Philosophy 242 MEDICAL ETHICS SUM2014, M-F, 9:40-10:40, SAV 156 INSTRUCTOR: BENJAMIN HOLE OFFICE HOURS: M-F, 10:40-11  EMAIL: BVHOLE@UW.EDU

Agenda Clicker Quiz Where we are and what we’re doing Gerald Dworkin, “Paternalism” Mini-lecture Discussion Please set your Turning Technology Clicker to channel 41 Press “Ch”, then “41”, then “Ch”

John Stuart Mill Gerald Dworkin Both Neither Which philosopher champions the view that “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others”? John Stuart Mill Gerald Dworkin Both Neither

How does Dworkin describe impure paternalism? “the class of persons whose freedom is restricted is identical with the class of persons whose benefit is intended to be promoted by such restrictions” “protect the welfare of a class of persons we find that the only way to do so will involve restricting the freedom of other persons besides those who are benefited”

What does Mill consider as an exception to his “harm principle”? Consenting to slavery Consenting to being eaten after you die Consenting to physician assisted suicide Consenting to colonialism

Where we are and what we’re doing Schedule Paper Writing Discussion

Week Required June 22-26: Introduction to Bioethics in Philosophy Benjamin Hole, Phil242 Syllabus and Course Website Chapter 1 “Moral Reasoning in Bioethics” (3-32) Chapter 2 “Bioethics and Moral Theories” (33-40) June 29- July 3: Bioethics and Moral Reasoning   Writing Assignment due June 30 “Writing Philosophy” (PDF), Mark Woodhouse “The Principle of Utility” (PDF), Jeremy Bentham “Utilitarianism,” John Stuart Mill (52-54) “The Moral Law,” Immanuel Kant (55-60) July 6-10: Access to Healthcare Chapter 11, “Dividing up Health Care Resources” (681-695) “Famine, Affluence, and Morality” (PDF), Peter Singer “Lifeboat Ethics” (PDF), Garrett Hardin “The Survival Lottery,” (PDF) John Harris July 13-17: Patient Autonomy and Informed Consent Writing Assignment due July 14 Dax’s Case (in-class movie) Chapter 3, “Paternalism and Patient Autonomy” (71-83) Chapter 5, “Informed Consent” (180-185) “Confronting Death: Who Chooses, Who Controls?” (PDF), Robert Burt and Dax Cowart July 20-24: Disability and Culture “Paternalism,” Gerald Dworkin (84-93) Sound and Fury (in-class movie) “Ethical Relativism in a Multicultural Society,” Ruth Macklin (164-174) “Defending Deaf Culture,” (PDF) Robert Sparrow July 27-31: Disability and Biomedical Enhancement Writing Assignment due July 28 FIXED: The Science/Fiction of Human Enhancement (in-class movie) “A Fatal Attraction to Normalizing” (PDF), Anita Silvers “Ethical Issues in Human Enhancement” (PDF), Nick Bostrom & Rebecca Roache August 3-7: Reproductive Genetic and Ethics “Is Gene Therapy a Form of Eugenics?,” John Harris (571-577) “Genetic Dilemmas and the Child’s Right to an Open Future,” Dena Davis (553-562) “The Non-Identity Problem and Genetic Harms,” Dan W. Brock (567-570) “The Wisdom of Repugnance,” Leon Kass (483-498) August 10-14: Abortion Writing Assignment due August 11 “The Unspeakable Crime of Abortion” (PDF), Pope John Paul II “On the Legal and Moral Status of Abortion,” Mary Anne Warren (333-342) “Why Abortion is Immoral,” Don Marquis (317-328) “A Defense of Abortion,” Judith Thomson (307-316) August 17-21: Paper Conference and Review  Writing assignment 8/18, Final Paper due 8/20, Final Exam 8/21

Schedule this week Monday “Paternalism,” Gerald Dworkin (84-93) Tuesday Sound and Fury (in-class movie) Wednesday Finish movie Discuss movie Start “Defending Deaf Culture,” (PDF) Robert Sparrow Thursday Finish “Defending Deaf Culture,” (PDF) Robert Sparrow Start “Ethical Relativism in a Multicultural Society,” Ruth Macklin Friday Finish “Ethical Relativism in a Multicultural Society,” Ruth Macklin

Paper Writing Short Writing Assignments June 30: Align course goals with personal learning goals and practice philosophical argumentation. July 14: Practice philosophical writing and self-assess development of philosophical skills. July 28: Critical summary; outline final paper. August 11: Critical summary; prepare for paper conference and final examination. August 18: Final paper self-assessment; course objectives self-assessment Final Paper August 17-: Paper Conference August 20: Final Paper

Discussion Be thoughtful about: Priority for: depth versus breadth clarification versus argumentation Priority for: Direct engagement New voices

Gerald Dworkin “Paternalism”

Principles in Bioethics Autonomy “autonomous persons should be allowed to exercise their capacity for self-determination” (9) Beneficence “we should do good to others and avoid doing them harm” (10) Utility “we should produce the most favorable balance of good over bad (or benefit over harm) for all concerned” (11) Justice “people getting what is fair or what is their due” (12)

Paternalism Paternalism—The overriding of a person’s actions or decision-making for his or her own good. Weak paternalism—Paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished. Strong paternalism—The overriding of a person’s actions or choices although he or she is substantially autonomous.

John Stuart Mill Utilitarianism Qualitative Hedonism Rule Utilitarianism? Harm Principle “The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”

Gerald Dworkin Mill’s Principle is Twofold “asserting that self- protection or the prevention of harm to other is sometimes a sufficient warrant” “claiming that the individual’s own good is never a sufficient warrant for exercise of compulsion either by the society as a whole by its individual members” “By paternalism I shall understand roughly the interference with a person’s liberty of action justified by reasons referring exclusively to the welfare, good, happiness, needs, interests or values of the person being coerced.”

Paternalistic Laws Pure Paternalism Impure Paternalism “the class of persons whose freedom is restricted is identical with the class of persons whose benefit is intended to be promoted by such restrictions” Prohibition of suicide “protect the welfare of a class of persons we find that the only way to do so will involve restricting the freedom of other persons besides those who are benefited” Prohibition of drug dealing

Paternalistic Laws Requiring motorcyclists to wear helmets Forbidding swimming in dangerous areas without a lifeguard Forbidding certain sexual conduct (e.g., homosexuality) in private Regulating certain drug use Making suicide criminal Regulating forms of gambling Regulating maximum interest rates on loans Requiring a license to practice certain professions (e.g., lawyer, doctor, etc.) Putting fluorides in community water

Paternalism & Collective Action Mill “required not to overrule the judgment of individuals respecting their own interests, but to give effect to that judgment they being unable to give effect to it except by concert, which concert again cannot be effectual unless it receives validity and sanction from the law.” Dworkin “Paternalism might be thought of as the use of coercion to achieve a good which is not recognized as such by those persons for whom the good is intended.”

Mill’s Argument Against Paternalism Since restraint is an evil the burden of proof is on those who propose such restraint Since the conduct which is being considered is purely self- regarding, the normal appeal to the protection of interests of others is not available. Therefore we have to consider whether reasons involving reference to the individual’s own good… are sufficient to overcome the burden of justification. We either cannot advance the interests of the individual by compulsion, or the attempt to do so involves evil which outweighs the good done. Hence the promotion of the individual’s own interests does not provide a sufficient warrant for the use of compulsion.

Mill’s Argument Against Paternalism Since restraint is an evil the burden of proof is on those who propose such restraint Since the conduct which is being considered is purely self- regarding, the normal appeal to the protection of interests of others is not available. Therefore we have to consider whether reasons involving reference to the individual’s own good… are sufficient to overcome the burden of justification. We either cannot advance the interests of the individual by compulsion, or the attempt to do so involves evil which outweighs the good done. Hence the promotion of the individual’s own interests does not provide a sufficient warrant for the use of compulsion.

Mill’s Exception to the Harm Principle “an engagement by which a person should sell himself, or allowed to be sold, as a slave, would be null and void… The ground for thus limiting his power of voluntarily disposing of his own lot in life, is apparent, and is very clearly seen in this extreme case… But by selling himself for a slave, he abdicates his liberty; he foregoes any further use of it beyond that single act.”

It is morally permissible to consent to a life of slavery. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

There should be prohibitions against consensual slavery. Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree

The Collapse of RC Argument Does RC admit exception cases? If yes If no Act utilitarianism / Distribution Objection Rule Worship / Deontology

Dworkin “Under certain conditions it is rational for an individual to agree that others should force him to act in ways in which, at the time of action, the individual may not see as desirable” Odysseus orders his men to tie him up because he can’t resist the sirens Taking your friend’s car keys when overindulging in alcohol

Case Study: Dax Cowart In Dax’s case? “it is rational for an individual to agree that others should force him to act in ways in which, at the time of action, the individual may not see as desirable”

Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree In Dax’s case, “it is rational for an individual to agree that others should force him to act in ways in which, at the time of action, the individual may not see as desirable” Strongly Agree Agree Somewhat Agree Neutral Somewhat Disagree Disagree Strongly Disagree