background of the moral evaluation of the life sciences. It seems to .... existence of such a technology will affect the life of everybody, we can't simply delegate.
Marcus Düwell
Needs, Capacities and Morality - Over Problems of the Liberal to Deal with the Life Sciences Introduction I will discuss in this paper some basic assumptions of a modern, liberal ethos against the background of the moral evaluation of the life sciences. It seems to me that each moral statement concerning the life sciences has to make evaluative assumptions that are partly in conflict with the scope of moral convictions that are covered by the classical liberal ethos or the political liberalism. I will especially focus on the ethical neutrality concerning the moral evaluation of human needs and capacities. Therefore – I will argue – bioethics has to reflect on a substantial criterion how to weight human needs and capacities. In the current debate Nussbaum and others proposed the ‘capabilities approach’ as an Aristotelian framework for such a moral evaluation. I will examine weather the notion of ‘human capabilities’ can provide us with an evaluation-criterion that is not arbitrary and substantial enough to justify moral judgments in our current bioethical discussions. Afterwards I will shortly propose a Kantian alternative to such a framework.
The liberal ethos There is an important conviction we have pertaining to the treatment of the human body, which generally holds that the treatment of the human body has to be legitimated by the decision-making and the self-understanding of the autonomous person. Hence, a person can decide what others may do with his or her body, and can set limits by saying “you may not do that with me.” It’s morally important that that individual person is the only one who can decide what will happen to him or her. Yet, if one’s capacity to control his or her own action is an important and morally justified limitation on the freedom of others, then we are evaluating this capacity to control our own action in itself as valuable, despite to the aims we want to reach with our actions. In a specific way, the idea that one can control what happens with their body belongs to the core of an ethos of the modern 1
world. Social contract-theories are discussing the legitimization of institutions that can protect this control. Utilitarianism’s aim is to protect our liberty and to coordinate the possibilities of preference-fulfillment. And in the center of the moral philosophy of Kant we’ll find the autonomous, free and rational being that is giving laws to him- or herself. Of cause, the coordination of our actions in a social contract as well as the lawgiver from Kant is limiting the scope of legitimate aims we can want to reach with our actions. Kant even thinks that the individual has some duties against him- or herself, and that not everything one wants to do with their body is morally permissible. But Kant will defend these limitations of a person’s self-control by arguing that those prohibited actions would contradict to important preconditions of individual’s autonomy. Furthermore, he will think that these duties towards ourselves are relevant for the consciousness of the individual (virtue ethics) and not for the moral regulation of action in the public or the legal sphere. So even if there are reasons to assume that there are moral limits concerning the way we may treat our own body, the individual is the only one who may set those limitations to him- or herself. No external institution is morally allowed to decide for me what has to happen with my own body. For the liberal ethos it’s furthermore important that this value of our ability of self-control is not only one value next to others but that it forms the core of a liberal morality. The protection of human dignity and human rights are seen as an explication of such an ethos and this ethos is seen as indispensable and universally binding. This liberal perspective involves the conviction that we should evaluate neither the ways of dealing with our own body nor our needs and desires as such from a m o r a l perspective. If someone wants to realize his homosexual desires, it’s fine as long as his partner agrees with that. The needs and desires are not morally bad or good as such. And whether I want to develop specific capacities or not is something I have to decide. Only in some respects the liberal ethos knows direct evaluations of our needs and capacities: If our needs, for instance, are affecting the way we are treating others, it will be different. Sadistic desires, aggressive habits or the like are morally problematic due to their impact on our behavior towards others. Similarly, if our desires are affecting our basic abilities for being a autonomous person (drugs, addictions) or if young people are influenced in a way that the developments of their basic abilities are disturbed, than we’ll evaluate those
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needs and attitudes against ourselves directly. But all those exceptions are related to the protection of the capability of the autonomous decision-making of the individual. Needs and desires as such, however, are seen as morally neutral; they are like factual circumstances since we take them as they are. It’s morally relevant that the autonomous individual is the only one who is dealing with his or her own needs and capacities, and that others may do so only insofar as they are given permission by the individual. The development of regulations of (bio-)medicine after World War II was strongly committed to this liberal ethos. The whole regulatory framework is very much concentrated on the idea of protecting the self-control of the patient concerning the treatment of his or her body. The central role of the autonomy of the patient and the establishing of the idea of informed consent is an indicator for that development (Dworkin 1988). The historical reasons are well known: The experience of abuse of medical authority in the concentration camps of the Nazis, the need for more regulations of medicine due to the development of biomedicine and the establishing of liberal societies are some factors worth mentioning.1 In any case the ethos of informed consent replaced the Hypocrathic ethos. Therefore bioethics was mainly concerned with problems that are arising if the protection of the autonomy of the patient is from such central importance, e.g. how to deal with those who are not able to give consent. Furthermore attention was drawn how to avoid that the protection of the informed consent has unintended side-effects for the most vulnerable groups of society, e.g. the disabled people that are in danger of being the victim of new discrimination by the developments of biomedicine. A significant amount of debates in bioethics are concerned with regulatory problems of the implementation of a liberal ethos under complex circumstances. In the core of a lot of bioethical declarations we find the moral conviction concerning the selfcontrol of our own body. And in general the protection of human dignity and human rights is interpreted in terms of individual self-determination and informed consent.2 And that implies that our body, and our needs and desires, are in a distinct sense morally neutral.
1 2
Jonsen 1998, Düwell/Neumann 2005. See Beyleveld/Brownsword 2001.
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Of cause this observations concerning the informed consent has to be much more described into detail. One relevant distinction shall be mentioned here: In the last years a lot of critical remarks to the informed consent are made. Those criticisms are related to problems of the implementations of informed consent in the practice (much bureaucracy etc.), to the problem how to make people so competent that they are able to give an informed consent, to the overwhelming possibilities of medical choices or to the problem how to deal with informed consent under the perspective of public health. In that context it’s important to distinguish between the value of patient’s autonomy that is forming the evaluative basis of what has morally to be protected and the informed consent as an instrument of this protection. The informed consent is implemented as a mode of protection and not as a moral value as such. Morally there is the value of the selfdetermination and self-control of the patient that deserves protection. Under regulatory circumstances the informed consent became so important cause it seemed to be the most appropriate way of implementing this protection. But if the practice of the informed consent is nowadays under criticism it has to be distinguished between those criticism directed against the moral values behind the idea of informed consent and criticism of the informed consent as an appropriate instrument of protection.
The liberal ethos and the developments in the life sciences This liberal ethos came under pressure for several reasons. It’s important to notice that the liberal perspective is criticized by many authors beyond just those who have fundamental objections against the liberal ideas, such as Hegelians, communitarians, feminists, or the other usual suspects. The ethical debate in the last decades has been accompanied by a criticism of the whole modern project. In old Europe the whole project of a liberal ethics were especially criticised in relation to its metaphysical presumptions that became suspect in the context of the ‘dialectics of enlightenment’3 or in Heideggers
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It’s worthwhile to mention that at least Adorno’s criticism of the modern subject is criticizing the raping of the subject in modern society through the idea of abstract rationality. But in his criticism the idea of the emancipation of the individual is always the normative basis of his criticism. Especially in his ‘Minima Moralia’ one can see that he even criticize the modern myth of the individual by referring to the value of individualism (Adorno 1951)
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criticism of metaphysics (Heidegger 1953). Another prominent example is Elisabeth Anscombe criticism of the ‘modern moral philosophy’ (Anscombe 1958). And the criticism of Anscombe is precisely related to the problem of the moral neutrality concerning the human needs, desires and the human body. Anscombe is criticizing that Kant, Hume, Hobbes and Mill by all differences in detail are commonly assuming that our ideas of justice or moral obligations have to be legitimated by an idea of the independent individual and that for this legitimization no recourse on a substantial psychology or anthropology is necessary or possible. By doing so, the birth of the modern moral subject is accompanied by a destruction of the historically grown sources of traditional morality.4 This kind of criticism is not focussing on specific developments of the liberal world but criticizing the whole idea of autonomous self-control of the individual as a starting point of moral consideration. In the consequence, the whole idea of human dignity and human rights came under pressure. In this context we’re not focussing on fundamental anti-modernist thinking or the internal dialectics of modernity. We’ll focus on problems with the liberal framework by considering the development of the life sciences. So, even if one accepts the concept of freedom of decision-making about one’s own body and ourselves as the core of our moral convictions, there are several reasons to doubt whether it can be sufficient to provide answers to crucial questions in the actual bioethical debates. And I want to mention here some examples for discussions where I think that a liberal position seems to be insufficient. First, the liberal ethos seems to deal only with the application of new technologies for the individual. But there are a lot of ethical discussions about the questions whether or not some biotechnological methods should be developed at all, e.g. cloning. Since the existence of such a technology will affect the life of everybody, we can’t simply delegate such questions to the decision-making of the individual. In several cases, the very existence of technologies in the life sciences are of crucial importance to our selfperception, as well as to the scope of possible actions. It’s seems that the liberal ethos is blind for the development-process of new technologies and only wants to protect the 4
See as well the discussion of Anscombe approach in: O’Hear 2004. A similar criticism we find in MacIntyre (1981).
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individual against technologies that are already existing. But seen the impact of these technologies on our life one could aspect some kind of ethical standards that shows us why the development of those technologies should be accepted by everybody. And all kind of moral evaluation of the development of new technologies seems already to presuppose an evaluation of those needs that are the reason for the development of those technologies. If reproductive medicine is legitimated to create possibilities of assisted fertilization than the desire to have a child of once own, seems to be a legitimate reason to develop such a technology. Another judgement of this kind would it be to say that the desire of a couple to clone a baby to replace a lost child is a problematic desire. So, it seems that for the moral evaluation of the development of new technologies a value judgment concerning human desires and capacities seems to be necessary. Second, we have to evaluate desires and needs when deciding whether or not a technology shall be offered. Is the desire for a smaller nose a sufficient reason to offer cosmetic surgery? If we reject that this desire is a legitimate reason, we will perhaps argue that it is not a therapeutic measure against any illness. Since the distinction between health and illness is not a biological one alone, we will need a stronger means of evaluation in order to make use of this distinction. And if, in the case of cosmetic surgery, we adopt a liberal solution, then we need a value-judgment to justify whether or not insurance companies must pay for such a treatment. This whole debate became more important in the context of the new debate about enhancement-technologies (Parens 2000, President’s Council of Bioethics 2003). The scope of technologies where we have doubts about the medical need is increasingly grown. A distinction between different legitimate needs or desires seems to be unavoidable. Third, a very striking example is that of a deaf couple that have the desire to have a child that is also deaf. Can their desire justify the use of preimplantation genetic diagnosis (PGD)? The deaf couple can refer to the fact that deafness is accepted as a specific way of living, as an own deaf culture. If we accept the use of PGD for that purpose we accept that medical technologies are used for the fulfilment of the wishes of parents and are used to produce disability. If not, we have to answer the question what the desire of the deaf couple makes so different from the desire to have a so-called healthy child? How is such a judgment possible without a substantial evaluation of the relevant desires and wishes? 6
And last, but not least, the discussions about priorities in the health care system force us to extend the scope of necessary valuations in moral judgements. If we argue for priorities in the health care system we seem to presuppose a non-arbitrary and substantial notion of human flourishing that is guiding the forming of a hierarchy of important goods. We can of cause delegate that solely to the market. But that means that we don’t make any attempt to try a moral legitimization of these priorities at all.
Bioethical approaches and a substantial criterion It seems that there are several discussions in bioethics where both the ethos of autonomous decision-making and the delegation of decision-processes to the individual patient are insufficient for an ethical evaluation. They are not insufficient in the sense that their outcome is obviously ethically unacceptable. But it means that this ethos isn’t able to formulate moral judgements on the basis of its own resources. It will has to refer to other kinds of believe, like the presupposition that scientific progress is an value in itself or believes that modern institutions will have the capacity to deal with the side-effects of new technologies or considerations the like. All those are convictions may be true, but they are going beyond the argumentative capacity of the liberal ethos itself. Up to know we don’t have a reason to assume that the liberal ethos is wrong. We have only seen that we’re not able to give a moral judgement in several bioethical discussions without making value judgements concerning our bodies and our needs, and without making some anthropological assumptions. If we take this tension between the modern ethos and the need for those evaluations into account, it seems to be unavoidable that we have a kind of evaluation criterion that allows us such a moral evaluation of needs and desires to a degree that we can hope to find answers in the mentioned bioethical discussions. And, the universalization or generalization of such a criterion must be justified. I will call that a ‘substantial criterion’, because it must have enough content for a moral evaluation of needs and capacities. That doesn’t mean that such a criterion has to determine the value of specific needs and capacities in all perspectives. It is possible that some capacities are from value for me only insofar as I want to reach a specific goal in life. Such a capacity would be valuable in the context of a specific idea of a good life. A
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substantial criterion mustn’t or perhaps even shouldn’t imply a sufficient determination of the value of needs and capacities in the perspective of a perfectionist ethics (Hurka 1993). A ‘substantial criterion’ will only help us to determine whether such needs and capacities are morally valuable in the sense that it is morally obligatory, permissible or prohibited to develop specific capacities or to fulfil specific needs. It’s not obvious whether or not such a moral criterion is available. It’s not self-evident whether or not such a criterion can be formulated to an extent that is concrete enough for our bioethical debates. But that are the questions that should be discussed in detail. Before we have a look at concrete proposals to formulate such a criterion, some remarks concerning the need of such a criterion are necessary. The mainstream of bioethical approaches will try to avoid at formulating a substantial criterion. For example a procedural approach like discourse ethics. But in concrete bioethical discourses they will have only two alternatives: Either the evaluation of our needs and capacities will be an issue discussed in the discourse, than we have necessarily to ask on which basis the search for an evaluation criterion can be decided. Or they will find a substantial criterion with regard to the preconditions of the procedure as such, e.g. by arguing that only those capacities are morally valuable that are compatible with the preconditions of the discourse procedure. In the first case the whole question of the legitimization of a substantial criterion would reappear in the context of the discourse, in the second case the approach would propose an own substantial criterion.5 Similar things could be said concerning the theories of prima-facie duties or mid-level principles, like those of Beauchamp/Childress (Beauchamp/Childress 2001, Düwell 2006). We would need a substantial criterion in the application of that an approach. Judging the relative relevance of the four principles regarding the urgency and importance of prima-facie-duties already presupposes that we have some value standards in the background. And the justification of that evaluative standard is precisely the issue in question. Theories like casuistry, particularistic or contextualistic approaches are in a
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In the debate between Habermas and Apel about discourse ethics it seems that Habermas choose the first strategy while Apel argued at the beginning for the last strategy (Apel 1976). In his new book on bioethics however, Habermas idea concerning the dignity of humankind includes something like a substantial criterion (Habermas 2001).
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similar situation.6 They want to avoid a discussion over criteria and principles, but in the attempt to do so they shift the problem to concrete practical debates and avoid a systematic explication and justification of such a criterion. The evaluative assumptions are implicitly playing a role here, but in a totally unclear and uncontrolled way. The urgency for a justification of such a substantial criterion has even increased in the development of bioethical debate. Casuistry and principlism are methods for bioethical debates that could be successfully applied in contexts where established practices exist, and where standards of good practice are generally accepted. If we are in a clinical setting where we have no doubts what a good doctor has to do, we can try to transfer the characteristics of accepted evaluations in one case to other more complex cases. The characteristics of the bioethical debate are, however, increasingly changing with regard to the kind of questions that are at stake. We are confronted with discussions that have not in the first case to do with extreme medical cases. Bioethics has become confronted with the challenge that the creation of the relevant knowledge and the development and the perspectives of the technologies as such require moral evaluation. Bioethics has to face the fact that newly developed technologies can be implemented in very different cultural contexts, and the development of the life sciences are accompanied by a lot of unforeseen implications. The challenge of biomedicine is not in the first place that bad people can use technologies for bad aims or that some technologies are inherently bad; rather, the central challenge is that we are faced with great research activity with increasingly global importance and strong impact of our lives, where we don’t have an understanding of what the possibilities of technological applications could be in the future, but we can be aware that the applications will be in very different cultural, political and institutional contexts. Taking that into consideration, it seems inadequate to use methods for the evaluation of such developments in the life sciences that depend on moral convictions that are shared only in specific cultural and political circumstances. Bioethics that want to give answers to this challenge has to become moral philosophy in a much more fundamental sense and that implies what I have called the discussion about a substantial criterion.
6
Arras 1999, Dancy 2004, Jonsen/Toulmin 1988, Jonsen 2005, Steigleder 2003, Van Willigenburg 2005.
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Capabilities Approach A promising proposal for such a criterion offers the ‘capabilities approach’, a notion that is used in very different contexts. There is some intuitive plausibility to the claim that capabilities necessary for human flourishing should be protected and supported. Such a notion seems especially fruitful for bioethics since it seems to be internally linked to the idea of medicine. Medicine shall help people in cases where fundamental capabilities are endangered. This notion is furthermore internally linked with the idea of “human rights”. Rights shall protect fundamental capacities or shall empower us to develop and enlarge the spectrum of relevant capabilities. It is necessary to determine which capacities are relevant for human beings for being able to discuss the content of human rights. Each concept of rights presupposes an idea about what kind of capacities are endangered. If we assume that we should have freedom of speech, for example, we presuppose that free communication and articulation are valuable and can be in danger. If we enlarge the spectrum of assumed rights, we suppose that the potential threats are changing; such a thing has happened in the recent decades in discussions in our environmental discussion. We realized that the destruction of nature could destroy the preconditions of our existence and that scope of moral obligations had to be extended. Furthermore, we are in general presupposing that we can not only expect that others, society and political institutions are respecting our fundamental freedoms, but we also assume that the community should support us, at least to some degree, in the development of our capacities. We think that children worldwide have a right to be well educated, and we think that people with disabilities or people in difficult social situations should be supported, at least to some degree. The entire propaganda for the development of biomedicine makes the assumption that governments have a moral obligation to use a significant amount of their available budgets for the development of biomedicine, we presuppose that there is a strong obligation to make large efforts to make peoples’ lives easier, to provide the possibilities for medical treatments against Alzheimers, etc. There is some intuitive plausibility to the idea that we are morally obligated to protect and support the capabilities of human beings, and there is some plausibility to the assumption that this protection of human capabilities could be the central criterion for deciding which
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moral obligations we have — a criterion that could be used in order to solve moral conflicts. Amartya Sen has used the notion of “human capabilities” as a criterion to measure and compare the welfare level of different societies.7 He seems to presuppose that we are morally committed to support equal life standards, and that the notion of capabilities should function as an instrument for that measurement of the standard of equality. But he doesn’t tell us very much why we have an obligation to protect human capabilities, why that is morally significant at all. Martha Nussbaum has in several books presented a list of human capabilities that are, as far as she is concerned, essential for human existence and the preconditions to develop those capabilities should be guaranteed to the entire world.8 She internally links this notion of capabilities with the notion of rights. Everybody has a right that the preconditions for the development of capabilities are realized. What is in several respects unclear in Nussbaum’s approach is the internal structure of the list: First of all, she doesn’t tell us why we have an obligation to act according to these capabilities. In her Aristotelian view, the essential importance of some capacities for a ‘human’ existence is sufficient for her to assume their moral importance. But since she defends the claim that the capabilities ground the notion of rights, much more argumentation is needed. She has to defend why, in a strong sense, it’s immoral not to act according to those capabilities, and that everybody can strongly expect it. Second, there isn’t a clear structure to her list of capabilities. Nussbaum mentions that the list is not to be seen as a description of necessary preconditions of a good life but as a survey over the relevant aspects of a flourishing life. We can’t imagine a good life where those aspects are not fulfilled. But are all of these capabilities from the same importance? If yes, than the list is so broad that it is unhelpful as a guide to resolving conflicts between different capabilities. So, if such a capabilities approach should have more than merely heuristic importance, more than a checklist of things that are – more or less – morally relevant, and if the list really should provide us with a moral criterion, there should be an
7 8
The first time he introduced that notion in Sen (1980)
Nussbaum 1988 and 2000. The most recent version of the list can be found in: Nussbaum 2006, 76-78. 11
argument about a kind of non-arbitrary hierarchy in the list. But an Aristotelian framework makes such a hierarchy not obvious. Besides problem of the normative force of the capabilities and the internal hierarchy of the list, there should be some answer to the question of whether the protection of human capabilities is an exclusive moral criterion or not. For many bioethical discussions, it would be important to know whether we are only obliged to protect human capabilities or whether the protection of animals and the environment are in themselves of moral importance. The new book Frontiers of Justice is dealing with questions like that. Nussbaum wants to show that the capabilities approach has some strength in comparison to contract-theories especially when we’re dealing with the question in how far the vulnerable people in the poor countries, people with disability and animals has to be taken into moral consideration. In that book she holds the position that the capabilities approach is to be interpreted in the line of Rawls political liberalism without the limitations of a contract-theory. She defends a concept of dignity without relating it to Kant’s concept of personhood. It’s however an Aristotelian concept of dignity (159-160) that defines the dignified life in terms of fulfillment of the necessary capabilities. Here Nussbaum defends the claim that animal capabilities must be protected analogously to human capabilities. She even defends the position that human dignity is only our speciesspecific form of dignity, whereas for horses a kind of horse dignity has to be supposed. It’s not very likely that this concept has very much to do with Aristotle. But it’s unclear as well in how far one can use the concept of dignity in the Kantian sense as a prohibition of treating entities that have dignity as means only, without referring to the notion of personhood. For Kant the fact that the rational being is capable of giving aims to him- or herself is the central reason why we shall not treat those rational beings as means only. It is furthermore unclear what the normative implications are of being an entity with dignity. In the chapter about animals we learn that it’s allowed to sterilize or kill animals, if it seems to be appropriate (371). So, a systematic explication of the moral consequences for the dignified being is missing. Furthermore is the explication why animals should have such a moral status and not plants or landscapes.9 Concerning the moral status Nussbaum writes: “Instead, we should adopt a disjunctive approach: if a 9
Balzer/Rippe/Schaber (1998), Düwell (2006a). Taylor (1986), Warren (1997). 12
creature has either the capacity for pleasure and pain or the capacity to movement from place to place or the capacity for emotion and affiliation or the capacity for reasoning, and so forth (we might add play, tool use, and others), then that creature has moral standing.” (362) It’s very unclear why we should give moral attention to all those creatures, what the normative implications are if a being has such a moral status and whether or not all of these moral status are from the same importance. The new book Frontiers of Justice made unclear what seemed to be clear in the capabilities approach up to now.
Kantian Perspectives My objections are not motivated from such a negative attitude against the capabilities approach as it may look like. The aim was to make a short inventory of the problems that have to be answered before the notion of human capabilities can function as a moral criterion. And, answers – I guess - will not be found within an Aristotelian framework. If human capacities have to be protected because they are necessary for human flourishing, then it’s not clear where the normative force will come from. How can the fact that one needs some goods in order to live a flourishing life stand as a reason to expect that others have the obligation to give them to me? We have to think of the fundamental interrelation between a) the relevance of some capacities for us, b) our vulnerability and dependency for protection through others, and c) moral obligation. We can only claim that everybody should act in accordance with the protection and the support of our fundamental capacities if we can show that there is a fundamental interrelationship between those capacities and the sources of moral normativity. Our agency is the reason why there can be moral obligations at all. Without the ability of human beings to take the interests of others into account there would be no moral obligation at all. Human capacities are of central moral importance only because human beings, as bodily existing beings are vulnerable and dependent on the protection of others and, at the same time, capable of action and capable of morality. Only if we are able to keep in mind the relation between moral obligations, our vulnerability and our agency as a necessary interrelation, can we have a reason to think that the protection of human capabilities has normative force.
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In that line one should expect that the Kantian notion of human dignity can provide us with a perspective to develop a substantial criterion10 If we are relating human capabilities to human agency as the source of moral obligations, we find an evaluative standard that allows for a hierarchical perspective on our capacities. Not all human capacities which are important for a good life are on the same level, but the necessity of them for the possibility of being a moral agent will be the angle from which the importance of capacities has to be judged. Doing so, the evaluative standard will not be in concurrence to the fundaments of the liberal idea that the self-control of our body is the starting point of a moral ethos. On the contrary, it will show that our existence as an autonomous agent is the standard that has to be protected. But such an approach will deny that the consequence for such an ethos of the autonomous agent is that all bioethical debates can be solved by referring to the decision of the agent and that the freedom of informed consent is the core of that goods, that in biopolitical measures has to be protected. If we, in the first place, have to protect the conditions of agency for everybody, we have to realize that there are some measures that are more urgent than others and this will provide us with some hierarchy of relevant goods. The application of such a measure will in several respects not so much differ from Nussbaum’s version of a capabilities approach. I guess, e.g., like her that for our existence as a moral agent it is important that we have the freedom to play, to have the possibility to make esthetic experiences and so on. But I think we have to argue for the normative force and we have to find a hierarchy of morally relevant goods if such a concept should play a relevant role in bioethics.
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In that line: Gewirth 1978, 1996. Steigleder, 2002.
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