Uncertain Bioethics

Uncertain Bioethics “Stephen Napier argues with verve and subtlety for a cautious and restrained approach to acts of killing in bioethics; central to his argument is the difficulty of being sure that active interventions are per- missible. This book intriguingly combines insights from a wide variety of different recent philosophical literatures to offer an important and interesting contribution to numerous current debates.” Sophie-Grace Chappell, Professor of Philosophy at Open University, UK Bioethics is a field of inquiry and as such is fundamentally an epistemic discipline. Knowing how we make moral judgments can bring into relief why certain arguments on various bioethical issues appear plausible to one side and obviously false to the other. Uncertain Bioethics makes a significant and distinctive contribution to the bioethics literature by culling the insights from contemporary moral psychology to highlight the epistemic pitfalls and distorting influences on our apprehension of value. Stephen Napier also incorporates research from epistemology addressing pragmatic encroachment and the significance of peer disagreement to justify what he refers to as epistemic diffidence when one is considering harming or killing human beings. Napier extends these developments to the traditional bioethical notion of dignity and argues that beliefs subject to epistemic diffidence should not be acted upon. He proceeds to apply this framework to traditional and developing issues in bioethics including abortion, stem cell research, euthanasia, decision- making for patients in a minimally conscious state, and risky research on competent human subjects. Stephen Napier is an associate professor of philosophy at Villanova University. His previous publications include Virtue Epistemology: Motivation and Knowledge, and he edited Persons, Moral Worth, and Embryos. His interests include epistemology, bioethics, and the metaphysics of persons. Routledge Annals of Bioethics Series Editors: Mark J. Cherry St. Edward’s University, USA Ana Smith Iltis Saint Louis University, USA 11 The Ethics of Gender-Specific Disease Mary Ann Cutter 12 Death, Posthumous Harm, and Bioethics James Stacey Taylor 13 Human Dignity in Bioethics From Worldviews to the Public Square Edited by Stephen Dilley and Nathan J. Palpant 14 Parental Obligations and Bioethics The Duties of a Creator Bernard G. Prusak 15 The Bioethics of Pain Management Beyond Opioids Daniel S. Goldberg 16 The Ethics of Pregnancy, Abortion, and Childbirth Exploring Moral Choices in Childbearing Helen Watt 17 Medical Ethics, Prediction, and Prognosis Interdisciplinary Perspectives Edited by Mariacarla Gadebusch Bondio, Francesco Spöring, and John-Stewart Gordon 18 Care Ethics and Social Structures in Medicine Ruth E. Groenhout 19 Uncertain Bioethics Moral Risk and Human Dignity Stephen Napier Uncertain Bioethics Moral Risk and Human Dignity Stephen Napier First published 2020 by Routledge 52 Vanderbilt Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business 2020 Taylor & Francis The right of Stephen Napier to be identified as author of this work has been asserted by him in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. The Open Access version of this book, available at www.taylorfrancis. com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Napier, Stephen E., author. Title: Uncertain bioethics : human dignity and moral risk / by Stephen Napier. Description: New York : Taylor & Francis, 2020. | Series: Routledge annals of bioethics ; 19 | Includes bibliographical references and index. Identifiers: LCCN 2019012772| ISBN 9780815372981 (hbk : alk. paper) | ISBN 9781351244510 (ebk) Subjects: LCSH: Bioethics. | Dignity. Classification: LCC QH332 .N35 2020 | DDC 174.2—dc23 LC record available at https://lccn.loc.gov/2019012772 ISBN: 978-0-8153-7298-1 (hbk) ISBN: 978-1-351-24451-0 (ebk) Typeset in Sabon by Swales & Willis Ltd, Exeter, Devon, UK To Katherine, lux quia lucet Contents Acknowledgments x 1 Introduction 1 PART I Foundational Matters: The Perception of Value, Persons, and Human Worth 7 2 Moral Inquiry and the Apprehension of Value 9 Motivated Cognition, Attention, and Moral Perception 9 The Problem of Epistemic Circularity 12 “Questioned-Source Contexts” 14 Conclusion 26 3 Epistemic Justification, Peer Disagreement, and Moral Risk 31 The Epistemic Effects of Disagreement: Dogmatism and Flaccidity 32 Moral Risk, Presumption, and Burden of Proof 43 Conclusion 50 4 Persons and Human Beings 55 Human Beings and Substances 56 When Do You and I Come into Existence? 63 Persons are not Human Beings 65 Critique of the Functional Brain View 70 5 Human Dignity 83 Two Tasks and a Note on Method 85 Dignity: Three Aspects 86 viii Contents Discharging Misunderstandings 94 Alternatives: Interests and Autonomy 100 Conclusion: The Ecumenical Nature of Dignity 103 PART II Dignity at the Beginning and End of Life 107 6 Abortion 109 What is the Act of Abortion? 109 The Moral Analysis 112 The Argument from Epistemic Diffidence 121 Conclusion 131 7 Human Embryonic Destructive Stem Cell Research 135 The Twinning Argument 137 The Totipotency Argument 141 Rescue Cases 144 Natural Loss Arguments 149 The Argument from Epistemic Diffidence 151 8 Euthanasia 159 Definitions and Clarifications 160 What Can Be Presumed 164 The Arguments 166 Appraisal of the Arguments 173 Conclusion 181 PART III Balancing Dignity and Autonomy 187 9 Decision-Making for Patients with Suppressed Consciousness 189 The Minimally Conscious State 190 Undercutting the Argument from Advance Directives 192 Objections 201 Epistemic Diffidence and the Argument for Not Removing PEG Feeding 204 Conclusion 206 Contents ix 10 Decision-Making for Patients with Apparent Competency 209 The Basing Condition 211 Competency Assessments 214 The Argument for Stricter Conditions 215 Clarifications and Application to Cases 218 Conclusion 221 11 Risky Research on Competent Adults: Justice and Autonomy 225 Children Actually Enjoy Greater Protection 227 Children Should Not Enjoy Greater Protection: Direct Benefit and Theodicy 229 Objections 231 Conclusion 243 12 Conclusion 246 Bibliography 248 Index 271 Acknowledgments The following individuals contributed to the present project in various ways. David Benrimoh, Joe Butera, John Carvalho, Dan Cheely, Rev. Alfred Cioffi, Michael Degnan, Mark Doorley, Jason Eberl, Karl Hahn, Stephen Heaney, Rev. James McCartney, Matthew O’Brien, David Prentice, Benjamin Richards, Mike Rota, John Travaline, Helen Watt, Peter Wicks, and Brett Wilmot commented on some of the material present here. Edmund Howe and Matthew Braddock wrote separate essays in reply to some of the material herein (Howe’s is published). Sarah- Vaughan Brakman and Peter Koch formed a writing group that involved sharing comments on our respective work. This proved immensely helpful. David Hershenov reviewed, in exquisite detail, two penultimate chapters. I sent him 8,000+ word count documents, and received 5,000+ ones in return. I have no excuse for any errors except that philosophy is difficult. I’d like to thank two anonymous reviewers and the editors at Routledge, namely, Mark Cherry, Andrew Weckenmann, Allie Simmons, and freelance editor Judith Harvey for their very helpful guidance and feedback on this project. In writing this book I have made use of previously published material. Chapter 3 includes some material from my article, “The Justification of Killing and Psychological Accounts of the Person,” American Catholic Philosophical Quarterly 89(4) (2015): 651–680. Chapter 6 includes paragraphs from “Vulnerable Embryos: A Critical Analysis of Twinning, Rescue, and Natural-Loss Arguments,” American Catholic Philosophical Quarterly 84(4) (2010): 783–812. Chapter 8 includes paragraphs from “Perception of Value and the Minimally Conscious State,” HEC Forum 27(3) (2015): 265–286; and “The Minimally Conscious State, the Disability Bias and the Moral Authority of Advance Directives,” International Journal of Law and Psychiatry (2018), doi: 10.1016/j. ijlp.2018.03.001. Chapter 9 derives mostly from “When Should We Not Respect a Patient’s Wish?” Journal of Clinical Ethics 25(3) (2014): 196–206. And Chapter 10 derives mostly from “Challenging Research on Human Subjects: Justice and Uncompensated Harms,” Theoretical Medicine and Bioethics 34(1) (2013): 29–51. I wish to thank the editors Acknowledgments xi and the anonymous reviewers of these journals for their significant contri- butions to my thinking. Finally, I wish to thank the Office of the Provost at Villanova University for funding the Veritas Award which helped me write significant portions of the manuscript. 1 Introduction An informative introduction should frame the content that follows such that the reader is better able to understand the author’s intent and fundamental concerns. It should suggest how the work may be looked along as well as looked at. The change in preposition is important. This book should be understood as an essay on what the intellectual virtues of humility and justice look like in discrete areas of bioethical inquiry. Looking at it, one will find arguments for

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