In Risk and Luck in Medical Ethics Donna Dickenson explains in brilliant fashion the tension between ethics and luck, be it luck in outcomes of action on the one hand or luck in antecedent circumstances, in the problems that have to be faced, or character on the other. According to Dickenson, most of the philosophical debate so far has focused on how luck in outcomes affects agents’ ability to act as morally responsible people. But Dickenson thinks it is equally important to discuss how to modify one’s own luck through character development and environmental changes.

Throughout her lively inquiry, packed with interesting real life case studies, Dickenson requires her readers to consider philosophers’ desire “to minimize the effects of chance on moral character and the rightness of ethical choices” (p 2), a desire so intense that it led Kant to proclaim that even if the good will was “…wholly lacking in power to accomplish its purposes … it would [still] sparkle like a jewel in its own right, as something that had full worth in itself” (p 2). Philosophers want to believe that human beings control their own destiny. Yet they fear that nothing is really in their own control, and that the foundation of morality—autonomy, choice, freedom—is illusory.

Dickenson claims that we can both acknowledge the role luck and risk play in our lives and maintain a robust Kantian sense of self (free, autonomous, and, above all, morally responsible) if we properly limit that for (Dickenson’s emphasis) which we are responsible (p 19). Moral agents are not responsible for all the outcomes of their actions, but only for some. Similarly, moral agents are not responsible for the way they initially find themselves in the world; but they are responsible …