Genetic Enhancement and the bondage of future people by present people

In chapter 8 of “Enhancing Evolution” Harris considers the view of Habernas that the use of genetically enhancing technologies might involve the bondage of future people by present people. This is an example of good rhetoric, but what does in mean if anything. In this posting I will examine exactly what is meant by “the bondage of future people”. I will assume the bondage of future people must affect their ability to make autonomous decisions. It follows I must consider how genetic enhancement might affect autonomy. Autonomy might be affected in two possible ways.
1. Genetic enhancement might mean the choices available to some future agent are curtailed.
2. Genetic enhancement means a future agent’s capacity to make autonomous decisions is damaged.

In this posting I will not consider the second of these possibilities. The reason being I believe any genetic manipulation which damages someone’s capacity to make autonomous decisions cannot be a genuine enhancement. Prima facie it might seem, provided genetic enhancement does not damage a future agent’s capacity to make autonomous decisions, that genetic enhancement does not affect his autonomy. Consider the possible genetic enhancements mentioned by Harris such as an increased resistance to the development of cancer or life extension. Clearly if such enhancements do not directly affect an agent’s mental status they do not affect his capacity to make autonomous decisions. Moreover it would still possible for an agent to jeopardise his enhanced status by engaging in dangerous pastimes such as motor racing.
It might of course be argued the fact an agent has an increased resistance to cancer and the prospect of greater longevity means he doesn’t see the prospect of engaging in dangerous pastimes as a sensible option. It might then be concluded that because genetic enhancement might cut down on an agent’s available options, even if his capacity for autonomy is unaltered, his ability to make autonomous decisions is slightly damaged. Harris argues future agents would gladly accept such a slight limitation on their ability to make autonomous decisions in exchange for the benefits of enhancement. He further argues vaccination of children against childhood diseases may slightly limit their ability to make future choices, but that no one seriously questions such vaccination. Indeed it might be argued limiting someone’s future choices does not damage their ability to make autonomous decisions. Someone may wantonly choose among a large array of options; yet few would argue such decisions are autonomous, see Frankfurt (1999, Necessity, Volition, and Love, Cambridge University Press, page 106). It might then be further argued for an agent to retain the ability to act autonomously he does not need a large number of options, he only needs options he can care about. According to this view for an agent to act autonomously simply means he is able to do what he wants. If this simple view of autonomy is accepted then even if genetic enhancement limits the options available to an agent it does not necessarily limit his ability to make autonomous decisions provided he has options he can identify with. It is very easy to imagine future agents identifying with living longer and not getting cancer! It can be concluded even genetic enhancements limit the options available to an agent that this might not affect his ability to make autonomous decisions.
I believe such a conclusion depends on a simplistic view of autonomy. Autonomy is a hybrid concept. This concept includes identifying with one’s choices, caring about something, and making a reflective choice. Furthermore whilst autonomy clearly has instrumental value it also has intrinsic value. To me the intrinsic value of autonomy lies in being recognised as the kind of person who has the right to make his own decisions. Moreover it seems to me if people now take decisions on behalf people in the future they are failing to recognise the intrinsic value of their autonomy. As has been noted above Harris assumes future persons would gladly give up some autonomy in order to benefit from enhancements. It seems to me there are two objections to this assumption.
1. Provided we are recognised as the kind of person who has the right to determine his own future then any attempt to determine our future fails to recognise the intrinsic value of our autonomy.
2. Harris automatically assumes future people would want to be enhanced even if this limits their autonomy. Such an assumption is dangerous for as was pointed out by Berlin (1969, Four essays on liberty, The Clarendon Press, page 132) this assumption seems to be based on what some idealised future person would choose rather than an actual person.

Harris would doubtless reply to my objections by arguing many of the things parents do for their children affect their future autonomy; education for example. He might further argue that by doing so parents do not damage their children’s future status as the kind of persons who have the right to make their own decisions. It would follow not all attempts to benefit someone damages the intrinsic value of his autonomy. I accept parents do not usually damage the intrinsic value of their children’s autonomy. However I am not at all sure it can then be argued by analogy that some genetic enhancements also do not damage the intrinsic value of autonomy. It seems to me the analogy fails to work because the usual benefits parents confer to their children differ in a significant way from genetic enhancement. The usual benefits parents confer to their children may be rejected by these children later in life. For instance someone may reject the benefits of his education and lead a slothful or purely hedonistic life. It seems non genetic benefits may be accepted or rejected. This ability to accept or reject these non genetic benefits means the intrinsic value of an agent’s autonomy is not damaged in this context. However it might be impossible for an agent to reject a genetic enhancement. It follows even if a particular genetic enhancement does not greatly damage the intrinsic value of someone’s autonomy the cumulative effect of many enhancements might. It might then be concluded Habernas is correct in his belief that the use of genetically enhancing technologies might involve the bondage of future people by present people.
In the light of the above discussion some might possibly conclude that genetic enhancement should not be permitted. I believe such a conclusion would be premature and that genetic enhancement should be permitted subject to safeguards. I argued above the way some parents attempt benefit their children might seem to partly determine their future. I further argued in practice such attempts do not damage these children’s autonomy because these benefits may be accepted or rejected. These benefits may be seen as gifts. It seems to me provided genetic enhancements can also be seen as gifts that these enhancements should be permitted. It follows Habernas’ belief may be wrong and that genetic enhancements do not bind future generations, provided these enhancements can be seen as a gift. However the idea of genetic enhancement as a gift must be explored a little further. It must be asked if a genetic enhancement is a gift to who is the gift intended. There seem to be two possible answers to this question.
1. The enhancement is a gift to those people who are enhanced.
2. The enhancement is a gift to future generations.

A gift it something the recipient can reject. You cannot force someone to accept a gift. It may of course be bad manners to reject a gift. Let it be assumed that some genetic enhancement is seen as a gift to future generations. It follows if a genetic enhancement is a gift then it must be possible to undo this enhancement for these future generations; even if the enhancement cannot be undone for particular individuals. I suggest in this context no genetic enhancement should be permitted until it is possible to undo this enhancement for future generations. Let it be assumed that some genetic enhancement is seen as a gift to those people who are enhanced. It follows the enhanced person must be able to see his genetic enhancement as a gift which he must be able to decide to use or not use. I suggest in this context any enhancements someone must use should not be permissible.

Cognition Enhancing Drugs

John Harris argues it would not be wrong to use cognition enhancing drugs such as Ritalin in order to obtain good grades in examinations (1). Prima facie it would appear the taking of such drugs, provided these drugs have no adverse side effects, would be an enhancement to the drug user as they appear to increase his cognitive abilities. It seems to me in practice the question as to whether it would be wrong to use cognition enhancing drugs in the context of examinations is not as straightforward as Harris believes. Let it be accepted that the use of cognition enhancing drugs to enhance someone’s cognition will allow him to obtain a better grade in an examination. I now want to question whether such an enhancement should be permissible.

Let it be accepted that an enhancement should not be permissible if it denies to others the goods they are rightfully entitled to. Does the fact that some candidate might improve his grade in an examination by the use of cognition enhancing drugs, whilst others do not take these drugs, potentially deny these others some goods they are entitled to? In order to answer this question we must first consider the purpose of an examination. This purpose is not simply to assess someone’s ability to pass an examination. The purpose of an examination might be defined as an attempt to assess someone’s proficiency in some subject which depends on his cognitive abilities in much the same way as a driving test tests someone’s proficiency to drive a car. An examination might be defined as a test of someone’s knowledge and cognitive abilities. The above definition still needs some further refinement. In an examination the attempt to assess someone’s proficiency takes place at time T. However the purpose of this assessment is not simply to gauge a candidate’s proficiency at time T. The purpose of an examination might be defined as an attempt to assess someone’s proficiency over an ongoing period of time. Examinations would clearly be pointless if candidates immediately lost all proficiency in the subject examined after the examination. Consider two candidates A and B taking some examination. Let it be assumed A takes cognition enhancing drugs in an attempt to improve his grade whilst B doesn’t. Let it be further assumed A is successful in obtaining a better grade in the examination than B and as a result obtains a better position than B. Let it be still further assumed that A’s stops taking the cognitive enhancing drugs after the examination and that his proficiency drops to below that of B. Prima facie it appears B has been deprived of some good he is entitled to. It follows that the possibility of using of cognition enhancing drugs in examinations might deny candidates who do not take these drugs the goods they are entitled to.

The above conclusion seems to depend on two factors. Firstly A’s use of cognition enhancing drugs in the examination does not enhance his proficiency in the subject examined in an ongoing way. Secondly his use similarly fails to enhance his cognitive abilities. Both these factors seem plausible. Taking aspirin after all only relieves pain for a limited period. Moreover it also seems reasonable to assume if someone stops taking cognitive enhancing drugs his cognitive abilities fall. If his abilities did not fall then it might be questioned whether the drugs concerned were really cognitive enhancing.

However even if both of these factors are true it does not automatically mean A’s use of cognition enhancing drugs denies B some goods he might be entitled to in all circumstances. Firstly A might continue to take cognition enhancing drugs after passing the examination. In these circumstances the fact he took these drugs in order to do well in the examination does deprive B of any goods he is rightfully entitled to. Furthermore provided someone’s continuing taking of these drugs has no long term adverse effects it again seems plausible A will continue to do so. After all some people after all continue to take a daily aspirin in order to reduce the possibility of heart attacks and strokes. It would seem in these circumstances the use of cognition enhancing drugs becomes a genuine enhancement and not one limited to the context of passing examinations. Secondly the taking of cognition enhancing drugs for a short period leads to cognition enhancement in the long term. I find this possibility unlikely. It follows that the use of cognition enhancing drugs in examinations ought to be permissible provided one or both of the two following conditions holds.

1. The short term use of cognition enhancing drugs by a candidate in an examination either increases his proficiency in the subject examined or his cognitive abilities in an ongoing way.
2.  Any candidate using cognition enhancing drugs in an examination must continue to use these drugs.

It might be objected that in practice the first condition is unlikely to hold. I accept this objection. It is also possible to object to my second condition. My objector might argue that it would seem to be impossible to ascertain whether someone would continue taking cognitive enhancing drugs after his examination. If someone fails to continue taking these drugs then the results of the examination will provide an inaccurate assessment of someone’s proficiency over an ongoing period of time. My objector might then conclude if cognition enhancing drugs are permitted in examinations that the value of examinations is devalued. However I would suggest that subject to the condition that the use of a cognition enhancing drug has no adverse side effects, it seems probable that anyone who benefits from this drug would continue to take it. To stop doing something which benefits someone and which does him no harm would seem to be illogical. It follows the second condition listed above should normally hold. It further follows Harris is correct to argue it should be permissible for someone to use cognition enhancing drugs in an examination provided those drugs benefit the users if taken in the long term and doing them no harm.

1. John Harris, 2007, Enhancing Evolution, Princeton University Press

Practical Rationality

In chapter 7 of “The Ethics of Care and Empathy” Slote questions whether the concept of practical rationality is a meaningful concept. In this posting I will deal directly with this question and will not comment on Slote’s arguments.
Hume famously argued that it is not contrary to reason to prefer an acknowledged lesser good to an acknowledged greater good (A Treatise of Human Nature, Oxford University Press, 1978, originally 1739-40, page 416). It is important to be clear that Hume is referring to practical reason and not referring to theoretical rationality. Theoretical rationality is concerned with the truth or falsity of a statement. Practical rationality roughly speaking is simply concerned with someone making decisions about what would make her life go well. If Hume’s statement is accepted it is hard to see why practical reason should even exist. This follows because by definition practical rationality exists to useful. If Hume is correct it is hard to see how any sort of rationality would be useful in helping agents make decisions about which course of action to follow. In this posting I will argue these difficulties fade away when practical rationality is not considered in isolation but is considered in connection with the concept of autonomy.
Lionesses often co-operate when hunting. They do this by forming an ambush to capture their prey. Such behaviour appears to be both practical and follow a rational course. Perhaps the behaviour of the lionesses is rational but any reasoning is unconscious and would appear to be non-reflective. Intuitively even if the lionesses’ behaviour is rational any reasoning involved does not appear to be an instance of practical rationality. This suggests practical rationality can only be applied by creatures capable of conscious reasoning. Let us consider a conscious robot, assuming such a thing is possible, consciously following a rational course of action. Would such a creature be using practical rationality? In science fiction robots are often thought as excellent examples of rational creatures because their thoughts are uncontaminated by emotions. However even in the vacuum of outer space practical reason does not exist in isolation. Psychologists usually define practical rationality as whatever kind of thinking best helps people to achieve their goals. It would seem practical reason can only be useful among creatures with conscious goals. It appears to follow the question as to whether a conscious robot can use practical reason depends on whether such a robot can have conscious goals. It might be further argued this depends on whether the conscious robot is autonomous. It seems to me most questions about the status of more advanced robots and computers should not be tackled by considering their rationality alone, but rather by considering whether such entities can ever be regarded as autonomous.
Autonomy is often thought of as simply someone’s second-order capacity to reflect on her desires and to accept or change these desires in the light of her goals and values (Dworkin (1988) The Theory and Practice of Autonomy, Cambridge University Press, page 20). Such a simple definition concurs with our intuitions. The trouble with such an intuitive definition is that there seems to be very little to differentiate autonomy, so defined, from an individual’s capacity for practical reason. Practical reason might be defined as autonomy lite. Moreover an autonomous action might be simply defined as the product of extra careful practical reasoning. It would appear if the above simple definition of autonomy is adopted the question as to whether a conscious robot is capable of using practical reason cannot be dependent on whether the robot in question is autonomous. This appearance depends on the conclusion that it is impossible to differentiate between autonomy and practical reason in a meaningful way. I suggested above that intuitively an autonomous agent must reflect on her decisions. I would also suggest that intuitively an autonomous agent must identify in some way with her decisions. If it is accepted that an autonomous agent must identify with her decisions then it might be possible to differentiate between autonomy and practical reason. What is meant by an agent identifying with her decisions? The fact that an agent reflects long and hard about a decision alone does not guarantee she identifies with her decision. Indeed the fact an agent thinks long and hard about her decision may be a sign that she is unable to identify with her decision. It would seem to be hard for an agent to identify herself with any decision she doesn’t care about at all. In such circumstances the agent might as well make a random choice. It can be concluded if an agent identifies with her decision then she must care about her decision.
It is important to be clear about what is meant by “caring about a decision” in the context of an agent identifying with her decision. The fact an agent cares a great deal about some decision she faces does not mean she identifies with the actual decision she makes. For instance a young woman may have both academic abilities and tennis prowess. Furthermore she may be faced with a decision about which of these two capacities she should develop. She may care a great deal about this decision but still be unable to make a clear cut choice. Let it be accepted without argument a clear cut choice is one the agent identifies with. If the above is accepted then caring about a decision means an agent makes a choice she identifies with and cares about. The question now naturally arises what is meant by a choice one cares about? I concur with Frankfurt (1988, The Importance of What We Care About, page 83) in believing that in this context “caring about a choice” means someone becomes vulnerable to the losses and susceptible to the benefits dependent on whether her choice is diminished or enhanced. Let it be assumed in the above example the young women chooses to concentrate on her tennis career. Let it be further assumed our potential tennis star will be pleased if she is successful in her career and her choice is accepted by those close to her. Furthermore she will be hurt if her career is unsuccessful and her choice is not accepted. Let it be still further assumed our potential star also takes pleasure her academic abilities and if she decides to follow a tennis career then she will feel damaged by being unable to develop these abilities in a way that would satisfy her. In these circumstances it must be questioned if our potential star can fully identify with her decision to concentrate on her tennis career. It seems to follow our potential star can only identify with her decision to follow a tennis career provided she cares more about this career than her academic aspirations. Accepting the above leads to the conclusion that if an agent is to identify with something she must care about it more than something else it conflicts with. A further question now arises, how do we know an agent clearly cares about something in preference to another thing she also cares about? It might be argued if someone chooses X in preference to Y and is satisfied with her decision and exhibits no restlessness to change her decision, then she can be said to have made a choice she as to whether robots might care about or love and the consequences of their so doing are not purely an intellectual exercise. These ideas care about. It follows if our potential tennis star is satisfied with her decision and shows no restlessness to change this decision that she clearly cares about her tennis career and identifies with her choice. Near the beginning of this posting I suggested the answer to the question as to whether a conscious robot can use practical reason depends on whether such a robot is autonomous. In the light of the above discussion the question as to whether a robot is autonomous depends on whether a robot can care about or love. This question was explored in a light-hearted way in Spielberg’s 2001film AI.
It seems possible for a non-autonomous mother to go out binge drinking, which she doesn’t care about, in preference to caring for her child which she loves a great deal. Such a decision has nothing to do with practical rationality as without goals and values the agent cares about practical rationality can serve no useful purpose. It follows a non-autonomous agent may indeed choose something she cares about a very little in preference to something she greatly cares for. Intuitively such a decision appears to be an incompetent decision, however in the light of the previous discussion the reason why such a decision appears to be incompetent is not simply because it is irrational but rather because it is non-autonomous. Accepting the above means it can be concluded it is impossible for an autonomous agent to prefer a good she acknowledges is a lesser good rather than a good she acknowledges is greater. To understand this conclusion, consider an autonomous agent choosing between two conflicting options she cares about. If this agent could choose an option she cares about less rather than an option she cared about more then because she is autonomous it would imply she could choose this option without any restlessness to change her decision. Such a situation seems to be inconceivable. I have argued practical rationality is of no use to non-autonomous agents. This does not mean practical does not exist or is of no use to any agents. At the beginning of my posting I suggested if Hume’s statement is accepted it is hard to see why practical reason should even exist. It seems such a suggestion is baseless when considered in conjunction with autonomous agents. When considered in conjunction with autonomy practical rationality is useful in helping agents make decisions about which course of action to follow in order to achieve their goals.

Caring, Empathy and Love

Michael Slote argues we must choose between care ethics and traditional liberalism’s ideas of autonomy. He argues liberal Kantian autonomy requires critical vigilance. This he believes would mean someone would have to continually critically assess all his emotions and relationships including those with his parents and children. He further argues this continual critical vigilance would destroy love. Because of this fact he argues we should develop responsive vigilance. Slote quotes William’s example of a man deciding which of two drowning people he should save, when one of these people is his wife, as intuitively suggesting there is something wrong with continual critical assessment. I agree with Slote continual critical assessment destroys love. However I do not agree because of this we must choose care ethics over traditional liberalism.

Slote seems to be arguing that because of problems associated with loving we should adopt a more restricted basis for respecting autonomy.

“I believe that the more restricted of autonomy, and respect for autonomy that care ethics can articulate and defend represent a more ethically adequate picture of what is all about than anything we find in the mainstream tradition of liberal moral and political philosophy.”(1)

I want to raise two objections to the above. Firstly it is no means clear to me that any caring ethic based solely on empathy would give a lower priority to respecting autonomy and secondly not all ideas of liberal autonomy are based on continual critical assessment.

At this point it is useful to define two sorts of care ethics. Firstly there is care ethics in general in which care depends on empathy, sympathy and places emphasis on people’s relationships. I will refer to this as care ethic (G). Secondly a care ethic may be based solely on empathy as advocated by Slote. I will refer to this as care ethic (E). I have argued in a previous posting a care ethic based solely on empathy would seem to value autonomy over beneficence. I will not pursue this point however it is not all obvious why care ethic (E) should give a lower priority to respecting autonomy than traditional liberal approaches to autonomy.

Let it be accepted that care ethic (G) does give a lower priority to respecting autonomy than Kantian approaches to autonomy. However it only follows, one must choose between giving a high priority to respecting autonomy or a lower priority to respecting autonomy whilst placing greater emphasis on caring (G), if the above are the only two possible concepts of autonomy. Slote argues for a caring ethic based on sentimentalism. It is also possible to give an account of autonomy based on what people care about. Furthermore such an account seems able to account for love or even be love based. According to Harrt Frankfurt,

“The will can only be one that incorporates what Kant calls a ‘pure’ will. … Now this pure will is a very peculiar and unlikely place in which to locate an indispensable condition of individual autonomy. After all its purity consists precisely in the fact that it is wholly untouched by any of the personal features that make people distinctive and charecterize their specific identities” (2)

Autonomy according to Frankfurt involves reflection but it is primarily based on what the agent cares about.

“The formation of a person’s will is most fundamentally a matter of his coming to care about certain things, and of his coming to care about some of them more than others.” (3)

It is important to note Frankfurt’s ideas of “caring about” or love are volitional rather than simple emotions and hence are not identical to Slote’s and other care ethicists ideas of caring. However, subject to above proviso, Frankfurt’s ideas on autonomy can account for love. It seems Frankfurt’s account of autonomy explains why a man can automatically save his wife from drowning, as opposed to a stranger, without any need for critical reflection. It follows Slote is wrong to suggest only a care based ethic account of autonomy can make room for love. It further follows a more restricted concept of autonomy and respect for autonomy are not needed to account for love.

1. Michael Slote, 2007The Ethics of Caring and Empathy, Routledge.
2. Harry Frankfurt, 1999, Necessity, Volition, and Love, Cambridge University Press.)
3. Harry Frankfurt, 1988, The Importance of What We Care About, Cambridge University Press.

The Ethics of Care and Empathy.

The differences between men and women’s attitudes to morality are spelled out by Carol Gilligan and in greater detail by Nel Noddings. These philosophers set out a feminist morality based on caring about the feelings of others and relationships between people. Slote attempts to base morality simply on empathy and is not directly with concerned with relationships. Slote defines a wrong action as follows on page 31.

“Actions are wrong if, and only if, they reflect or exhibit or express a deficiency of a caring motivation, one can claim that actions are morally wrong and contrary to moral obligation if, and only if, they reflect or exhibit or express an absence (or lack) of a fully developed empathic concern for (caring about) others on behalf of the agent.”

In practice this means we have a greater moral obligation to those close to us rather than strangers. Slote argues this definition accounts for our moral intuitions. I want now to look at possible problems with this partialistic account of morality. Because of this partiality I will question the extent of the domain of a care ethic based on empathy.

In chapter 5 on page Slote states it is possible that “In the sphere of morality women are basically superior to men” and on page 73 he thinks it is possible that
“Women can mind being held more accountable for their actions than men”.

These statements I believe point to problems with the domain of a care ethic based on empathy. I accept in general it is possible that women act more altruistically than men. However accepting this does not mean accepting that women act more morally than men. Surely the purpose of morality is to set standards of behaviour that the majority of people can accept and observe. In order to hold a driving licence someone must reach a certain standard of driving assessed by her passing a driving test, any extra driving capabilities are unimportant when assessing her competence to drive. It might then be argued by analogy the same holds true for moral competence.
It might be objected that my argument by analogy is true in most cases but not in hard cases. Consider the case of Ms B [2002, All ER 449] who was a tetraplegic patient who was kept alive by a ventilator and who decided she wished to have the ventilator switched off. Ms B had not consented to being placed on this machine. Whether Ms B desire to have her ventilator switched off should be respected or ventilation continued because ventilation seems to be in Ms B’s best interests is intuitively a moral question. It might then be argued in most cases women do not act more morally than men but that in hard cases such as this women are morally superior to men. If this argument is accepted then perhaps some form of Maternalism would have to be accepted. I believe this objection fails because in some hard cases it is also hard to see how empathic caring can be usefully applied.
Atkins (2000) in the Journal of applied philosophy 17(1)) uses Nagel’s classic paper on what it is like to be a bat to argue that because of the subjectivity of experience it is impossible for us to understand what it is like to be a patient in circumstances such as those of Ms B. I believe it follows in such cases it is not fully possible for agents to exhibit a fully developed empathic concern for others. Slote himself discusses how we could have empathy for an extraterrestrial on pages 125, 6. We can of course be sympathetic, as were Ms B’s care team, but sympathy unlike empathic caring can lead to paternalism or maternalism. I believe if we accept Slote’s attempt to base morality simply on empathy that the domain of morality is defined by the circumstances in which a moral agent can exhibit or express a fully developed empathic concern for others.
I have suggested any system of morality must be one in which the vast majority of the population, to which it applies, can act in a moral manner. It follows if we accept Slote’s idea of morality the domain of morality is defined by the degree of the population can develop an empathic concern for others. It further follows that because we might be unable to develop for others such as Ms B that such cases are outside the domain of morality. It is easy to think of other examples such as that of abortion or stem cell research in which our empathy seems partial. I would argue we can only have empathic caring for the potential mother, in first example and the recipients of any treatment developed using stem cells in the latter. Intuitively these examples seem to examples of moral decisions. However our intuitions may be wrong and the domain of morality restricted to those areas in which most people can exhibit at least a partially developed empathic concern for others. Accepting these ideas about the domain of morality would have important consequences for bioethics. It might be argued many of the questions bioethics is concerned with lie outside the remit of morality. I personally believe cases such as Ms B do lie outside the remit of morality. In such cases I believe clinicians should only be concerned with two questions. Firstly is the patient non-autonomous? Secondly even if the patient is non-autonomous is there a generally agreed best option for this patient? In all circumstances when the answer to these questions is no the patient’s decision should always be accepted. Medical issues such as confidentiality, truthfulness and the scope of medicine are still important but it seems to these are general philosophical questions rather than specialist bioethical ones. Noddings believes a feminist (empathic caring) ethic is an incomplete of morality. If she is right it might then be argued hard cases such as Ms B are indeed moral cases but that a different account of morality must be employed.
The following question arises. What sort of empathic caring is possible for most people? Slote talks about emphatic “caring about” in the definition quoted above. Frankfurt in “The importance of what we care about” (1988) argues if someone cares about something the following holds

“He identifies himself with what he cares about in the sense that he makes himself vulnerable to losses and susceptible to benefits depending upon whether what he cares about is diminished or enhanced.”

Identification, so defined, seems to be a necessary condition for empathic caring. If I am not vulnerable to the feelings of others I am incapable of empathic caring. I may still be capable of sympathy. In order for be to be vulnerable to others the carer must understand what would enhance or diminish what the others care about or love. Slote would probably disagree with this. However it seems to me that Slote must accept that empathic caring requires a carer to be vulnerable to that which diminishes or enhances the emotions of others. This seems only to be possible with a person who shares a lifestyle or part of a lifestyle with someone. It would be difficult to imagine what would enhance or diminish what Ms B cares about because of the subjectivity of experience. It further follows we must accept certain cases that are intuitively moral cases are outside a caring ethic.
However if we accept Frankfurt’s condition for caring does form a basis for empathic caring it can help deal with certain supposed bias’s in Slote’s attempt to base morality on empathy. It might be argued even if women are not more moral than men that because this is a partialistic account they may favour other women in preference to men, men might do likewise. The same might apply to race or religion. However if we accept the above conditions this partiality is caused by our finding it easier to understand. What enhances or diminishes our empathic feelings about someone is whether this person is close to us rather than racism or sexism. Many women may indeed find it easier to understand what enhances or diminishes other women but others may find it easier to understand what enhances or diminishes their partner. Similarly some may understand what enhances or diminishes the things colleague cares about of a different race rather than a non-colleague of the same race. See Slote’s account on page 36.