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Want to Read saving…. Want to Read Currently Reading Read. Other editions. Enlarge cover. Error rating book. Refresh and try again. Open Preview See a Problem? Details if other :. Thanks for telling us about the problem. Return to Book Page. Garrett ,. Rosellen M. This book explores the full range of contemporary issues in health care ethics from a practical wisdom philosophical perspective.

The authors present the fundamental concerns of modern medical ethics: autonomy, beneficence, justice, and confidentiality. They then provide analysis, cases, and insights to develop problems. Get A Copy. Paperback , pages. Published July 6th by Prentice Hall first published January 1st More Details Original Title. Other Editions 5. Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about Health Care Ethics , please sign up.

Lists with This Book. This book is not yet featured on Listopia. Community Reviews. Showing Rating details. Forgot password? Old Password. New Password. Password Changed Successfully Your password has been changed. Returning user. Request Username Can't sign in? Forgot your username? Enter your email address below and we will send you your username. Thomas Aquinas as setting the standard for natural law theory, just as Aristotle serves as the standard-bearer for virtue ethics. Thomas structures the work in the form of a series of ques- tions, which he answers.

STIaIIae 91, 2.

Medical Ethics and Law

The rational creature is subject to Divine providence in the most excellent way. Wherefore it has a share of the Eternal Reason, whereby it has a natural inclination to its proper act and end: and this par- ticipation of the eternal law in the rational creature is called the natural law ST IaIIae91,2. This establishes that natural law is given by God and thus authoritative over all humans. Not only can we know the law, but also as ratio- nal and moral creatures, we can violate it. Recall Aristotles concept of practical wisdom; Aquinas uses the same concept.

In fact, he calls Aristotle the Philosopher and cites him as frequently as Scripture. The importance of practical reason, how it works, its similarity to Aristotles conception of it, and the most concise statement of what the natural law compels are all found in Aquinas: The first principle of practical reason is one founded on the notion of good, viz. Hence, this is the first precept of law, that good is to be done and pursued, and evil is to be avoided. All other precepts of the natural law are based upon this: so that whatever the practical reason naturally apprehends as mans good or evil belongs to the precepts of the natural law as some- thing to be done or avoided.

ST IaIIae 94, 2 Unfortunately, some have stopped at this quote and simply say that natu- ral law means to do the good and avoid the evil. It sells the theory short. Again, following Aristotles lead, Aquinas notes that when it comes to practical reason, the rules might be clear, but their application might not be. Thomas then offers an excellent example that shows the difficulty at hand.

Everyone would agree that in general goods entrusted to another should be restored to their owner ST IaIIae 94, 4. However, he noted that it may happen in a particular case that it would be injurious, and therefore unreason- able, to restore goods held in trust; for instance, if they are claimed for the pur- pose of fighting against ones country. And this principle will be found to fail the more, according as we descend further into detail ST IaIIae 94, 4.

Taking this practical wisdom approach even further, he generalized that the greater the number of conditions added, the greater the number of ways in which the principle may fail ST IaIIae 94, 4. Aquinas even went so far as to note that, although all are governed by the atural law, all might not know it or act upon it: In some the reason isperverted n by passion, or evil habit, or an evil disposition of nature ST IaIIae 94, 4.

In seeking a principle to determine what is good and what is bad, it is not difficult to find specific behaviors listed in Aquinas. However, an excellent philosophical overview of natural law by Michael Murphy concluded that there are no obvious master principles, but only examples of flawed acts. All decisions are specific and the details will change, so do we have any decision rules? At this point, scholars disagree on exactly how Aquinas resolves the quan- dary, and we do not need to follow them in those debates.

However, there is still a need for a decision principle when there are disputes regarding which of various actions to take. There are two such principles, and the one most closely associated with natural law theory is that of the double effect. Principle of Double Effect The first principle that proposes to distinguish between a good and an evil is the theory of double effect. Derived from Summa Theologica, the principle has four key points: That we do not wish the evil effects, but make all reasonable efforts to avoid them; That the immediate effect be good in itself; That the evil is not made a means to obtain the good effect; for this would be to do evil that good might come of ita procedure never allowed; the end cannot justify the means; That the good effect be as important at least as the evil effect.

For example, under this view, abortion is an evil, but saving the life of a mother is a good. Under this view euthanasia is an evil, but relieving pain by use of morphine is a good. If the person dies, and the death was not intended, then is it acceptable? Major issues arise in the application of the theory concerning how to determine a persons intent. We know that not everyone is a person of practical wisdom who only has a good intent. However, how would we know the intent in a particular case? What good comes of it? Because there are few rich and many poor, does the good of the rich count more than the good lost by the poor?

Note that the further we delve into these types of questions, the more impor- tant consequences seem to become, until natural law becomes a form of con- sequentialism, perhaps rule consequentialism. Relative to that end, a second decision rule for natural law is available. Entitlement to Maximize Your Potential The key to understanding this proposed decision rule relates to metaphysics: Ethics especially is impossible without metaphysics, since it is according to the metaphysical view we take of the world that ethics shapes itself. This means that it is a part of the natural order for all entities to strive to maximize their potential.

To deny something its abil- ity to actualize its potential is to violate its very n ature. Such a violation causes harm to the entity and would be a violation of its nature and of the natural law to avoid harm. Thus, natural law proscribes any activities that would violate an entitys potential. Many religions and social activists place a considerable emphasis on social and political factors that prevent humans from actualizing their potential.

These groups often are at the forefront of social justice movements addressing poverty, ignorance, unhealthy living conditions, and slavelike working condi- tions. Clearly, healthcare professionals need to understand natural law theory when working with patients who believe in its tenets and with those who advo- cate social justice.

This might include those who are working to improve public health, social conditions, or human rights. Now let us look at another common ethical theory, deontology. The derivation of deontology comes from the Greek word deon, which means duty. Thus, deontology is concerned with behaving ethically by meeting our duties. The ethical theory of deontology originates with the German philoso- pher Immanuel Kant Following the review of Kant, we shall examine some of the more contemporary advocates of deontological theories.

Kants Metaphysics and Epistemology Ground His Ethics Kant is most well known for his work in metaphysics and epistemology, the Critique of Pure Reason,53 but he also did groundbreaking work in eth- ics. Kants writings on ethics appear in several different volumes, with titles such as Groundwork of the Metaphysics of Morals54 and Critique of Practical Reason,55 among others. The concept of honoring commitments clearly did not start with Kant, but his approach to the issue led to the identification of his ethical theory with deontology. Kants work in metaphysics and epistemology had a significant influence on this approach and his ethical views.

As seen with Aristotle and Aquinas, a complete understanding of ethics often includes a view about the nature of the world and how we know it, in other words, the disciplines of metaphysics and epistemology. Instead, the structure of conscious- ness processes sense data through the means of categories of thought and two forms of intuition: space and time. Of these categories of thought, the one that relates most directly to ethics is causality. All experiences are subject to causation, which in Kants view under- mines free will.

In the Newtonian world of his time, it was widely believed that if you could completely know the behavior of all the matter in existence, you could predict the future behavior of anything material. This did not pose a problem for most people at this time owing to the earlier dividing of mind and matter by Rene Descartes Like most people, Kant finds free will to be essential for ethics. If a persons every act is determined, how can he or she be held responsible for his or her choices?

At the same time, Kants reasoning inexorably leads him to conclude that we cannot know what the world is like in and of itself. It is beyond knowing, because we cannot experience anything without use of the categories and forms of intuition. He thus divided the realm of being into the phenomenal world of experience and the noumenal world. We can think about the noumenal world, but we cannot directly experience it.

Thus, we have an unavoidable ignorance of things in themselves and all that we can theoretically know are mere appear- ances B xxix. Free will is the precondition of ethics. If all things are determined by natural causescausality is one of Kants categories by which we are conscious of the phenomenal worldthen our supposed ethical choices are specious, an illu- sion. Humans, as a natural phenomenon, are determined by natural laws; cau- sality applies to all natural phenomena.

However, the self, in and of itself the soul , is free from those laws. However, Kant believed that he left a crack in the door that is wide enough to allow for moral- ity. He does this by arguing that the concept of freedom, although not know- able in a scientific way, is something we can think about without contradiction: Morality does not, indeed, require that freedom should be understood, but only that it should not contradict itself, and so should at least allow of being thought B xxix. According to Kant, There is no contradiction in supposing that one and the same will is, in the appear- ance, that is, in its visible acts, necessarily subject to the law of nature, and so far not free, while yet, as belonging to a thing in itself, is not subject to that law, and is therefore free B xxviii.

However, he was concerned that the properties that constitute good character, without a good will to correct them, could lead to bad outcomes. Forexample, we can misuse courage and perseverance without the direction of good will. Thus, Kant set a high standard. Some of his language even suggests that the true test of a good will is if the person continues to act out of duty and reverence for the moral law even when it has no personal benefit and might involve many a disappointment to the ends of inclination AK Reason, Autonomy, the Moral Law, and the Will Kant is distinctive relative to his predecessors in seeking to ground our duties in a self-governing will.

This is an appeal to reason itself being autonomous, meaning that we are free to choose, and that if we choose according to reason, we shall conform to the moral law: If reason completely determined the will, the action would without exception take place according to the rule AK Typically, an autonomous agent is one who makes his or her own rules and is responsible for his or her actions. Thus, one does not seek the foundation of ethics in the development of a person of good character seeking to actualize his or her intrinsic nature, seeking the end of eudaimonia.

Instead, the subject matter of ethics is not character, but rather the nature and the content of the principles that determine a rational will. Free will is determined by moral principles that cohere with the categorical imperative. This abstruse approach, for many, simply disconnects the moral law and free will from real life. The idea of autonomy here is not the view that individuals make their own laws. It means that the laws that bind you in some sense derive from your own making, your own fundamental nature as a self. This capac- ity to make such a choice is what makes humans members of what he called the kingdom of ends.

The person has chosen freely to bind himself or herself to the constraints of the categorical imperative and the dictates of reason. The requirement of the duty to obey the moral law to express a good will brings the notion of intent into the discussion. Why a person acts in such a way as to conform to the moral law is an important component of ethical evalua- tion in the Kantian scheme. Let us turn to what Kant thought would count as rational principles that would ground ethics or the moral law.

Kant attempted to discover the rational principle that would ground all other ethical judgments. He called this principle the categorical imperative. The categorical imperative is not so much a rule as a criterion for determina- tion of what ethical principles meet the test of reason.

These are historical accidents. We shall later see how Rawls used similar ideas in developing his concept of a veil of igno- rance. Kant developed several formulations of the categorical imperative. The most commonly presented ones follow. The Categorical Imperative as a Formal Decision Criterion Although Kant believed that these two statements of the categorical imper- ative were formally equivalent, the first illustrates the need to apply moral principles universally.

That a principle be logically consistent was important to Kant. This principle of universal application is also what allowed ethical egoism to be dismissed as something humans do when making decisions, but not as something that is an ethical theory. The second formulation points to making the radical distinction between things and persons and emphasizes the necessity of respect for persons. Kants theory evaluates morality by examining the nature of actions and the will of agents rather than goals achieved. You have done the right thing when you act out of your obligation to the moral law, not simply because you act in accordance with it.

Note the fundamental importance of intent as compared with any concern with outcomes. One reason for the emphasis on duties in Kants deontology is that we are praised or blamed for actions within our con- trol, and that includes our willing, not our achieving. In terms of the common morality, most people think that there is something wrong with saying that people are good when they do not have a good will and their good outcomes were merely happenstance.

Kant did care about the outcomes of our actions, but he thought that, as far as the moral evaluation of actions was concerned, consequences did not matter. As Kant pointed out, this total removal of conse- quences is strange enough and has no parallel in the remainder of practical knowledge AK The Categorical Imperative as Respect for Persons The second version of the categorical imperative emphasizes respect for per- sons. According to Kant, you should [s]o act as to treat humanity, whither in thine own person or in that of any other, in every case as an end withal, never as means only AK Their value is never a means to our ends; they are ends in themselves.

Kant holds this view because of his belief that people are rational and that this bestows them with absolute worth: our rational nature exists as an end in itself AK In this sense, it is our duty to give every person consideration, respect, and dignity. Individual human rights are acknowledged and inviolable in a deontological system.

The major emphasis on autonomy in health care springs from these considerations and others like them. Although most people who defend autonomy and treating people as ends and not merely as means do not use these formalistic Kantian reasons, this principle of autonomy is foundational in healthcare ethics. It is part of health cares common morality. The Categorical Imperative and the Golden Rule According to the categorical imperative, if the maxim or the rule governing an action is not capable of being a universal law, then it is unacceptable.

Note that universalizability is not the same as universality. Kants point is not that we would all agree on some rule. Instead, we must logically be able to accept that it could be universal. This is why the concept seems very much like the Golden Rule: Do unto others as you would have them do unto you. As indicated earlier, many think Kants first formulation of the categorical imperative implies or even is a restatement of the Golden Rule.

If it is fair for me to do something, then it should be fair for everyone. Alternatively, in consequential terms, we typically hear officials, merchants, managers, and parents, when they are considering exceptions to policy, say that If I do X for you I have to do X for everyone. If one made exceptions for each individual, then the consequences would be bad and unfair. Kant wanted to get beyond such issues.

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He wanted to know whether a per- son performed an act out of duty to moral law and thus expressed a good will. He stipulated that the moral agent acting solely out of a good will should ignore empirical considerations such as consequences, fairness, inclinations, and preferences.

For Kant, an act carried out from an inclination, no matter how noble, is not an act of morality AK Indeed, he went so far as to say that the less we benefit from acting on the moral law, the more sublime and dignified it is AK This sets up the very difficult standard that we can only know if persons are morally worthy or obeying the moral law when there is nothing in it for them. Their actions would be opposed to their desires, inclinations, even their self-interest. Taking such an extreme position essentially disconnects Kant from the real world in which people live and make ethical judgments.

Virtue Ethics and Kants Moral Law Although likely controversial, it seems, for purposes of healthcare ethics, that the best way to make sense of Kant is to conceive of the person of good will in a manner akin to Aristotles virtue ethics. Does this inclusion of Aristotle reject Kants work? No, but a critical analysis and comparison to virtue ethics is warranted. Although Kants theory suffers from disconnection from any normal motiva- tional structure in human life, it still has applications in healthcare ethics.

Kant put into sharp relief the ethical idea that it is wrong for people to claim they can follow a principle or maxim that suits their interests but would not want others to do the same. Most important for health care is the recognition of human dignity and autonomy. To use people solely as means to an end, whether as teaching material in medical schools, prisoners in research experiments, or slaves, is fundamentally a violation of all being.

Deontology poses two problems that lead many to reject it. First, the state- ment of categorical imperatives, maxims, duties, rules, or commandments yields only absolutes. Kant really has only one absolute. His absolute is that you must act solely on the basis of a good will: a reverence for, and an obliga- tion to, the moral law formalized by the categorical imperative. However, the lack of prescriptive content leaves many unsatisfied. Actions either pass or fail, with no allowance for a gray area. Virtue ethics handles the gray areas by depending on the wisdom of the person of practical wisdom.

This is one rea- son why as an ethical tool virtue ethics enables us to handle the problems of healthcare ethics more robustly. The inability to make distinctions between lesser evils or greater goods is the other problem. Moral dilemmas are created when duties come into conflict and there is no mechanism for resolving them. Kant, with his very limited descrip- tion of only one ethical dutyto obey the moral lawcan claim to escape this problem within his philosophy.

He used the radical view that such decisions are outside the bounds of morality if based on inclinations or consequences. Defining the real world of ethics in this radical way does not help much when faced with decisions that involve your inclinations and the weighing of con- sequences. Even if you have, as Kant seemed to think, only one duty, it is a formal one, and its various manifestations could conflict.

Virtue ethics and the natural law theory face this problem of conflicting duties as well. For example, whereas abortion is clearly wrong under the natural law theory, the outcomes of unwanted children, starving children, child abuse, overcrowding, malnutrition, and so on also have a moral bearing.

Duties often conflict in healthcare situations. For example, if I tell the truth in some situation, it may lead to someone getting hurt, whereas a lie could have prevented it. My duty is both not to lie and not to do things that lead others to harm. No matter what I do, I violate a duty. Pure deontology theory does not allow for a theoretically satisfying means of ranking conflicting duties. However, most duty-driven people are not going to be so literal with the Kantian version of deontology that they find themselves unable to rank conflicting duties.

Virtue ethics offers the guidance of a person of practical wisdom using the available tools of considered judgments, common morality, ethical theories, and ethical principles to resolve the difficulty and move on. Virtue ethics is more interested in the development of ethical persons than in the development of maxims and imperatives.

The normal understanding of the Golden Rule works perfectly well in ethical decision making within the framework of virtue ethics, even if Kant himself disavowed it. The policy implications for deontology are significant because of the empha- sis on duty and the training of most healthcare professionals in the duties incumbent upon them. The emphasis on duty leads most clinicians to consider themselves deontologists.

However, most would balk at the pure Kantian ver- sion of duty and would more readily assent to the duties experienced by a person of practical wisdom, following the virtue ethics tradition. Duty-driven clinical staff can walk into a meeting and know in advance what the right thing to do is: to maximize the benefit to their patients.

This is their duty, and their professional code of ethics codifies this duty. If they had to rank their duties, they would be patient first, their profession second, other clinical professionals third, with maybe their employing organization a distant fourth. Having such a clear sense of their duties and having only a few duties on the list makes it very easy for clinicians to talk about their obligations to patient care.

In contrast, healthcare managers and officials who make policy have a much more difficult ethical chore. They must balance competing claims among many groups.

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Their loyalty is not simply to one group, such as patients. For healthcare managers, even if their loyalty is only to patients, that loyalty is in the aggregate. Managers represent the organization, whereas clinicians rep- resent the individual patients. The ethical obligations of managers are much more complex; if the organization fails, the clinicians will not be able to help the patients. Let us now look at two deontologists whose theories have more practical bearing on the issues involved today in deciding about healthcare policy.

Such concerns are important owing to the need to allocate burdens and benefits such as access to health care that is of high quality and that is not delivered in a way that denies us other social goods because of its high costs. This section takes up two influential and relatively recent theorists from the deontological tradition.

Rawls and Nozick have different ideas of what is right and argue that by following their principles of what is right, a more just society will result. Of course, as philosophers do, they disagree over not only what is right, but also what is just. These two thinkers have influenced the debate on the provision of health care in our nation, including the recent healthcare reforms. Knowledge of his ideas is part of the common morality of most policy makers, even if many expressly reject those ideas. The basic idea behind Rawlss theory of justice is justice as fairness.

Yet, they recognize agreed-upon methods to arbitrate disputes so that they are capable of continued functioning within the society. In other words, a disappointment or a disagreement does not lead to violence or to call for rebellion. Rawls identifies himself as being in the tradition of social contract theorists and as a deontologist, even a Kantian. Rawls says that his theory is essentially deontological because it is not consequentialist. All of these thinkers conceived of the beginnings of civil society as a compact or contract made among consenting adults to give up certain things in order to achieve others, such as order, har- mony, trade, security, and protection.

They agreed in establishing the idea of a hypothetical situation that could be altered by persons acting to obtain some rights and privileges in exchange for others without the use of coercion. Rawls used a similar hypothetical situation and called it the original position, in which rational people are behind a veil of ignorance relative to their per- sonal circumstances. The decisions about the principles of a just society that they select when they know nothing about their circumstances are what Rawls says are the principles of a just society.

Rawls emphasized that people seek to protect and maximize their self- interest. He argued that fundamental to that goal is liberty. He further arguedhis most controversial pointthat to have a just society requires an infrastructure and a system of rights that protect the minority and those who have fared less well in lifes lottery than others.

The key to his theory is the situation in which the bargaining about the nature of society takes place and what those who are bargaining know about their society and themselves. Rawls called this the original position. The Original Position and the Veil of IgnoranceIn explaining the original position, Rawls takes as rational the ethical egoists position that everyone would want to maximize his or her personal self-interest.


However, while negotiating the most just society for yourself, you are asked to v oluntarily draw a veil of ignorance over yourself. This veil of ignorance is, from a personal perspective, absolute. You know nothing about yourself at all. You do not know your station in life, your preferences, your motivational structure, your willingness to take risk, your age, your health, your socioeconomics, your intelligence, your demographicsnothing.

You know you want to be in the best possible circumstances when the veil of ignorance is lifted and you leave the original position. It is not unusual in healthcare settings to have patients who are in need of treatment but are completely unable to communicate their wishes to us. We know nothing of their family, their station in life, and so forth.

Often, we cannot find anyone to speak for them, and they cannot speak for them- selves. We have no clues what they would have wanted. We are forced back onto the idea of deciding what to do for such persons based on the idea of what the rational person would want in such circumstances, or what is sometimes called the best interests standard. In this situation, this original position, we are all truly equal, because we know nothing of our circumstances. Rawls allows those who are behind the veil of ignorance to know general laws pertaining to political affairs and economic theory and to know something of human psychology.

Thus, they have no way of calculating the probability that they will wind up in a certain position as a result of their choices.

Only by such extreme means does he believe one can ensure the fairness of the result. It is a hypothetical thought experiment that, he argues, guarantees that whatever principles are chosen are just. In his view, everyone should get an equal share of the burdens and benefits unless there is a material reason to discriminate. If our job is to come up with a set of principles that will decide what those material reasons are, then we should carry out our job with the least bias. If we go back to the ideal of justice as blind, we see that the blindfold has become a veil of ignorance.

Rawls does not at all advocate that we would seek an equalitarian outcome. He assumes we are persons who want to maximize our self-interest, but he does not assume concepts such as benevolence or even nonmaleficence. Two Basic Principles of Justice The first principle of justice meets with little objection, but the second inspires considerable debate. Rawls orders these principles serially in that liberties in the first principle cannot be rationally traded for favorable inequalities described in the second principle.

Their perspective, according to Rawls, is that there is only one principle: the greatest good for the greatest number. Bill of Rights and can be called a process right. He described these rights as follows Political liberty the right to vote and to be eligible for public office Freedom from arbitrary arrest and seizure which goes back to habeas corpus Freedom of the person along with the right to hold personal property Freedom of speech and assembly Liberty of conscience and freedom of thought.

Rawls took a controversial position relative to the distribution of i nequalities of office, income, wealth, and of goods. He called this the difference principle. In addition, the inequalities should be connected to positions, offices, or jobs in society that everyone has an equal opportunity to attain. Rawls also said that society cannot justify a decrease in liberty by an increase in social and economic advantages.

In this sense, liberty is the most important of the principles. A classic example of how Rawlss principles might apply relates to physi- cians. Physicians often command superior incomes and social status, which are clearly inequalities. This circumstance requires an explanation. Once every- body is out of the original position and back in the real world, the hope is that anybody can become a doctor if he or she has the talent. However, obtaining the education needed to actually become a physician requires an inequality: less fortunate people help pay for this education with their taxes.

In the just society envisioned by Rawls, the person desiring the education would have to compen- sate the less fortunate in some way once he or she became a physician. The physician is free to keep the wealth, or at least some of it. But, because gains in wealth are allowed only if they benefit the least advantaged along the way, the physician would never escape an obligation to help the less fortunate. Some Concerns with Rawlss TheoryAccording to the difference principle, inequalities may be justified, but only if they are to the advantage of the least well off.

Rawls considers it common sense that all parties should be happy with such a principle. Consider the relatively bitter discussion about reparations to the descendants of slaves. Many if not most of the wealthy would also be unlikely to assent to the thought experiment of putting on a veil of ignorance because they would not accept the forced benevolence that the difference principle imposes.

Simply put, many are less interested in justice than in keeping their advantages for themselves and their children. Thus, Rawlss position, although just, runs into human nature. Some might argue that because Rawls is running up against human nature his theory should be dismissed. Rawls addressed such arguments. He was per- fectly aware of the imperfections of the real world outside the veil of ignorance; that is why he invented the thought experiment.

The fact that the distribution of burdens and benefits by nature is unequal is not an excuse. Occasionally this reflection is offered as an excuse for ignoring injustice, as if the refusal to acquiesce in injustice is on a par with being unable to accept death. Rawls believed that the natural distribution is neither just nor unjust.

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What is just and unjust is the way that institutions deal with these facts. Rawls concedes that one might affirm his contract approach but eschew the difference principle, or vice versa. Nozick neither accepts the contract approach of the original position nor the difference principle.

Robert Nozick and Libertarianism Robert Nozick and John Rawls both worked in the Harvard Philosophy Department at the same time, but their philosophies disagreed considerably. However, both authors described themselves as coming from the d eontological tradition relative to ethical theory in that they rejected consequentialism. Nozicks first and most famous book, Anarchy, State, and Utopia , was an attack on Rawlss work that focused on the extensive state envisioned as necessary to bring about Rawlss ends. Nozick and his followers represent the conservative tradition that if you want something you should obtain it yourself.


Like Rawls, Nozick claimed roots in Immanuel Kant. However, Nozick focused on the second formulation of the categorical imperative. You may recall that Kant said So act as to treat humanity, whither in thine own person or in that of any other, in every case as an end withal, never as means only AK In the very first sentence of the book he stated his approach clearly: Individuals have rights, and there are things no person or group may do to them without violating their rights.

He stated that this version of autonomy can express the inviolability of others. Rather, he said we should treat others as ends in every case, never as means only. People obviously are means to ends. If people are means to ends, then how is it possible to treat them only as ends? Nozick also said that if we take his view of Kant and the inviolability of persons seriously, then we misspeak when we say that someone must make a sacrifice for the social good.

He argued that there is no social entity to whom we can make a sacrifice; there are only other persons. Using one of these people for the benefit of others uses him and benefits others. Nothing more. Talk of an overall social good covers this up. He opposed the forced redistribution of benefits and burdens so that the less fortunate are made bet- ter off as the price for the more fortunate being more fortunate: Holdings to which people are entitled may not be seized, even to provide equality of oppor- tunity for others. In the absence of magic wands, the remaining means towards equality of opportunity is convincing persons each to choose to devote some of their holdings to achieving it.

If you want people to help others, convince them to do it. Is this justice? Is it distributive justice? Are we really being just if we tell people who are severely disadvantaged and who have little capacity for work to simply choose to improve themselves? Rawls would hold that such outcomes are arbitrarynot justin that they are based on the natural lottery, over which we have no control.

The veil of igno- rance is intended to get us to think about the principles of justice that would follow if we did not know our personal circumstances.

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For Rawls, what is just is what persons in that original position would choose. Nozick claimed that theories like Rawlss could be defeated by voluntary agreements. Indeed, he opposed the use of the term distributive justice because it implied a cen- tral distribution authority. This is not the reality of free adults, so he preferred the term holdings and talked of how they are acquired and transferred. He specified three conditions that meet the requirements of distributive justice 1. A person who acquires a holding in accordance with the principle of justice in acquisition is entitled to that holding.

If a person is entitled to the holding and transfers the holding, the person to whom it was transferred is now entitled to it.