Risk and Luck in Medical Ethics
January 2003, Polity
intrude. It has been said that 'While one can be lucky in one's business, in
one's married life, and in one's health, one cannot, so it is commonly
assumed, be subject to luck as far as one's moral worth is concerned.' But
although we do not normally hold people responsible for outcomes beyond
their control, a serious examination of the role of luck and risk may lead
us to conclude that very few outcomes are really within people's control.
This is the paradox of 'moral luck'.
Risk and Luck in Medical Ethics examines the 'moral luck'
paradox in greater
detail, relating it to Kantian, consequentialist, and virtue-based
approaches to ethics. Dickenson applies the paradoxes of risk and
luck to medical ethics, including timely discussion of risk and luck in the
allocation of scarce health care resources, informed consent to treatment,
decisions about withholding life-sustaining treatment, psychiatry,
reproductive ethics, genetic testing, and medical research and
The book concludes with an examination of the relevance of risk
and luck in
a medical context to the study of global ethics. If risk and luck are taken
seriously, it would seem to follow that we cannot develop any definite moral
standards at all, that we are doomed to moral relativism. However, Dickenson
offers strong counter-arguments to this view that enable us to think in
terms of universal standards for judging ethical systems. This claim has
direct practical relevance for practitioners as well as philosophers.
Chapter One: Ethics versus Luck.
The myriad forms of luck.
A preliminary typology of luck.
Outcome luck: further considerations.
Moral luck: how serious and genuine is the paradox?.
Judgement from hindsight: Gauguin and Anna Karenina.
Escaping from the paradox.
Chapter Two: The Fragility of Virtue and the Robust Health of Kantianism.
Moral luck and virtue.
The fragility of goodness.
Kantianism and moral luck.
Chapter Three Utilitarianism and Luck in Outcomes.
Remorse and regret.
Chapter Four: Risk and Consent.
The law of consent: prudent patient versus reasonable doctor.
Remorse, responsibility and consent.
Rationality and risk.
How much is the doctor responsible for?.
Chapter Five: Death and Dying.
Withdrawal of life-sustaining treatment and assisted suicide.
Chapter Six: Moral Luck and the Allocation of Health Care Resources.
The `micro level`.
Knowing our limits: ‘the macro level’.
Chapter Seven: Reproductive Ethics: What Risks Can Women Be Asked to Bear?.
Risk, contract and ‘surrogacy’.
Therapeutic and human cloning.
Chapter Eight Psychiatry and Risk.
Risk and dangerousness: luck in outcomes.
Luck in character.
Chapter Nine: Luck, genetics and moral character.
Are genes us?.
Genetics and luck in decisions to be faced.
Genetics and luck in antecedent circumstances.
Gauguin revisited: character, genetics and moral luck.
Chapter Ten Moral Luck and Global Ethics.
Towards justice and virtue: O’Neill’s account.
The final synthesis: global ethics and moral luck.
Donna Dickenson is Director of the Centre for the Study of Global Ethics, University of Birmingham
- examines the 'moral luck' paradox, relating it to Kantian,
consequentialist, and virtue-based approaches to ethics;
- applies the paradoxes of risk and luck to medical ethics,
including discussion of the allocation of scarce health care
resources, informed consent to treatment, psychiatry, reproductive
ethics, genetic testing and medical research;
- offers strong arguments that enable us to think in terms of
universal standards for judging ethical systems;
- has direct practical relevance for practitioners as well as
- concludes with an examination of the relevance of risk and luck in a medical context to the study of global ethics.
John R. Williams, The Heythop Journal
"Dickenson's book is truly groundbreaking. By viewing issues of
applied ethics through the unusual prism of moral luck, she throws
an unexpected light on familiar themes in medical ethics, and by
bringing the problem of moral luck into relatively unchartered
areas, she goes some way in rectifying the neglect into which this
important problem has fallen in recent years."
Stuart Rennie, Ethical Perspectives
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