The authors submit an ethical theory which rejects categorical conceptions of right and wrong, and adopts a scaled view of rightness, believing that it can depolarise the debate over the use of human embryonic stem cells (hESC) in medical research. I will argue that their proposal is unsuccessful.

They argue that binary ethics must be forgone in preference of a non- binary understanding of rightness and wrongness: pro and contra reasons cannot be reduced to a binary moral conclusion, and a single pro or contra reason should ever rule out acts which go against it (and vice versa). If it were otherwise, an illegitimate "deontic leap" is made, and a binary conclusion (e.g. action X is right/wrong) is forced. Below I offer one major reason why this theory cannot do what the authors claim it can.

Crucially, "right" and "wrong" remain (apparently) undefined, though they are essential to the debate. Those who oppose to the use of hESC often assume that embryocide is murder--a belief not easily trumped even by the forceful argument of medical research.1 So, if the means to an end are seen as absolutely wrong, the "non-binary" analysis will mean nothing to those whose ethic includes deontological considerations such as "do not kill".

The authors do not seem to recognise this. Hence, they imply that "right" and "wrong" are synonyms of "pro" and "con" respectively; they assume a quantitative view of ethics. Thus, they reveal that their ethic is utilitarian. Regardless of whether utilitarianism is valid or not, it is na?ve to think that it could resolve a debate so bound up in religion and politics.2 Simply, it is a different ethical language to that of some of the major voices in the debate.

Espinoza and Peterson's non-binary ethical theory falls short of its promise to depolarise the ethical debate. Its utilitarian design sidesteps other ethical considerations in order to redefine the terms of the debate, making it unconvincing to many.

1. Meilaender, G. 2013. Bioethics: A Primer for Christians. Cambridge: Eerdmans 2. Green, R. M. 2008. "Embryo as epiphenomenon: some cultural, social and economic forces driving the stem cell debate". Journal of Medical Ethics, 34, pp 840-844.

Conflict of Interest:

None declared

I look to clarify and reinforce my criticisms of the Moorean defence by Curtis and Vehmas of their proposition that all humans have an equal moral status that is higher than that of all non-human animals. In particular, I point to the relative scope for inventive new arguments against that proposition, and suggest that what misgivings we have about rejecting it are inadequate to make that type of strategy appropriate.

Introduction

In 'Having hands and moral status', I made two principal claims about Curtis and Vehmas' Moorean defence of the following proposition:¹

H>A: Humans have an equal moral status that is higher than the moral status of non-human animals.

The "basic idea" of their Moorean strategy "is that our confidence in the truth of this proposition is greater than our confidence in the propositions that make up those philosophical views that entail that it is false, and that this is sufficient to justify rejecting those views and to continue to believe H>A."³ In other words, any deductive argument for a contrary proposition is really "no more than an invitation to compare plausibility:"⁴ if it is more plausible that a premise of that argument is false than that its conclusion is true, then "we should not be moved by the argument".¹

My first claim was that although their strategy is logically valid, "it is not powerful." My second, which I labelled "[m]y own view", was that "resort to the argument the authors make reflects too great a pessimism about the class of accounts which are unresponsive to PIDs", or profound intellectual disabilities. In a short rejoinder, Curtis and Vehmas explain why they believe I fail to establish those two claims. Since the authors misunderstand the points of both of them -- and given the significance of the issues our papers cover -- I look to clarify and reinforce those criticisms here.

Valid, but not powerful

Arguments 'for' propositions

The first sense in which the Moorean strategy is "weak"³-- a word I never use -- is general to any issue to which it is applied. This is that "it does not give one any stronger reason than one had" to believe in the proposition defended: "all it does is point out that one's confidence in that position is a reason not to believe in others."¹ In that particular sense, it is not an argument for H>A or for an external world: what disagreement we have about that label is in principle purely semantic.

Curtis and Vehmas also note -- and read a great deal into -- my aside about ghosts: that a conviction in their reality is a reason to doubt attempts to explain them away, but not a reflexive reason to believe in them more. The comment was not a reductio of their argument, not least because I disagree with their assumption that using the Moorean strategy to defend one's ghostly beliefs against empirical attacks "is obviously not something that one would be justified in doing".³ Rather, my point was precisely that a Moorean argument which plays on how strongly you disbelieve a conclusion does not, as I use the label, count as an argument for your disbelief: "[h]aving confidence in the existence of ghosts is a pro tanto reason not to put stock by attempts to explain away ghostly appearances with optics or psychology, but it is not a reflexive reason to be confident in the existence of ghosts."¹

Out of the sceptical context

The more important sense in which the Moorean strategy is "weak" is specific to its application to the issue of moral status. In my reply to Curtis and Vehmas' paper, I wrote that:

Moore's original argument from his confidence he has hands to the existence of external things is unusually powerful because the sceptical arguments he opposes tend not to offer reasons to be confident about any alternatives: rather than suggesting just that we do not have hands, scepticism challenges our reasons to be confident about any of the possibilities; there need not be a change to the order of the options we have confidence about.

The case of moral status is fundamentally different. Each plausible argument for an account which conflicts with all and only humans having full moral status is potentially capable of tipping the balance against that proposition. Such arguments are not sceptical reasons to doubt our confidence in everything: they advance opposition to the defended account relative to it.¹

The authors assert that I misconstrue Moore's argument, which, on the "common interpretation" which they ascribe to Lycan, "is not from [Moore's] confidence that he has hands to the existence of external things, but from his confidence that he knows he has hands to that he knows that external things exist".³ Lycan actually attributes both versions to Moore, with Curtis and Vehmas' reading being a development of what Moore first intended which makes "a rubber arrow" of an objection to any role played by common sense.⁴ Moreover, my claim that "[t]he case of moral status is fundamentally different"¹ remains importantly true regardless of to which level the shared schema is applied.

A typical sceptical argument asks us to imagine that we are, for example, brains in vats, fed artificial neural signals which generate a convincing illusion of reality. It then invites us to note that we cannot rule this possibility out, since all of our perceptual experiences would be as they are in actuality; deduces that we cannot know that this possibility is not actual; and concludes that, since we would not have hands were we brains in vats, we do not meet the standard for knowledge of whether we do have hands.

The Moorean insight is that if it is more plausible that we know that we have hands than that it is possible that we are brains in vats, then the sceptical argument need not be threatening: rather than accepting its conclusion, we ought to -- or at least are free to -- deny that it is possible that we are brains in vats. What makes Moore's anti-sceptical position exceptionally secure, or his defensive strategy "unusually powerful",¹ is how difficult it is to make it more credible that a sceptical possibility could be real: that we could be brains in vats or be plugged into the Matrix, or be duped by Cartesian demons or locked in vivid dreams.

That security is not transferrable to questions of moral status. As a project, sophisticated opposition to H>A is still relatively immature. There is plausibly plenty of scope for inventive new arguments for positions with which H>A conflicts, whether drawing on unconsidered intuitions, metaethical innovations, zoological discoveries, or studies of psychological biases. Curtis and Vehmas note in their original paper how the best-known objections to H>A are "based upon a set of theoretical claims, such as the claim that moral status can depend only upon the possession of intrinsic properties," and that new arguments which drew on empirical facts would be "of an entirely different sort than those usually offered".² The point is that there is ample latitude for such arguments to be developed or publicised, whereas the same is not nearly so plainly true of sceptical opposition to Moorean dogmatism. In this sense, the authors' deployment of the strategy is importantly different and significantly less enduringly effective.

Reflecting too great a pessimism

Denying H>A

Recall that my original second claim was that "resort to the argument the authors make reflects too great a pessimism about the class of accounts which are unresponsive to PIDs."¹ The Moorean strategy is one to adopt when none of the positions we can positively defend are anything but barely appealing: when the arguments for them are so uncompelling that we feel free to assume their conclusions are false. With this in mind, I used the final paragraph of my discussion to outline an account on which a being's moral status is proportionate to the "magnitude" of their interests, or more roughly to their capacity for satisfactions and dissatisfactions. Non-human animals -- or at least those of which we know, and then as far as we know them -- plausibly do have a smaller scope of interests than we as humans do.

That account is "unresponsive to PIDs" in the sense that it does not make any person's moral status directly dependent on their cognitive capacities: that is, to borrow from Curtis and Vehmas, "those capacities to do with conceptual abilities, understanding, problem solving and rational decision-making."² Instead, the entitlements, rights, or distributive heft of a person depend entirely and exclusively on their capacities for joys, disappointments, excitements and distresses: if PIDs are relevant to moral status, it is via those amplitudes only.

In their restatement of my claim, Curtis and Vehmas replace "the class of accounts which are unresponsive to PIDs" with "the accounts available that purport to justify H>A", then finding my comments "puzzling" because on my proposal H>A is false.³ The conclusion they should instead have drawn is that I do not think an account needs to vindicate H>A to be compelling enough to make a struthious Moorean strategy inappropriate; it is in that sense that falling back on the strategy "reflects too great a pessimism".¹ In particular, I do not think that accounts which satisfy H>A are unique in respecting what we find most troubling about the traditional criteria for moral status, nor that H>A is robust and self-evident enough to be aptly labelled "common sense".²

What is troubling about those accounts of moral status which follow the liberal Lockean tradition -- making one's status contingent on autonomy, agency, or cognitive capacities -- is not in itself that they are sensitive to real differences within and across species, but rather that they fixate on distinctions which ought not at all to matter. Lacking cognitive capacities does not make a person any less inherently and importantly valuable and dignified: it does not justify inequalities of moral consideration. As Alastair Norcross put it, the fact that beings "can't be moral agents doesn't seem to be relevant to their status as moral patients: moral status "is not some kind of reward for moral agency."⁵ We agree, I think, in opposing "the view that such intrinsic psychological capacities as rationality and autonomy are requisites for claims of justice, a good quality of life, and the moral consideration of personhood",⁶ but we part soon after there.

If one human is ever entitled to less than another, it ought to be because they have less use or need for what is at stake: that they lack some latitude to be satisfied or dissatisfied. That latitude, or that magnitude of interests, plausibly does matter to our dues or to our heft in distributive algorithms, and it plausibly is what creates moral gradations amongst known sentient beings.^{7, 8} It is not that we are innately unequal as beings or as humans, but rather that our interests are:⁹ that "a mayfly imago which needs not even feed will also not be fearing homophobia or pondering the frustration of its childhood dreams."¹ Provided we keep this distinction in mind, H>A might if anything seem implausible in principle; short of that, it does not just seem "common sense".

Non-human animals

Curtis and Vehmas draw attention, however, to the account's implications for those humans and non-humans who share their sentient capacities for joys and disappointments.^{2, 3} Suppose, to take their example, that equality is true of humans with PIDs and dogs, and that we begin with the credible assumption that the moral status of a humans with PIDs exceeds -- perhaps significantly -- that of a dog. The standard argument is that we then face a trilemma: either acknowledge that dogs have greater moral status than we thought, being equal to that of humans with PIDs; accept instead that the status of humans with PIDs is lesser than assumed, being equal to that of dogs; or endorse, after all, something similar to H>A, and here defend it with a Moorean shift. I have, like many, no attraction to the second option. I will close this paper by both suggesting that the first is favourable to third and attempting to undermine any concerns.

Many of our thoughts about the moral status of animals relative to humans with PIDs may, firstly, stem simply from a lack of knowledge of what most humans with PIDs are like. Eva Kittay, for example, describes her own daughter -- "diagnosed as having severe to profound retardation" -- as "enormously responsive, forming deep personal relationships with her family ... and friendly relations with her therapists and teachers," and with a discerning taste for "especially but not exclusively classical symphonic music".¹⁰ Kittay's daughter is not comparable to any non-human animal as most of us understand them: if there is a dog which matches her for sentience, then that dog is truly exceptional. Our misgivings may not be about genuinely equal cases.

Secondly, we need to be clear that moral status need not even closely align with how a person should be treated: it is not a guide to whether we can "farm and eat the flesh" of people,² or an indication of how much we value them. We stand in relations to humans with PIDs which we rarely if ever do with any non-human animals: we care deeply about them and about our relationships with them, and the facts that they matter so much to us, that we identify with them, and that they may depend on us give us perfectly permissible reasons to treat them exceptionally well. It is a fallacy that two beings with equal moral status need to be treated the same, and we should consider how much this accounts for the extent to which we find the first option challenging.

Thirdly -- and finally -- recall the reasons I gave for thinking the Moorean strategy which Curtis and Vehmas proposed to be, albeit "valid", far from "powerful."¹ We must be incredibly careful not to see that strategy as permitting us to be more confident about the truth of H>A: despite the titles of both their papers, it is not an argument for that proposition in the most conventional evidential sense. If H>A was ungrounded before, it remains as ungrounded now: it is a dialectical last resort. I suggest that we have greater reason to adopt an alternative view than we do to maintain H>A in the face of foundational difficulties "that we do not know how to overcome";² H>A is, at least, nothing like our convictions that we really know that we have hands.

References

1. Roberts AJ. Having hands and moral status: a reply to Curtis and Vehmas. J Med Ethics 2016;42:265 doi:10.1136/medethics-2015-103355.

2. Curtis B, Vehmas S. A Moorean argument for the full moral status of those with profound intellectual disability. J Med Ethics 2016;42:41--5 doi:10.1136/medethics-2015-102938.

3. Curtis B, Vehmas S. The Moorean argument for the full moral status of those with profound intellectual disability: a rejoinder to Roberts. J Med Ethics 2016;42:266--7 doi:10.1136/medethics-2016-103437.

4. Lycan WG. Moore against the new skeptics. Philos Stud 2001;103:39+42 doi:10.1023/A:1010328721653.

5. Norcross A. Puppies, pigs, and people: eating meat and marginal cases. Philosophical Perspectives 2004;18:243 doi:10.1111/j.1520-8583.2004.00027.x.

6. Kittay EF. At the margins of moral personhood. Ethics 2005;116:100 doi:10.1086/454366.

7. Singer P. Speciesism and moral status. Metaphilosophy 2009;40:567-81 doi:10.1111/j.1467-9973.2009.01608.x.

8. DeGrazia D. Moral status as a matter of degree? South J Philos 2008;46:181-98 doi:10.1111/j.2041-6962.2008.tb00075.x.

9. DeGrazia D. Equal consideration and unequal moral status. South J Philos 1993;31:17-31 doi:10.1111/j.2041-6962.1993.tb00667.x.

10. Kittay EF. The personal is philosophical is political: a philosopher and mother of a cognitively disabled person sends notes from the battlefield. Metaphilosophy 2009;40:616 doi:10.1111/j.1467-9973.2009.01600.x.

orcid.org/0000-0002-7080-478X

Conflict of Interest:

None declared

Dr. Miller cites the "professional integrity of physicians" and the uncertainty of whether additional interventions will restore a patient's desire to live.

Does Dr. Miller's professional integrity include honesty, truthfulness, and sincerity when speaking to severely treatment-resistant patients? Particularly with respect to the efficacy of treatments that will provide rapid response and prolonged remission? Does that integrity extend to honestly communicating with these patients regarding scientific data on the likelihood, severity, and duration of relapse or recurrence?

Or is Dr. Miller referring to the integrity that embodies a physician's personal ethics, morality and righteousness? Given Dr. Miller's emphasis of the uncertainty about whether additional interventions with the patient can improve quality of life, it appears the physician's beliefs should trump the ability of informed patients to decide.

As Drs. Schuklenk and van de Vathorst stated, "if the pace of developments leading to therapeutic success in major depressive disorder is anything to go by, many people suffering from TRD would have reason to be sceptical about the odds of such a treatment regimen coming about within a timeframe that they would consider acceptable."

Patients suffering from treatment-resistant major depression have likely undergone extensive long-term professional psychiatric care. "Typically they would have tried a fairly significant number of antidepressants, psychotherapy, probably electroconvulsive therapy, and they would have experienced the failure of these varied therapeutic approaches."

Dr. Miller places considerable weight on the "uncertainty of whether additional interventions will restore a patient's desire to live." As Dr. Schuklenk points out, this argument unjustly ignores "the high burden that is paid by patients who happen to wait unsuccessfully for a successful treatment that may not come about at all or that may come about too late."

Drs. Schuklenk and van de Vathorst provided sound recommendations in their article. Dr. Miller appears to personally disagree.

Conflict of Interest:

None declared