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I am a physician taking care of a woman with bad asthma who requires admission

I am a physician taking care of a woman with bad asthma who requires admission to the hospital. She happens to be six months pregnant, which is clinically relevant because low oxygen levels in the blood will affect the fetus. I inform her that if she refuses treatment, her unborn child will suffer oxygen deprivation, and will likely be mentally retarded. She says that "God will take care of us, I'm going home."

The situation that you describes raises all sorts of interesting philosophical questions, I’m not sure which to address. I'll assume for the sake of this discussion that you’re not wondering whether your patient could possibly be right about God’s intentions. So, let’s assume that she’s wrong: God won’t take care of her and her fetus, and she’s placing her future child at significant risk of harm that would permanently and seriously restrict his (let’s give him a gender for the sake of this discussion) future life opportunities. There are then two questions that you might have in mind. One: “Is she doing something that is morally wrong?” Two: “What are my own moral obligations in this situation?” The answer to neither question is straightforward.

First question: The answer to the first question is complicated by two facts– (a) the individual who would be harmed by your patient’s lack of treatment is currently a fetus, and (b) your patient is apparently ignorant of the fact that she really is putting her future child at risk of harm.

While the rights of children are fairly uncontroversial, the rights of fetuses are highly contested. However, we can avoid this controversy by talking simply about your patient’s future child. If this future child were to be mentally handicapped because she now refuses to take treatment, then she would have made him much worse off than he otherwise would have been. As a result of her action, he would have a significantly more restricted range of reasonable life plans available to him than he would otherwise have had. Her action, then, puts her future child at significant risk of significant harm. From a moral point of view, it seems to me, it is irrelevant whether one’s actions causesomeone immediate harm or harm someone some time in the distant future.On these grounds alone, I would conclude that your patient’s refusal oftreatment is morally wrong.

However, some might argue that wecannot say that her action is morally wrong, since she is doing what she thinks is best for her future child– she just happens to be mistaken aboutwhat is best for her future child. Only if her ignorance is itself culpable,can we charge her with immorality.

Though many philosopherswould disagree with me, I would like to distinguish the conditionsunder which one counts as performing an action that is wrong and theconditions under which one counts as being a bad person or as doingsomething that is morally blameworthy. An action can be wrong, perhaps because it has terrible consequences. But the person who does the wrongaction might nonetheless be a good person because through no fault ofher own, she did not anticipate these bad consequences. To use afamiliar example, a Good Samaritan might go to some trouble to save thelife of a person who turns out to be a serial murderer. Was her actionmorally correct? I would want to say “no.” Had she not so acted, manyvaluable lives would not been shortened. No action with such bad (evenif indirect) consequences could be morally right. Other philosopherswould insist that what the Good Samaritan did was morally correct,since the direct result of her own action was the extending of the lifeof a fellow human being (who just happened to be a serial killer) andsince the shortening of the lives of his victims wasn't the directresult of her own action but instead was the direct result of theserial killer's actions. Despite this disagreement about the moralityof her action, all of us can agree that the Good Samaritan was a goodperson and that she could not be morally blamed for doing what she did.

Returningnow to your patient. I would say that her action is morally wrong.Others would say that her action is morally wrong only if she isculpably ignorant of the likely harmful consequences of her action.It’s an interesting question, which I can’t answer here, whethersomeone who lives in the 21st century who believes that God will takecare of her and her fetus is culpably ignorant and thus morallyblameworthy for the consequences of actions that are based on thisbelief.

Second question: What are your moral obligations? Onthe assumption that your patient’s behavior is morally wrong, whatfollows? Unfortunately, not much. The fact that one person’s potentialactions are immoral does not by itself imply that another person ismorally permitted to prevent her from acting immorally. Physicians playan important beneficial role within our society and their ability toplay that beneficial role could be jeopardized if they were to take itupon themselves (especially as a matter of professional obligation) toprevent their patients from acting immorally. Patients might refuse toget further treatment from those whom they regard as meddling doctors,and the health consequences for both patients and fetuses (and thefuture children they become) could be devastating.

This is a time when overpopulation is a growing problem. It seems that there is

This is a time when overpopulation is a growing problem. It seems that there is no slowing down of procreation even though people are aware of the problem. At the rate it is going I see that it will result in Authorities having to take drastic action to sustain the human race. Any decision they make will be unfair in some way. I wonder whether it would be right to stop trying to cure terminal illnesses such as Cancer and AIDS (as they seem an unbias/fair population control system). On the one hand it would be better for the future of mankind and yet it seems unjust to let people die when we can help them. Where does this issue stand with ethics? as it seems both moral and immoral.

Letting terminally ill people die will do little to slow population growth because the vast majority of these people are not going to have (additional) children anyway. But there are other solutions that would actually work.

You write that there seems to be no slowing of procreation. This is quite false. Total fertility rates (average number of children per woman) have fallen spectacularly since 1955 ... but only in countries and regions where poverty has been meaningfully reduced. For example, the TFR of East Asia fell from 5.42 to 1.72 (below the rate of reproduction) -- and East Asia is the most populous region on Earth. So this is highly significant. There were large drops also in Portugal, Australia, Botswana, Italy, and so on. Where poverty persists, on the other hand, so do high TFRs. Many African states are good examples of this. Niger's TFR has increased from 6.86 to 7.15, and other high-poverty countries (Mali, Senegal, Equatorial Guinea) are not far behind. The evidence is overwhelming, and the lesson is clear: ensure that people have some social security, so they need not depend in their old age on having surviving children; ensure that infant mortality is low, so people need not get lots of children to ensure that a few will survive; ensure that women have good educational and employment opportunities so that they have important social roles other than that of bearing and raising children.

Is it ethical for psychologists and psychometricians to lie to their clients

Is it ethical for psychologists and psychometricians to lie to their clients about their IQ if it protects them from harm to their self-esteem? I ask because I highly suspect that such a practice is both very common and something that has been practiced on me. I am told I have an IQ of a 138 which to me seems highly improbable given my academic record and my SAT scores, but I always wanted to join Mensa and I think i told my tester that. However when I applied for Mensa I had to have my records sent three times to their headquarters but each time they somehow got "lost" and so I never became an official member. It also seems improbable that so many people I have known have IQs higher than 150, it's like it's just very common for practitioners to give their clients high feel good numbers.

I think it is unethical for psychologists to lie to their clients about such test results. It would be best practice for a psychologist to ask their client why they want to take such a test and what they think the result means, as part of the process of consent for taking the test. Apparently this was not done in your case, and this is regrettable, since you seem to think that the test has great significance.

A well known book you might enjoy is Howard Gardner's "Frames of Mind" which discerns seven different kinds of intelligence.

Is there any validity in the following argument?

Is there any validity in the following argument? By medical science we keep people with severe chronical diseases alive and these people are free to reproduce. Already there has been an increase in people with chronical diseases, maybe because of our progression in medical science. So, in the future, it is possibly that we will all struggle with many chronical diseases, unless we accelerate in stem-cell research or genetic manipultaion. With this I see only two opportunities: either deny the chronically diseased to reproduce (Which I think is quite unethical) or "play God" and rid our selves with these plagues with either genetic manipulation or stem-cell research (which is also unethical, for some). But not matter what ethical principles one leans on, these two options are the only sensible ones, of course to the exception of not doing anything (which is also unethical). So we have here, three unethical options, depending on one´s ethical affiliation: 1. Everyone will be chronically diseased. 2....

We have been grappling with these ethical issues since the mid-nineteenth century and the beginning of the Eugenics movement. You have obviously done some deep thinking yourself, and perhaps it is time for you to engage with some texts in history and ethics in order to see how to take the questions further. I suggest Diane Paul's "Controlling Human Heredity" and "The Politics of Heredity" (both cheap paperback books) and an essay by Erik Parens "The Goodness of Fragility" widely reprinted in bioethics texts (there are many other bioethics resources, such as bioethics.net and http://bioethics.georgetown.edu/publications/scopenotes/

If you have a loved one in the hospital with a terminal illness and this person

If you have a loved one in the hospital with a terminal illness and this person no longer has a capacity to communicate, sustain thought, or make critical decisions, can it be considered ethical to pull the plug on them without their consent given their circumstances?

What can be considered ethical will, of course, depend on what conception of ethics (and also, perhaps, what metaphysical assumptions) one brings to bear on the question. So, for example, if one believes in the absolute sanctity of (human) life, then the fact that the loved one continues to be (biologically) human and alive will provide the answer. On the other hand, if you think that what makes something human (in the ethical sense) is the ability to make decisions (I think it can be argued that Aristotle, for example, believed this), then it would seem that it is ethically open to end the biological life of the loved one, since their human life had already ended, in your scenario. However, it would also follow from the Aristotelian view that there is nothing wrong with terminating the life of a fetus (or even infant!) until the time it is able to engage in decision-making.

In other words, a proper answer to your question must flow from having, first, an adequate conception of what sort of being we are dealing with here. The fact that something is biologically human and alive does not seem to be enough to make a confident ethical judgment--we wouldn't, for example, afford a "right to life" for living tissue samples, for example. Once we get a grip on that question, then we also need to make some basic ddecisions about how things of that kind are to be recognized within our ethical theories.

Speaking just for myself, I am inclined to be very suspicious of "all or nothing" answers to these sorts of questions, as if there is some clear conceptual breaking point between what deserves to be afforded a right to life and what does not. But certainly ethical theories that recognize a central role for "rights" not only exist, they continue to flourish within the philosophical community.

In the ethical approach I favor (virtue theory), questions about when and what circumstances merit which sorts of actions are understood, instead, in terms of desirable characteristics of agents. In this way of looking at things, your sort of question would turn into something like this: What would an excellent human being decide to do about a loved one in such a circumstance? I expect that the questioner might find this version of the question not much help, because it is difficult to try to get a grip on all that an excellent human being might bring to bear on such a decision. So, virtue theorists, I think, have to concede that there may be no such thing as fixed and fully general answers to such questions--nothing that might be regarded as an "algorithm" or decision principle for making ethical judgments of the sort you seek here. That may be simply a failing of virtues theories, and some critics have held it to be such. But some of us, anyway, think that it is actually a virtue of virtue theory--it recognizes the necessity of the exercise of human judgment, because the morally relevant circumstances of any given situation may be such as to merit different answers in different cases.

In other words, your question seems to want to force a "yes" or "no" answer, and I am suggesting that either answer is likely to be artificial and forced. Does the loved one have medical insurance that will indemnify his or her heirs against the likely heavy medical costs of continuing his or her life? Are there other loved one's whose opinions and feelings about this very question matter, and if so, how do they feel about it? Would the limited resources that are going to be used in maintaining the life of this person be such as to be better assigned to something (or someone) else? Did this person leave a living will, or some other document that proposed an answer to this very question, if such a situation arose? And so on... I suspect that if we tell the rest of the story in such a way as to capture all of the morally relevant details, we might find we are prepared to offer different answers to different cases, precisely because of the effects (potentially incommensurable, but still significant to the agent practicing judgment) of these morally relevant details.

In brief, then, I think you should be wary of the very idea that questions like this one can be given clear, definitive, and ethically defensible answers! Not so fast!

How justified is a doctor's decision to practise cosmetics when he had sworn

How justified is a doctor's decision to practise cosmetics when he had sworn upon the Hippocratic Oath?

The Hippocratic Oath says a number of things, not all of which doctors swear to today (for example, the Hippocratic Oath forbids any kind of surgery). Perhaps you are thinking of the most well-known part of the Hippocratic Oath, that forbids harm. This is regularly interpreted as forbidding "unnecessary harm," e.g. vaccinations hurt, but they are a necessary harm to prevent a greater harm. Cosmetic surgery involves harm to the patient--the pain of surgery and the risks of surgery--so the question is, does it prevent a greater harm? The right people to ask about this is the people who undergo cosmetic surgery--both the ones with successful and the ones with unsuccessful results. They should be fully informed so as to balance the potential harms and benefits for themselves.

Could ADHD drugs like Adderall be accurately described as strengthening a person

Could ADHD drugs like Adderall be accurately described as strengthening a person's will?

We tend to regard the will as something that is marked off from the rest of the person, because, somehow, it is a direct manifestation of the person's being. So an ADHD drug could not be described as "strengthening people's will", because it if were described in this way it could not then be said to be be their own will that was being strengthened; they would be having it down for them.

Similarly, one might think, you can do my work for me, but not my thinking, because then it would not be my thinking that was being done. (Still, in that sense you would not be doing my work - my working - and it is just as impossible for you to do my work as it is for you to think my thoughts or even perhaps to wear my boots, taken to be the ones I am wearing ("Look, his boots (borrowed boots) have mud on them")).

One might on the other hand regard the will as the energy or strength to carry something through. Or one might regard it as determination, though here too the paradox shows through. If my determination is bolstered by a drug, is it really determination? But one can surely lack psychic energy or strength for just the sort of reason (anaemia, say) that one lacks physical energy. In such a case, one could well speak of "strengthening a person's will" or ability to carry through.

It seems to me possible by the way that one could learn from a drug, as Peter Kramer seems to imply can happen with Prozac, in his 1993 book Listening to Prozac. So the possibility seems to exist that the drug can actually teach someone who lacks it what strength of will is, and perhaps then they could do more easily "on their own" later.

Your problem is very interesting and difficult.

Over the past few years, my wife has become a staunch antivaccinationist. (We

Over the past few years, my wife has become a staunch antivaccinationist. (We have a son on the autism spectrum; she has bought into the discredited vaccine causation theory of autism.) She is unreachable on this topic; no facts or reason will move her from her position. Unfortunately, she has decided that our children are to have no further vaccinations. She will not compromise on this. I, of course, want our children to be protected from dangerous diseases and thus want them to be vaccinated. My question: What are my ethical obligations in this situation--to my wife, to my children, and to society? Going behind my wife's back and having the children vaccinated without her knowledge does not seem ethical. Agreeing to her demand that the children receive no further shots also seems unethical--this would put my kids at risk of disease, as well as other people. Telling my wife up front that I'm taking the children to get their shots, despite her objections, also seems problematic--they are her children...

I agree with Professor Smith. The only thing I would add may be obvious and may be something you've already tried. It sometimes helps to have third parties intervene to provide all the facts and arguments you would use to try to persuade your wife to change her mind. Here, your knowledge of who might influence her is useful. Would she trust your family's pediatrician or react harshly against him/her as a member of the 'vaccine conspiracy'? Her parents or yours? Mutual friends? While an 'intervention' would be extreme, making friends and family aware of a serious issue that affects the health of your children (and others) and enlisting their help might make it easier for your wife to back down without feeling pressured to do so solely by you. But should these methods fail, then Prof. Smith's suggestion seems appropriate.

Would the possibility of women competing on equal footing with men be thinkable

Would the possibility of women competing on equal footing with men be thinkable without contraceptives, birth control, and access to abortion?

Certainly. The fact that women have children does not mean that they are obliged to be the main carers for those children once they are born, nor does it mean that while pregnant they are in any way incapacitated. If childcare were to be shared equally, or adequately organized by the state or community, the fact that women have children would be no hindrance to any of their other putative activities.

Hello, and thanks for this amazing site. I am a 17 year old guy in a

Hello, and thanks for this amazing site. I am a 17 year old guy in a relationship. My girlfriend (although the word comes with a certain stigma of immaturity, which I don't like) and I have been together for well over a year. We have had a very successful relationship, even though we've had our bumps and bruises. However, our relationship is now in turmoil. My girlfriend is trying to end the relationship - although we both still love each other very much, enjoy each other's company, and feel the same as day one. The reason is her commitment issues. They come from a very troubled past, but I will not betray her privacy and give further details. This has been an issue which she has avoided for a long time. Never could we have a productive discussion on the issue. In truth, she needs therapy. She admits this, she knows this. She discontinued therapy (for PTSD and other things) a couple years ago. The reason why she refuses to go to therapy, why she is driven to break apart our relationship rather then go to...

Thanks for this thoughtful question, and I'm sorry for what you're all going through!

However I'm not convinced this is, in the end, a 'philosophical' matter -- it sounds more like one that's for the professional psychologists and therapists .... and I wonder if it might be useful even for YOU to consult with one, to get some useful advice about how to deal with this complicated situation! (There are some philosophers with some psychology expertise, but I don't know if any of the panelists on this site are those!)

best of luck!
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