Allen, Anita L., and . Mental Disorders and the “System of Judgmental Responsibility”

2010, Boston University Law Review 90: 621-640.

Diversifying SyllabiThesis: Those affected by mental disorders whose actions are episodically influenced by their disorder are often overlooked by philosophers of moral and ethical responsibility. Allen gives us reasons for thinking it is inappropriate to either:

a) “summarily exclude people with mental problems out of the universe of moral agents, reducing them to the status of rocks, trees, animals, and infants”
b) “include the group on the false assumption that their moral lives are precisely like the paradigmatic moral lives of the epistemically-sound and well-regulated people never personally touched by a mental condition”

We must explore a revised approach to moral and ethical responsibility and obligation for this group.

Comment: This text is useful in teaching in two main contexts: (1) in discussing ethical issues related to mental disorders; and (2) to provide a challenging case in classes on blame and responsibility. The text can be also used in the context of the free will and determinism debate, and as a further reading in classes on moral agency.

Bordo, Susan, and . Anorexia Nervosa: Psychopathology as the Crystallization of Culture

1993, In her Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley: University of California Press.

Diversifying Syllabi: Bordo claims that the recent increase in women with Anorexia is a symptom of the “central ills” of our culture. Bordo discusses three sources of this “cultural illness” which leads to anorexia: the dualist axis, the control axis, and the gender/power axis. She spends the bulk of the paper discussing each “axis” or problematic component of society which is reflected back to us in the increasing diagnosis of anorexia. These “psychopathogolgies” are expressions of the culture, she claims.

Comment: This text is most readily applicable in teaching feminist theory and social philosophy. However, it is also very useful in at least three other contexts: (1) as a critical approach to mind-body dualism, especially when teaching on Descartes or Plato's Phaedo; (2) in teaching on the ethics of mental illness and the anti-psychiatry movement, as an example of socially constructed disorders; and (3) more broadly in teaching on personal and collective moral responsibility.

Haksar, Vinit, and . The responsibility of psychopaths

1965, The philosophical quarterly 15(59): 135-145.

Content: The paper examines various arguments looking at the responsibility psychopaths bear for their immoral actions, using neurological knowledge about psychopathy.

Comment: Useful in teaching about the 'mad or bad' dilemma, and about responsibility and issues in psychiatric ethics in general.

Jackson, Jennifer, and . Ethics in medicine: Virtue, Vice and Medicine

2006, Cambridge: Polity.

Publisher: How, in a secular world, should we resolve ethically controversial and troubling issues relating to health care? Should we, as some argue, make a clean sweep, getting rid of the Hippocratic ethic, such vestiges of it as remain? Jennifer Jackson seeks to answer these significant questions, establishing new foundations for a traditional and secular ethic which would not require a radical and problematic overhaul of the old.
These new foundations rest on familiar observations of human nature and human needs. Jackson presents morality as a loose anatomy of constituent virtues that are related in different ways to how we fare in life, and suggests that in order to address problems in medical ethics, a virtues–based approach is needed. Throughout, attention is paid to the role of philosophy in medical ethics, and how it can be used to clarify key notions and distinctions that underlie current debates and controversial issues. By reinstating such concepts as justice, cardinal virtue, and moral duty, Jackson lays the groundwork for an ethics of health care that makes headway toward resolving seeming dilemmas in medical ethics today.
This penetrating and accessible book will be invaluable to students of sociology and health care, as well as those who are interested in the ethical uncertainties faced by the medical world.

Comment: Particularly useful in teaching is Chapter 10 which discusses abortion, reviewing arguments made by J.J. Thompson and M. Tooley, and enquiring into what makes killing wrong. Chapter 9 looks at distributive justice in medicine, reviewing some problematic cases and distinguishing between bad luck and injustice. Chapter 5 treats on conscientious objection and issues related to toleration and imposition of values.

Jaworska, Agnieszka, and . Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value

1999, Philosophy and Public Affairs 28(2): 105–138.

Comment: Jaworska asks: 'Should we, in our efforts to best respect a patient with dementia, give priority to the preferences and attitudes this person held before becoming demented, or should we follow the person’s present preferences?' (p. 108). The article offers a useful critical overview of the views expressed by Rebecca Dresser and Ronald Dworkin. It is best used as a primary reading in ethics classes focusing directly on medical ethics or autonomy, or as further reading in general ethics teaching on autonomy.

O'Neill, Onora, and . Some limits of informed consent

2003, Journal of Medical Ethics 29 (1):4-7

Abstract: Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given.

Comment: A great introductory text offering a short overview of the problems related to consent. The point regarding the intransitivity of consent is likely to inspire interesting discussions. As the paper is quite short, it can easily be used in conjunction with other texts.

Sherman, Nancy, and . From Nuremberg to Guantánamo: Medical Ethics Then and Now

2007, Washington University Global Studies Law Review 6(3): 609-619.

Abstract: On October 25, 1946, three weeks after the International Military Tribunal at Nuremberg entered its verdicts, the United States established Military Tribunal I for the trial of twenty-three Nazi physicians. The charges, delivered by Brigadier General Telford Taylor on December 9, 1946, form a seminal chapter in the history of medical ethics and, specifically, medical ethics in war. The list of noxious experiments conducted on civilians and prisons of war, and condemned by the Tribunal as war crimes and as crimes against humanity, is by now more or less familiar. That list included: high-altitude experiments; freezing experiments; malaria experiments; sulfanilamide experiments; bone, muscle, and nerve regeneration and bone transplantation experiments; sea water experiments; jaundice and spotted fever experiments; sterilization experiments; experiments with poison and with incendiary bombs. What remains less familiar is the moral mindset of doctors and health care workers who plied their medical skill for morally questionable uses in war. In his 1981 work, The Nazi Doctors, Robert Jay Lifton took up that question, interviewing doctors, many of whom for forty years continued to distance themselves psychologically from their deeds. The questions about moral distancing Lifton raised (though not the questions about criminal experiments) have immediate urgency for us now. Military medical doctors, psychiatrists and psychologists serve in U.S. military prisons in Guantánamo, Abu Ghraib, Kandahar, and, until very recently, in undisclosed CIA operated facilities around the world where medical ethics are again at issue. Moreover, they serve in top positions in the Pentagon, as civilian and military heads of command, who pass orders and regulations to military doctors in the field, and who are in charge of the health of enemy combatants, as well as U.S. soldiers. Because we recently marked the sixtieth anniversary of the judgment at Nuremberg, I want to awaken our collective memory to the ways in which doctors in war, even in a war very different from the one the Nazis fought, can insulate themselves from their moral and professional consciences.

Comment: This text is best used as an additional reading in bioethics, or in just war theory (post ad bellum).

Sreenivasan, Gopal, and . A Human Right to Health? Some Inconclusive Scepticism

2012, Aristotelian Society Supplementary Volume 86 (1):239-265.

Abstract: This paper offers four arguments against a moral human right to health, two denying that the right exists and two denying that it would be very useful (even if it did exist). One of my sceptical arguments is familiar, while the other is not.The unfamiliar argument is an argument from the nature of health. Given a realistic view of health production, a dilemma arises for the human right to health. Either a state’s moral duty to preserve the health of its citizens is not justifiably aligned in relation to the causes of health or it does not correlate with the human right to health. It follows that no one holds a justified moral human right to health against the state.Education and herd immunity against infectious disease both illustrate this dilemma. In the former case, the state’s moral duty correlates with the human right to health only if it demands too much from a cause of health; and in the latter, only if it demands nothing from a cause of health (that is, too little).

Comment: Useful in teaching on distributive justice in medicine or medical ethics in general. Can also be used as further reading in political and moral philosophy modules on human rights.

Walker, Rebecca L., and . Medical Ethics Needs a New View of Autonomy

2009, Journal of medicine and philosophy 33: 594-608.

Abstract: The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order.

Comment: Walker argues against the Black Box view advocated by Beauchamp and Childress. The text is most useful when discussing principlism in biomedical ethics and more general issues related to autonomy and consent. The text works well when read alongside's Onora O'Neill's "Some limits of informed consent."