Published Articles
"Does
Professional Autonomy Protect Medical Futility Judgments?,” Bioethics
20 (2006): 92-104.
Despite
substantial controversy, the use of futility judgments in medicine is quite common,
and has been backed by the implementation of hospital policies and professional
guidelines on medical futility. The
controversy arises when health care professionals (HCPs) consider a treatment
futile which patients or families believe to be worthwhile: should HCPs be free
to refuse treatments in such a case, or be required to provide them? Most physicians seem convinced that
professional autonomy protects them from being forced to provide treatments they
judge medically futile, given the lack of patient benefit as well as the waste
of medical resources involved. The
argument from professional autonomy has been presented in a number of articles,
but it has not been subjected to much critical scrutiny. In this paper I distinguish three
versions of the argument: 1) that each physician should be free to exercise his
or her own medical judgment; 2) that the medical profession as a whole may
provide futility standards to govern the practice of its members; and 3) that
the moral integrity of each physician serves as a limit to treatment
demands. I maintain that none of
these versions succeeds in overcoming the standard objection that futility
determinations involve value judgments best left to the patients, their
designated surrogates, or their families.
Nor do resource considerations change this fact, since they should not
influence the properly patient-centered judgment about futility.
“A Framework for Moral Reasoning,” in Moral Dilemmas in Community Health Care, B.C. White & J. Zimbelman, eds. (NY: Pearson Longman, 2005): 1-27.
This essay offers a systematic framework for reasoning about the kinds of ethical issues that come up in health care contexts. After an introduction to the topic of ethics, the essay sets out the major moral principles that are especially important to medical ethics, and then describes a five-step procedure for analyzing and resolving ethical issues that incorporates those principles. The procedure offers a principled alternative to the appeals to gut instinct, tradition, and politics that all too often characterize ethical problem-solving. In closing, the essay discusses how studying moral philosophy can also improve one's skills in ethical decision-making.
“Human Nature: Metaphysical,
Empirical, or Moral Debate?”, Contemporary Philosophy 26 (2004):
47-51.
The debate
over human nature continues unabated despite a long history of inquiry. I suggest that while the question
appears to be metaphysical or empirical, it can be better understood as a moral
question concerning how we should view and respond to human beings, including
ourselves.
“Ethics,
Reference, and Natural Kinds,”
Ethical naturalists aim to be realist about ethical value, without including supernatural facts in their ontologies. Terence Horgan and Mark Timmons have argued against naturalist strategies modeled on synthetic reductions in science (e.g. water, temperature). In my paper, I criticize their argument, as too dependent on obscure Twin Earth intuitions. I then offer an alternative argument, based on the claim that ethical terms are not backed by the sorts of referential intentions allowing synthetic reduction in the standard cases. This provides a principled basis, in ordinary linguistic use and semantic theory, for rejecting naturalist approaches to ethics.
“The Normativity of Meaning,” Philosophical Studies 86 (1997): 221-242.
The normative dimension of meaning has been cited by Kripke, Davidson, and others in prominent arguments about the nature of language and mind. But these authors have said surprisingly little about the kind of ‘normativity’ on which their arguments depend. In this paper I develop a precise thesis about the normative character of linguistic meaning. I go on to defend that thesis as both plausible and of philosophical consequence, in that it defines a general constraint on a theory of meaning which many naturalistic theories are unlikely to meet, including most dispositionalist, functionalist and evolutionary accounts.
“Resolving Moral Dilemmas: a Case-Based Method,” (with Becky Cox White), Healthcare Ethics Committee Forum 8 (1996): 85-102.
Health care is subject to an enormous number of explicit rules, policies, codes, and laws, as well as a vast number of unstated norms and standards embedded in the profession, the specialty, the institutional setting, or the specific practice. Learning these norms is an important part of what it is to learn clinical skills. But these norms are not the court of last appeal. Ethical issues come up in health care contexts because of cases where there are disagreements or uncertainty about what would be the morally better path. This essay sets out a framework for moral reasoning that is helpful in resolving such disagreements and uncertainties about cases.
“A Method for Teaching Ethics,” Teaching Philosophy 19 (1996): 371-383.
Graced with enthusiastic students and a little luck, ethics can be a rewarding and relatively easy subject to teach. Nevertheless, those who have taught ethics know the very elements which help make the task easy can also create difficulties. The students' intrinsic interest in the issues can make them balk at attempts to introduce complex distinctions, theories, or arguments, since what they want is immediate relevance and a chance to try out their own views. The willingness to defend pre-existing opinion threatens to turn the classroom into an Oprah/Donahue show, and also fuels resistance to attempts to introduce structure or sophistication into the debates. And the students' background knowledge can make them suspicious of the idea that the teacher is an authority from whom they should learn, hardly a problem when teaching a class in epistemology. For these reasons, even the most gifted teachers of ethics experience occasional classes that never catch fire. I have developed a strategy which has helped me avoid such an outcome, reliably producing a constructive class environment and genuine learning. The guiding idea is to emphasize a simple five-step method of ethical reasoning, a method which students see as enjoyable and useful for everyday ethical thinking, yet which also leads students to recognize the value of more abstract, philosophical reflections. In this paper I explain the method I have developed, and how I use it in the classroom.
“A Defense of the Autonomy of Ethics: Why Value Is Not Like Water,” Canadian Journal of Philosophy 26 (1996): 191-209
There has recently been a revival of interest in "naturalizing" ethics. A naturalization seeks to vindicate ethical realism, without violating the naturalist constraint that science sets the limits of ontology. The revival has been prompted by successful scientific reductions (temperature, water), and by the emergence of nonreductive naturalist approaches (e.g. for biological and mental properties). I argue against such approaches in ethics, on the grounds that 1) reductive strategies depend on referential intentions that are absent in ethics, and 2) nonreductive strategies cannot both ensure causal realism and avoid Moorean complaints.
Other
Published Writings
Review of Morality in a Natural World by David Copp, in Notre Dame Philosophical Reviews (2008).
“An Ethicist’s
Analysis,” in Moral Dilemmas in Community Health Care, B.C. White
& J. Zimbelman, eds. (
“Bush’s Dilemmas,” Inside Chico State 32:3-A (September 27, 2001).
"To Pie or
Note to Pie,"
"An Ethicist's Perspective," Bioethics Bulletin 6:3 (Fall, 1998).
Review of Intrinsic Value by Noah Thomas, in Ethics 106:3 (April 1996) 667-668.
Review of An Introduction to Ethics, by Geoffrey Thomas, in Ethics 105 (1995): 439.
“An Ethicist’s Perspective on Futility,” Bioethics Bulletin (1994)
Personal Values: Moral Problems in Daily
Life (ed. with T. Imhoff).