From reason to practice in bioethics: An anthology dedicated to the works of John Harris

By Manchester University Press

From reason to practice in bioethics brings together original contributions from some of the world’s leading scholars in the field of bioethics. With a particular focus on, and critical engagement with, the influential work of Professor John Harris, the book provides a detailed exploration of some of the most interesting and challenging philosophical and practical questions raised in bioethics. The book’s broad range of chapters will make it a useful resource for students, scholars, and practitioners interested in the field of bioethics, and the relationship between philosophical and practical ethics. The range of contributors and topics afford the book a wide international interest.

• Language: English
• Publisher: Manchester University Press
• Release date: May 1, 2015
• ISBN: 9780719098024

Book preview

Part I

Introductions

1

Editors’ introduction

John Coggon, Sarah Chan, Søren Holm and Thomasine Kushner

Introductions

Bioethics is an extraordinary field of analytical inquiry and practical endeavour. Its growth, impact and diversity have proven as remarkable as the range of interests and perspectives that are brought to the table in its name. Definitions of the field abound. Debates rage not just within it, but also about it. The literature is filled with contested accounts of its history, scope, nature, purpose and methods. For some it is a discipline; specifically, a subset of ethics or practical philosophy. For others it is a general area of study, identifiable more by the types of issues that we find problematised than by any one particular means of finding something to be problematic. So many academic disciplines are represented in bioethics that it would be invidious to try to list them comprehensively, for the certain fear of offending colleagues whose approaches would be left out. Contributions come from the humanities – including philosophy, of course, but also law, politics, history, literature and others – as well as the social, behavioural, biomedical, health, environmental and natural sciences. The breadth of the field, as well as the contestability of its boundaries, make a hard task of a pithy presentation of what bioethics is, still less what it does.

Nevertheless, there are familiar questions, themes, ideas and approaches that pervade a great many, if not all, of bioethics’ distinct but somehow connected realms. Similarly, whilst we find some scholars who have carved out niche sub-specialities – people whose expertise is simply in euthanasia, or public health, or reproduction, or climate change, for example – others have had a role (whether or not they accept the claim) in shaping and speaking to the field as a whole; true expert generalists. Foremost amongst this latter breed of intellectual in UK bioethics is John Harris, a scholar whose work has been pivotal in the shaping of bioethics both in the UK and across the world. His expertise is in philosophy, with a particular focus on moral and political theory. But the development and application of his ideas over the last four and some decades have been born of discussions, debates and collaborations with academics from across disciplines, with public figures and policy-makers, practitioners from a huge range of backgrounds, and many others too. John Harris is the quintessential public intellectual, and that fact no doubt owes much to his unabating appetite for understanding important aspects of our world, and working to make the world a better place.

It is therefore with considerable pleasure that we introduce a collection of original essays, which together serve as a foundational text on bioethics, and each of which has been written in John Harris’s honour. As the book’s title suggests, the aim of this work is twofold. It is, we hope, a fitting tribute to John’s huge contribution to scholarship and practice. And it also interrogates – and perhaps will help some readers to resolve, at least at some level – one of the core difficulties in bioethics, whatever any given practical focus may be: the process of establishing first principles, working from them to theory, and from theory to practical solutions, be they in the form of individual moral imperatives or large-scale policy.

It is with wry amusement (and perhaps understatement) that we would observe that John Harris is a divisive figure in bioethics. Whilst we would stress that our intention – begging John’s pardon for an abuse of his beloved Shakespeare – is to praise him, not to bury him, the following essays demonstrate the many points at which disagreement arises with the claims he has made and championed over the years. And as much – perhaps more – can be learned from points of disagreement as it can be from points of apparent consensus. John is celebrated for his commitment to the conclusions of his moral argument, even where these fly in the face of ‘common sense’, invoke some ‘yuk factor’, or discount the emotional or other non-moral reasons that motivate people’s practical reasoning. From amongst the essays below, we find various representations of John’s approach. Jonathan Glover, for example, characterises the ‘John Harris tone of voice’ as advancing ‘gleefully disrespectful questioning’; Florencia Luna praises his position ‘in the tradition of the critical intellectual and the questioning philosopher’; Margot Brazier recognises John’s place with those who ‘would not bend their principles to suit princes’. The chapters in Parts II and III of this volume (on which more detail in the next sections) pick up different points of analysis, and raise questions about how and what we should think, and why. In Part IV, John takes the chance to respond.

Prior to entering debate, however, there is a wonderful introductory chapter also written by John. It contains a biographical as well as an intellectual history; a rare contribution not just because of the insights it lends, but also the thoughts and emotions that it inspires. Working with John, as each of us has the privilege of doing, one is often confronted by suppositions and ideas about what John ‘is’: there are ‘folk figures’ of John Harris. These figures are often the product of (sometimes amusing, sometimes charming, sometimes misguided) inference. The opportunity to read about the world that shaped the scholar, rather than simply the shapes the scholar would put on the world, is something that itself merits celebration. Those who fervently disagree with John’s ethics will likely not be moved to a change of mind by his account in the next chapter (nor is that his intention in writing it!). But when we visit ideas not just about the quality of argument in bioethics, but also the shaping of bioethics, the value of his opening contribution is inestimable; perhaps more than he realised when writing it. It is excellent and most apt to allow the first substantive contribution to the volume not simply to set out an overview of the body of John’s work, but also to give life to it.

Bioethical debates: from theory to practice

Following this editors’ introduction, and John Harris’s chapter on ‘Thought and Memory’, the book is split into three further parts. Part II examines the very grounding and formulation of moral argument. Practical reasoning in philosophical bioethics relies on the quality of foundational ethical premises, and the quality of analysis given these. Discussion of such questions brings in perspectives from ethics, but also epistemology, metaphysics and other areas of philosophical and social inquiry. The controversial questions entailed in formulating basic moral arguments are particularly acute in relation to John Harris’s work, which has proven so controversial precisely because of his moral concepts of personhood and the good, and the strength of his commitment to reasoned consistency in formulating moral imperatives given responsibilities to and for each of these. The eight chapters in Part II speak to different and overlapping problems and concerns with this primary exercise in bioethical theorising.

The opening chapter, by Jonathan Glover, picks up Harris’s discussion of George Orwell’s ideas about ‘moral nose’. Orwell spoke favourably of the way that we can sense when a situation is morally problematic, yet Harris finds such a faculty, which relies precisely on impression rather than reason, to be dangerous: it is dangerous because it may cause harm (e.g. think of the ‘moral’ sense about Jews that led to the atrocities perpetuated in Nazi Germany, and elsewhere); and it is dangerous because it fails to allow moral actors to distinguish unfounded prejudice from sound moral evaluation. It is Glover’s purpose to give some defence to the role of intuition in ethical assessment. In part, his argument reinforces Harris’s own concerns about appeals to the ‘yuk factor’. But Glover also notes that abstract thinking alone can itself be bad for actors in the real world, where it can be more dangerous to intellectualise the wrongs of, say, torture, than it is for us simply to possess an intuitive disgust of the practice. Drawing from prominent examples at the time of drafting his paper, Glover’s analysis suggests that there are distinct roles that might be given to the use of moral nose. Whilst it is a problematic concept for the closing down of arguments, it serves an important function in alerting us to matters that require moral scrutiny. After all, we need triggers for thought and action. Furthermore, central to us as living, human, moral agents is the capacity for moral nose. Our moral psychology requires the ability to empathise with others, and to recognise their pain and the harm that it can do. As such, whilst the dangers Harris alerts us to are important ones, we should, on Glover’s account, retain some legitimate role for moral nose.

In chapter 4, Richard Ashcroft continues the focus on the idea of rationality, and consistency in thinking in moral argument, and its centrality in Harris’s ethics. The practical springboard for Ashcroft’s analysis is one of the perennial problems in bioethics. He starts with the idea that people see a moral inconsistency in a position that permits abortion, yet prohibits infanticide. And he adds to this the practice of looking for a morally relevant distinction between the two, rather than submitting to the apparent demands of reason and changing one’s view on either abortion’s permissibility, or the impermissibility of infanticide. In short, the chapter explores the (supposed) need for reasoned, rational, consistent, logical argument in ethics. What alternatives might there be? One is to study perception rather than reason, but Harris – as discussed in Glover’s chapter – is opposed to its reliability. So Ashcroft explores various alternatives to allowing logic to bind us in ethical deliberation. In his argument, particularism seems to lead to the best way out, but he cautions we still need to be wary of assertions that we can satisfactorily maintain ill logic. However, his concluding comments take us beyond logic to questions in epistemology: the key to compelling practical argument will not be just the strength of logic, but the strength of the moral proposition on which any formal reasoning is based. So in the abortion/infanticide example, our preeminent moral work is in establishing the truth of the relevant moral premise. As suggested in other chapters in Part II, whether we follow Harris or others on substantive premises, establishing them is a deeply complex problem for scholars in philosophical bioethics.

Chapter 5, by Michael Parker and Micaela Ghisleni, commences with a quotation from Harris’s work that emphasises the need for people to explain why a moral claim is true. Parker and Ghisleni are particularly interested to explore this idea of a duty explicitly to give reasons. For one thing, they argue, it suggests that moral development is correlative with capacity for reason. For another, it suggests public duties; moral agents have to publicise the rationales for their beliefs and actions. As the authors note, Harris is hardly alone in espousing a view that has the capacity for morality develop with the capacity for reason, nor is he unique in arguing in favour of a need for the giving of reasons. However, Parker and Ghisleni offer various reasons to question the positions. First, drawing from Gilligan’s influential studies in psychology, they advance argument that sheds doubt on the idea that reason can provide the complete picture of what it is to be moral. This leads to further arguments about the roles of judgment, virtue and sensitivity to context, rather than imagining that more abstract rules can serve to determine questions of ethics. Assuming their claims stand, Parker and Ghisleni thus suggest that a wider concept of moral understanding is needed than that which would be provided by the rational processes typically attributed to Harris. The upshot is not a paper calling for a wholesale rejection of Harris’s means of bioethical inquiry. Rather, they contend that Harris fails to give the full ethical picture, accounting for empirical reality. Furthermore, whilst Parker and Ghisleni do not share the view that everyone has an obligation to account coherently and publicly for their reasons, they do agree that those in public positions of power (such as doctors) should be able to do so. And in this regard, it is right that Harris should push for it.

In Chapter 6, Torbjörn Tännsjö moves directly into epistemological questions in bioethics. He opens with a reflection on contemporary trends in philosophical understandings of basic truth, contrasting foundationalism – where knowledge and understanding are based on the self-evident – and coherentism – where knowledge and understanding are based on a system that requires consistency with a person’s wider beliefs. In the context of moral philosophy, Tännsjö notes that foundationalism can lead to scepticism, given that what is self-evidently true varies between people and across time. Tännsjö does not aim or purport to answer the question of whether foundationalism or coherentism is a superior approach to understanding moral truth. Rather, he uses his chapter to explore coherentism, and examine the approach it lends to justification in moral theory (noting, as he does, that rather than provide a method it provides a criterion of justification). After all, we want our beliefs to be true, and coherentism is based on a search for truth. Nevertheless, and in a way that we might contrast with earlier chapters that have looked to deductive, logical reasoning, Tännsjö emphasises the role for inductive reasoning in practical ethics, and the strong role for ‘considered intuitions’ on which we can rely. He also notes the importance of thought experiments in tests of our moral understanding, and demonstrates his point through a discussion of his use of a modified version of John Harris’s celebrated idea of the survival lottery. This is one of various thought experiments that Tännsjö has employed in studies examining the ethics of killing, and the study of reasons that might be framed in terms of the sanctity of life, the right to life, and utilitarianism. As Tännsjö demonstrates, the use of thought experiments can enable you to recognise and interrogate your own ethics.

The importance of challenging ourselves and others philosophically is a theme that is carried into chapter 7, where Florencia Luna discusses the role of philosophy and bioethics. Her analysis is informed by reference to John Harris’s approach and position in bioethics, but includes a much wider presentation of reflections on the use of philosophical ideas in evaluations of the status quo, and the role of public intellectuals. In Luna’s framing, we can look at the relationships that individual thinkers have with power, and with people in government. She distinguishes, amongst other things, the modern-ist role of ‘intellectual as legislator’ – whereby the moral expert would be taken to have the best access to truth, and would thus just declare what it is – and the postmodernist role of ‘intellectual as interpreter’ – a position in which the expertise comes in having access to a range of competing perspectives and being able to say what they mean. Within this framework, the intellectual as interpreter is directly involved in government, and thus has real power. The interpreter, by contrast, is more remote from power. Proximity to power is, Luna argues, an important point to think about, as is the nature of intellectuals’ reaction to power. It is possible to present historical claims about the impact – often the positive impact – that developments in thought have had on societies, including, for example, in emphasising and respecting minority voices. Regarding bioethics, we find a field that pushes philosophy and philosophers out of the ivory tower, and forces them to get their hands dirty. And within this, Harris and his affronts to dominant social dogma are crucial.

In chapter 8, Harry Lesser looks to a distinct, but also prominent, question in bioethical reasoning. His concern is the concept of the natural, which – rather like moral nose and the yuk factor – can clearly be seen as doing quite a bit of normative work in bioethical reasoning. Lesser’s focus is on rationality, and which appeals in morality are appeals to reason. Whilst we find that appeal to what is natural is a common resort in everyday argument, there is on examination good reason to doubt its strength. To demonstrate as much, Lesser finds Harris’s work a useful starting point, given his famed application of reason to bioethical questions. Lesser explores first quite what ‘natural’ might denote as a moral category, before contrasting the formal validity of moral claims based on the natural with their ethical persuasiveness (points which we might contrast with those made, amongst others, by Ashcroft in chapter 4). Lesser’s analysis covers the difficulty of attributing a purpose to nature or history, and from there seeking to infer sound moral arguments. He also demonstrates errors made about classes of people – men, for example – by noting that there are distinctions between what is generally true of the group, and what is specifically true of an indi-vidual; such distinctions serve usefully to undermine hard claims about the truth of ‘natural’ properties. Lesser nevertheless suggests various reasons not to reject altogether the utility of claims about things being natural, arguing that often what is natural will also be the less harmful alternative. The upshot of his analysis is that in a foundational, metaphysical sense, ‘the natural’ is a category to be ignored. However, in giving empirical content to a rationally thought-through ethic, Lesser’s position is that the natural can be a helpful concept.

In the next chapter, Deryck Beyleveld takes another concept that is often seen as foundational in philosophical bioethics, yet which is also often treated with wariness. His concern is with dignity, and he develops a defence of dignity as a core concept in bioethics. He starts by noting the proliferation of references to dignity in legal and regulatory measures – especially human rights instruments – whilst reflecting that philosophically dignity has largely been viewed as a Kantian idea. This philosophical perspective permits of two views: dignity as an empowering concept, associated with a rationality-based understanding of autonomy; and dignity as a constraining concept, which places fetters on what we might choose to do. As Beyleveld notes, dignity’s critics, including Harris, are concerned with dignity serving as a constraint on legitimate action: here he cites complaints that dignity is too vague a concept, or is often simply empty rhetoric used to close down argument. He further notes that critics of dignity as empowerment complain that the arguments in its favour can be made without resort to dignity itself; concepts such as autonomy or capacity are sufficient. Against these views, Beyleveld’s position is that dignity is, in his words, ‘essential for bioethics’. He explores the concept as relating to the essence of personhood, persons being the focal subjects of moral concern. As he notes, there are plenty of arguments within bioethics that misapply dignity, or beg questions in their application (for example, in claims about means and ends in relation to human embryos). But dignity as empowerment requires an understanding, he argues, of vulnerable moral agents who (possibly) possess rights and require due recognition. Within his modified account of Gewirthian morality, justifiability demands a sensitivity to uncertainties about who is or is not an agent. Dignity as empowerment aids our understanding in this regard.

The final chapter of Part II also focuses on personhood. Simon Woods pays tribute to the large body of work that Harris has created, but claims that Harris has failed to develop fully enough the foundational subject of moral concern: the person. He therefore uses his chapter to take issue with Harris’s account of the person, and to advance an argument in favour of a more embedded, human concept of the person. Woods’ argument is illuminating not simply for its substantive content, but also for the light it sheds on the importance of foundations in bioethics; again a theme that we see woven throughout Part II of this book. He demonstrates the difficulties that arise when we overestimate quite what a theory can achieve, and raises specific concerns for what he sees as an overreach of Harrisian rationality. For Woods it is a problem that Harris’s imperatives are wildly out of kilter with ‘everyday morality’. And beyond that, he suggests that Harris’s concept of the person, defined as an agent that is able to value its own existence, is too thin an idea. Whilst this person allows us to avoid accusations of speciesism, it underplays the importance of community in our understanding of morality, and thus places less emphasis on the moral importance of humanity. In substantiating this argument, Woods invites the reader to distinguish claims based on biology, which may be ill-founded as moral arguments, and arguments relating to humaneness, which have, he argues, their own special importance. A concept of the person that is too far abstracted from this is therefore problematically impoverished. Separately, Woods pushes Harris to provide a more explicit account of moral worth, to account for entities that matter morally even if they are not ‘persons’. Whilst Woods would favour a gradualist approach, he finds Harris’s theory to be too narrow, abstract, and remote from humanity.

Following these varied but connected chapters on the foundations of moral argument, the book moves in Part III from fundamental moral questions, to concerns for specific practical imperatives, with a particular focus on questions of policy. So much of bioethics concerns practice in public or quasi-public settings (such as hospitals, University laboratories), and touches on law and regulation (should abortion, euthanasia, or stem-cell research be lawful?; should the State be able to claim people’s organs after they die, or limit the freedom they have to make unhealthy choices?). Whilst moral argument and policy argument are both formally and substantively distinguishable, an important role for bioethicists – including Harris – is in speaking to the defensibility (or otherwise) of policy. As such, it is fascinating to look at a series of chapters that explore the marrying of ethical concerns and methods with the analysis or giving of practical imperatives.

The first chapter of Part III is written by Margaret Brazier, an academic lawyer who has worked alongside John Harris since the 1980s. Brazier’s chapter revisits a question on which she and Harris have long disagreed: the validity of laws and policies governing posthumous organ transplantation. Brazier notes the strength and consistency of Harris’s views, and outlines their rational foundations. She is clear about his commitment to argument, and the price at which this has come. Despite the apparent virtue of his position, however, Brazier looks to the value of compromise in policy and the reasons why we might accommodate and respect apparently ‘irrational’ or ‘unreasonable’ systems of belief, even when doing so will cost the lives of people who might benefit from organs that will otherwise be lost. For Harris, where the harm will be great, a lot less is to be given to non-moral reasons (such as ones based on religious belief or emotion) than should be given to moral reasons. Brazier does not seek to deny or contradict Harris’s arguments about what becomes of our bodies after we die, or to refute the claims of the good that would be done in a world where more organs were available. However, she presents an apparent paradox. Harris’s standards of rationality do not fit comfortably on the actors to whom they supposedly relate; people do not share his rationality, yet we are entreated to behave as if they do. In Brazier’s argument, considerable importance remains in respecting people’s wishes even where these are not ‘rational’. The alternative (on pain of consistency) seems to be a great deal of State interference with our choices, where legal mechanisms are required to meet the ‘failings’ in our reasoning. In closing her chapter, Brazier reflects in a different way on Harris’s contributions to bioethics and law. She notes how he can be relied upon to test proposed reforms to law and policy. Whilst she cannot accept that moral foundations are the whole story, she reminds us how important it is to hold laws up to the sort of rational scrutiny that a Harrisian analysis commands.

In chapter 12, Alastair Campbell continues with the practical focus on organ transplantation. This chapter looks at Harris’s arguments in favour of procurement policies, noting both Harris’s advocacy for mandatory procurement of organs from the dead, and for a market in organs of the living. As highlighted in Brazier’s chapter, Harris’s position concerning the dead is that whatever interests survive our deaths, claims to posthumous control of the body are weaker than the compelling interests of the living who need transplanted organs. Campbell explores and rejects the idea that organs are a resource. As such, it is wrong, he suggests, to think of them as something that either can be sold on the market, or claimed as a subject of public ownership. Within this policy-framing, and in a way that again moves very neatly from the concerns of Part II, Campbell is interested in the weight that Harris claims for his concept of rationality, and the validity of Harris’s rejection of other widely held views about the body as to what can rightfully be done with it. For example, Campbell argues that Harris confuses the significance, say, to grieving relatives of the dead body with their mistaken belief that body parts will remain intact after death. Or Campbell suggests that Harris makes leaps in logic when moving from a position that holds that we can donate organs, to one that holds that we can sell organs. In these sorts of ways, Campbell shows not just what philosophy can do for our understanding of policy, but also what our appreciation of policy can do for our philosophical understanding. Claiming that Harris falls into a Cartesian mind/body dualism, Campbell looks to alternative methods of analysis that he argues would be useful in debates on organ policy: specifically, phenomenology, aesthetics, and anthropology. For Campbell, policy, practice, and indeed philosophy need to be able to account for valuing embodied existence.

The next chapter, by Ruth Macklin, moves the focus. From a philosophical perspective, part of the work of bioethics in the policy arena is in shifting attention from basic theories of morality to theories more familiar to political philosophers, theories of justice that purport to mediate tensions fairly between individual and collective claims. Macklin’s interest here is in Harris’s views on justice in health care, and his claims in favour of a principle of equal opportunity. On this understanding, the opportunity to benefit from the health care system should exist for all equally, regardless of the chance or quality of benefit, or the amount of life that a patient has left. Within this framing, the focus in assessing the worthiness of a treatment is rooted in the patient’s conception of benefit, rather than that of the funder. Macklin is sympathetic with Harris’s aim of offsetting a commitment to optimal outcomes with a theory of fairness. However, she argues that he fails to look at principles of justice other than equal opportunity. Whilst that is apt for analysis of emergency care settings, it is not so suited to wider public health settings. So in her chapter, Macklin takes the practical problem of priority-setting for allocating limited antiretroviral drugs in resource-poor countries, and explains and explores some alternative approaches: treat like cases alike; utilitarianism; egalitarianism; ‘fair innings’; and prioritarianism. Her overall conclusion, given consideration of the impact of John’s model, is that it does not do enough to provide fair outcomes, either for individuals or society, and thus more nuance is needed.

In chapter 14, Andrew Edgar continues this theme. His aim is to revisit the concept of the Quality Adjusted Life Year – the QALY – which Harris has famously taken to task in a sustained manner over the past decades. Edgar stresses the importance of Harris’s interventions in these debates, but wishes to explore quite what is happening when quality of life is used as a measure in resource-allocation decisions. His argument defends a view that quality of life measures are in fact necessary to a proper understanding of the questions raised by resource-allocation problems. Following a presentation of QALYs and Harris’s objections, Edgar suggests that we are wrongly identifying QALYs if we see them as a tool for making allocation decisions within the Accident and Emergency ward of a hospital. They are a tool for macro-level planning, rather than micro-level decisions. As such, the important moral and political question is whether QALYs are a bad tool for officials, not whether they would be a bad tool for doctors. This is not merely a conceptual point. Edgar embeds his analysis in the practical reality that resources have to be allocated in a planned way; resource decisions cannot be made in immediate response to the next problem that arises. As such, a sound analysis needs to account for the nature of people as social beings who accept and expect a particular sort of medical and administrative culture. And claims to legitimacy must be tied to this requirement. As Edgar’s argument develops, we find that the idea of quality of life may be a valid one to include in assessments. In his framing, the truth of this comes out especially by reference to ideas about deliberative democracy, and public discourse – or ‘negotiation’ – on the very meanings of health and illness. Edgar advises caution against prejudice feeding into such discourse, but maintains the importance of the link between public debate and the soundness of including quality of life concerns in resource allocation models.

The following chapter is by Andreas Hasman. Whilst also focusing on a publicly funded health system, Hasman’s concern is somewhat distinct. Looking to Harris’s (as yet unpublished) works on the safety of the people, Hasman raises arguments about the justifiability of health policy, and in particular of public health promotion. The ideas to which he is responding are founded on Hobbesian arguments about the rights and duties of the State, and lead to claims that the State should ensure the availability of health care. However, if these arguments extend to duties to produce health promotion policies, Hasman has concerns. Where policy is not just about remediation, but also about addressing social determinants of ill health and disability, there are arguments – arguments of which Hasman is wary – that lifestyle choices cause disease, and people should be subject to duties to be healthy. Given this, he explores the question of when and why a policy would be unacceptable, even if it could be shown that it would improve health. For Hasman, the arguments in favour of providing a health care system can be founded in a rule of rescue and commitment to equal concern and respect. But whilst the State should protect people from harms, Hasman draws a line between protections from potential threats to health, and immediate threats. There are clear utilitarian reasons at play here, and these can be evidenced, for example, in developing tobacco policies. But for Hasman, we should not lose focus – as neither Hobbes nor Harris would have us do – on the importance of allowing people to identify for themselves what is good: whilst the State needs to protect people, he urges, it cannot define for them what is good, other than in the safeguarding of third party interests.

Chapter 16 changes the emphasis again. Here, Margaret Battin takes a key philosophical (and particularly John Harris) methodology, the thought experiment, and challenges the reader to visit questions about race. If we could easily change our skin colour, and thus experience being different colours, what would this teach us? The thought experiment is just that, of course. It is necessarily provocative, and certainly is not a policy proposal. But analysing it gives rise to many difficult questions both at the level of individual decision-making, and in relation to systemic problems. This is drawn out as, before engaging in ethical analysis, Battin considers different reasons why someone might choose to live for a while in a different colour. These cover questions of combating, or avoiding, individual instances of prejudice, seeking to ‘enhance’ status to avoid general instances of prejudice, pursuing particular jobs or professions, facilitating social interaction, pursuing cosmetic and aesthetic interests, and exploring self-identity. Battin’s analysis here uncovers deep matters of principle, but also exposes some uncomfortable truths about the non-ideal circumstances that play on people’s deliberations. This in turn gives rise to questions of how much we can, and should, compromise our principles given other concerns, such as prudential or aesthetic ones. With regard to morality, Battin argues that there is something troubling about the scenario that her thought experiment presents. She works towards finding out what that is, and what it teaches us about racism. In the end, the moral problem seems to be that racial prejudice may be rather more of a problem than many of us (like to) think.

Inez de Beaufort follows in chapter 17 with a different thought experiment. Her focus revisits the public health theme. She presents the idea of a State vaccination policy that would protect people from Smoking, Alcohol, and Drugs (the ‘SAD programme’). The thought experiment includes alcohol as she thinks this may unsettle some double-standards. The import of the idea is that nobody who had been vaccinated would suffer for it in the sense that there would be no desire for cigarettes, alcohol, or drugs. As such, there would also be no concern about scrambles for illicit sources. We have, then, a (fictitious) policy proposal that cannot suffer objections based on real examples of prohibition. Despite the obvious health benefits, and this lack of suffering or wider civil unrest, de Beaufort is uncomfortable with the idea of SAD. Her chapter is therefore dedicated to exploring the reasons for this discomfort, by pushing the line of the pro-SAD reformers. De Beaufort’s reasoning works through a range of questions. She scrutinises the strength of an analogy with immunisation against disease, such as a mumps vaccination. Smoking, she argues, is not analogous with disease. But perhaps addiction is. Such reasoning, however, leads to problematic line-drawing exercises, and this in turn