Virtue Theory and Abortion

Rosalind Hursthouse, “Virtue Theory and Abortion,” Philosophy and Public Affairs 20(3), Summer 1991, 223-246.

Responds to 9 common objections to virtue theory: 7 minor, 2 “major”. The two major objections are related to a concern about the applicability and justificatory power of virtue theory in relation to particular decisions, and Hursthouse aims to ameliorate this concern by demonstrating how virtue theory should lead us to think about abortion.

Begins with a nice structural comparison of deontology (connects the concepts of ‘right action,’ ‘moral rule,’ and ‘rationality’), utilitarianism (connects the concepts of ‘right action’, ‘consequences,’ and ‘happiness’), and virtue theory (connects the concepts of ‘right action’, ‘virtuous agent’ and ‘flourishing’).

The 7 minor objections and responses:
Objection 1: Eudaimonia is a hopelessly and uniquely obscure concept.
Response: No more so than ‘rationality’ or ‘happiness’

Objection 2: VT is trivially circular, specifying right action in terms of virtuous agents in terms of right action.
Response: Right action is specified in terms of virtuous agents/virtues which are in turn specified in terms of flourishing. There may be a larger (non-trivial?) circle from there back to right action.

Objection 3: VT is about Being and not Doing.
Response: False. VT does answer the question “What should I do?”

Objection 4: VT is unprincipled and guides only by example.
Response: There is a role for principles. Every virtue generates a positive instruction (act justly, kindly, courageously, etc). Not necessary to have an example of a virtuous person.

Objection 5: VT reduces all moral concepts to virtuous agency.
Response: To the contrary, VT is anti-reductionist and relies on thick moral concepts like charity and benevolence as well as thinner ones like good, evil, harm, worthwhile, pleasant, etc.

Objection 6: Which traits count as virtues is a debatable or even relativist matter.
Response: Both VT and deontology at some point have to stick their necks out and say that some trait or rule is the right one, and those who deny it are mistaken.

Objection 7: Virtues can generate conflicting requirements.
Response: Even a deontology with just one rule can yield contrary instructions in certain circumstances (e.g. Williams’ Jim and Pedro).

Objection 8: VT has to just assert that certain actions are virtuous or not, without argument.
Response: A theory that doesn’t make it easy to apply a moral rule or concept isn’t inadequately action-guiding, but rather accurate.
Objection 9: VT has to just declare certain actions or ways of being worthwhile, without argument.
Response: A theory that requires taking a stand on what is worthwhile isn’t inadequately action-guiding, but rather accurate. The alternative would be to say that a good moral theory should make it possible for someone with no or extremely mistaken opinions on what is worthwhile to give good advice about what morally one should do.


Abortion
VT makes both women’s rights and fetal status irrelevant to the question whether it is right or wrong to have an abortion in certain circumstances.
• In exercising a moral right, one can do something cruel or callous or stupid or disloyal, etc.
• And having the correct attitude toward something such as a fetus is not a matter of its (metaphysical) status, but rather having the familiar biological facts about the fetus and the pregnancy operate in one’s practical reasoning in a virtuous way.

• The biological facts about human reproduction and our emotions in relation to them make pregnancy and terminating it morally serious. Thus to think of abortion as insignificant or purely instrumental to a trivial end is not virtuous. (Consistent with sense that grief over miscarriage is appropriate.)
• Value assumptions: 1. parenthood, motherhood, and childbearing are intrinsically valuable. 2. Else being equal, it is an “evil” when a human life is cut short.
• Some suggestion that it is at least understandable that we should treat early abortion as less serious. Unclear whether she thinks it in fact is less serious.
• In some circumstances, viewing abortion as the blessed escape from a prospect of 8 months of misery and near unbearable burden “does not manifest lack of serious respect for human life or shallow attitude toward motherhood.” This indicates something wrong with the circumstances. (VT has “built-in indexicality”.)
• Sometimes abortion is the right thing to do, but one is in the circumstances where it is the right thing to do through a failure of virtue. Hence it can be appropriate to feel guilt and regret at rightly choosing an abortion.

Theories of the Emotions: Taxonomy

I. General Theories of the Emotions: 3 kinds

1.Somatic
James
Damasio
Prinz

2. Appraisal/Cognitive
Stoics
LeDoux
Lazarus
Nussbaum
De Sousa
Solomon

3. Combo
Aristotle
Schachter & Singer
Calhoun
Stocker

Other
Ryle: nothing but beh’l disp’ns
Griffiths: against folk category
A. Rorty



II. Emotions & Morality

Williams
Wolf
Stocker
Velleman
Annas
Nussbaum
Baier


III. Emotions Related to Hope

1. Trust
Baier
Holton
O’Neill

2. Love
Solomon
Velleman
Annas
Williams

Tags: emotions, taxonomy

Informed Consent and RCTs

Truog et al, “Is Informed Consent Always Necessary for Randomized, Controlled Trials?” NEJM 340 (10), 804-807.

Informed consent is morally necessary only when it is essential for guaranteeing that patients’ right to self-determination is respected.
The right to self-determination [is respected? not disrespected?] when conditions 1-5 are met. (NB some of these conditions have more directly to do with risk minimization than respecting self-determination.)
Therefore, informed consent is not always morally necessary.

Furthermore, requiring specific informed consent sometimes prevents small but meaningful improvements in care.

“When benefits to society and to future patients can be gained without meaningfully compromising respect for patients’ autonomy and without any serious increase in risk to those involved, blind insistence on informed consent is not only unnecessary, but also harmful.”

Tags: consent, trial design

Lessons from ECMO

Robert D. Truog, “Randomized Controlled Trials: Lessons from ECMO,” Clinical Research 40 (3), 519-527, 1992.

ECMO trial’s use of randomized consent should be seen as symptom of two deeper ethical concerns about trial design:

1. ECMO was a potentially life-saving therapy. When the experimental therapy is a potentially life-saving therapy, clinical equipoise is insufficient justification for randomizing patients between the experimental therapy and standard care, because patients don’t expect physicians to weigh benefit to society (generalizable knowledge generated by RCT) against personal views about best therapy. Also, informed consent is not a sufficient waiver of the therapeutic obligation, because patients in these situations are extremely vulnerable and desparate.
2. ECMO was a rapidly developing technology. The length of an RCT means that, as the trial progresses, the experimental therapy used within the trial ceases to be state-of-the-art, and the control therapy ceases to be the best standard care. Also, by the end of the trial, the compared therapies may be obsolete.

Truog proposes a prospective observational study as an alternative to RCT, for getting data about the effectiveness of ECMO in pediatric patients.

Tags: consent, trial design

Between Consenting Adults

Onora O’Neill, “Between Consenting Adults,” Philosophy and Public Affairs 14 (3), 252-77.

Examines the moral ideals of not “using” people, and of “treating others as persons.”

Rejects three common conceptions of these ideals:
1. “The Personal Touch:” living up to these ideals is a matter of employing a certain tone and manner, or not being indifferent. Rejected as neither necessary (impersonal relation w/salesperson) nor sufficient (charming seduction).
2. “Actual Consent:” living up to these ideals is a matter of never treating people in ways they do not consent to being treated. Rejected because consent is opaque and actual consent may not track the morally significant aspects of plans, proposals, and intentions consented to.
3. “Hypothetical Consent:” living up to these ideals is a matter of never treating people in ways that a fully rational person would not consent to be treated. Rejected because it may lead to coercing people in the name of more rational selves (cf Isaiah Berlin, “Two Conceptions of Freedom”). Also, conception needs to be supplemented with an account of which aspects of action must be hypothetically consented to—which aspects are morally significant.

A related, general point: these ideals are not primarily a matter of treating people as they want or would want to be treated: “If wants or rationalized preferences are morally fundamental, consent is of derivative concern.”

Proposes (Kantian) alternative: “Possible Consent”
• Actions are done on maxims (underlying principles, not necessarily fundamental intentions)
• Two kinds of maxims involve using another (failures of respect)*:
o Maxims to which no other [sic? Another?] could possibly consent, such as maxims of coercion or deception. Doesn’t cash out the notion of possible consent.
o Maxims to pursue ends that another cannot share
• Failing to live up to the ideal of treating others as persons may require yet more positive consideration—requires taking into account “humanity in their person”; their particular capacities for rational and autonomous action. Requires endeavoring to further the ends of others (beneficence)*.

*A little unclear whether respect/beneficence are supposed to track don’t use/treat as person.

Discusses how these ideals, conceived in Kantian way, play out in the context of sexual relationships and employment.

Tags: consent, respect for persons, using people

Moral Luck (Nagel)

Thomas Nagel, “Moral Luck,” in Mortal Questions (Cambridge 1979), 24-38.

*********
“The inclusion of consequences in the conceptions of what we have done is an acknowledgment that we are parts of the world, but the paradoxical nature of moral luck which emerges from this acknowledgment shows that we are unable to operate with such a view, for it leaves us with no one to be. The same thing is revealed in the appearance that determinism obliterates responsibility.”
************

The paradoxical nature of moral luck: “A person can be morally responsible only for what he does; but what he does results from a good deal that he does not do; therefore he is not morally responsible for what he is and is not responsible for.”

In other words, an important condition for finding a person responsible for an act under a certain description is that she have control over that act (and that act being of the relevant description). But moral luck means that we lack control over considerations that should not undermine attributions of responsibility.
• Four kinds of moral luck: Constitutive luck (personality); circumstantial luck; luck in how one is antecedently determined (includes determination of the will/problem of free will); luck in how actions and projects turn out (includes decision under uncertainty & negligence).
• NB: We can say in advance how a moral verdict depends on the results of a choice, so this isn’t the claim that moral judgment depends on temporal standpoint.
• The compatibilist solution is to carve out categories of control—some absences of control undermine attributions of responsibility, and some don’t. This solution doesn’t show how the problem arises in the first place.
How the problem arises: “Something in the idea of agency is incompatible with actions being events, or people being things.”
• We work with an internal view of ourselves that includes a rough boundary between what is us/not us and what we do/what happens to us.
• We apply this internal self-conception to others when we morally assess them.
• Reactive attitudes have something to do with this self-conception and its application to others.

(note: possibly something here makes sense of why we feel guilt about hoping for bad things, even when we do nothing to bring them about.)

Tags: moral luck, freewill, agency, reactive attitudes

Freedom and Resentment

P.F. Strawson, “Freedom and Resentment,” in Freedom and Resentment and Other Essays, (London: Methuan, 1974).

Participatory vs. Objective Attitudes: not entirely mutually exclusive (e.g. attitude taken in child-rearing may straddle the two); participatory attitude involves responding to self and others with reactive attitudes; objective attitude may be “emotionally toned,” but cannot include the attitudes “which belong to involvement of participation with others in inter-personal human relationships.”

Reactive Attitudes, categories and paradigmatic examples:
• (Other)-reactive
o Personal
> Resentment
o Impersonal
> Indignation
• Self-reactive
>Sense of obligation
>Guilt

Two kinds of consideration that mollify/modify reactive attitudes:
• Considerations that invite us to view the injury as something the attitude should apply to, or as something for which the agent was not (fully) responsible
o E.g. “She didn’t mean to;” or “She couldn’t help it”
• Considerations that invite us to view the agent as someone reactive attitudes in general should apply to, or as someone who is not (fully) responsible for her behavior
o E.g. “She’s only a child;” or “She’s schizophrenic”

Why determinism wouldn’t undermine reactive attitudes:
1. It’s not (psychologically/humanly) possible for us to adopt “a thoroughgoing objectivity of attitude to others as the result of a theoretical conviction of the truth of determinism”
2. If it were possible for us to make such a “god-like choice, the rationality of making it or refusing it would be determined” by the “gains and losses to human life” that would result from the choice,” and “the truth or falsity of a general thesis of determinism would not bear on the rationality of this choice.”

A diagnosis of the free will debate: Optimists/Compatibilists and Pessimists/Incompatibilists both “misconstrue the facts in very different styles,” or “over-intellectualize:”
• Optimists try to justify moral practices (punishment, praise & blame) in purely pragmatic/consequentialist terms, and thereby lose sight of the “human attitudes of which these parctices are, in part, the expression”
• Pessimists insist that these practices are justified only if a metaphysical thesis is true
• But in fact:

“Inside the general structure or web of human attitudes and feelings of which I have been speaking, there is endless room for modification, redirection, criticism, and justification. But questions of justification are internal to the structure or relate to modifications internal to it.”

Tags: freewill, agency, reactive attitudes, emotions