I provide an updated version of The Impairment Argument against abortion and respond to numerous objections that can be (and have been) raised to it.

In his recent article Perry Hendricks presents what he calls the impairment argument to show that abortion is immoral. To do so, he argues that to give a fetus fetal alcohol syndrome is immoral. Because killing the fetus impairs it more than giving it fetal alcohol syndrome, Hendricks concludes that killing the fetus must also be immoral. Here, I claim that killing a fetus does not impair it in the way that giving it fetal alcohol syndrome does. By (...) examining the reason why giving a fetus this condition is wrong, I conclude that the same reasoning, on common pro‐choice accounts, does not apply to killing the fetus. Accordingly, Hendricks's argument does not succeed in showing abortion is immoral. (shrink)

Perry Hendricks has recently presented the impairment argument for the immorality of abortion, to which I responded and he has now replied. The argument is based on the premise that impairing a fetus with fetal alcohol syndrome is immoral, and on the principle that if impairing an organism is immoral, impairing it to a higher degree is also—the impairment principle. If abortion impairs a fetus to a higher degree, then this principle entails abortion is immoral. In (...) my reply, I argued that abortion does not impair an organism in the way fetal alcohol syndrome does, and showed that interest theorists can avoid the argument. Hendricks has responded to my criticisms by demonstrating how abortion does impair an organism. In this reply, I acknowledge Hendricks’ point, but proceed to criticise the application of the impairment principle to abortion, showing that it is invalid if we accept his explanation for why inflicting fetal alcohol syndrome is immoral. I also argue that counter-examples show the impairment principle itself to be dubitable, concluding that the impairment argument remains unpersuasive. (shrink)

Perry Hendricks’ original impairment argument for the immorality of abortion is based on the impairment principle (TIP): if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. Since abortion impairs a fetus to a higher degree than fetal alcohol syndrome (FAS) and giving a fetus FAS is immoral, it follows that abortion is immoral. Critics have argued that the ceteris paribus is not met for FAS and (...) abortion, and so we proposed the Modified Impairment Principle (MIP) to avoid these difficulties. Dustin Crummett has responded, arguing that MIP is open to various counterexamples which show it to be false. He also shows that MIP can generate moral dilemmas. Here, we propose a modification to MIP that resolves the issues Crummett raises. Additionally, Alex Gillham has criticized our appropriation of Don Marquis’ ‘future like ours’ reasoning about the wrongness of impairment. We show that his objections have minimal implications for our argument. (shrink)

According to Hendricks Impairment Argument (IA), abortion is immoral because it impairs the fetus. Here, I argue it is not sufficient to show merely that abortion impairs, Hendricks must show that it harms the fetus. If the fetus is not numerically identical to the person it will become, then it isn't harmed by an abortion. But if the fetus is numerically identical to the person it will become, it is harmed by the deprivation of a future of value. (...) However, taking this route ultimately undermines the novelty of the impairment argument. (shrink)

With Perry Hendricks, I recently outlined a strengthened version of the impairment argument for the immorality of abortion. Alex Gillham has argued that our use of Don Marquis’ deprivation of a ‘future-like ours’ account entails we were merely restating Marquis’ argument for the immorality of abortion. Here, I explain why SIA is more than just a reframing of Marquis.

A common justification for abortion rights is that the death of the fetus does not violate any of the fetus’s time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a necessary condition for harming someone is that his or her time-relative interests are frustrated. Regarding the justification for abortion, this account falls prey to impairment arguments. Impairment arguments entertain cases of prenatal injury, such as the mother using illicit drugs that disable the child. (...) The intuition is that the child who is born with such disabilities is harmed by the mother’s drug use. But it is unclear what time-relative interest is violated in cases of prenatal harm. Typical responses to impairment arguments point out that the abortion case is different because the child does not exist to experience such harms; but in prenatal injury + survival cases, the child does live to experience those harms. Thus, the TRIA justification for abortion is not impugned by impairment counter-examples. This article argues that this response to impairment arguments is viciously circular. The response must say that so long as you kill the child, no harm is done. But this assumes that killing itself is morally inconsequential and is not itself a case of harm. The response to impairment arguments, then, assumes the permissibility of abortion. (shrink)

Blackshaw and Hendricks recently developed a strengthened version of the impairment argument (SIA) that imports Marquis’ account of the wrongness of abortion. I then argued that if SIA imports Marquis’ account, then it restates Marquis’ position and thus is not very significant. In turn, Blackshaw and Hendricks explained why they take SIA to be importantly different from Marquis’ account. I have two aims in this response. First, I reconstruct Blackshaw and Hendricks’ arguments for the claim that SIA is (...) importantly different from Marquis’ account. Second, I argue that SIA is not importantly different from Marquis’ account in the respect that Blackshaw and Hendricks take it to be. (shrink)

The ‘impairment argument’ against abortion developed by Perry Hendricks aims to derive the wrongness of abortion from the wrongness of causing foetal alcohol syndrome. Hendricks endorses an ‘impairment principle’, which states that, if it is wrong to inflict an impairment of a certain degree on an organism, then, ceteris paribus, it is also wrong to inflict a more severe impairment on that organism. Causing FAS is wrong in virtue of the impairment it inflicts. But (...) abortion inflicts an even more severe impairment, and so, ceteris paribus, is also wrong. Notably, Hendricks thinks that this argument does not require the claim that the foetus is a person. Here, I respond to Hendricks by arguing that the ceteris paribus clause of the impairment principle is not met in ordinary cases of pregnancy. Carrying an unwanted pregnancy to term is much more burdensome than is refraining from excessive drinking for nine months. This provides a pro tanto justification for obtaining an abortion that does not apply to causing FAS. If the foetus is not a person, it seems fairly clear to me that this justification is strong enough to render abortion permissible. Hendricks is therefore incorrect in claiming that the impairment argument can go without claims concerning foetal personhood. If the foetus is a person, then whether burdensomeness justifies abortion depends on certain questions relating to Thomson’s famous violinist argument. I will not attempt to answer those. But anyone who is otherwise sympathetic to Thomson’s argument should not be moved by the impairment argument. (shrink)

In response to criticism of the impairment argument for the immorality of abortion, Bruce Blackshaw and Perry Hendricks appeal to Don Marquis’s future-like-ours (FLO) account of the wrongness of killing to explain why knowingly causing fetal impairments is wrong. I argue that wedding the success of the impairment argument to FLO undermines all claims that the impairment argument for the immorality of abortion is novel. Moreover, I argue that relying on FLO when there are (...) alternative explanations for the wrongness of causing FAS begs the question. I conclude, therefore, that the impairment argument remains unsuccessful. (shrink)

Perry Hendricks’ impairment argument for the immorality of abortion is based on two premises: first, impairing a fetus with fetal alcohol syndrome is immoral, and second, if impairing an organism to some degree is immoral, then ceteris paribus, impairing it to a higher degree is also immoral. He calls this the impairment principle. Since abortion impairs a fetus to a higher degree than FAS, it follows from these two premises that abortion is immoral. Critics have focussed on (...) the ceteris paribus clause of TIP, which requires that the relevant details surrounding each impairment be sufficiently similar. In this article, we show that the ceteris paribus clause is superfluous, and by replacing it with a more restrictive condition, the impairment argument is considerably strengthened. There are no data in this work. (shrink)

Most opposition to abortion stands or falls on whether a fetus is the sort of being whose life it is seriously wrong to end. In her influential paper ‘A defense of abortion,’ Judith Jarvis Thomson effectively sidesteps this issue, assuming the fetus is a person with the right to life yet arguing this alone does not give it the right to use the mother’s body. In a recent article, Perry Hendricks takes inspiration from Thomson and assumes the fetus is not (...) a person, arguing that abortion is wrong because causing fetal impairment is wrong and abortion is worse than causing fetal impairment. Here I argue Hendricks’ impairment argument fails. For Hendricks, risking fetal impairment is wrong because it risks harm to a future person, but if we assume the fetus is not a person, abortion doesn’t harm anyone, it merely prevents them from existing. (shrink)

Blackshaw and Hendricks have recently developed and defended the impairment argument against abortion, arguing that the immorality of giving a child fetal alcohol syndrome (FAS) provides us with reason to believe that abortion is immoral. In this paper, we forward two criticisms of the impairment argument. First, we highlight that, as it currently stands, the argument is very weak and accomplishes very little. Second, we argue that Blackshaw and Hendricks are fundamentally mistaken about what makes (...) giving a child FAS immoral. Once we acknowledge this, it is clear that our intuitions about giving a child FAS provide no support for the supposed immorality of abortion. (shrink)

I argue here that the impairment principle requires clarification. It needs to explain what makes one impairment greater than another, otherwise we will be unable to make the comparisons it requires, the ones that enable us to determine whether b really is a greater impairment than a, and as a result, whether causing b is immoral because causing a is. I then develop two of what I think are the most natural accounts of what might make one (...) impairment greater than another. The quantitative understanding of greater impairment is problematic because it leaves the impairment principle vulnerable to counterexamples; just because impairment b impairs a larger number of abilities or the same number of abilities but for a longer period or to a higher degree does not mean that b is a greater impairment than a. The qualitative understanding of greater impairment is problematic because it does not explain examples of greater impairment used in the literature, means that an abortion is always a qualitatively more severe impairment than causing fetal alcohol syndrome regardless of how the organism is affected, and/or entails that lethal impairment is always greater than nonlethal impairment. (shrink)

In an article of this journal, Perry Hendricks makes a novel argument for the immorality of abortion. According to his impairment argument, abortion is immoral because: (a) it is wrong to impair a fetus to the nth degree, such as causing the fetus to have fetal alcohol syndrome (FAS); (b) it is wrong to impair a fetus to the n+1 degree (to cause the fetus to be more impaired than to have FAS); (c) killing the fetus impairs (...) the fetus to the n+1 degree (causes it to be more impaired than to have FAS); (d) abortion kills the fetus; (e) therefore, abortion is immoral. The impairment argument is a promising account for the wrongness of abortion because it does not rely on the controversial metaphysical premise that a fetus is a person. This article aims to show, that despite some immediate advantages over the rival theories of the immorality of abortion there is a reason to believe that the impairment argument is untenable. That is because there are goods that can be achieved by abortion but that cannot be achieved by impairing the fetus. (shrink)

In order for the so-called strengthened impairment argument (SIA) to succeed, it must posit some reason R that causing fetal alcohol syndrome (FAS) is immoral, one that also holds in cases of abortion. In formulating SIA, Blackshaw and Hendricks borrow from Don Marquis to claim that the reason R that causing FAS is immoral lies in the fact that it deprives an organism of a future like ours (an FLO). I argue here that SIA fails to show that (...) it is immoral to cause FAS and abort fetuses that will not be born because it deprives them of an FLO. This is because fetuses that will not be born have no chance of having an FLO in the first place, so causing FAS for and aborting them cannot deprive them of one. I then consider three responses to my argument. I conclude that each fails. SIA does not accomplish its task of showing why it is immoral to impair fetuses that will not be born. Perhaps it can accomplish the task of showing why it is immoral to impair fetuses that will be born, but not without sacrificing at least some of its alleged significance. (shrink)

In my article "Even if the fetus is not a person, abortion is immoral: The impairment argument" (this journal), I defended what I called “The impairment argument” which purports to show that abortion is immoral. Bruce Blackshaw (2019) has argued that my argument fails on three accounts. In this article, I respond to his criticisms.

The impairment argument aims to establish the immorality of abortion without relying on the fetus’s moral status. Instead, it appeals to logical consistency in moral reasoning: if it is immoral to impair a fetus by causing injury, then it must be even more immoral to impair it by causing death. For this reasoning to succeed, all the morally relevant details between these impairments must be held constant, which the author of the argument, Perry Hendricks, refers to as (...) the _ceteris paribus_ requirement. This requirement has proven difficult to define, and in his latest work, Hendricks suggests a more precise explanation of the _ceteris paribus_ clause based on the valuable goods that obtain from impairments. He also outlines a test to determine if the _ceteris paribus_ clause is broken, thereby causing the impairment argument to fail. In this paper, I argue that this new formulation is too narrow, resulting in fatal counterexamples. Accordingly, I show that in addition to valuable goods, the harms of impairment must be considered, as well as the reasons why impairing a fetus is considered immoral. I demonstrate that these reasons ultimately rest on one’s view of the fetus’ moral status, rendering the impairment argument superfluous. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that (...) the fetus is a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

This paper offers a new argument against raising and killing sentient non-human animals for food. It is immoral to non-lethally impair sentient non-human animals for pleasure, and since raising and killing sentient animals for gustatory pleasure impairs them to a much greater degree, it also is wrong. This is because of the impairment principle: if it is immoral to impair an organism to some degree, then, ceteris paribus, it is immoral to impair it to a higher degree. This (...) argument is structurally analogous to Perry Hendricks’s impairment argument for the immorality of abortion. However, the argument is more defensible applied to the raising and killing of sentient nonhuman animals for food because of the sentience of the non-human animals involved. I explain how the argument is distinct from other pro-vegan, pro-vegetarian arguments. (shrink)

Kyle van Oosterum and Emma Curran have recently argued that the impairment argument against abortion is weak and accomplishes little. They also claim that impairment fails to explain what makes giving a child fetal alcohol syndrome (FAS) immoral, which is an important premise of the argument. Here, I explain that the impairment argument is not as weak as they believe. Further, I argue that impairment offers a superior explanation for what makes giving a (...) child FAS immoral than their proposal based on creative beneficence. (shrink)

In his recent article “Even if the fetus is not a person, abortion is immoral: The Impairment Argument,” Perry Hendricks sets out to sidestep thorny metaphysical questions regarding human fetuses and present a new argument against abortion – if impairing a fetus with fetal alcohol syndrome is immoral, then killing the fetus is immoral. Hendricks takes inspiration from Judith Jarvis Thomson’s defense of abortion – that even if fetuses are persons with a right to life, the right (...) to life is not the right to use others, so it is acceptable to induce abortion. Together with Bruce Blackshaw, Hendricks set out to strengthen the impairment argument by appealing to Don Marquis’s future like ours (FLO) account of the wrongness of killing. Here I argue the impairment argument falls short in three ways. First, Hendricks and Blackshaw fail to assume fetuses aren’t persons, broadly construed. Second, they fail to show that impairing a fetus is immoral. Third, they overlook abortions that (merely) let the fetus die. Finally, I argue Thomson’s defense of abortion preempts the significance of the impairment argument; Thomson seems to show that even if killing a fetus is prima facie immoral, women still have the right to induce abortion. (shrink)

A basic criticism of Perry Hendrick's "Even if the fetus is not a person, abortion is immoral: The Impairment Argument," is offered, namely that the reasons why intentionally causing fetal alcohol syndrome is wrong simply do not apply to fetuses and so the "Impairment Argument" against abortion fails.

Perry Hendricks’ original ‘impairment argument’ against abortion relied on ‘the impairment principle’ (TIP): ‘if it is immoral to impair an organism O to the nth degree, then,ceteris paribus, it is immoral to impair O to the n+1 degree.’ Since death is a bigger impairment than fetal alcohol syndrome (FAS), Hendricks reasons that, by TIP, if causing FAS is immoral, then,ceteris paribus, abortion is immoral. Several authors have argued that this conclusion is uninteresting, since theceteris paribusclause is (...) not satisfied in actual cases of abortion: women have reasons for wanting abortions which do not apply to drinking during pregnancy, so all else is not equal, and the conclusion is irrelevant to the morality of actual abortions. In a recent article in this journal, Hendricks and Bruce Blackshaw try to evade this criticism by replacing TIP with the ‘modified impairment principle’ (MIP): ‘if it is immoral to impair an organism O to the nth degree for reason R, then, provided R continues to hold (or is present), it is immoral to impair O to the n+1 degree.’ MIP allows us to derive theultima faciewrongness of abortion (not just itsceteris paribuswrongness) because MIP lacks aceteris paribusclause. But I argue that this lack also renders MIP false: MIP faces counterexamples and implausibly produces genuine moral dilemmas. Since the moral principle on which it relies is false, the modified impairment argument fails. I close by considering what a principle would need to do for the impairment argument to succeed. (shrink)

This chapter critically examines arguments for the permissibility of abortion that presume that what is killed is one of us. Even though what is killed is one of us, they argue that when abortions are typically done we may be permissibly killed. There are two main arguments for consideration: those that focus on interests, and those that focus on bodily rights. The chapter begins by defining abortion, and then turns to the time-relative interest account (TRIA) of harm or wrongdoing. The (...) TRIA posits that harm requires the frustration of a being’s time-relative interests, which are contingent on consciousness or sentience. Thus, preconscious human beings, lacking such capacities, cannot be harmed. However, the chapter considers impairment arguments (e.g., prenatal drug abuse, neuronal removal), where preconscious beings are intuitively harmed. TRIA proponents respond with either the “Experience Condition” (no harm if not experienced) or “Content Specification” (only select interests count). The chapter argues that the “Experience Condition” response is viciously circular, as it assumes the permissibility of killing. This circularity is identified as a severe de jure defect, rendering the TRIA justification for abortion unable to create independent reasons for an uncommitted audience. The chapter considers at length bodily rights arguments. It argues among other conclusions, that when bodily rights considerations are applied to the developing human being, we get an argument against abortion not for it. Bodily rights arguments lack coherence. (shrink)

Hendricks’ The Impairment Argument (TIA) claims that it is immoral to impair a fetus by causing it to have fetal alcohol syndrome (FAS). Since aborting a fetus impairs it to a greater degree than causing it to have FAS, then abortion is also immoral. In this article, I argue that TIA ought to be rejected. This is because TIA can only succeed if it explains why causing an organism to have FAS impairs it to a morally objectionable degree, (...) entails that abortion impairs an organism to a morally objectionable and greater degree than causing FAS, and satisfies The Impairment Principle’s ceteris paribus clause. In order to do all three things, TIA must presuppose some theory of well-being. Even then, no theory of well-being accomplishes all three tasks that TIA must in order to succeed. However, even if this is false and TIA can meet all three objectives by presupposing some theory of well-being, it would not do very much to advance the debate about the morality of abortion. As I argue, TIA would essentially restate well-established arguments against abortion based on whatever theory of well-being it must presuppose in order to be successful. (shrink)

Could it be that if a fetus is not a person abortion is still immoral? One affirmative answer comes in the form of ‘The Impairment Argument’, which utilizes ‘The Impairment Principle’ to argue that abortion is immoral even if fetuses lack personhood. I argue ‘The Impairment Argument’ fails. It is not adequately defended from objections, and abortion is, in fact, a counterexample to the impairment principle. Furthermore, it explains neither what the wrong-making features of (...) abortion are nor what features of fetuses ground their supposed moral significance. By presupposing the fetus lacks personhood and providing no alternate account of the basis of fetuses’ moral significance, there is nothing to constitute abortion’s wrongness. Attempts to modify it fail for the same reasons. Thus, the impairment argument fails to show abortion is immoral. (shrink)

The impairment argument claims that abortion is immoral, because it results in a greater impairment to a fetus than other actions that are clearly immoral, such as inflicting fetal alcohol syndrome. Alex Gillham argues that the argument requires clarification of the meaning of greater impairment. He proposes two definitions, and points out the difficulties with each. In response, I argue that while the impairment argument’s definition of greater impairment is narrow in scope, (...) it is sufficient for its intended purpose. Broadening its scope to more controversial comparisons of impairment is likely to undermine the intuitive appeal of the impairment principle that the argument is based upon. (shrink)

Most democratic countries either limit or deny altogether voting rights for people with cognitive impairments or mental health conditions. Against this weight of legal and practical exclusion, disability advocacy and developments in international human rights law increasingly push in the direction of full voting rights for people with cognitive impairments. Particularly influential has been the adoption by the UN of the Convention on the Rights of Persons with Disabilities in 2007. Article 29 declares that states must ‘ensure that persons with (...) disabilities can effectively and fully participate in political and public life on an equal basis with others, directly or through freely chosen representatives, including the right and opportunity for persons with disabilities to vote and be elected’. This article also argues for the right of all people to vote, including people with cognitive impairments, by adopting a uniquely strategic approach. Firstly, some of the strategic limitations of existing arguments in favour of extending the franchise are highlighted. Most such arguments are flawed because they run the risk of inviting disparaging philosophical commentary which compares disabled people to animals, or because they are based on implausible empirical claims, or because they inadvertently tie the case for voting rights for the disabled to other cases unlikely to ever enjoy widespread acceptance. This article, instead, justifies extending voting rights to all people with cognitive impairments based on a simple cost-benefit analysis that avoids all of these problems. (shrink)

Tom Shakespeare’s important new book includes, among other topics, a persuasive critique of the social model of disability. A key component in his case against that model consists in an argument against the impairment/disability distinction as this is understood within the social model. The present paper focuses on the case Shakespeare makes against that distinction. Three arguments mounted by Shakespeare are summarised and responded to. It is argued that the responses adequately rebut Shakespeare’s case on this specific issue. (...) Moreover, as the engagement with Shakespeare’s argument illustrates, his claim to employ a critical realist perspective appears to be in considerable tension with the case he offers against the impairment/disability distinction. (shrink)

An ethical and legal obligation generally exists for informed consent to be obtained prior to the administration of medical interventions. This includes vaccinations. For an individual’s informed consent to be valid, it must be given voluntarily. Hence, when individuals are required to be vaccinated—for example, as a condition of employment—we might ask whether this impairs the voluntariness of their informed consent, thereby rendering it invalid. If this turns out to be the case, then this would count as a pro tanto (...) reason to think vaccine mandates are unethical. Assuming vaccine mandates count as ‘coercive’, interrogating this question requires an account of consent under third-party coercion, since the pressure or coercion exerted by vaccine mandates is exerted by third parties, such as employers, rather than the recipients of consent. Accordingly, this paper draws on Maximilian Kiener’s Interpersonal Consenter–Consentee Justification account of the voluntariness of medical consent under third-party coercion to develop an explicit argument as to why vaccine mandates do not vitiate the voluntariness of informed consent. Vaccine mandates do not necessarily impair the voluntariness of informed consent because, in such cases, the consent-receiver neither contributes to a vaccine mandate’s coercive threat nor wrongs the consent-giver in any way. Consent is not obtained by coercion in such cases, even though it may be motivated by it. The mere presence of third-party coercion does not invalidate consent since third parties cannot directly negate the voluntariness of consent. (shrink)

A medical device manufacturer pays a surgeon to demonstrate a novel medical instrument in a live broadcast to an audience of specialists in another city. The surgical patient is unaware of the broadcast and unaware of the doctor's relationship with the manufacturer. It turns out that the patient required a different surgical approach to her condition—one that would not have allowed a demonstration of the instrument—and she later dies. The paper is an exploration of whether the manufacturer shares, along with (...) the doctor, responsibility for the death of the patient. Three arguments for corporate responsibility are considered; two are criticized and the third is offered as sound. (shrink)

This paper presents a critique of the social model of impairment. It situates the social model of impairment within the broader framework of the social model of disability, where the distinction between disability and impairment originates. The paper begins by outlining the social model of disability and contrasting it with the individual (medical) model. It then offers an initial critique of the social model. Subsequently, two strategies employed to defend the social model are analysed. The first strategy (...) posits that critiques of the social model arise from misinterpretations; however, this paper argues that such an approach reduces substantive issues to mere semantic debates. The second strategy, which serves as the primary focus of this paper, asserts that both disability and impairment are socially constructed. This argument is critiqued on the grounds that it relies on inconclusive evidence and, if accepted, would lead to nihilistic implications, ultimately undermining the moral responsibility of able-bodied individuals to support those with severe disabilities. (shrink)

Manipulation or manipulative behavior, which is widespread in many life contexts and interpersonal relationships, is mostly associated with a negative connotation. Often considered roughly a form of control over others that cannot be equated with coercion or argumentation, manipulation is an umbrella term for strategies that serve to make another person (or oneself) experience x or do y or induce certain situations and interpersonal constellations. Frequently, the use of manipulative strategies is deemed to result from egoistic or even hostile motives. (...) Such an appraisal has a major impact on the stigma patients with Borderline Personality Disorder (BPD) are confronted with, given that many of their behaviors are often interpreted as manipulative. In the past decade or so, however, researchers and clinicians have pointed out that what is generally identified as manipulation in persons with BPD needs to be seen through the lens of their lifeworld in order to facilitate an empathetic and more positive attitude towards these individuals. In this paper, I discuss the different functions manipulation may have for persons with BPD and argue that instead of seeing it as a clear expression of malevolence or belligerence, a heightened disposition to manipulations should be considered as both the fruit and seed of a painful and isolating social impairment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Kinds, Ethics, and Market ForcesStephen Ticehurst (bio)KeywordsAlzheimer’s disease, dementia, human kinds, mild cognitive impairment, natural kindsIn their article, Graham and Ritchie (2006) robustly confront the term mild cognitive impairment (MCI). They contrast a "real" diagnosis of Alzheimer's disease (AD) with a potentially spurious human invention called MCI. They argue we should not push MCI and AD too close together, lest MCI catch too much (...) of the reflected reality it does not deserve. I agree with their purpose, but suspect their argument is not as clear cut as we might hope.Classification is fundamental to the human activity called science. It is reflected also in the way we allocate and refine words. Classification allows us to determine the usefulness of terms, to share meaning, and hopefully to predict. MCI is an attempt at classification in this manner.The first problem is the clarity of definition. Graham and Ritchie imply that others see MCI as a precursor to dementia. At times they fall prey to this belief themselves. But is this what MCI claims? This link to AD and its recursive coloring of MCI is central to their argument. It seems that many hope that MCI is a term for "at risk of dementia." This confusion hampers much of the debate. The current operationally defined nosological criteria specify MCI is not dementia. This means that MCI can not be dementia without changing the criteria for one or both. At present, the evidence does not support this. Those people with MCI who will go on to develop dementia cannot reliably be distinguished from those who have a defective memory for other reasons. In the meantime, the link between MCI and dementia of various types is a valid area for investigation. Graham and Ritchie should have more confidence that usefulness can be determined by science and that this will triumph in the end.Modern psychiatry is very keen to believe it is naturalistic. Everything can be measured and will soon be explained by physical laws. However, Graham and Ritchie point to the intrusion of human concepts and values that may be shaping the way we measure the natural world. They invoke the term human kind to differentiate this activity from natural kinds. Psychiatry has always struggled to connect its diagnoses to naturalistic ideas of pathology and etiology. It could be argued that psychiatric nosology has always been susceptible to the creations of humans. Another modern invention—early psychosis—has parallels with the MCI story. But as the Rorschach test shows, most of us continue to see shapes in what really [End Page 53] is only an inkblot. If the shape is something we really want to see, expect, or have been trained to look for, so much the better. A definable precursor state to dementia (or schizophrenia) would make us all happy, not just those insatiable shareholders. However, the earlier in the unfolding of degenerative dementia we go, the less reliable and valid are our clinical diagnoses.Graham and Ritchie say MCI is a human kind, unlike Alzheimer's disease, which is an essential natural kind. The authors argue that the purported relationship between MCI and AD feed back in a loop to give MCI a natural kind standing that it does not yet deserve. They examine the underlying social processes that support this firming of an as yet insubstantial concept. These include the desire for patients and their doctors to have hope and pharmaceutical companies to have markets and profits. They invoke a mythical authorized person who can determine a diagnosis as a newly formed kind after a common act of recognition. Using kind in this context appears to refer to a thing rather than a term. But it is the term that is being socially validated, not the thing. AD is a more socially validated term than MCI, but its relationship with reality remains humanly constructed.Does the invocation of kinds aid this argument? A kind is not really what it appears. A kind is a term to describe a concept that humans hold about the world. Therefore, dividing kinds into various types, such as natural, human, and practical, betrays the inevitable human... (shrink)

Smith and Mackie offer a conditional defence of vaccine mandates.1 Their argument is conditional, because it is based on Kiener’s interpersonal consenter-consentee account of consent.2 (Smith and Mackie do not defend this account of consent.) According to Kiener, whether an influence undermines consent depends not only on its effects, but on who exerts it (p372).2 If A coerces B, this would invalidate consent that B gives to A, but it does not invalidate consent that B gives to C. The (...) fact of A’s coercion is irrelevant to the consent relationship between B and C, because A is a third party. Thus, a physician (consent-receiver) still acts permissibly when vaccinating a patient (consent-giver), even if the patient’s consent was involuntary because of some third-party mandate. One worry about this argument is whether the physician is sufficiently distanced from the coercion. Kiener notes that the patient’s consent …. (shrink)

Perry Hendricks’ ‘impairment argument’, which he has defended in this journal, is intended to demonstrate that the generally conceded wrongness of giving a fetus fetal alcohol syndrome (FAS) shows that abortion must also be immoral, even if we allow that the fetus is not a rights-bearing moral person. The argument fails because the harm of causing FAS is extrinsic but Hendricks needs it to be intrinsic for it to show anything about abortion. Either the subject of the (...) wrong of causing FAS is a person who does not exist in the case of abortion or the wrong is negligible. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Under the Floorboards:Examining the Foundations of Mild Cognitive ImpairmentMichael Bavidge (bio)KeywordsAlzheimer’s disease, culture, dementia, normal aging, science"Building a mystery: Alzheimer disease, mild cognitive impairment, and beyond" (Gaines and Whitehouse 2006) is an absorbing and important case study of how Alzheimer's disease (AD) came to be seen as a disease and how mild cognitive impairment (MCI) has been constructed in recent years as a related incipient condition.The interdisciplinary (...) approach taken in the article produces findings of very different sorts, which are then marshaled to challenge the status of AD and MCI. The factors identified as contributing to the emergence of dementia as a disease include the inconclusive nature of the empirical evidence relating to the causes of dementia, the divergence in the paradigms of the biological sciences, the social pressures resulting from the aging of the population, consumerism in medicine, research funding, the profit motive in the pharmaceutical industries, and our "hypercognitive culture."There is a danger in a short article drawing on detailed work in different disciplines that no single argument is conclusive and the combination of inconclusive arguments remains unsatisfactory. Nevertheless, the picture that emerges is convincing. It is interesting to follow the details of a particular case history to track the intricate interlacing of clinical findings and social decision making that enter into the construction of a disease. The article traces the factors that encouraged the identification of dementia as a widespread, treatable condition and the diagnostic techniques and treatments that determined the delineation of the disease.In the case of AD and MCI, the implications of this process of construction extend beyond taxonomy. They call into question our attitude to aging. Do we see aging as itself a pathology? When Professor Tom Kirkwood writes "from a biological point of view, there is nothing necessary or inevitable about aging" (2001, xi), he does not mean to deny that as the years pass people get older (inevitably); he means that the deteriorations that at present we cannot but see as normal features of aging, are not inevitable. Do we have a spurious ideal of competence based on a time-slice taken from what we like to think of the prime of our lives? Why do we not think of the "cognitive [End Page 75] impairments" of childhood and adolescence as pathological? These are fundamental questions about our experience and understanding of living, aging and dying and they add layers of significance to the topic of the paper (Bavidge 2006).The main focus of the article is to expose the complex process involved in the classification of dementia as "a degenerative, biological, clinical entity" (Gaines and Whitehouse 2006, XX) and to raise doubts about its distinction from normal aging. Not everyone will be happy that so much weight is placed on disease as a dysfunctional clinical entity. Nor will everyone think that so much hangs on the disease status of dementia and MCI. However, on any account, the contrast between disease and normal aging has become less clear because our understanding of both terms of the comparison has become less secure. The question "Is dementia a disease?" is matched by the question "Is aging normal?"Many of the disabilities or degenerations associated with aging are now understood to be conditions that could be avoided, cured, or controlled. So although the article raises doubts about the stability of the category of AD, parallel problems have arisen about normal aging. If important elements of what we classify as dementia should be seen as normal human development, it is equally the case that some aspects of what we accept as part of the normal aging experience should be seen as pathological. The authors assert "we have not argued that there is no 'there' there. Rather, we suggest that the mystery of the 'there' (i.e., AD, MCI) may not be much different (if at all) from, and probably is, the mystery of the 'everywhere' (i.e., aging)" (Gaines and Whitehouse 2006, 61).The article is an exercise in the sociology of knowledge. This will be enough in itself to raise some hackles. It is interesting how an historical and sociological approach to the sciences has... (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge (...) in the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)

Couples should not be allowed to select either for or against deafnessRecently, a US couple deliberately attempted to ensure the birth of a deaf child via artificial insemination.1 In opposing this action, I wish to focus on one argument they employ to support it, namely that in trying to have a deaf child, the women see themselves as no different from parents trying to have a girl. Girls can be discriminated against the same as deaf people and “black people (...) have harder lives”, one of them argues. They compare themselves to a minority group.2In using this argument to justify their attempt to secure the birth of a deaf child, they make four claims: It is not wrong to deliberately try to have a child who is expected to experience harm when the harms the child will experience are socially imposed. As a group experiencing socially imposed harms, the deaf are to be understood as a minority group. Women and people of colour also experience social harms, and are to be understood as minority groups. Because the deaf, women, and people of colour are all groups experiencing socially imposed harms, distinctions should not be made between attempts to have a child who will be a member of one of these groups.In reply, I will advance two arguments. First, I will argue that this couple’s decision is inherently just. Here I will acknowledge that this couple’s position draws a great deal of strength from its appeal to the experiences of women. My second argument will contend, however, that despite the reasonableness of this choice, the intentional selection of deaf children is indefensible. Granting this couple’s contestable assertion that the deaf ought to be understood as a minority cultural group, allowing individuals to secure the birth of deaf …. (shrink)

In ‘Parental Virtues: A New Way of Thinking about the Morality of Reproductive Actions’ Rosalind McDougall proposes a virtue-based framework to assess the morality of child selection. Applying the virtue-based account to the selection of children with impairments does not lead, according to McDougall, to an unequivocal answer to the morality of selecting impaired children. In ‘Impairment, Flourishing, and the Moral Nature of Parenthood,’ she also applies the virtue-based account to the discussion of child selection, and claims that couples (...) with an impairment are morally justified in selecting a child with the same impairment. This claim, she maintains, reveals that the flourishing of a child should be understood as requiring environment-specific characteristics. I argue that McDougall's argument begs the question. More importantly, it does not do justice to virtue ethics. I also question to what extent a virtue ethics framework can be successfully applied to discussions about the moral permissibility of reproductive actions. (shrink)

In his paper, “The Relevance of Rawls’ Principle of Justice for Research on Cognitively Impaired Patients” (Theoretical Medicine and Bioethics 23 (2002):45–53), Giovanni Maio has developed a thought-provoking argument for the permissibility of non-therapeutic research on cognitively impaired patients. Maio argues that his conclusion follows from the acceptance of John Rawls’s principles of justice, specifically, Rawls’s “liberty principle” Maio has misinterpreted Rawls’s “libertyprinciple” – correctly interpreted it does notsupport non-therapeutic research on cognitivelyimpaired patients. Three other ‘Rawlsian’ arguments are suggested (...) by Maio’s discussion –two “self-respect” arguments and a “presumed consent” argument – but none of them are convincing. However, an alternative argument developed from Rawls’s discussion of “justice in health care” in his most recent book, Justice as Fairness: A Restatement, may justify certain kinds of non-therapeutic research on some cognitively impaired patients in special circumstances. We should not expect anything more permissive from a liberal theory of justice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reifying Relevance in Mild Cognitive Impairment:An Appeal for Care and CautionJanice E. Graham (bio) and Karen Ritchie (bio)KeywordsAlzheimer’s disease, construction, dementia, market forces, mild cognitive impairmentWe thank the reviewers for their thoughtful comments that probe shadowy areas in our argument, and we welcome this opportunity to elucidate our position. First, we are not repudiating the natural and social facts of pathologic brain degeneration and the physical and (...) cognitive impairments that manifest in people affected by dementia disorders. We are, however, questioning the epistemology, politics, and persistence by some to harden the construct of mild cognitive impairment (MCI) prematurely as a "natural" precursor to dementia. We suggested insufficiencies in viewing MCI as prodromal to Alzheimer's disease (AD; Graham and Ritchie 2006, 36), and pointed to evidence for the prognostic irrelevance of some MCI subcategories (35). The commentators have read our manuscript as suggesting that AD and MCI are different kinds, and that a diagnosis of AD is more "real" than that of MCI. But AD is also fraught with classification issues, as we describe in the section of our paper that deals with consensus committees, published practice guidelines, and the determination of treatment efficacy. Like MCI, AD is a heterogeneous condition, but unlike MCI, AD is a constructed practical kind that does some "work" beyond essentialist (neural degeneration, brain atrophy) claims. Its criteria identify people with well-defined dementia symptoms and multiple cognitive and functional impairments who are in need of, and benefit from, support. Even with these criteria, however, there have been great attempts to achieve definitional accuracy in dementia diagnoses. Practical refinements to the differential diagnosis of dementia based on solid research evidence have made way for more specific recognitions of vascular dementias, dementia of the Lewy body type, and other subtypes beyond AD. So AD too has been subject to more careful, more cautious operationalization in recent years, with research supporting multiple factors and the comorbidity of several types (kinds) of dementia in any one individual.Our paper takes up concerns that are not resolved for dementia and suggests that the nascent category of MCI is still so insufficiently defined as to be ambiguous, and as such, is in danger of identifying individuals with what will be, and has [End Page 57] already been, linked to a debilitating and deeply stigmatizing and fatal disorder (AD). We are not contesting the reality that some people begin to display early signs of cognitive loss, nor are we suggesting that symptoms be ignored; as researchers, we stand behind the careful tracking of symptoms and signs in patients and research participants as an essential clinical and research practice. In a era where the public has been made wary of the potentially fatal effects of new treatments whose more careful scrutiny in specific populations would have saved lives (e.g., Fontanarosa, Rennie, and DeAngelis 2004; Psaty and Furberg 2005), and made all the more popular by what Kramer coined "diagnostic bracket creep" (1993, 15), we are questioning the drivers and value of a premature diagnostic classification whose definitional accuracy is neither sufficient nor effective for specific identification of individuals.That matters of fact are constructed does not take away from their natural fact. Some people have subjective reports or show objective evidence of cognitive decline while having preserved activities of daily living—the construction of this evidence indicates they are not normal and they are not demented. Based on such evidence, where then does the balance of probability for MCI lie? A multidisciplinary international group of experts gathered in Stockholm in 2003 to discuss MCI concepts (Winblad et al. 2004). They acknowledged that the heterogeneous etiology of MCI contributes to "some confusion concerning the specific boundaries of the condition", stating that this "not normal, not demented" condition is nonetheless "useful both clinically and as a research entity" (p. 241). Importantly, they concluded that MCI needs "better definition" (p. 246). It was at this stage that we first wrote our manuscript, and in the subsequent two years we have eagerly awaited new studies, and the recognition of flexible, practical subtypes to evolve.We state "that MCI cannot be considered to be a separate clinical entity" (Graham and... (shrink)

This chapter addresses the ethical challenges posed by caring for cognitively impaired children whose illnesses bring them repeatedly to intensive care. It argues that the central difficulty arises not from their impairment but from assumptions that wrongly equate diminished cognition with diminished value. Non-consequentialist ethics easily grounds a doctor’s obligation to treat such children with respect, but consequentialist approaches risk misvaluation by expressing personal worth exclusively in terms of capacities for benefit, preference or autonomy.The chapter distinguishes between two forms (...) of valuation often confused in debates about ventilation: the value of the person, which is constant, and the value of prolonging life, which varies with the burdens and benefits of the interventions needed to do so. Cognitive impairment may affect what actions serve a child’s interests, but it does not alter the child’s inherent worth; to deny intensive care categorically on cognitive grounds is therefore to commit the same adult-normative error that underpins arguments for infanticide.Turning to rationing, parental authority and the role of courts, the chapter argues for an age-neutral ethic in which decisions emerge from dialogue between medical and parental expertise, directed solely to expressing the child’s objective and subjective interests. Cognitive impairment neither diminishes a child’s capacity to suffer nor licenses avoidable harm; ethical systems must therefore prevent prolonged suffering caused by adult disagreement or procedural delay. (shrink)

The literary legacy of Abū al-‘Alāʾ al-Ma‘arrī, one of the most unique and controversial poets of the 10th and 11th centuries, is examined in this article, with a particular focus on the theme of “vision” in relation to his blindness. The fact that the poet, despite being blind, frequently addresses the theme of “vision” in his works makes this topic especially intriguing. The inclusion of elements related to vision by someone who is physically devoid of the ability to see confronts (...) the reader with a profound reflection and paradox. The poet’s blindness transforms into a metaphor for inner vision or sensory awareness, a transformation that is clearly visible in Ma‘arrī’s poetry. In ancient times, blindness was often interpreted in con-nection with supernatural powers, whereas in the Middle Ages, it was frequently used as a form of punishment. During the Renaissance, blind-ness gained a dual significance as both a form of punishment and a symbol of spiritual insight. Despite losing his sight at a young age, Ma‘arrī defied the conventional poetic understanding of his time with his philosophical depth and critical approach, drawing attention for his skeptical thoughts. This article examines how words related to vision in the poet’s divan are conceptualized and how his personal experiences and philosophical inquiries are reflected in his poetry. Moreover, through the metaphor of “vision,” it delves into the poet’s profound exploration of existential ques-tions and the meaning of life, analyzing how this theme shapes Ma‘arrī’s literary persona and intellectual world. The study proves that Ma‘arrî transformed his blindness into a literary and philosophical strength, pre-senting a universal argument on how physical limitations can nurture ar-tistic creativity. (shrink)

Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but also authenticity; (...) the ability to determine for oneself what is good for oneself.2 Furthermore, our relationships support or undermine both capacity and authenticity, and autonomous expression manifests throughout evolving relationships. This invites us to view respect differently—as an ongoing conversation with another person, capable of holding values that may move us. In Smajdor’s terminology, it requires that we recognise them. We describe how we operationalise this in our research. Three broad arguments usually support respect for autonomy.2 One—owed to JS Mill—holds that permitting individuals free choice promotes utility of all, by helping them fulfil ideas of the good, demonstrating ‘experiments in living’. Another draws from Kant’s categorical imperative; its Formula of Humanity holds that the capacity to determine our own values gives us reason to act, and we ought, therefore, to treat others’ values with the respect we show our own. Lastly, many simply assume ‘liberal neutrality’—an intrinsic value in people being permitted to pursue the …. (shrink)

A recent article argued for the immorality of abortion regardless of personhood status by comparing the impairment caused by fetal alcohol syndrome to the impairment caused by abortion. I argue that two of the premises in this argument fail and that, as such, one cannot reasonably attribute moral harms to abortion on the basis of the moral harms caused by fetal alcohol syndrome. The impairment argument relies on an inconsistent instantiation, which undermines the claim that (...) personhood is irrelevant, and it does not fulfill its own ceteris paribus clause, which demands that no additional benefit be gained from abortion that would not be gained from causing fetal alcohol syndrome. (shrink)

The high prevalence of brain injury incidents in adolescence and adulthood demands effective models for re-learning lost cognitive abilities. Impairment in brain injury survivors’ higher-level cognitive functions is common and a negative predictor for long-term outcome. We conducted two small-scale interventions (N = 12; 33.33% female) with persons with acquired brain injuries in two municipalities in Sweden. Age ranged from 17 to 65 years (M = 51.17, SD = 14.53). The interventions were dialogic, inquiry-based, and inspired by the Philosophy (...) for Children Programme, a participatory thinking skills approach with documented higher-order cognitive outcomes, such as developed argumentation skills, in other target groups. Philosophical dialogues were conducted once a week in the two groups, totalling 12 dialogues per group. Group argumentation development was measured through compared scores from structured observations of filmed dialogues early and late in the intervention. Large positive changes in mean scores from early to late in the intervention, together with constantly high facilitator quality, suggest argumentation development in the sample due to the intervention. (shrink)