David Benatar

A tale of two novel transplants not done: the ethics of limb allografts

When it becomes technically possible to perform a “ground breaking” surgical procedure, an important moral problem arises. In view of the strong incentive for surgeons to be the first to perform a novel operation, their judgments about whether such an intervention is justified may well be clouded. We describe two cases in which surgeons decided not to perform a novel transplant. In the second case transplantation continued to be considered until the ethical analysis performed in writing this paper was completed. #### Summary points At the Red Cross Childrens Hospital in Cape Town it was decided, on ethical grounds, against novel limb allografts for two patients—one with no hands and one with no hands or feet The costs to health and cumulative lifetime risks of immunosuppression for child recipients of a limb allograft are substantial and do not outweigh the functional benefits There are good reasons for not using “informed consent” to bypass the difficulties of weighing the benefits of limb allografts against the costs The ideal candidate for limb transplantation is somebody who could gain the most and for whom the associated costs and risks are lowest A potential recipient should be very close to this ideal if transplantation is to be morally justified In July 1994, a 3 year old boy was admitted to the intensive care unit at the Red Cross Childrens Hospital in Cape Town with meningococcal septicaemia. He developed infarction of all his fingers and these were amputated at the level of the carpus bilaterally with skin grafting of the stumps. In January 2000, a 4 year old girl was admitted to the same hospital, also with meningococcal septicaemia. She developed distal necrosis of all four limbs. Both hands were amputated just distal to the carpus, leaving three metacarpal stumps on the right hand and a vestige of …

Evaluations of circumcision should be circumscribed by the evidence

One common mistake in discussions about the ethics of infant male circumcisioni is to attempt to answer the question of the practices permissibility by appealing to general principles and bypassing the empirical evidence about purported benefits and harms of the practice. Joseph Mazor1 avoids the mistake of appealing only to general principles. He correctly argues that it is not sufficient to invoke a childs right to bodily integrity or to self-determinationii. Moreover, he does not appeal to parents’ rights to religious or cultural freedom in order to make his case for the permissibility of parents having their sons circumcised for religious or cultural reasons. However, in invoking empirical considerations, he is insufficiently careful. For example, he includes, on the negative side of the circumcision ledger, a reduction in sexual pleasure, yet it is not clear that even his own reasoning warrants this. The problem is that he seems to want both, to acknowledge the absence of clear evidence for this claim, and to accept it as one of the costs of circumcision. He says that Michael Benatar and I2 ‘carefully reviewed the medical evidence’1 about circumcision. In the paper that he cites, we noted that competing claims were made about the effect of circumcision on sexual pleasureiii and we established that no conclusion could be drawn from the limited and conflicting evidence available on this question. Dr Mazor notes that critics could point (selectively) to those studies that lend support to the conclusion that circumcision reduces sexual pleasure, but he concedes that this would be controversial,1 …

Teaching moral theories is an option: reply to Rob Lawlor

In his response to my earlier criticism, Rob Lawlor argues that the benefits I suggest can be derived from teaching moral theories in applied ethics courses can be obtained in other ways. In my reply, I note that because I never claimed the benefits could be obtained only from teaching moral theories, Dr Lawlor’s response fails to refute my earlier argument that some attention to moral theories is an option in applied ethics courses.

Informed consent and research

In the debate opened by the BMJ on whether research is ethical if it meets the standards of the Declaration of Helsinki but is conducted without informed consent, Len Doyal provides some powerful arguments for why the request for informed consent should be inviolable.1 While vigorously defending the inviolability of informed consent, he concedes that it is not necessary in certain circumstances. An uncontroversial case is that of incompetent patients (although even here other rigorous requirements must be met). However, the other exceptional cases he mentions seem to have some unfortunate implications for his defence of informed consent. He thinks that for epidemiological research on patient records the informed consent requirement may be waived if certain conditions are met: ( a ) that access to the clinical record is essential to the research; ( b ) that consent is not practicable; ( c ) that the research is of sufficient merit; ( d ) that it may benefit the patient whose records are studied; ( e ) that, when possible, the researchers are unable to connect the records with the patients identity, but that where this …

Indiscretion and other threats to confidentiality

Confidentiality is a central principle of medical ethics. The most common breaches of this principle are not the rare cases in which the principle is overridden by other considerations. Instead, confidentiality is most often breached when it clearly should be respected. In this paper I outline these threats to confidentiality, the most frequent and disturbing of which is indiscretion in its many forms.

How does anybody live in this strange place? A reply to Samantha Vice

Abstract Samantha Vice has argued that ‘white’ South Africans are so tainted by the history of racial oppression in their country that they are incapable of attaining a great degree of moral virtue. She recommends that they should live in humility and political silence. There are a number of flaws in her argument. First, none of the characteristics of ‘white’ South Africans that she says provides the basis for these conclusions can distinguish (almost) all ‘white’ South Africans from (almost) all ‘black’ South Africans. Second, because it is not only ‘white’ South Africans but everybody in the world who either perpetrates serious injustice or is tainted by others’ perpetration of it, her argument, if sound, would imply that nobody is capable of great virtue and that everybody ought to be politically silent. Finally, her recommendation that ‘white’ South Africans should be politically silent is a very dangerous one.

Why the Naïve Argument against Moral Vegetarianism Really is Naïve

When presented with the claim of the moral vegetarian that it is wrong for us to eat meat, many people respond that because it is not wrong for lions, tigers and other carnivores to kill and eat animals, it cannot be wrong for humans to do so. This response is what Peter Alward has called the naive argument. Peter Alward has defended the naive argument against objections. I argue that his defence fails.

Life Is Not Good

The claim that “life is good” is a popular mantra among the cheery and those aspiring to such “positive thinking”. In opposition to this optimism, it is argued in this chapter that while some lives are better than others, no life is good enough to count as non-comparatively good. This conclusion will strike many as outrageous, and thus the paper also considers good reasons why we should distrust positive assessments of the quality of life. Various “secular theodicies”—attempts to reconcile the vast amount of evil in life with the claim that “life is good”—are also raised and rejected. Finally, the chapter considers what does and what does not follow from the grim view defended.

Rape and the Straw Man A Response to Lindsay Kelland

Lindsay Kelland has taken issue with a claim I made in a book titled The Second Sexism: Discrimination Against Men and Boys. In response to this claim, she has argued that when a woman is raped, it matters that her rapist is a male because “her situation as a woman under patriarchy is partly constitutive of the harm that she suffers” in being raped. In my response to her article, I show that she has taken my claim out of context and thereby misrepresented it. As a result, her article fails to respond to anything I said.

Every conceivable harm : a further defence of anti-natalism

Many people are resistant to the conclusions for which I argued in Better Never to Have Been. I have previously responded to most of the published criticisms of my arguments. Here I respond to a new batch of critics (and to some fellow anti-natalists) who gathered for a conference at the University of Johannesburg and whose papers are published in this special issue of the South African Journal of Philosophy. I am also taking the opportunity to respond to two other critics whose articles have previously been published in South African philosophy journals. Clearly I cannot respond to all the arguments in each of these papers and thus I shall focus on what I take to be some of the central issues in each. None of the arguments to which I shall respond have caused me to revise my views. However, I am pleased to have the opportunity to show why this is the case.