Is it ethical for surgeons to use economic considerations when setting their fees? For example, is it ethical for a surgeon who is known to have better results for a certain operation to charge more than a surgeon who has worse results? Likewise is it ethical for a surgeon who has a scarce skill in a region to charge exorbitant fees for that skill simply because it would be unaffordable for most patients to travel to another region to attend another surgeon?

It may also matter what sort of operation we are talking about. If this is cosmetic surgery (beautifying belly buttons, say), then the service does seem quite similar to other commodities (face cream), and the reasons against the surgeon's charging what she will seem quite weak. As we move to the other end of the spectrum -- to operations that are a matter of life and death -- Peter Fosl's points become ever more compelling. Such operations should not be rationed on the basis of wealth: A medically important operation that is routinely available to the wealthy should also be available, in roughly the same quality, to the poor. Call this the medical equity principle (MEP). It does not follow from the MEP (here comes my second point) that it is unethical for the best surgeons to charge more. Societies that have organized themselves around the MEP need to have enough high-quality doctors to take care of the medical needs of all. To attract people into the profession of surgeon, and to entice them...

Is it ethical for a surgeon to perform an operation on his own mother? Especially when it may involve the finding of a cancer?

Doctors try to avoid such situations, and, I think, for good reason. They add extra stress to what is already a difficult task -- stress for the surgeon and also stress for the patient. Such extra stress, in turn, is likely to diminish the prospects for success. And a surgeon who performs a major operation on his mother may then be acting unethically by not giving his patient the best chances of a successful outcome. If so, he should step aside, even if his mother would prefer to be operated by him. But what if some surgeon is, and is known by his mother to be, especially cool and unemotional, thus adding no stress to the proceedings? Or what if he is much better than the other available surgeons so that his greater skill more than makes up for the extra stress? In such cases, I would think, there's nothing unethical about him doing the operation himself -- provided, of course, his mother agrees. So, as I see it, performing a surgical operation on a loved one is not unethical as such, it is...

If I for example went out in my car and somebody pulled up at a junction waiting for me, do you think his life would be different later on because of the wait at the junction, thus altering the time to get to his destination and also the chain reaction of other people delaying or speeding up their journies? In other words, is everything meant to be, like the order of the universe? (Note you could have missed an important event by answering or not answering this question.)

From what we know, the answer would seem to be yes. The effects of small events like the one you describe will reverberate through our modern traffic, trade, and communications systems and will have a slight impact on the schedules of many people (probably excepting only those who die shortly after your drive). In many case, this impact will suffice to affect the DNA of future persons, which depends on which one of any man's 20 million functional sperm cells (per ejaculation) will get a role in reproduction. As time goes on, you can be increasingly confident that, had you not taken your drive, none of the people who is in fact be born would have been born without it. A few years down the road, all newborn human beings, animals, etc., will owe their existence to your little outing. And these beings will be displacing a similar multitude of beings who would have been born then if you had not taken that drive.

My girlfriend likes to hang out with some people at our school who like to call themselves whores, sluts, and the like. They will sit around and say things like "Gee, you're such a slut! Don't give me that look, I'm just a whore as well!" They also don’t care when other people refer to them in the same manner. This kind of talk really bothers me; I find it insulting, demeaning, and distasteful. It has only been leveled at me once before I told them not to include me in it, and they have honored my request. The thing is, I just find it downright impolite, and it drives me crazy to hear them talk like that. It is not at all an accurate description of any of them, they just do it for the hell of it, I guess. Now, my question is, am I being too sensitive? It has nothing to do with me directly, but it still bothers me and makes me feel uncomfortable. I just do not see the need to be like that at all, it just seems pointless and demeaning. Do I have the right to feel so strongly about it and be hurt that my...

Such language is demeaning, as you say. It demeans women in general and members of that group in particular. It would be better if such words fell into disuse. When young women use such words in reference to themselves, it is important to understand why. Is it lack of self-respect? Is it preemptive (they feel that others refer to them in this way and want to show that they don't care)? Or something else? An effort to explore this question with your girlfriend may be preferable to simply asking her to stop. It's more respectful (less controlling) and also offers the prospect of overcoming the underlying problem rather than merely its most obvious symptom.

I have been reading Kant recently and have wondered what his stance would be on homosexuality, not in marriage, but just in general. It seems that he would say it is immoral because it goes against one's duty, since if everyone was homosexual, there would be no new babies. Can this be true? Is there something else in Kant's thinking that would contradict this?

Kant better not say this. If everyone remained childless, then there would be no new babies either. So, by the same token, Kant would be condemning his own decision to remain childless. A good way of showing how remaining childless can be seen as permissible on Kant's ground is to interpret the categorical imperative as asking whether one can will not the universal adoption , but rather the universal availability of one's maxim. In a world in which enough children are born by to those who want to have children, I can will my maxim of remaining childless to be universally available: Even if everyone who wants to adopt this maxim does so, humanity will still continue. Applying this interpretation of the categorical imperative to homosexuality, it turns out that homosexuality is likewise permissible. Even if I cannot will humankind to go extinct, I can will the universal availability of a homosexual life: There are enough heterosexuals who want to have children to propagate the human race...

Can there ever be a meaningful distinction in science between the "unknown" and the "unknowable"? I see no reason why science should not,in 100,000 years or so, unlock what now seem to be unknowable questions like the nature of a Prime Mover, if he exists, simply by accruing more and more knowledge of the universe. We know pretty much what happened a trillionth of a second after the Big Bang and we acquired this knowledge in about 100 years so why assume everything before that is unknowable? Surely the scientific method would insist that this is "presently unknown". Is it that metaphysics and the persistence of religious belief color our approach? Is "unknowable" even a valid term in philosophy, and, if so, what definitive, unassailable examples are there of it (which would also apply, say, 100,000 years from now)? Thanks in advance.

Let's begin by distinguishing two senses in which something might be said to be unknowable. In some cases something is said to be unknowable because it isn't the kind of thing about which, in principle, knowledge could be had. For example, do you know the minimum number of hairs a man must have on his head to escape being bald? Well, there is no such minimum number to be known or discovered, because the concept of baldness is too vague for this. Do you know what time of day it is now on the sun (Wittgenstein)? Would you be happier dead? Again, there's nothing to be known or discovered in these regards. Philosophers have said about such cases that "there is no fact of the matter." Let us set these cases aside, because they are not the ones that interest you. In the cases that interest you, there is a fact of the matter. And the claim is then either that it is impossible for us (human beings including all future generations) to know this fact or even, more dramatically, that it is in principle...

I've been thinking about how people generalize all the time when trying to figure out if something is moral. Let's say I enact some form of vigilante justice, like shooting some criminal at large whom I know will repeat heinous acts if unstopped. Naturally I would find myself on trial and would face some variation of the argument: so do you believe, then, that everyone should take the law into their own hands? It seems that this generalizing argument/question flows naturally from the demands of logic. But I think it's a perversion of thought and distortion of morality. Why would Justice be so limited a concept that it must bow in all instances to some simply statable, spiffy sounding, ostensibly proceeding from almighty logic claim like the generalizing one? I feel that I can answer "no" to this question without surrendering my belief that what I did was right. It shouldn't involve me in any contradiction (nor would it be a huge deal if it did) to claim: what I did was right, but I don't believe...

You are right that the generalizing argument you criticize is invalid. The claim that some particular act is permissible cannot be defeated merely by pointing out that this act falls under a more general type and that not all acts of this type are permissible. The argument involves two kinds of generalization. It generalizes from one particular agent (token) to a type of agent and it generalizes from one particular act (token) to a type of act. Yesterday, I encountered someone who ordered me to open my bag. I could have asked her many generalizing questions: Do you think that any middle-aged woman may give orders to others? Do you think that any New Yorker may go through other people's luggage? And so on. It's absurd to think that the answer to all such questions must be affirmative for her conduct to be permissible. This shows that, when challenged by a generalizing question, one always has at least two options. One can try to support an affirmative answer, or one can reject the...

In what sense is being put to death a punishment? How we can talk about things like "suffering" or "loss" if a person is dead (i.e., not conscious)?

It is true that, once a person has been executed, she is no longer around to suffer the loss of years she might otherwise have lived. But the point of an execution is not to punish the person after she's dead, but before. She is subjected to the experience of living on death row and later to the experience of being killed in the execution chamber; and she must expect all along that many things she cared for are less likely to thrive or to come to fruition. You might respond that this answer works only for people who know about their impending execution. What about someone who is killed painlessly in her sleep? Could this ever be construed as a punishment? We can give an affirmative answer if we think of punishment in a somewhat extended sense as the setting back of a person's interests. Suppose you have given offense to someone and, in order to punish you, he has been embezzling money from your account. Being an affluent entrepreneur, you never notice the losses (you rather take your business to...

It seems that most astronomers and theoretical physicists believe that time only began at the formation of the universe with the "big bang". Assuming that this is correct, is it possible for time to end (to no longer exist)? If so, what conditions would be necessary for this to occur? JW (Australia)

The easiest way to think of this may be in terms of some regular relation between time and the size of the universe. Expressing this regular relation as some mathematical formula, it may turn out that, going back from the present in accordance with this formula, we get to a past point of time at which the size of the universe is zero. We would have reason to postulate such a starting point as the origin of the universe if all we know about the universe supports or is at least consistent with our backward extrapolation. Big bang theorists believe that this is (by and large) the case. The same mathematical formula may be such that, going forward from the present, we get to a future point of time at which the size of the universe is zero once more. We would have reason to postulate such an end point of the universe if all we know about the universe supports or is at least consistent with our forward extrapolation. There are other conceivable end-of-time scenarios. The amount of stuff in the...

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