For your midterm paper, I would like you to write a concise, precise, and well-organized argumentative essay on one of the topics we have covered in this class thus far. It should be 1000-1200 words.

S ocrates , in P lato’s R EPUBLIC (ca. 390 bc ) 1.1. The Problem of Definition Moral philosophy is the study of what morality is and what it requires of us. As Socrates said, it’s about “how we ought to live”—and why. It would be helpful if we could begin with a simple, uncontroversial definition of what morality is, but unfortunately we cannot. There are many rival theories, each expounding a different conception of what it means to live morally, and any definition that goes beyond Socrates’s simple formulation is bound to offend at least one of them.

This should make us cautious, but it need not paralyze us. In this chapter, I will describe the “minimum concep- tion” of morality. As the name suggests, the minimum con- ception is a core that every moral theory should accept, at least as a starting point. First, however, we will examine some moral controversies having to do with handicapped children.

This discussion will bring out the features of the minimum conception. 1.2. First Example: Baby Theresa Theresa Ann Campo Pearson, an infant known to the public as “Baby Theresa,” was born in Florida in 1992. Baby Theresa had anencephaly, one of the worst genetic disorders. Anen- cephalic infants are sometimes referred to as “babies without brains,” but that is not quite accurate. Important parts of rac19065_ch01_001-014.indd 1rac19065_ch01_001-014.indd 1 9/5/14 2:44 PM9/5/14 2:44 PM 2 THE ELEMENTS OF MORAL PHILOSOPHY the brain—the cerebrum and cerebellum—are missing, as is the top of the skull. The brain stem, however, is still there, and so the baby can breathe and possess a heartbeat. In the United States, most cases of anencephaly are detected dur- ing pregnancy, and the fetuses are usually aborted. Of those not aborted, half are stillborn. Only a few hundred are born alive each year, and they usually die within days.

Baby Theresa’s story is remarkable only because her par- ents made an unusual request. Knowing that their baby would die soon and could never be conscious, Theresa’s parents vol- unteered her organs for immediate transplant. They thought that her kidneys, liver, heart, lungs, and eyes should go to other children who could benefit from them. Her physicians agreed. Thousands of infants need transplants each year, and there are never enough organs available. But Theresa’s organs were not taken, because Florida law forbids the removal of organs until the donor has died. By the time Baby Theresa died, nine days later, it was too late—her organs had deterio- rated too much to be harvested and transplanted.

Baby Theresa’s case was widely debated. Should she have been killed so that her organs could have been used to save other children? A number of professional “ethicists”—people employed by universities, hospitals, and law schools, who get paid to think about such things—were asked by the press to comment. Most of them disagreed with the parents and phy- sicians. Instead, they appealed to time-honored philosophi- cal principles to oppose taking the organs. “It just seems too horrifying to use people as means to other people’s ends,” said one such expert. Another explained: “It’s unethical to kill person A to save person B.” And a third added: “What the parents are really asking for is, Kill this dying baby so that its organs may be used for someone else. Well, that’s really a horrendous proposition.” Is it horrendous? Opinions were divided. These ethicists thought so, while the parents and doctors did not. But we are interested in more than what people happen to believe. We want to know what’s true. Were the parents right or wrong to volunteer their baby’s organs for transplant? To answer this question, we have to ask what reasons, or arguments, can be given on each side. What can be said for or against the parents’ request? rac19065_ch01_001-014.indd 2rac19065_ch01_001-014.indd 2 9/5/14 2:44 PM9/5/14 2:44 PM WHAT IS MORALITY ? 3 The Benefits Argument. The parents believed that Theresa’s organs were doing her no good, because she was not con- scious and was bound to die soon. The other children, however, could be helped. Thus, the parents seem to have reasoned: If we can benefit someone without harming anyone else, we ought to do so. Transplanting the organs would benefit the other children without harming Baby Theresa. Therefore, we ought to transplant the organs. Is this correct? Not every argument is sound. In addi- tion to knowing what arguments can be given for a view, we also want to know whether those arguments are any good.

Generally speaking, an argument is sound if its assumptions are true and the conclusion follows logically from them. In this case, the argument has two assumptions: that we should help someone if no harm would come of it, and that the transplant would help the other children without harming Theresa. We might wonder, however, about the claim that Theresa wouldn’t be harmed. After all, she would die, and isn’t being alive better than being dead? But on reflection, it seems clear that, in these tragic circumstances, the parents were right. Being alive is a benefit only if you can carry on activities and have thoughts, feelings, and relations with other people—in other words, if you have a life . Without such things, biological existence has no value. Therefore, even though Theresa might remain alive for a few more days, it would do her no good.

The Benefits Argument, therefore, provides a powerful reason for transplanting the organs. What arguments exist on the other side? The Argument That We Should Not Use People as Means. The ethicists who opposed the transplants offered two arguments.

The first was based on the idea that it is wrong to use people as means to other people’s ends . Taking Theresa’s organs would be using her to benefit the other children; therefore, it should not be done.

Is this argument sound? The idea that we should not “use” people is appealing, but this idea is vague. What exactly does it mean? “Using people” typically involves violating their autonomy —their ability to decide for themselves how to live their own lives, according to their own desires and values. rac19065_ch01_001-014.indd 3rac19065_ch01_001-014.indd 3 9/5/14 2:44 PM9/5/14 2:44 PM 4 THE ELEMENTS OF MORAL PHILOSOPHY A person’s autonomy may be violated through manipulation, trickery, or deceit. For example, I may pretend to be your friend, when I am only interested in going out with your sis- ter; or I may lie to you so you’ll give me money; or I may try to convince you that you would enjoy going to a movie, when, really, I only want you to give me a ride. In each case, I am manipulating you in order to get something for myself.

Autonomy is also violated when people are forced to do things against their will. This explains why “using people” is wrong; it is wrong because it thwarts their autonomy.

Taking Baby Theresa’s organs, however, could not thwart her autonomy, because she has no autonomy—she cannot make decisions, she has no desires, and she cannot value any- thing. Would taking her organs be “using her” in any other morally significant sense? We would, of course, be using her organs for someone else’s benefit. But we do that every time we perform a transplant. We would also be using her organs without her permission. Would that make it wrong? If we were using them against her wishes, then that would be a reason for objecting—it would violate her autonomy. But Baby Theresa has no wishes.

When people are unable to make decisions for themselves, and others must step in, there are two reasonable guidelines that might be adopted. First, we might ask, What would be in their own best interests?

If we apply this standard to Baby Theresa, there would be no problem with taking her organs, for, as we have already noted, her interests will not be affected. She is not conscious, and she will die soon no matter what.

The second guideline appeals to the person’s own pref- erences: We might ask, If she could tell us what she wants, what would she say?

This sort of thought is useful when we are deal- ing with people who have preferences (or once had them) but cannot express them—for example, a comatose patient who signed a living will before slipping into the coma. But, sadly, Baby Theresa has no preferences about anything, nor has she ever had any. So we can get no guidance from her, even in our imaginations. The upshot is that we are left to do what we think is best. The Argument from the Wrongness of Killing. The ethicists also appealed to the principle that it is wrong to kill one person rac19065_ch01_001-014.indd 4rac19065_ch01_001-014.indd 4 9/5/14 2:44 PM9/5/14 2:44 PM WHAT IS MORALITY ? 5 to save another.

Taking Theresa’s organs would be killing her to save others, they said; so, taking the organs would be wrong.

Is this argument sound? The prohibition against killing is certainly among the most important moral rules. Neverthe- less, few people believe it is always wrong to kill—most peo- ple think there are exceptions, such as killing in self-defense.

The question, then, is whether taking Baby Theresa’s organs should be regarded as another exception. There are many reasons to think so: Baby Theresa is not conscious; she will never have a life; she is going to die soon; and taking her organs would help the other babies. Anyone who accepts this will regard the argument as flawed. Usually, it is wrong to kill one person to save another, but not always.

There is another possibility. Perhaps we should regard Baby Theresa as already dead. If this sounds crazy, bear in mind that our conception of death has changed over the years. In 1967, the South African doctor Christiaan Barnard performed the first heart transplant in a human being. This was an exciting development; heart transplants could potentially save many lives. It was not clear, however, whether any lives could be saved in the United States. Back then, American law understood death as occurring when the heart stops beating. But once a heart stops beating, it quickly degrades and becomes unsuitable for transplant. Thus, under American law, it was not clear whether any hearts could be legally harvested for transplant. So American law changed.

We now understand death as occurring, not when the heart stops beating, but when the brain stops functioning: “brain death” is our new end-of-life standard. This solved the prob- lem about transplants because a brain-dead patient can still have a healthy heart, suitable for transplant.

Anencephalics do not meet the technical requirements for brain death as that term is currently defined; but per- haps the definition should be revised to include them. After all, they lack any hope for conscious life, because they have no cerebrum or cerebellum. If the definition of brain death were reformulated to include anencephalics, then we would become accustomed to the idea that these unfortunate infants are stillborn, and so taking their organs would not involve killing them. The Argument from the Wrongness of Killing would then be moot. rac19065_ch01_001-014.indd 5rac19065_ch01_001-014.indd 5 9/5/14 2:44 PM9/5/14 2:44 PM 6 THE ELEMENTS OF MORAL PHILOSOPHY On the whole, then, the arguments in favor of transplant- ing Baby Theresa’s organs seem stronger than the arguments against it. 1.3. Second Example: Jodie and Mary In August 2000, a young woman from Gozo, an island south of Italy, discovered that she was carrying conjoined twins. Know- ing that the health-care facilities on Gozo couldn’t handle such a birth, she and her husband went to St. Mary’s Hospital in Manchester, England. The infants, known as Mary and Jodie, were joined at the lower abdomen. Their spines were fused, and they had one heart and one pair of lungs between them.

Jodie, the stronger one, was providing blood for her sister.

No one knows how many sets of conjoined twins are born each year, but the number seems to be in the hundreds. Most die shortly after birth, but some do well. They grow to adult- hood and marry and have children themselves. However, the outlook for Mary and Jodie was grim. The doctors said that without intervention the girls would die within six months.

The only hope was an operation to separate them. This would save Jodie, but Mary would die immediately.

The parents, who were devout Catholics, opposed the operation on the grounds that it would hasten Mary’s death.

“We believe that nature should take its course,” they said. “If it’s God’s will that both our children should not survive, then so be it.” The hospital, hoping to save Jodie, petitioned the courts for permission to perform the operation anyway. The courts agreed, and the operation was performed. As expected, Jodie lived and Mary died.

In thinking about this case, we should distinguish the question of who should make the decision from the question of what the decision should be . You might think, for example, that the parents should be the ones to decide, and so the courts were wrong to intrude. But there remains the separate ques- tion of what would be the wisest choice for the parents (or anyone else) to make. We will focus on that question: Would it be right or wrong to separate the twins?

The Argument That We Should Save as Many as We Can. The rationale for separating the twins is that we have a choice rac19065_ch01_001-014.indd 6rac19065_ch01_001-014.indd 6 9/5/14 2:44 PM9/5/14 2:44 PM