our own psychological needs, our own personal or cultural biases, or our concern for personal advantage. Throughout history, some people’s feelings led them to conclude that women should be burned for witchcraft, that whole races should be exterminated, that black men should be lynched, and that adherents of a different religion were evil. Critical reasoning can help restrain such terrible impulses. It can help us put our feelings in proper perspective and achieve a measure of impartiality. Most of should be considered equal, that everyone’s inter ­ ests should count the same. From the perspective of morality, no person is any better than any other. Everyone should be treated the same unless there is a morally relevant difference between persons. We probably would be completely baf ­ fled if someone seriously said something like “murder is wrong . . . except when committed by myself,” when there was no morally relevant dif ­ ference between that person and the rest of the world. If we took such a statement seriously at all, we would likely not only reject it but also would not even consider it a bona fide moral statement. The requirement of moral impartiality pro ­ hibits discrimination against people merely be ­ cause they are different— different in ways that are not morally relevant. Two people can be dif ­ ferent in many ways: skin color, weight, gender, income, age, occupation, and so forth. But these are not differences relevant to the way they should be treated as persons. On the other hand, if there are morally relevant differences between people, then we may have good reasons to treat them differently, and this treatment would not be a violation of impartiality. This is how phi ­ losopher James Rachels explains the point: The requirement of impartiality, then, is at bottom nothing more than a proscription against arbitrariness in dealing with people. It is a rule that forbids us from treating one person differ ­ ently from another when there is no good reason to do so . But if this explains what is wrong with racism, it also explains why, in some special kinds of cases, it is not racist to treat people dif ­ ferently. Suppose a film director was making a movie about the life of Martin Luther King, Jr.

He would have a perfectly good reason for ruling out Tom Cruise for the starring role. Obviously, such casting would make no sense. Because there would be a good reason for it, the director’s “dis ­ crimination” would not be arbitrary and so would not be open to criticism. 1 Reasonableness. To participate in morality— to engage in the essential, unavoidable practices of 01-Vaughn-Chap01.indd 6 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 7 purports to explain right actions, or make judg­ ments about right or wrong actions. Moral values, on the other hand, generally concern those things that we judge to be morally good, bad, praiseworthy, or blameworthy. Nor ­ mally we use such words to describe persons (as in “He is a good person” or “She is to blame for hurting them”), their character (“He is virtu ­ ous”; “She is honest”), or their motives (“She did wrong but did not mean to”). Note that we also attribute nonmoral value to things. If we say that a book or bicycle or vacation is good, we mean good in a nonmoral sense. Such things in them ­ selves cannot have moral value.

Strictly speaking, only actions are morally right or wrong , but persons are morally good or bad (or some degree of goodness or badness).

With this distinction we can acknowledge a all, it can guide us to moral judgments that are trustworthy because they are supported by the best of reasons.

The moral life, then, is about grappling with a distinctive class of norms marked by normative dominance, universality, impartiality, and rea ­ sonableness. As we saw earlier, these norms can include moral principles, rules, theories, and judgments. We should notice that we commonly apply these norms to two distinct spheres of our moral experience— to both moral obligations and moral values .

Moral obligations concern our duty, what we are obligated to do. That is, obligations are about conduct, how we ought or ought not to behave.

In this sphere, we talk primarily about actions .

We may look to moral principles or rules to guide our actions, or study a moral theory that IN DEPTH MORALITY AND THE LAW Some people confuse morality with the law, or iden - tify the one with the other, but the two are distinct though they may often coincide. Laws are norms enacted or enforced by the state to protect or pro - mote the public good. They specify which actions are legally right or wrong. But these same actions can also be judged morally right or wrong, and these two kinds of judgments will not necessarily agree.

Lying to a friend about a personal matter, deliberately trying to destroy yourself through reckless living, or failing to save a drowning child (when you easily could have) may be immoral— but not illegal. Racial bias, discrimination based on gender or sexual orien - tation, slavery, spousal rape, and unequal treatment of minority groups are immoral— but, depending on the society, they may not be illegal. Much of the time, however, morality and the law overlap. Often what is immoral also turns out to be illegal. This is usually the case when immoral actions cause substantial harm to others, whether physical or economic. Thus murder and embezzlement are both immoral and illegal, backed by social disapproval and severe sanctions imposed by law. Controversy often arises when an action is not obviously or seri - ously harmful but is considered immoral by some who want the practice prohibited by law. The conten - tious notion at work is that something may be made illegal solely on the grounds that it is immoral, re - gardless of any physical or economic harm involved.

This view of the law is known as legal moralism , and it sometimes underlies debates about the legalization of abortion, euthanasia, reproductive technology, con traception, and other practices.

Many issues in bioethics have both a moral and legal dimension, and it is important not to confuse the two. Sometimes the question at hand is a moral one (whether, for example, euthanasia is ever morally permissible); whether a practice should be legal or illegal then is beside the point. Sometimes the ques - tion is about legality. And sometimes the discussion concerns both. A person may consider physician- assisted suicide morally acceptable but argue that it should nevertheless be illegal because allowing the practice to become widespread would harm both patients and the medical profession. 01-Vaughn-Chap01.indd 7 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 8 PART 1: PRINCIPLES AND THEORIES simple fact of the moral life: A good person can do something wrong, and a bad person can do something right. A Gandhi can tell a lie, and a Hitler can save a drowning man.

In addition, we may judge an action right or wrong depending on the motive behind it. If John knocks a stranger down in the street to pre ­ vent her from being hit by a car, we would deem his action right (and might judge him a good person). But if he knocks her down because he dislikes the color of her skin, we would believe his action wrong (and likely think him evil). The general meaning of right and wrong seems clear to just about everyone. But we should be careful to differentiate degrees of meaning in these moral terms. Right can mean either “obliga­ tory” or “permissible.” An obligatory action is one that would be wrong not to perform. We are obli­ gated or required to do it. A permissible action is one that is permitted. It is not wrong to perform it.

Wrong means “prohibited.” A prohibited action is one that would be wrong to perform. We are obli ­ gated or required not to do it. A supererogatory action is one that is “above and beyond” our duty.

It is praiseworthy— a good thing to do— but not required. Giving all your possessions to the poor is generally considered a supererogatory act.

moral principles in bioethics As noted earlier, the main work of bioethics is trying to solve bioethical problems using the potent resources and methods of moral phi ­ losophy, which include, at a minimum, critical reasoning, logical argument, and conceptual analysis. Many, perhaps most, moral philoso ­ phers would be quick to point out that beyond these tools of reason we also have the consider ­ able help of moral principles. (The same could be said about moral theories, which we explore in the next chapter.) Certainly to be useful, moral principles must be interpreted, often filled out with specifics, and balanced with other moral concerns. But both in everyday life and in bio ­ ethics, moral principles are widely thought to be indispensable to moral decision ­making. We can see appeals to moral principles in countless cases. Confronted by a pain ­racked, terminally ill patient who demands to have his life ended, his physician refuses to comply, rely ­ ing on the principle that “it is wrong to inten ­ tionally take a life.” Another physician makes a different choice in similar circumstances, insist ­ ing that the relevant principle is “ending the suf ­ fering of a hopelessly ill patient is morally permissible.” An infant is born anencephalic (without a brain); it will never have a conscious life and will die in a few days. The parents decide to donate the infant’s organs to other children so they might live, which involves taking the organs right away before they deteriorate. A critic of the parents’ decision argues that “it is unethical to kill in order to save.” But someone else appeals to the principle “save as many chil ­ dren as possible.” 2 In such ways moral principles help guide our actions and inform our judg ­ ments about right and wrong, good and evil. As discussed in Chapter 2, moral principles are often drawn from a moral theory, which is a moral standard on the most general level. The principles are derived from or supported by the theory. Many times we simply appeal directly to a plausible moral principle without thinking much about its theoretical underpinnings. Philosophers make a distinction between ab ­ solute and prima facie principles (or duties). An absolute principle applies without exceptions.

An absolute principle that we should not lie de ­ mands that we never lie regardless of the cir ­ cumstances or the consequences. In contrast, a prima facie principle applies in all cases unless an exception is warranted. Exceptions are justi ­ fied when the principle conflicts with other principles and is thereby overridden. W. D. Ross is given credit for drawing this distinction in his 1930 book The Right and the Good . 3 It is essen­ tial to his account of ethics, which has a core of several moral principles or duties, any of which might come into conflict. Physicians have a prima facie duty to be truth­ ful to their patients as well as a prima facie duty to promote their welfare. But if these duties come 01-Vaughn-Chap01.indd 8 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 9 their consent, treating competent patients against their will, physically restraining or confining pa­ tients for no medical reason— such practices con­ stitute obvious violations of personal autonomy. Not all restrictions on autonomy, however, are of the physical kind. Autonomy involves the capacity to make personal choices, but choices cannot be considered entirely autonomous unless they are fully informed. When we make decisions in ignorance— without relevant information or blinded by misinformation— our autonomy is diminished just as surely as if someone physi ­ cally manipulated us. If this is correct, then we have a plausible explanation of why lying is generally prohibited: Lying is wrong because it undermines personal autonomy. Enshrined in bioethics and in the law, then, is the precept of informed consent , which demands that patients be allowed to freely consent to or decline treat ­ ments and that they receive the information they need to make informed judgments about them. In many ways, autonomy is a delicate thing, easily compromised and readily thwarted. Often a person’s autonomy is severely undermined not by other people but by nature, nurture, or his or her own actions. Some drug addicts and alcohol ­ ics, people with serious psychiatric illness, and those with severe mental impairment are thought to have drastically diminished autonomy (or to be essentially nonautonomous). Bioethical ques ­ tions then arise about what is permissible to do to them and who will represent their interests or make decisions regarding their care. Infants and children are also not fully autonomous, and the same sorts of questions are forced on parents, guardians, and health care workers. Like all the other major principles discussed here, respect for autonomy is thought to be prima facie. It can sometimes be overridden by considerations that seem more important or compelling— considerations that philosophers and other thinkers have formulated as princi ­ ples of autonomy restriction. The principles are articulated in various ways, are applied widely to all sorts of social and moral issues, and are themselves the subject of debate. Chief among in conflict— if, for example, telling a patient the truth about his condition would somehow result in his death— a physician might decide that the duty of truthfulness should yield to the weight ­ ier duty to do good for the patient. Moral principles are many and varied, but in bioethics the following have traditionally been extremely influential and particularly relevant to the kinds of moral issues that arise in health care, medical research, and biotechnology. In fact, many— perhaps most— of the thorniest issues in bioethics arise from conflicts among these basic principles. In one formulation or another, each one has been integral to major moral theories, providing evidence that the principles capture something essential in our moral expe ­ rience. The principles are (1) autonomy, (2) non­ maleficence, (3) beneficence, (4) utility, and (5) justice. 4 Autonomy Autonomy refers to a person’s rational capacity for self ­governance or self ­determination— the ability to direct one’s own life and choose for oneself. The principle of autonomy insists on full respect for autonomy. One way to express the prin ­ ciple is: Autonomous persons should be allowed to  exercise their capacity for self-determination. According to one major ethical tradition, autono ­ mous persons have intrinsic worth precisely because they have the power to make rational decisions and moral choices. They therefore must be treated with respect, which means not violating their autonomy by ignoring or thwarting their ability to choose their own paths and make their own judgments. The principle of respect for autonomy places severe restraints on what can be done to an autonomous person. There are exceptions, but in general we are not permitted to violate people’s autonomy just because we disagree with their decisions, or because society might benefit, or because the violation is for their own good. We cannot legitimately impair someone’s autonomy without strong justification for doing so. Con ­ ducting medical experiments on patients without 01-Vaughn-Chap01.indd 9 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 10 PART 1: PRINCIPLES AND THEORIES these is the harm principle: a person’s autonomy may be curtailed to prevent harm to others. To prevent people from being victimized by thieves and murderers, we have a justice system that prosecutes and imprisons the perpetrators. To discourage hospitals and health care workers from hurting patients through carelessness or fraud, laws and regulations limit what they can do to people in their care. To stop someone from spreading a deadly, contagious disease, health officials may quarantine him against his will.

Another principle of autonomy restriction is paternalism. Paternalism is the overriding of a person’s actions or decision ­making for her own good. Some cases of paternalism (sometimes called weak paternalism ) seem permissible to many people— when, for example, seriously de ­ pressed or psychotic patients are temporarily restrained to prevent them from injuring or kill ­ ing themselves. Other cases are more controver ­ sial. Researchers hoping to develop a life ­saving treatment give an experimental drug to some ­ one without his knowledge or consent. Or a physician tries to spare the feelings of a compe ­ tent, terminally ill patient by telling her that she will eventually get better, even though she in ­ sists on being told the truth. The paternalism in such scenarios (known as strong paternalism) is usually thought to be morally objectionable.

Many controversies in bioethics center on the morality of strong paternalism.

Nonmaleficence The principle of nonmaleficence asks us not to intentionally or unintentionally inflict harm on others. In bioethics, nonmaleficence is the most widely recognized moral principle. Its aphoris ­ tic expression has been embraced by practitio ­ ners of medicine for centuries: “Above all, do no harm.” A more precise formulation of the prin ­ ciple is: We should not cause unnecessary injury or harm to those in our care . In whatever form, nonmaleficence is the bedrock precept of count ­ less codes of professional conduct, institutional regulations, and governmental rules and laws designed to protect the welfare of patients. A health care professional violates this prin ­ ciple if he or she deliberately performs an action that harms or injures a patient. If a physician intentionally administers a drug that she knows will induce a heart attack in a patient, she obvi ­ ously violates the principle—she clearly does something that is morally (and legally) wrong.

But she also violates it if she injures a patient through recklessness, negligence, or inexcusable ignorance. She may not intend to hurt anyone, but she is guilty of the violation just the same. Implicit in the principle of nonmaleficence is the notion that health professionals must exer ­ cise “due care.” The possibility of causing some pain, suffering, or injury is inherent in the care and treatment of patients, so we cannot realisti ­ cally expect health professionals never to harm anyone. But we do expect them to use due care— to act reasonably and responsibly to minimize the harm or the chances of causing harm. If a physician must cause patients some harm to effect a cure, we expect her to try to produce the least amount of harm possible to achieve the re ­ sults. And even if her treatments cause no actual pain or injury in a particular instance, we expect her not to use treatments that have a higher chance of causing harm than necessary. By the lights of the nonmaleficence principle, subjecting patients to unnecessary risks is wrong even if no damage is done.

Beneficence The principle of beneficence has seemed to many to constitute the very soul of morality— or very close to it. In its most general form, it says that we should do good to others . (Benevolence is dif­ ferent, referring more to an attitude of goodwill toward others than to a principle of right action.) Beneficence enjoins us to advance the welfare of others and prevent or remove harm to them. Beneficence demands that we do more than just avoid inflicting pain and suffering. It says that w e should actively promote the well-being of others and prevent or remove harm to them . In bioethics, there is little doubt that physicians, nurses, researchers, and other professionals have 01-Vaughn-Chap01.indd 10 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 11 possible benefits of the treatment outweigh its risks by an acceptable margin. Suppose a man’s clogged artery can be successfully treated with open­heart surgery, a procedure that carries a considerable risk of injury and death. But imag ­ ine that the artery can also be successfully opened with a regimen of cholesterol ­lowering drugs and a low ­fat diet, both of which have a much lower chance of serious complications.

The principle of utility seems to suggest that the latter course is best and that the former is mor ­ ally impermissible. The principle also plays a major role in the creation and evaluation of the health policies of institutions and society. In these large arenas, most people aspire to fulfill the requirements of beneficence and maleficence, but they recognize that perfect beneficence or maleficence is im ­ possible: Trade ­offs and compromises must be made, scarce resources must be allotted, help and harm must be balanced, life and death must be weighed— tasks almost always informed by the principle of utility. Suppose, for example, we want to mandate the immunization of all schoolchildren to pre ­ vent the spread of deadly communicable dis ­ eases. The cost in time and money will be great, but such a program could save many lives.

There is a down side, however: A small number of children— perhaps as many as 2 for every 400,000 immunizations— will die because of a rare allergic reaction to the vaccine. It is impos ­ sible to predict who will have such a reaction (and impossible to prevent it), but it is almost certain to occur in a few cases. If our goal is social beneficence, what should we do? Children are likely to die whether we institute the program or not. Guided by the principle of utility (as well as other principles), we may decide to proceed with the program since many more lives would likely be saved by it than lost because of its implementation. Again, suppose governmental health agencies have enough knowledge and resources to de ­ velop fully a cure for only one disease— either a rare heart disorder or a common form of skin such a duty. After all, helping others, promoting their good, is a large part of what these profes ­ sionals are obliged to do. But not everyone thinks that we all have a duty of active beneficence. Some argue that though there is a general (applicable to all) duty not to harm others, there is no general duty to help others. They say we are not obligated to aid the poor, feed the hungry, or tend to the sick.

Such acts are not required, but are supererogatory, beyond the call of duty. Others contend that though we do not have a general duty of active beneficence, we are at least sometimes obligated to look to the welfare of people we care about most— such as our parents, children, spouses, and friends. In any case, it is clear that in cer ­ tain professions— particularly medicine, law, and nursing— benefiting others is often not just supererogatory but obligatory and basic.

Utility The principle of utility says that we should pro - duce the most favorable balance of good over bad (or benefit over harm) for all concerned. The prin ­ ciple acknowledges that in the real world, we cannot always just benefit others or just avoid harming them. Often we cannot do good for people without also bringing them some harm, or we cannot help everyone who needs to be helped, or we cannot help some without also hurting or neglecting others. In such situations, the principle says, we should do what yields the best overall outcome— the maximum good and minimum evil, everyone considered. The utility principle, then, is a supplement to, not a substi ­ tute for, the principles of autonomy, beneficence, and justice. In ethics this maxim comes into play in sev ­ eral ways. Most famously it is the defining pre ­ cept of the moral theory known as utilitarianism (discussed in Chapter 2). But it is also a stand ­ alone moral principle applied everywhere in bio ethics to help resolve the kind of dilemmas just mentioned. A physician, for example, must decide whether a treatment is right for a patient, and that decision often hinges on whether the 01-Vaughn-Chap01.indd 11 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 12 PART 1: PRINCIPLES AND THEORIES cancer. Trying to split resources between these two is sure to prevent development of any cure at all. The heart disorder kills 200 adults each year; the cancer occurs in thousands of people, causing them great pain and distress, but is rarely fatal. How best to maximize the good? On which disease should the government spend its time and treasure? Answering this question (and others like it) requires trying to apply the utility principle— a job often involving complex calculations of costs and benefits and frequently generating controversy.

Justice In its broadest sense, justice refers to people get­ ting what is fair or what is their due. In practice, most of us seem to have a rough idea of what justice entails in many situations, even if we cannot articulate exactly what it is. We know, for example, that it is unjust for a bus driver to make a woman sit in the back of the bus because of her religious beliefs, or for a judicial system to arbitrarily treat one group of citizens more harshly than others, or for a doctor to care for some patients but refuse to treat others just be ­ cause he dislikes them. Questions of justice arise in different spheres of human endeavor. Retributive justice , for ex­ ample, concerns the fair meting out of punish ­ ment for wrongdoing. On this matter, some argue that justice is served only when people are punished for past wrongs, when they get their just deserts. Others insist that justice demands that people be punished not because they de ­ serve punishment, but because the punishment will deter further unacceptable behavior. Dis- tributive justice concerns the fair distribution of  society’s advantages and disadvantages— for example, jobs, income, welfare aid, health care, rights, taxes, and public service. Distributive jus ­ tice is a major issue in bioethics, where many of the most intensely debated questions are about who gets health care, what or how much they should get, and who should pay for it. Distributive justice is a vast topic, and many theories have been proposed to identify and justify the properties, or traits, of just distribu ­ tions. A basic precept of most of these theories is what may plausibly be regarded as the core of the principle of justice: Equals should be treated equally. (Recall that this is one of the defining elements of ethics itself, impartiality.) The idea is that people should be treated the same unless there is a morally relevant reason for treating them differently. We would think it unjust for a  physician or nurse to treat his white diabetic patients more carefully than he does his black diabetic patients— and to do so without a sound medical reason. We would think it unfair to award the only available kidney to the trans ­ plant candidate who belongs to the “right” po ­ litical party or has the best personal relationship with hospital administrators. The principle of justice has been at the heart of debates about just distribution of benefits and burdens (including health care) for society as a whole. The disagreements have generally not been about the legitimacy of the principle, but about how it should be interpreted. Different theories of justice try to explain in what respects equals should be treated equally. Libertarian theories emphasize personal free ­ doms and the right to pursue one’s own social and economic well ­being in a free market with ­ out interference from others. Ideally the role of  government is limited to night ­watchman functions— the protection of society and free economic systems from coercion and fraud. All other social or economic benefits are the respon ­ sibility of individuals. Government should not be in the business of helping the socially or eco ­ nomically disadvantaged, for that would require violating people’s liberty by taking resources from the haves to give to the have ­nots. So uni ­ versal health care is out of the question. For the libertarian, then, people have equal intrinsic worth, but this does not entitle them to an equal distribution of economic advantages. Individu ­ als are entitled only to what they can acquire through their own hard work and ingenuity. Egalitarian theories maintain that a just dis ­ tribution is an equal distribution. Ideally, social 01-Vaughn-Chap01.indd 12 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 13 But moral objectivism is directly challenged by a doctrine that some find extremely appeal ­ ing and that, if true, would undermine ethics itself: ethical relativism. According to this view, moral standards are not objective but are rela ­ tive to what individuals or cultures believe.

There simply are no objective moral truths, only relative ones. An action is morally right if en ­ dorsed by a person or culture and morally wrong if condemned by a person or culture. So eutha ­ nasia is right for person A if he approves of it but wrong for person B if she disapproves of it, and the same would go for cultures with similarly diverging views on the subject. In this way, moral norms are not discovered but made; the indi ­ vidual or culture makes right and wrong. Ethi ­ cal relativism pertaining to individuals is known as subjective relativism, more precisely stated as the view that right actions are those sanctioned by a person. Ethical relativism regarding cultures is called cultural relativism, the view that right actions are those sanctioned by one’s culture. In some ways, subjective relativism is a com ­ forting position. It relieves individuals of the burden of serious critical reasoning about mo ­ rality. After all, determining right and wrong is a matter of inventorying one’s beliefs, and any sincerely held beliefs will do. Morality is essen ­ tially a matter of personal taste, which is an ex ­ tremely easy thing to establish. Determining what one’s moral views are may indeed involve deliberation and analysis—but neither of these is a necessary requirement for the job. Subjective relativism also helps people short ­circuit the un ­ pleasantness of moral debate. The subjective relativist’s familiar refrain—“That may be your truth, but it’s not my truth”—has a way of stop ­ ping conversations and putting an end to rea ­ soned arguments. The doctrine, however, is difficult to maintain consistently. On issues that the relativist cares little about (the moral rightness of gambling, say), she may be content to point out that moral norms are relative to each individual and that “to each his own.” But on more momentous topics (such as genocide in Africa or the Middle benefits— whether jobs, food, health care, or some thing else— should be allotted so that every ­ one has an equal share. Treating people equally means making sure everyone has equal access to certain minimal goods and services. To achieve this level of equality, individual liberties will have to be restricted, measures that libertari ­ ans would never countenance. In a pure egali ­ tarian society, universal health care would be guaranteed. Between strict libertarian and egalitarian views of justice lie some theories that try to achieve a plausible fusion of both perspectives. With a nod toward libertarianism, these theories may exhibit a healthy respect for individual liberty and limit governmental interference in econo­ mic enterprises. But leaning toward egalitarian ­ ism, they may also mandate that the basic needs of the least well ­off citizens be met.

In bioethics, the principle of justice and the theories used to explain it are constantly being marshaled to support or reject health care poli ­ cies of all kinds. They are frequently used— along with other moral principles— to evaluate, design, and challenge a wide range of health care pro ­ grams and strategies. They are, in other words, far from being merely academic. ethical relativism The commonsense view of morality and moral standards is this: There are moral norms or principles that are valid or true for everyone.

This claim is known as moral objectivism, the idea that at least some moral standards are ob ­ jective. Moral objectivism, however, is distinct from moral absolutism, the belief that objective moral principles allow no exceptions or must be applied the same way in all cases and cultures. A moral objectivist can be absolutist about moral principles, or she can avoid absolutism by ac ­ cepting that moral principles are prima facie. In any case, most people probably assume some form of moral objectivism and would not take seriously any claim implying that valid moral norms can be whatever we want them to be. 01-Vaughn-Chap01.indd 13 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 14 PART 1: PRINCIPLES AND THEORIES East), she may slip back into objectivism and declare that genocide is morally wrong— not just wrong for her but wrong period .

Such inconsistencies hint that there may be something amiss with subjective relativism, and indeed there is: It seems to conflict violently with commonsense realities of the moral life. For one thing, the doctrine implies that each person is morally infallible. An action is morally right for someone if he approves of it— if he sincerely believes it to be right. His approval makes the action right, and— if his approval is genuine— he cannot be mistaken. His believing it to be right makes it right, and that’s the end of it. If he endorses infanticide as a method of population control, then infanticide is morally permissible.

His sincere approval settles the issue, and he cannot be in error. But our commonsense moral experience suggests that this relativist account is absurd. Our judgments about moral matters— actions, principles, and people— are often wide of the mark. We are morally fallible, and we are rightly suspicious of anyone who claims to be otherwise. There is a more disturbing way to frame this point. Suppose former Iraqi leader Saddam Hussein approved of slaughtering thousands of Iraqis during his reign. Suppose Hitler approved of killing millions of Jews during World War II.

Suppose American serial killer and cannibal Jeffrey Dahmer approved of his murdering 17  men and boys. Then by the lights of subjec ­ tive relativism, all these mass killings were mor ­ ally right because their perpetrators deemed them so. But we would find this conclusion almost impossible to swallow. We would think these actions morally wrong whether the killers ap ­ proved of their own actions or not. Subjective relativism also implies that an ­ other commonplace of the moral life is an illu ­ sion: moral disagreement. Consider: Hernando tells Sophia that allowing seriously impaired infants to die is morally right. Sophia replies that allowing seriously impaired infants to die is morally wrong. We may think that Hernando and Sophia are having a straightforward dis ­ agreement over an important moral issue. But according to subjective relativism, no such dis ­ agreement is happening or could ever happen.

In stating his approval of the actions in ques ­ tion, Hernando is essentially expressing his per ­ sonal taste on the issue, and Sophia is expressing her personal taste. He is saying he likes some ­ thing; she says she does not like it— and they could both be correct. Subjective relativism im ­ plies that they are not uttering conflicting claims IN DEPTH ANTHROPOLOGY AND MORAL DIVERSITY Many moral philosophers have been quick to point out that differences in moral judgments from culture to culture do not in themselves prove a difference in moral standards. Some anthropologists have made the same argument. Solomon Asch, for example, says, We consider it wrong to take food away from a hungry child, but not if he is overeating. We consider it right to fulfill a promise, but not if it is a promise to commit a crime. . . . It has been customary to hold that diverse evaluations of the same act are automatic evidence for the presence of different principles of evaluation.

The preceding examples point to an error in this interpretation. Indeed, an examination of the relational factors points to the operation of constant principles in situations that differ in concrete details. . . . Anthropological evidence does not furnish proof of relativism. We do not know of societies in which bravery is despised and cowardice held up to honor, in which generosity is considered a vice and ingratitude a virtue. It seems rather that the relations between valuation and meaning are invariant. 5 01-Vaughn-Chap01.indd 14 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 15 it a solemn duty to surgically remove the clito­ rises of young girls; others say this is immoral and cruel. Some commend the killing of people who practice a different religion; others believe such intolerance is morally reprehensible. We are forced to conclude that diversity of moral judgments among cultures is a reality. But what of premise 1— is it also true? It says that because cultures have different moral beliefs, they must also have different moral standards, which means morality is relative to cultures. If diverse moral standards arise from each culture, then morality cannot be objective, applying to all people everywhere. There is no objective mo ­ rality, just moralities .

Premise 1, however, is false. First, from the fact that cultures have divergent moral beliefs on an issue, it does not logically follow that there is no objective moral truth to be sought, that there is no opinion that is objectively correct.

People may disagree about the existence of bio ­ logical life on Mars, but the disagreement does not demonstrate that there is no fact of the matter or that no statement on the subject could be objectively true. Disagreements on a moral question may simply indicate that there is an objective fact of the matter but that someone (or everyone) is wrong about it. Second, a conflict between moral beliefs does not necessarily indicate a fundamental conflict between basic moral norms. Moral dis ­ agreements between cultures can arise not just because their basic moral principles clash, but because they have differing nonmoral beliefs that put those principles in a very different light.

From the annals of anthropology, for example, we have the classic story of a culture that sanc ­ tions the killing of parents when they become elderly but not yet enfeebled. Our society would condemn such a practice, no doubt appealing to moral precepts urging respect for parents and for human life. But consider: This strange (to us) culture believes that people enter heaven when they die and spend eternity in the same physical condition they were in when they passed away.

Those who kill their parents are doing so because at all— they are discussing different subjects, their own personal feelings or preferences. But this strange dance is not at all what we think we are doing when we have a moral disagreement. Be ­ cause subjective relativism conflicts with what we take to be a basic fact of the moral life, we have good reason to doubt it. Cultural relativism seems to many to be a much more plausible doctrine. In fact, many people think it obviously true, supported as it is by a convincing argument and the common con ­ viction that it is admirably consistent with social tolerance and understanding in a pluralistic world. The argument in its favor goes like this:

1. If people’s moral judgments differ from culture to culture, moral norms are relative to culture (there are no objective moral standards).

2. People’s moral judgments do differ from culture to culture.

3. Therefore, moral norms are relative to culture (there are no objective moral standards).

Is this a good argument? That is, does it pro ­ vide us with good reason to accept the conclu ­ sion (statement 3)? For an argument to be good, its conclusion must follow logically from the premises, and the premises must be true. In this case, the conclusion does indeed follow logically from the premises (statements 1 and 2). The truth of the premises is another matter. Let us look first at premise 2. All sorts of empirical evidence— including a trove of anthro­ pological and sociological data— show that the premise is in fact true. Clearly, the moral beliefs of people from diverse cultures often do differ drastically on the same moral issue. Some soci ­ eties condone infanticide; others condemn it.

Some approve of the killing of wives and daugh ­ ters to protect a family’s honor; others think this tradition evil. Some bury their dead; others cre ­ mate them. Some judge the killing of one’s elders to be a kindly act; others say it is cold ­hearted murder. Some think polygamy morally permis ­ sible; others believe it deplorable. Some consider 01-Vaughn-Chap01.indd 15 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 16 PART 1: PRINCIPLES AND THEORIES terrorist bombing of Pan Am flight 103 over Lockerbie, Scotland, killing 270 people (a tragedy for which the Libyan government eventually took responsibility). Then the bombing was morally right, and those who placed the bomb on board did no wrong. But all this seems very much at odds with our moral experience. We think it makes perfect sense sometimes to con ­ demn other cultures for morally wrong actions. Now consider the notion of moral progress.

We sometimes compare what people did in the past with what they do now, noting that current practices are morally better than they used to be. We no longer countenance such horrors as massacres of native peoples, slavery, and lynch ­ ings, and we think that these changes are signs of moral progress. But cultural relativism implies that there cannot be any such thing as moral progress. To claim legitimately that there has been moral progress, there must be an objective, trans­ cultural standard for comparing cultures of the past and present. But according to cultural rela ­ tivism, there are no objective moral standards, just norms relative to each culture. On the other hand, if there is moral progress as we think there is, then there must be objective moral standards. Cultural relativism also has a difficult time explaining the moral status of social reformers.

We tend to believe they are at least sometimes right and society is wrong. When we contem ­ plate social reform, we think of such moral ex ­ emplars as Martin Luther King, Jr., Mahatma Gandhi, and Susan B. Anthony, all of whom agi ­ tated for justice and moral progress. But one of the consequences of cultural relativism is that social reformers could never be morally right.

By definition, what society judges to be morally right is morally right, and since social reformers disagree with society, they could not be right— ever. But surely on occasion it’s the reformers who are right and society is wrong. There is also the serious difficulty of using cultural relativism to make moral decisions.

Cultural relativism says that moral rightness is whatever a culture or society approves of, but determining which culture or society one truly they do not want their elders to spend eternity in a state of senility but rather in good health.

This culture’s way is not our way; we are unlikely to share these people’s nonmoral beliefs. But it is probable that they embrace the same moral principles of respect for parents and life that we do. According to some anthropologists, diverse cultures often share basic moral standards while seeming to have little or nothing in common.

The argument we are considering, then, fails to support cultural relativism. Moreover, many considerations count strongly against the view.

Specifically, the logical implications of the doc ­ trine give us substantial reasons to doubt it. Like subjective relativism, cultural relativism implies moral infallibility, a very hard implica ­ tion to take seriously. As the doctrine would have it, if a culture genuinely approves of an action, then there can be no question about the action’s moral rightness: It is right, and that’s that. Cul ­ tures make moral rightness, so they cannot be mistaken about it. But is it at all plausible that cul ­ tures cannot be wrong about morality? Through ­ out history, cultures have approved of ethnic cleansing, slavery, racism, holocausts, massacres, mass rape, torture of innocents, burning of heretics, and much more. Is it reasonable to conclude that the cultures that approved of such deeds could not have been mistaken? Related to the infallibility problem is this difficulty: Cultural relativism implies that we cannot legitimately criticize other cultures. If a culture approves of its actions, then those ac ­ tions are morally right— and it does not matter one bit whether another culture disapproves of them. Remember, there is no objective moral code to appeal to. Each society is its own maker of the moral law. It makes no sense for society X to accuse society Y of immorality, for what soci ­ ety Y approves of is moral. Some may be willing to accept this consequence of cultural relativism, but look at what it would mean. What if the people of Germany approved of the extermination of millions of Jews, Gypsies, and others during World War II? Then the extermination was morally right.

Suppose the people of Libya approved of the 01-Vaughn-Chap01.indd 16 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 17 of moral precepts, codes, or commandments to guide the conduct of adherents. In Western civilization, this content has been so influential in moral (and legal) matters that many now take for granted that religion is the fundamental basis of morality. Secular or nontheistic sys­ tems of ethics (for example, the ethics of Stoicism, Confucianism, Buddhism, utilitarianism, and contractarianism) have also shaped how we think about morality. But for millions of people, religion is the fountainhead of the moral law. Many religious people, however, do not em ­ brace a moral theory related to a religious tradi ­ tion. They are comfortable being guided by one of the nontheistic systems. Others prefer the very influential moral perspective known as natural law theory (discussed in Chapter 2)—a view that comes in both secular and religious versions but has been nurtured and adopted by the Roman Catholic Church. Still others accept the perva ­ sive idea that morality itself comes from God. An important query in ethics is whether this latter view of morality is correct: whether morality depends fundamentally on religion, whether— to state the question in its traditional form— the moral law is constituted by the will of God. The view that morality does have this kind of dependence is known as the divine command t he or y. It says that right actions are those com ­ manded by God, and wrong actions are those forbidden by God. God is the author of the moral law, making right and wrong by his will. But many people— both religious and non ­ religious— have found this doctrine troubling.

Philosophers have generally rejected it, including some famous theistic thinkers such as Thomas Aquinas (1225– 1274), Gottfried Leibniz (1646– 1710), and Immanuel Kant (1724– 1804).

The problem is that the theory presents us with a disconcerting dilemma first spelled out in Pl a t o’s Euthyphro . In this dialogue, Socrates asks a penetrating question that is often expressed like this: Are actions morally right because God commands them, or does God command them because they are morally right? In the first option, God creates the moral law (the divine belongs to seems almost impossible. The prob ­ lem is that we each belong to many social groups, and there is no fact of the matter regarding which one is our “true” society. Suppose you are an African ­American Catholic Republican living in an artists colony in Alabama and enjoying the advantages of membership in an extremely large extended family. What is your true society?

If  you cannot identify your proper society, you cannot tell which cultural norms apply to you. Some people may be willing to overlook these problems of cultural relativism because they be ­ lieve it promotes cultural tolerance, an attitude that seems both morally praiseworthy and in ­ creasingly necessary in a pluralistic world. After all, human history has been darkened repeatedly by the intolerance of one society toward another, engendering vast measures of bloodshed, pain, oppression, injustice, and ignorance. The thought is that because all cultures are morally equal, there is no objective reason for criticizing any of them. Tolerance is then the best policy. Cultural relativism, however, does not neces ­ sarily lead to tolerance and certainly does not logically entail it. In fact, cultural relativism can easily justify either tolerance or intolerance. It says that if a society sanctions tolerance, then toler ­ ance is morally right for that society. But if a soci ­ ety approves of intolerance, then intolerance is morally right for that society— and the society cannot be legitimately criticized for endorsing such an attitude. According to cultural relativism, intolerance can be morally permissible just as tol ­ erance can. In addition, though moral relativists may want to advocate universal tolerance, they cannot consistently do so. To say that all cultures should be tolerant is to endorse an objective moral norm, but cultural relativists insist that there are no objective moral norms. To endorse universal tolerance is to abandon cultural relativism. ethics and religion How is ethics related to religion? One obvious connection is that historically religion has always had moral content—mostly in the form 01-Vaughn-Chap01.indd 17 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 18 PART 1: PRINCIPLES AND THEORIES norms. The religious may then claim that God is good— good because he abides perfectly by the moral law and guides the conduct of believers a c c ord i n g l y. If moral standards are not grounded in the divine will, if they are logically independent of religion, then morality is a legitimate concern for the religious and nonreligious alike, and every­ one has equal access to moral reflection and the moral life. The best evidence for the latter is ethics itself. The fact is that people do ethics. They use critical reasoning and experience to deter ­ mine moral norms, explore ethical issues, test moral theories, and live a good life. The results of these explorations are moral outlooks and stan ­ dards founded on good reasons and arguments and assented to by reflective people everywhere. In bioethics, the informed opinions of reli ­ gious people are as relevant as those of secular ­ ists. But all parties must be willing to submit their views to the tests and criteria of critical reasoning and evidence. But even if ethics does not have this indepen ­ dent status, there are still good reasons for reli ­ gious believers to know how to use the critical tools that ethics offers. First, like many secular moral rules, religious moral codes are often vague and difficult to apply to conflicts and issues, es ­ pecially in complex fields such as bioethics. Get ­ ting around this problem requires interpreting the codes, and this task involves consideration of broader norms or theories, a typical job for ethics. Second, like everyone else, believers must deal with moral conflicts of all sorts— including clashes between the moral beliefs of religious adherents, religious leaders, and religious tradi ­ tions. What is often needed is a neutral standard and critical analyses to arrive at a resolution— tools that ethics can easily provide. Third, public debate on ethical issues in a diverse society re ­ quires ground rules— chief among them being that positions must be explained and reasons must be given in their support. Unexplained as ­ sertions without supporting reasons or argu ­ ments are likely to be ignored. In this arena, ethics is essential.

command theory); in the second, the moral law is independent of God’s will so that even God is subject to it. Critics of the divine command theory have argued that the first option implies the moral law is entirely arbitrary. The second option denies the theory.

The arbitrariness is thought to arise like this:

If actions are morally right just because God commands them to be so, then it is possible that any actions whatsoever could be morally right.

The murder and rape of innocents, the oppres ­ sion of the weak, the abuse of the poor— these and many other awful deeds would be morally permissible if God so willed. There would be no independent standard to judge that these acts are wrong, no moral reasons apart from God’s will to suggest that such deeds are evil. God would be free to establish arbitrarily any actions whatsoever as morally right. Defenders of the divine command theory have replied to the arbitrariness charge by saying that God would never command some ­ thing evil because God is all ­good. But critics point out that if the theory is true, the assertion that God is all ­good would be meaningless, and the traditional religious idea of the goodness of God would become an empty notion. If God makes the moral law, then the moral term good would mean “commanded by God.” But then “God is good” would mean something like “God does what God commands” or even “God is what God is,” which tells us nothing about the goodness of God. Likewise, “God’s commands are good” would translate as “God’s commands are God’s commands.” This attempt to escape the charge of arbitrariness seems to have intol ­ erable implications. Theists and nontheists alike find this horn of  Socrates’ dilemma— the idea of an arbitrary, divinely ordained morality— incredible. They therefore reject the divine command theory and embrace the other horn, the view that right and wrong are independent of God’s will. Moral standards are external to God, binding on both God and mortals. If there are divine commands, they will conform to these independent moral 01-Vaughn-Chap01.indd 18 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 19 fallacies, exploiting emotions and prejudices, daz­ zling with rhetorical gimmicks, hiding or distort ­ ing the facts, threatening or coercing people— the list is long. Good arguments prove something whether or not they persuade. Persuasive ploys can change minds but do not necessarily prove any thing. So we formulate an argument to try to show that a particular claim (the conclusion) should be believed, and we analyze an argument to see if it really does show what it purports to show. If the argument is good, we are entitled to believe its conclusion. If it is bad, we are not entitled to believe it. Consider these two simple arguments:

argument 1 Law enforcement in the city is a complete failure. Incidents of serious crime have doubled.

argument 2 It’s wrong to take the life of an innocent person. Abortion takes the life of an innocent person. So abortion is wrong.

In Argument 1, the conclusion is “Law en ­ forcement in the city is a complete failure,” which is supported by the premise “Incidents of serious crime have doubled.” The conclusion of Argu ­ ment 2 is “abortion is wrong,” and it is backed by two premises: “It’s wrong to take the life of an innocent person” and “Abortion takes the life of an innocent person.” Despite the differences be ­ tween these two passages (differences in content, the number of premises, and the order of their parts), they are both arguments because they ex ­ emplify basic argument structure: a conclusion supported by at least one premise. Though the components of an argument seem clear enough, people often fail to distin ­ guish between arguments and strong statements that contain no arguments at all. Suppose we change Argument 1 into this:

Law enforcement in the city is a complete failure. Nothing seems to work anymore.

This situation is intolerable. moral arguments Critical reasoning is something we employ every time we carefully and systematically assess the truth of a statement or the merits of a logical argument. We ask: Are there good reasons for be ­ lieving this statement? Is this a good argument— does it prove its case? These sorts of questions are asked in every academic field and in every serious human endeavor. Wherever there is a need to acquire knowledge, to separate truth from falsity, and to come to a reliable understanding of how the world works, these questions are asked and answers are sought. Ethics is no excep ­ tion. Critical reasoning in ethics— called moral reasoning — employs the same general principles of logic and evidence that guide the search for truth in every other field. So we need not wonder whether we use critical reasoning in ethics but whether we use it well.

Argument Fundamentals Most critical reasoning is concerned in one way or another with the construction or evaluation of arguments. As you may have guessed, here argument denotes not an altercation but a pat ­ terned set of assertions: at least one statement providing support for another statement. We have an argument when one or more statements give us reasons for believing another one. The supporting statements are premises , and the supported statement is the conclusion . In critical reasoning, the term statement also has a techni­ cal meaning. A statement (or claim) is an asser ­ tion that something is or is not the case and is therefore the kind of utterance that is either true or false. You need to understand at the outset that argu - ment in this sense is not synonymous with persua - sion . An argument provides us with reasons for accepting a claim; it is an attempted “proof ” for an  assertion. But persuasion does not necessarily involve giving any reasons at all for accepting a claim. To persuade is to influence people’s opin ­ ions, which can be accomplished by offering a good argument but also by misleading with logical 01-Vaughn-Chap01.indd 19 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 20 PART 1: PRINCIPLES AND THEORIES Now look at this one:

argument 3 1. All dogs are mammals.

2. Rex is a dog.

3. Therefore, Rex is a mammal.

Again, there is no way for the premises to be true while the conclusion is false. The deductive form of the argument guarantees this. So a deductive argument is intended to have this sort of airtight structure. If it actually does have this structure, it is said to be valid . Argu­ ment 2 is deductive because it is intended to provide logically conclusive support to its con ­ clusion. It is valid because, as a matter of fact, it  does offer this kind of support. A deductive argument that fails to provide conclusive sup ­ port to its conclusion is said to be invalid . In such an argument, it is possible for the premises to be true and the conclusion false. Argument 3 is in ­ tended to have a deductive form, and because it actually does have this form, the argument is also valid. An elementary fact about deductive argu ­ ments is that their validity (or lack thereof ) is a separate issue from the truth of the premises.

Validity is a structural matter, depending en ­ tirely on how an argument is put together. Truth concerns the nature of the claims made in the premises and conclusion. A deductive argument is supposed to be built so that if the premises are true, the conclusion must be true— but in a par­ ticular case, the premises might not be true.

A valid argument can have true or false premises and a true or false conclusion. (By definition, of course, it cannot have true premises and a false conclusion.) In any case, being invalid or having false premises dooms a deductive argument. Inductive arguments are supposed to give probable support to their conclusions. Unlike deductive arguments, they are not designed to support their conclusions decisively. They can establish only that, if their premises are true, their conclusions are probably true (more likely to be true than not). Argument 1 is an inductive argument meant to demonstrate the probable Now there is no argument, just an expression of annoyance or anger. There are no statements giving us reasons to believe a conclusion. What we have are some unsupported assertions that may merely appear to make a case. If we ignore the distinction between genuine arguments and nonargumentative material, critical reasoning is undone. Assuming we can recognize an argument when we see it, how can we tell if it is a good one? Fortunately, the general criteria for judging the merits of an argument are simple and clear.

A good argument— one that gives us good rea ­ sons for believing a claim— must have (1) solid logic and (2) true premises. Requirement (1) means that the conclusion should follow logi ­ cally from the premises, that there must be a proper logical connection between supporting statements and the statement supported. Re ­ quirement (2) says that what the premises assert must in fact be the case. An argument that fails in either respect is a bad argument. There are two basic kinds of arguments— deductive and inductive— and our two require­ ments hold for both of them, even though the logical connections in each type are distinct.

Deductive arguments are intended to give logi - cally conclusive support to their conclusions so that if the premises are true, the conclusion ab ­ solutely must be true. Argument 2 is a deductive argument and is therefore supposed to be con ­ structed so that if the two premises are true, its conclusion cannot possibly be false. Here it is with its structure laid bare:

argument 21. It’s wrong to take the life of an innocent person.

2. Abortion takes the life of an innocent person.

3. Therefore, abortion is wrong.

Do you see that, given the form or structure of this argument, if the premises are true, then the conclusion has to be true ? It would be very strange— illogical, in fact— to agree that the two premises are true but that the conclusion is false. 01-Vaughn-Chap01.indd 20 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 21 Using our natural reasoning ability, we can ex­ amine how the premises are linked to the conclu ­ sion and can see quickly whether the conclusion follows from the premises. We are most likely to make an easy job of it when the arguments are simple. Many times, however, we need some help, and help is available in the form of methods and guidelines for evaluating arguments. Having a familiarity with common argument patterns, or forms, is especially useful when as ­ sessing the validity of deductive arguments. We are likely to encounter these forms again and again in bioethics as well as in everyday life.

Here is a prime example:

argument 51. If the surgeon operates, then the patient will be cured.

2. The surgeon is operating.

3. Therefore, the patient will be cured.

This argument form contains a conditional premise— that is, a premise consisting of a con ­ ditional, or if ­then, statement (actually a com ­ pound statement composed of two constituent statements). Premise 1 is a conditional state ­ ment. A conditional statement has two parts:

the part beginning with if (called the anteced- ent ) and the part beginning with then (k nown as the consequent ). So the antecedent of premise 1 is “If the surgeon operates,” and the conse ­ quent is “then the patient will be cured.” The best way to appreciate the structure of such an argument (or any deductive argument, for that matter) is to translate it into traditional argument symbols in which each statement is symbolized by a letter. Here is the symbolization for Argument 5:

1. If p , then q .

2. p.

3. Therefore, q .

We can see that p represents “the surgeon operates,” and q represents “the patient will be cured.” But notice that we can use this same symbolized argument form to represent countless other arguments— arguments with truth that “law enforcement in the city is a com ­ plete failure.” Like all inductive arguments (and unlike deductive ones), it can have true prem ­ ises and a false conclusion. So the sole premise— “incidents of serious crime have doubled”— can be true while the conclusion is false. If inductive arguments succeed in lending probable support to their conclusions, they are said to be strong . Strong arguments are such that if their premises are true, their conclusions are probably true. If they fail to provide this proba ­ ble support, they are termed weak . Argument 1 is a weak argument because its premise, even if true, does not show that more likely than not law enforcement in the city is a complete failure.

After all, even if incidents of serious crime have doubled, law enforcement may be successful in other ways, or incidents of serious crime may be up for reasons unrelated to the effectiveness of law enforcement. But consider this inductive argument:

argument 41. Eighty ­five percent of the students at this university are Republicans.

2. Sonia is a student at this university.

3. Therefore, Sonia is probably a Republican.

This argument is strong. If its premises are true, its conclusion is likely to be true. If eighty ­ five percent of the university’s students are Republicans, and Sonia is a university student, she is more likely than not to be a Republican, too. When a valid (deductive) argument has true premises, it is a good argument. A good deduc ­ tive argument is said to be sound . Argument 2 is valid, but we cannot say whether it is sound until we determine the truth of the premises. Argu ­ ment 3 is valid, and if its premises are true, it is sound. When a strong (inductive) argument has true premises, it is also a good argument.

A good inductive argument is said to be cogent .

Argument 1 is weak, so there is no way it can be cogent. Argument 4 is strong, and if its premises are true, it is cogent. Checking the validity or strength of an argu ­ ment is often a plain, commonsense undertaking. 01-Vaughn-Chap01.indd 21 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 22 PART 1: PRINCIPLES AND THEORIES 1. If p , then q .

2. Not p .

3. Therefore, not q .

The advantage of being able to recognize these and other common argument forms is that you can use that skill to determine readily the validity of many deductive arguments. You know, for example, that any argument having the same form as modus ponens or modus tollens must be valid, and any argument in one of the common invalid forms must be invalid.

Patterns of Moral Arguments All that you have learned about argument fun ­ damentals thus far applies directly to that sub ­ species of argument we are most interested in:

moral argument. A moral argument is an argu­ ment whose conclusion is a moral statement, an assertion that an action is right or wrong or that a person or motive is good or bad. We utter a moral statement when we say such things as “Physician ­assisted suicide is wrong,” or “Maria should not have had an abortion,” or “Dr. Jones is a good person.” We are constantly making moral statements and including them in our moral arguments, which we frequently devise and hold up for inspection and evaluation. Recall Argument 2, a simple (and common) moral argument:

1. It’s wrong to take the life of an innocent person.

2. Abortion takes the life of an innocent person.

3. Therefore, abortion is wrong.

Here, we can see all the standard features of a typical moral argument: (1) At least one premise (premise 1) is a moral statement asserting a gen ­ eral moral norm such as a moral principle; (2) at least one premise (premise 2) is a nonmoral statement describing an action or circumstance; and (3) the conclusion is a moral statement ex ­ pressing a moral judgment about a specific action or circumstance.

different statements but having the same basic structure.

It just so happens that the underlying ar ­ gument form for Argument 5 is extremely common— common enough to have a name, modus ponens (or affirming the antecedent). The truly useful fact about modus ponens is that any argument having this form is valid. We can plug any statements we want into the formula and the result will be a valid argument, a circum ­ stance in which if the premises are true, the con ­ clusion must be true. Another common argument form is modus tollens (or denying the consequent). For example:

argument 6 1. If the dose is low, then the healing i s slow.

2. The healing is not slow.

3. Therefore, the dose is not low.

1. If p , then q .

2. Not q .

3. Therefore, not p .

Modus tollens is also a valid form, and any argument using this form must also be valid. There are also common argument forms that are invalid . Here are two of them:

affirming the consequent argument 7 1. If the patient is getting better, then drugs are unnecessary.

2. Drugs are unnecessary.

3. Therefore, the patient is getting better.

1. If p , then q .

2. q.

3. Therefore, p .

denying the antecedent argument 8 1. If the rate of infection is increasing, then the patients will die.

2. The rate of infection is not increasing.

3. Therefore, the patients will not die. 01-Vaughn-Chap01.indd 22 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 23 we cannot legitimately arrive at a moral conclu­ sion. That is, from a nonmoral premise alone, a moral conclusion does not logically follow. For example, from the nonmoral fact that abortions are frequently performed, we cannot conclude that abortion is immoral. Nonmoral premises cannot support a conclusion expressing a moral judgment. Likewise, we cannot reason from a moral premise alone (one affirming a general moral principle) to a conclusion about the moral ­ ity of a particular action. We need a nonmoral premise affirming that the particular action in question is an instance of the general class of ac ­ tions referred to in the general moral premise. In Argument 2, the moral premise tells us it’s wrong to take the life of an innocent person, but we need the nonmoral premise to assert that abortion is an instance of taking the life of an innocent Notice how natural this pattern seems. If we want to argue that a particular action (or kind of action) is wrong, for example, we must provide a reason for this moral judgment. The natural (and logical) move is to reach for a general moral principle that supports the judgment. Why is performing surgery on Mrs. Johnson without her consent wrong? Because, we might say, treating people without their consent is a viola ­ tion of their autonomy (a moral principle), and performing surgery on Mrs. Johnson without her consent would be an instance of such a vio ­ lation (a nonmoral fact). This natural way of proceeding reflects the logical realities of moral reasoning. In a moral ar ­ gument, we must have at least one moral premise to draw a conclusion about the morality of a par ­ ticular state of affairs. Without a moral premise, REVIEW: Valid and Invalid Argument Forms Valid Forms Affirming the Antecedent ( Modus Ponens) Denying the Consequent ( Modus Tollens) If p, then q. If p, then q.

p. Not q.

Therefore, q. Therefore, not p.

Example: Example:

If Spot barks, a burglar is in the house. If it’s raining, the park is closed.

Spot is barking. The park is not closed.

Therefore, a burglar is in the house. Therefore, it’s not raining.

Invalid Forms Affirming the Consequent Denying the Antecedent If p, then q. If p, then q.

q. Not p.

Therefore, p. Therefore, not q.

Example: Example:

If the cat is on the mat, she is asleep. If the cat is on the mat, she is asleep.

She is asleep. She is not on the mat.

Therefore, she is on the mat. Therefore, she is not asleep. 01-Vaughn-Chap01.indd 23 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 24 PART 1: PRINCIPLES AND THEORIES IN DEPTH FALLACIES IN MORAL REASONING The world is full of bad arguments. Many of them occur again and again in different guises and con - texts, being so common that they have been given names and are studied by those who wish to avoid such mistakes. These common, defective arguments are called fallacies. Here are a few that often crop up in moral reasoning.

STR AW M A N The straw man fallacy is the misrepresentation of a person’s views so they can be more easily attacked or dismissed. Suppose you argue that because an immunization program will save the lives of thou - sands of children and will likely cause the death of only 1 child out of every 500,000, we should fund the immunization program. But then your opponent replies that you think the life of a child isn’t worth much. Thus your point has been distorted, made to look extreme or unsavory— and is now an easier target. The straw man fallacy, of course, proves nothing, though many people fall for it every day.

APPEAL TO THE PERSON Closely related to the straw man fallacy is appeal to the person (also known as the ad hominem fallacy).

Appeal to the person is the rejecting of a statement on the grounds that it comes from a particular person, not because the statement, or claim, itself is false or dubious. For example:

You can safely discard anything that Susan has to say about abortion. She’s a Catholic.

Johnson argues that our current health care system is defective. But don’t listen to him— he’s a liberal.

These arguments are defective because they ask us to reject a claim because of a person’s character, background, or circumstances— things that are gen- erally irrelevant to the truth of claims. A statement must stand or fall on its own merits. The personal characteristics of the person espousing the view do not necessarily have a bearing on its truth. Only if we can show that someone’s dubious traits some - how make the claim dubious are we justified in re - jecting the claim because of a person’s personal characteristics. Such a circumstance is rare. APPEAL TO IGNORANCE As its name implies, this fallacy tries to prove some - thing by appealing to what we don’t know. The appeal to ignorance is arguing either that (1) a claim is true because it has not been proven false or (2) a claim is false because it has not been proven true.

For example:

No one has proven that a fetus is not a person, so it is in fact a person.

It is obviously false that a fetus is a person because science has not proven that it is a person.

The first argument tries to prove a claim by pointing out that it has not been proven false. The second argument tries to prove that a claim is false because it has not been proven true. Both kinds of arguments are bogus because they assume that a lack of evidence proves something. But a lack of evi - dence can prove nothing. Being ignorant of the facts does not enlighten us. Notice that if a lack of evi - dence could prove something, then you could prove just about anything you wanted. You could reason, for instance, that since no one can prove that horses cannot fly, horses must be able to fly.

BEGGING THE QUESTION The fallacy of begging the question is trying to prove a conclusion by using that very same conclusion as support. It is arguing in a circle. This way of trying to prove something says, in effect, “X is true because X is true.” Here is a classic example:

The Bible says that God exists.

The Bible is true because God wrote it.

Therefore, God exists.

The conclusion here (“God exists”) is supported by premises that assume that very conclusion. 01-Vaughn-Chap01.indd 24 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 25 premises (moral and nonmoral) are left unsaid and are merely implied. Sometimes premises are unstated because they are obvious assumptions that need not be mentioned. But if we are to per­ form a thorough evaluation of an argument, we must drag the implicit premises into the open so they can be fully assessed. Such careful scrutiny is especially important in moral arguments be ­ cause the implicit premises are often question ­ able assumptions— the secret, weak links in the chain of reasoning. For example:

argument 91. In vitro fertilization is an entirely unnatural process, as far from natural reproduction as one could imagine.

2. Therefore, in vitro fertilization should not be used.

As it stands, this is a bad argument; the con ­ clusion does not follow from the premise. But there is an implied (moral) premise lurking here, person. After all, that a fetus is a person— the kind of entity that is deserving of full moral rights— is not obviously true and not assented to by everyone. We must spell out in a premise what we take to be the nonmoral fact of the matter. This discussion underscores a previously mentioned fact about moral disagreements.

When people disagree on a moral issue, they may or may not be disagreeing about moral principles. They may actually share the relevant moral principles but disagree about the non ­ moral facts— or vice versa. So when people take contradictory stands on the conclusion of a moral argument, the source of the conflict could lie with the moral premises or the nonmoral premises or both. Unfortunately, in everyday life moral argu ­ ments do not come with their premises clearly labeled, so we need to be able to identify the premises ourselves. This job is made more diffi ­ cult by a simple fact of the moral life: Often Here’s another one:

All citizens have the right to a fair trial because those whom the state is obliged to protect and give consideration are automatically due judicial criminal proceedings that are equitable by any reasonable standard.

This passage may at first seem like a good argu - ment, but it isn’t. It reduces to this unimpressive assertion: “All citizens have the right to a fair trial because all citizens have the right to a fair trial.” The conclusion is “All citizens have the right to a fair trial,” but that is more or less what the premise says. The premise — “those whom the state is obliged to protect and give consideration are auto - matically due judicial criminal proceedings that are equitable by any reasonable standard”— is equiva- lent to “All citizens have the right to a fair trial.” SLIPPERY SLOPE The metaphor behind this fallacy suggests the danger of stepping on a dicey incline, losing your footing, and sliding to disaster. The fallacy of slippery slope, then, is arguing erroneously that a particular action should not be taken because it will lead inevitably to other actions resulting in some dire outcome. The key word here is erroneously. A slippery slope sce- nario becomes fallacious when there is no reason to believe that the chain of events predicted will ever happen. For example:

If dying patients are permitted to refuse treatment, then soon doctors will be refusing the treatment on their behalf. Then physician- assisted suicide will become rampant, and soon killing patients for almost any reason will become the norm.

This argument is fallacious because there are no reasons for believing that the first step will ultimately result in the chain of events described. If good reasons could be given, the argument might be salvaged. 01-Vaughn-Chap01.indd 25 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 26 PART 1: PRINCIPLES AND THEORIES and if we make it explicit, the argument will be valid:

1. In vitro fertilization is an entirely unnatural process, as far from natural reproduction as one could imagine.

2. Any process that is unnatural should not be used.

3. Therefore, in vitro fertilization should not be used.

Now the argument is complete, and we can see both the nonmoral premise (premise 1) and the moral premise (premise 2), which is a moral principle. But now that we have brought the moral premise into the light of day, we can see that it is false or at least debatable. We use many processes and products that are unnatural (for example, modern pharmaceuticals, intravenous feeding, surgery, CAT scans, artificial limbs, and contact lenses), but we generally do not regard them as morally impermissible. Very often we can tell that an argument has an unstated premise because there is a logical leap between the stated premises and the con ­ clusion. The inference from stated premises to conclusion does not work unless the missing premise is supplied. A good candidate for the implicit premise will make the argument valid or strong and will be plausible in the context of the argument. The most straightforward ap ­ proach, however, is to treat the argument as de ­ ductive and look for a premise that will make the argument valid, as we did in Argument 9.

Evaluating Premises As we have seen, good arguments have true premises. But how do we know if the premises are true? Fortunately, there are ways to test, or evaluate, the truth of premises. The tests differ, however, depending on whether the premises are nonmoral or moral. Checking the truth of nonmoral premises can involve the exploration of either empirical or conceptual matters. An empirical belief, or claim, is one that can be confirmed by sense experience— that is, by observation or scientific investigation. Most nonmoral premises are em ­ pirical claims that we can check by examining our own experience or that of others or by con ­ sulting the relevant scientific findings. By these methods we can test (and support) a wide variety of empirical assertions, such as many of the non­ moral premises examined earlier: “Incidents of serious crime have doubled”; “Eighty ­five percent of the students at this university are Republicans”; “If the patient is getting better, then drugs are unnecessary.” In bioethics, among the most controversial nonmoral premises are those affirming that a medical treatment or program will or will not have a particular effect on people. The issue is whether it will help or harm and to what degree.

Sometimes reliable data are available to resolve the issue. Sometimes no clear evidence exists, leaving people to make educated guesses that are often in dispute. In any case, critical reasoning in bioethics demands that we always seek the most reliable evidence available and try to assess its worth ob ­ jectively. It requires that our empirical claims be supported by good empirical evidence and that we expect the same from others who make em ­ pirical assertions. A conceptual matter has to do with the mean ­ ing of terms, something we need to pay attention to because disputes in bioethics sometimes hinge on the meaning of a concept. For example, in disagreements about the moral permissibility of abortion, the crux of the matter is often how the disputants define person (as in Argument 2), or human life , or human being . Similarly, whether someone supports or opposes euthanasia often hangs on how it is defined. Some, for example, define it in the narrow sense of taking direct action to kill someone for his sake (mercy killing), while others insist on a wider sense that en ­ compasses both mercifully killing and allowing to  die. Whether we are devising our own argu ­ ments or evaluating those of others, being clear on the meaning of terms is essential, and any proposed definition must be backed by good reasons. 01-Vaughn-Chap01.indd 26 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 27 there was something wrong with utilitarianism or that other considerations (including alterna­ tive theories) outweigh utilitarian concerns. Another possible source of support for moral premises is what philosophers call our considered moral judgments . These are moral judgments we deem plausible or credible after careful reflection that is as unbiased as possible. They may apply to both particular cases and more general moral statements. For example, after deliberation we might conclude that “inflicting undeserved and unnecessary pain on someone is wrong,” or that “emergency care for accident victims should be provided regardless of their race or religion,” or that “amputating a patient’s leg for no good reason is never morally permissible.” Like moral principles and theories, such judgments can vary in how much weight they carry in moral argu ­ ments and can be given more or less credibility (or undermined completely) by relevant reasons.

(We examine more closely the relationships among theories, principles, and considered judgments in Chapter 2.) Moral premises can be called into question by showing that they somehow conflict with credible principles, theories, or judgments. One way to do this is to cite counterexamples , in­ stances in which the moral principle in question seems not to hold. Recall that a counterexample helps us see that the moral premise in Argument 9 is dubious. The premise says “Any process that is unnatural should not be used,” but we often use unnatural products or processes (CAT scans and contact lenses, for instance) and do not think these actions morally wrong. In the same way, we can use counterexamples to evaluate the moral premise in Argument 2:

1. It’s wrong to take the life of an innocent person.

2. Abortion takes the life of an innocent person.

3. Therefore, abortion is wrong.

Are there no exceptions to premise 1? Is it always wrong to kill an innocent person? We can imagine cases in which this premise seems Moral premises are like nonmoral ones in that they, too, should be supported by good reasons and be subjected to serious scrutiny. But just how are moral premises supported and scrutinized? Support for a moral premise (a moral principle or standard) can come from at least three sources:

other moral principles, moral theories, or our most reliable moral judgments. Probably the most common way to support a moral principle is to appeal to a higher ­level principle (which often turns out to be one of the four major moral principles discussed earlier). Suppose the moral premise in question is “The patient’s wishes about whether surgery is performed on him should not be ignored.” Some would argue that this principle is derived from, or is based on, the higher princi ­ ple that autonomous persons should be allowed to exercise their capacity for self ­determination.

Or let’s say the premise is “Individuals in a persis ­ tent vegetative state should never have their feed ­ ing tubes removed so they can ‘die with dignity.’” Many would base this assertion on the principle that human life is sacred and should be preserved at all costs. Frequently, the higher principle ap ­ pealed to is plausible, seemingly universal, or ac ­ cepted by all parties so that further support for the principle is not necessary. At other times, the higher principle itself may be controversial and in need of support. Moral premises can also be supported by a moral theory, a general explanation of what makes an action right or a person or motive good. (In Chapter 2 we discuss moral theories in depth.) For example, traditional utilitarianism is a moral theory affirming that right actions are those that produce the greatest happiness for all concerned. Appealing to utilitarianism, then, someone might insist that a baby born with severe brain damage who will die within a few days should not be allowed to wither slowly away in pain but should be given a lethal injection.

The justification for this policy is that it would produce the least amount of unhappiness (in ­ cluding pain and suffering) for all concerned, including baby, parents, and caregivers. Those who reject this policy would have to argue that 01-Vaughn-Chap01.indd 27 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 28 PART 1: PRINCIPLES AND THEORIES of prose. In any case, your job is to come up with a single conclusion statement for each con ­ clusion—even if you have to paraphrase large sections of text to do it. When you identify the conclusion, the hunt for premises gets easier.

Step 3. Identify the premises. Like the search for a conclusion, unearthing the premises may involve condensing large sections of text into manage ­ able form—namely, single premise statements.

To do this, you need to disregard extraneous material and keep your eye on the ‘‘big picture.’’ Remember that in moral arguments you are looking for both moral and nonmoral premises.

Let’s see how this procedure works on the follow ­ ing passage:

[1] John and Nancy Jones had a two ­year ­old son who suffered from a serious but very curable bowel obstruction. [2] For religious reasons, the Joneses decide to treat their son with prayer instead of modern medicine. [3] They refused medical treat ­ ment even though they were told by several doc ­ tors that the child would die unless medically treated. [4] As it turned out, the boy did die.

[5] The Joneses were arrested and charged with involuntary manslaughter. [6] Were the Joneses wrong to refuse treatment for their son? [7] The answer is yes. [8] Regardless of what faith or religious dogma would have the Joneses do, they allowed their child to die. [9] According to just about any moral outlook, the care of a child by the parents is a fundamental obligation.

[10] Above all other concerns, parents have a duty to ensure the health and safety of their children and to use whatever means are most likely to secure those benefits. [11] In other words, allowing a child to die when the death could easily have been prevented is morally reprehensible. [12] The Joneses were therefore guilty of a shockingly immoral act.

The first order of business is to find the con ­ clusion, and in doing so we can see that the first paragraph is entirely background information.

The conclusion is in sentence 12, and with this information, we can tell that sentence 7 is a short affirmation of the conclusion. We can also locate either doubtful or at least not obviously true.

What about situations in which many lives can be saved by taking the life of one person? What if all 50 people in a lifeboat at sea will drown unless one of them is cast overboard? What if the one unlucky person agrees to be cast over­ board to save all the others? Or suppose a person is dying of cancer and is suffering unspeakable pain that cannot be relieved by any medical means— and she begs for a lethal injection of morphine. Some would argue that these scenar ­ ios raise serious questions about premise 1, sug ­ gesting that at least in its current form, it may not be true. In response to these counterexamples, some who wish to defend the premise might modify it to take the scenarios into account or even try to show that despite its implications premise 1 is justified.

Assessing Whole Arguments Moral argument, like any other kind of argu ­ ments, usually come to us embedded in larger tracts of speech or writing. Often the premises and conclusion are embellished or obscured by other elements—by explanations, asides, reiter ­ ations, descriptions, examples, amplifications, or irrelevancies. So how do we evaluate such arguments in the rough? Following this procedure will help:

Step 1. Study the text until you thoroughly under­ stand it. You can’t locate the conclusion or prem ­ ises until you know what you’re looking for—and that requires having a clear idea of what the author is driving at. Don’t attempt to find the conclusion or premises until you ‘‘get it.’’ This understanding entails having an overview of a great deal of text, a bird’s ­eye view of the whole work.

Step 2. Find the conclusion. When you evaluate arguments surrounded by a lot of other prose, your first task is to find the conclusion . There may be a single conclusion, or several main conclu ­ sions, or one primary conclusion with several subconclusions. Or the conclusion may be nowhere explicitly stated but embodied in meta ­ phorical language or implied by large expanses 01-Vaughn-Chap01.indd 28 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 29 inductive argument metaethics moral absolutism moral argument moral objectivism morality normative ethics paternalism subjective relativism summary Morality refers to beliefs about right and wrong actions and morally good and bad persons or character. Ethics is the study of morality using the tools and methods of philosophy. The study of morality using the methodology of science is  known as descriptive ethics. Ethics has three main branches: (1) normative ethics, the search for, and justification of, moral standards, or norms; (2) metaethics, the study of the meaning and justification of basic moral beliefs; and (3) applied ethics, the use of moral norms and concepts to resolve practical moral issues. Bioethics is applied ethics focused on health care, medical science, and medical technology.

Moral norms differ from other kinds of norms because they are characterized by (1) normative dominance, (2) universality, (3) impartiality, and (4) reasonableness. We apply moral norms to two distinct spheres of our moral experience— obligations and values. Moral obligations concern our duty, what we are obligated to do or not do, and refer primarily to right and wrong actions.

Moral values generally concern those things that we judge to be morally good, bad, praiseworthy, or blameworthy. A right action can be obligatory (one that would be wrong not to perform) or permissible (one that is not wrong to perform).

A prohibited action would be one that would be wrong to perform. A supererogatory action is one that is “above and beyond ” our duty. In bioethics, five moral principles have been extremely influential and particularly relevant:

(1) autonomy (autonomous persons should be allowed to exercise their capacity for self ­ determination); (2) nonmaleficence (we should the premises. The nonmoral premise is in sen ­ tence 8: the nonmoral fact is that the Joneses permitted their child to die. The moral premise is stated most explicitly in sentence 11. Sentences 9 and 10 are equivalent to 11, although stated more ge ne r a l l y. The bare ­bones arguments then is:

[8] Regardless of what faith or religious dogma would have the Joneses do, they allowed their child to die.

[11] In other words, allowing a child to die when the death could easily have been prevented is morally reprehensible.

[12] The Joneses were therefore guilty of a shock ­ ingly immoral act.

This argument is deductively valid, so the crucial question is whether the premises are true. Presumably the nonmoral premise 8 is an uncontested assertion. We can imagine that everyone knows that the Joneses let their child die. Premise 11, the moral statement, seems to be a plausible moral principle—some would say it’s just common sense. Most people would find it difficult to think of a credible counterexample to it. But that is precisely what is at issue here:

whether it’s ever morally permissible to allow a child to die when the death can easily be pre ­ vented. To justify premise 11, those who accept it may appeal to a moral theory (utilitarianism or Kantian ethics, say) or to more general moral principles such as ‘‘always act to preserve life,’’ ‘‘treat persons with respect,’’ or ‘‘humans have a right to life.’’ On the other hand, it’s hard to see how the rejection of premise 11 could be based on anything other than a religious moral principle. key terms applied ethics bioethics cultural relativism deductive argument descriptive ethics divine command theory ethical relativism ethics 01-Vaughn-Chap01.indd 29 26/05/16 4:25 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 30 PART 1: PRINCIPLES AND THEORIES 1. Noah promised to drive Thelma to Los Angeles, so he should stop bellyaching and do it.

2. The refugees were shot at and lied to, and the authorities did nothing to stop any of this. The authorities should have intervened.

3. There was never any imminent threat from the Iraqi government, so the United States should not have invaded Iraq.

4. The Indian government posed an imminent threat to Pakistan and the world, so the Pakistanis were justified in attacking Indian troops.

5. Burton used a gun in the commission of a crime; therefore he should get a long prison term.

6. Ellen knew that a murder was going to take place. It was her duty to try to stop it.

7. Ahmed should never have allowed his daughter to receive in vitro fertilization.

Such a procedure is unnatural.

8. The doctors performed the experiment on twenty patients without their consent.

Obviously, that was wrong.

9. What you did was immoral. You hacked into a database containing personal information on thousands of people and invaded their privacy.

10. Ling spent all day weeding Mrs. Black ’s garden for no pay. The least Mrs. Black should do is let Ling borrow some gardening tools.

Exercise 1.2 For each of the following arguments, specify the conclusion and premises and indicate where possible whether it is cogent or sound. 1. Anyone who runs away from an automobile accident should be arrested.

Janet ran away from an automobile accident. She should be arrested.

2. I write in response to the Nov. 4 News article, ‘‘Plans for group home, storage facility opposed.” As the sister and not cause unnecessary harm to others); (3) be ­ neficence (we should do good to others and prevent or remove harm); (4) utility (we should produce the most favorable balance of good over bad for all concerned); and (5) justice (we should treat equals equally). According to ethical relativism, moral stan ­ dards are not objective but are relative to what individuals or cultures believe. A familiar argu ­ ment for cultural relativism is that if people’s moral judgments differ from culture to culture, then moral norms are relative to culture, and people’s moral judgments obviously do differ from culture to culture. But the first premise in the ar ­ gument is false. In addition, cultural relativism seems implausible because it implies moral infal ­ libility, immunity of all cultures from moral crit ­ icism from the outside, the automatic wrongness of the moral stance of social reformers, and the incoherence of the idea of moral progress. More ­ over, cultural relativism does not necessarily lead to tolerance and does not logically entail it. The divine command theory says that right actions are those commanded by God, and wrong actions are those forbidden by God. But many religious and nonreligious people have rejected the theory because it seems to imply that God’s commands are arbitrary. Most critical reasoning is concerned in one way or another with the construction or evalua ­ tion of arguments. All the skills required in deal ­ ing with arguments generally can be applied directly to handling moral arguments in partic ­ ular. A moral argument is one whose conclusion is a moral statement, an assertion that an action is right or wrong or that a person or motive is good or bad. ARGUMENT EXERCISES (All answers appear in the Appendix.) Exercise 1.1 In each of the following passages, add a moral premise to turn it into a valid moral argument. 01-Vaughn-Chap01.indd 30 26/05/16 4:26 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 31 2. Anyone who disagrees with the basic moral dictums of the prevailing culture should be censored. Dr. Tilden’s graduation speech clearly was inconsistent with the prevailing moral opinions on campus. She should be reprimanded.

Exercise 1.4 Identify the moral arguments in each of the following passages. Specify the premises and the conclusion, adding implicit premises where needed. 1. The movie Lorenzo’s Oil is about a family’s struggle to find a cure for their young son’s fatal genetic disease, an illness that usually kills boys before they reach their eleventh birthday. The script is based on the true story of a family’s attempt to save Lorenzo, their son, from this fatal genetic disease through the use of a medicinal oil.

The movie is a tear ­jerker, but it ends on a hopeful note that suggests that the oil will eventually cure Lorenzo and that the oil is an effective treatment for the genetic disease. The problem is, there is no cure for the disease and no good scientific evidence showing that the oil works. But the movie touts the oil anyway—and gives false hope to every family whose son suffers from this terrible illness. Worse, the movie overplays the worth of the oil, seriously misleading people about the medical facts. The movie, therefore, is immoral. It violates the ageless moral dictum to, above all else, ‘‘do no harm.’’ Lorenzo’s Oil may be just a movie, but it has done harm nonetheless.

2. I, like many of my fellow Muslims, was appalled by the latest bombing in Saudi Arabia (‘Among the Saudis, Attack Has Soured Qaeda Supporters,’ front page, Nov. 11). Yet I was disturbed to get the sense that Saudis were angered by this latest act of barbarity because the targets were mainly Arab and Muslim.

guardian of a profoundly retarded woman who lives in a group home, I can assure the gentlemen quoted that their fears are very much unfounded. The home in which my sister resides is large, lovely, brand new, well staffed and well maintained. It does nothing but enhance the community, bring neighbors together and create a wonderfully diverse neighborhood— Letter to the editor, Buffalo News 3. Scrawling ‘‘Rape all Asian bitches and dump them’’ on classroom walls is not a hate crime, and graffiti should be protected by the First Amendment, according to assis­ tant professor of communication Laura Leets. This is outrageous. I hope Ms. Leets is simply arguing from a narrow legalistic interpretation and is merely insensitive to the tremendous hurt such graffiti can inflict, not to mention the additional damage caused when a professor on campus defends it. Words can be just as destructive as physical violence. Drawing a technical distinction between the two is at best insensitive, at worst evil—Letter to the editor, Stanford Magazine 4. Yolanda took the money from petty cash even though she had plenty of money in her pocket. People shouldn’t steal unless they are destitute. She shouldn’t have taken that money.

5. There is one principle we can never avoid:

We should never do anything to disrespect human life. The artificial use of human cells—as scientists are now doing in stem ­cell research—shows a complete disregard for human life. Stem ­cell research is immoral.

Exercise 1.3 Evaluate the following arguments: 1. Any form of expression or speech that offends people of faith should not be tolerated. Penthouse magazine definitely offends people of faith. Ban it! 01-Vaughn-Chap01.indd 31 26/05/16 4:26 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics 32 PART 1: PRINCIPLES AND THEORIES Richard M. Fox and Joseph P. DeMarco, Moral Reason - ing , 2nd ed. (New York: Harcourt, 2001).

William K. Frankena, Ethics , 2nd ed. (Englewood Cliffs, NJ: Prentice ­Hall, 1973).

Bernard Gert, Morality: Its Nature and Justification (New York: Oxford University Press, 1998).

John ­Stewart Gordon, “Bioethics,” The Internet Ency - clopedia of Philosophy , http://www.iep.utm.edu/ (15 October 2015).

Chris Gowans, “Moral Relativism,” in The Stanford Encyclopedia of Philosophy (Spring 2004), ed. Edward N. Zalta, http://plato.stanford.edu/archives/spr2004/ entries/moral ­relativism/.

C. E. Harris, Applying Moral Theories (Belmont, CA: Wadsworth, 1997).

The Hastings Center , http://w w w.thehastingscenter.org/ (15 October 2015).

Melville Herskovits , Cultural Relativism: Perspectives in Cultural Pluralism (New York: Vintage, 1972).

Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998).

Kai Nielsen, Ethics Without God (Buffalo, NY: Prometheus, 197 3).

Louis P. Pojman, Ethics: Discovering Right and Wrong , 4th ed. (Belmont, CA: Wadsworth, 2002).

Louis P. Pojman and Lewis Vaughn, eds., The Moral Life , 3rd ed. (New York: Oxford University Press, 2007).

James Rachels, The Elements of Moral Philosophy , 4th ed. (New York: McGraw ­Hill, 2003).

Theodore Schick, Jr. and Lewis Vaughn, Doing Philoso - phy , 2nd ed. (New York: McGraw ­Hill, 2002), chap. 5.

Russ Shafer ­Landau, Whatever Happened to Good and Evil? (New York: Oxford University Press, 2004).

Peter Singer, ed., A Companion to Ethics (C a mbr id ge , UK: Blackwell, 1993).

Walter T. Stace, “Ethical Relativism,” in The Concept of Morals (New York: Macmillan, 1965), 8– 58.

Bonnie Steinbock, ed., The Oxford Handbook of Bioethics (Oxford: Oxford University Press, 2007).

Paul Taylor, Principles of Ethics (Encino, CA: Dickenson, 197 5).

Lewis Vaughn, Doing Ethics: Moral Reasoning and Con - temporary Issues (New York: W.W. Norton, 2008).

Lewis Vaughn, The Power of Critical Thinking , 2nd ed.

(New York: Oxford University Press, 2008).

Thomas F. Wall, Thinking Critically About Moral Problems (Belmont, CA: Wadsworth, 2003).

G. J. Warnock, The Object of Morality (London: Methuen & Co. 1971). You quote one person as saying of the bombing in Riyadh in May, “At that time it was seen as justifiable because there was an invasion of a foreign country, there was frustration.” Another says, “Jihad is not against your own people.” Regardless of whether the victims are Muslim or not, the vicious murder of innocent human beings is reprehensible and repugnant, an affront to everything Islam stands for. Any sympathy for Al Qaeda among the minority of Saudis should have evaporated after the May bombings in Riyadh, and it should have surprised no one in Saudi Arabia that Al Qaeda would attack a housing complex full of Arabs and Muslims. That is what Al Qaeda is: a band of bloodthirsty murderers.—Letter to the editor, New York Times further reading Anita L. Allen, New Ethics: A Guided Tour of the Twenty- First Century Moral Landscape (New York: Miramax, 2004).

John Arras, “Theory and Bioethics,” The Stanford Ency - clopedia of Philosophy (Summer 2013), Edward N.

Zalta (ed.), http://plato.stanford.edu/archives/sum2013/ entries/theory ­bioethics/ (15 October 2015).

Robert Audi, Moral Knowledge and Ethical Character (New York: Oxford University Press, 1997).

Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics , 5th ed. (New York: Oxford University Press, 2001).

Bioethics.com , http://www.bioethics.com/ (15 October 2 015).

Richard B. Brandt, Ethical Theory (Englewood Cliffs, NJ: Prentice ­Hall, 1959).

Steven M. Cahn and Joram G. Haber, Twentieth Century Ethical Theory (Upper Saddle River, NJ: Prentice ­Hall, 19 95).

Jean Bethke Elshtain, “Judge Not?,” First Things 46 (October 1994): 36– 41.

Fred Feldman, Introductory Ethics (Englewood Cliffs, NJ: Prentice ­Hall, 1978). 01-Vaughn-Chap01.indd 32 26/05/16 4:26 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics Chapter 1: Moral Reasoning in Bioethics 33 notes 1. James Rachels, The Elements of Moral Philosophy, 4th ed. (New York: McGraw ­Hill, 2003), 14.

2. This example is derived from James Rachels’ unique description of the case in “Ethical Theory and Bioethics,” from A Companion to Bioethics, ed. Helga Kuhse and Peter Singer (Oxford: Blackwell, 2001), 16– 17.

3. W. D. Ross, The Right and the Good (O x ford :

Clarendon Press, 1930).

4. In their classic text Principles of Biomedical Ethics (New York: Oxford University Press, 2001), Tom L. Beauchamp and James F. Childress work out a comprehensive approach to biomedical ethics using a framework of four moral principles. They choose to treat beneficence and nonmaleficence separately and regard utility as part of beneficence.

5.

Solomon Asch, Social Psychology (Englewood Cliffs, NJ: Prentice ­Hall, 1952), 378– 79. 01-Vaughn-Chap01.indd 33 26/05/16 4:26 PM 08/29/2018 - RS0000000000000000000001179164 (Kelso Cratsley) - Bioethics