How to Treat Persons 

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How to Treat Persons

This book takes its inspiration from Immanuel Kant’s “Formula of Humanity,” which commands that we treat persons never merely as means but always as ends in themselves. The book aims, first, to develop ideas suggested by the Formula of Humanity into clear, plausible moral principles. It builds a new, detailed account of when a person treats another merely as a means, that is, “just uses” the other and thereby acts wrongly. The book questions the plausibility of an orthodox Kantian account of the dignity of persons, but then offers a novel account of its own. The book’s second main goal is to show how the Kantian principles it develops shed light on pressing issues in bioethics. The book investigates how, morally speaking, scarce resources such as flu vaccine ought to be distributed. Allocating such resources in order to maximize benefits can be inconsistent with respecting persons’ dignity, the book argues. The book also explores the morality of regulated markets in organs (e.g., kidneys). In many contexts, buying organs from live “donors” involves failing to honour their dignity, the book contends. Finally, it probes the ethics of doing research on “anonymized” biological samples and of conducting placebo-controlled pharmaceutical trials in developing countries. The book champions the view that even if an agent gets another’s voluntary, informed consent to use parts of his body for transplantation or medical research, she might nevertheless be treating him merely as a means or failing to respect his dignity.

Abstracts of Chapters

Chapter 1 Introduction

This chapter provides background both for the book’s development of Kantian normative principles, including a constraint on treating others merely as means and a command to respect the dignity of persons, and for its application of these principles to issues in bioethics, including the fair distribution of scarce, life-saving resources, the morality of markets in organs, and moral constraints on medical research. After outlining the book’s contents, the chapter contrasts its methodology, namely, that of Rawlsian reflective equilibrium, with the methodology that Kant and some contemporary Kantians employ. The chapter defends the book’s methodology against criticisms suggested by Allen Wood and Peter Singer. The chapter then sets forth the notion of a person that the book employs. Finally, it explores briefly the relations of one of its main focuses, namely the idea of treating others merely as means, to other, related ideas such as manipulation.

Chapter 2 Death, Dignity, and Respect

Philosophers attracted to Kantian ethics have followed Kant himself in focusing on the Formula of Humanity (FH) as a basis for specifying what we are morally required to do. At bottom, FH commands us so to act that we always treat humanity as an end in itself. Allen Wood has developed a way of interpreting FH, namely the “Respect-Expression Approach,” according to which we treat humanity as an end in itself just in case our actions express proper respect for the value it possesses: its dignity. The main claim of this chapter is that if we take this approach, FH has problematic normative implications. The chapter specifies cases in which, many of us believe, withdrawing life-sustaining medical treatment, killing in self-defense, and heroically sacrificing one’s life for others are each morally permissible. But on the Respect-Expression Approach Kant’s principle yields the conclusion that these actions are wrong.

Chapter 3 The Mere Means Principle

This chapter develops an account of treating another as a means, that is, using another, which is a kind of action that is often morally permissible. Treating another merely as a means (or just using another) is typically wrong, the chapter argues, in contrast to Derek Parfit’s position. Inspired by Kant, one might hold that an agent treats another merely as a means if the other cannot share the end she is pursuing in using him or, instead, if he is unable to consent to her using him. One might interpret this inability to consent in terms of it being irrational to consent or, rather, in terms of the lack of an opportunity to consent. The chapter rejects these views individually but tries to combine elements of some of them into a plausible sufficient condition for an agent’s treating another merely as a means, namely the Hybrid Account.

Chapter 4 Treating Consenting Adults Merely as Means

This chapter explores sufficient conditions for an agent’s using another, but not merely as a means. An actual consent account, inspired by Robert Nozick, holds that the agent does not use the other merely as a means if the other gives his informed, voluntary consent to her use of him. A possible consent account, inspired by Onora O’Neill, contends that the agent does not use the other merely as a means if it is reasonable for her to believe that the other can avert this use by withholding his agreement to it. The chapter then argues that actual consent accounts suffer from a shortcoming not shared by possible consent accounts, namely, that of implying implausibly that certain ineffective or unnecessary attempts an agent makes at coercing or deceiving another to serve as a means to her ends do not amount to her “just using” the other.

Chapter 5 Dignity and the Mere Means Principle

This chapter presents a new, Kant-Inspired Account of the dignity of persons (KID). KID holds that dignity is a special status held by persons, according to which they ought not to be treated merely as means, but ought to be treated as having unconditional, transcendent worth. The chapter crystallizes the book’s account of treating others merely as means and explains the notion of worth that KID embraces. In order to clarify KID and underscore its plausibility, the chapter examines cases that diminish the credibility of traditional Kantian accounts of dignity as well as cases concerning transplant surgeons and trolleys that feature in normative ethics. The chapter maintains that it is always pro tanto wrong to fail to respect the dignity of persons, but that it is not always wrong all things considered to do so. The chapter explores when it is morally legitimate to fail to respect a person’s dignity.

Chapter 6 Dignity and the Distribution of Scarce, Life-Saving Resources  

This chapter explores what it means to respect persons when scarce, life-saving resources (e.g., flu treatment) must be distributed. In different age cases, both an older person and a younger one need a scarce resource to survive, but we can save only one; in different number cases, we can use the resource either to save one person or to save five, but not to save everyone. The chapter applies three accounts of respect for the worth or dignity of persons to such cases: the Respect-Expression Approach to Kant’s Formula of Humanity, an Equal Worth Account, suggested by Jeff McMahan, and a Kant-Inspired Account of Dignity (KID). The chapter argues that KID has more plausible implications than the others. The chapter ends by contrasting KID with a benefit-maximizing view of the distribution of scarce resources—one that uses the Quality Adjusted Life-Year (QALY) as a measure of improvement in health-related quality of life.

Chapter 7 Markets in Kidneys

This chapter applies Kantian principles to the issue of the moral permissibility of “live donor” kidney transplantation—specifically cases in which, in exchange for money, someone undergoes a kidney extraction. The chapter specifies contexts (e.g. “transplant tourism”) in which such market exchange of kidneys often involves a failure to respect the dignity of persons, according both to an orthodox Kantian account of dignity and to a newly developed one. The chapter also examines market exchange in light of the notion, familiar in bioethics, that autonomy has intrinsic value. The chapter argues that if, in a Kantian spirit, one values autonomy, then one should be wary of markets in organs. The chapter argues that market exchange of kidneys—even consensual, legal, and regulated exchange that would increase the number of kidneys available for transplant—would often be morally wrong. The chapter briefly considers alternative means of reducing the current shortage of organs.

Chapter 8 Medical Research and Respect for Dignity

This chapter specifies two kinds of cases in which using persons in experiments can amount to treating them merely as means and failing to respect their dignity, according to the Kant-Inspired Account of Dignity (KID). In the first, researchers obtain voluntary, informed consent from subjects to take biospecimens for use in a particular investigation. After the specimens have been “anonymized,” the researchers give them to another investigator who, without the subjects’ consent, uses them in a different study. In the second kind of case, pharmaceutical researchers obtain the voluntary, informed consent of citizens in a developing country to serve as subjects in a trial of a drug for a serious condition from which the citizens suffer. If a trial of this drug were conducted in a developed country, it would be active-controlled and all participants would receive effective treatment. But in the developing country, some subjects receive (an ineffective) placebo.