allows these lies behind the intuition that the context-unspecified meaning says neither Yes nor No to some objects. (Compare vagueness to nonsense: jumbaceous jabberwocks. No local convention could entail that I am and am not a jumbaceous jabbenvock, and any such convention could assign ‘jumbaceous jabberwock‘ a meaning either including or excluding me. So when we hesitate to assert ‘I am a jumbaceous jabberwock or I am not’ while not hesitating to assert ‘Not (I am not a jumbaceous jabbenvock and I am)’, we are taking ‘p or/and q’ in the sense of ‘the immediate conventions governing this utterance determine that p or/and they determine that q (given the facts)’. But the disjunction and the negated conjunction are not then equivalent.) I mean these remarks to show, against Williamson, that an ignorance interpretation could countenance truth value gaps, and that alternative or more fundamental ignorance-based explanations of the appeal of the sorites are possible.

I obviously do not think this book is the last word on this old subject. It isn’t meant to be. In a way it is the first word on a new subject. It is the first worked out ignorance theory and opens up many thoughts about knowledge, exactness, and linguistic convention. Read it. THE UNIVERSITY OF BRISTOL ADAM MORTON

ETHICS

‘The Least Worst Death: Essays in Bioethics at the End OfLiji

Oxford University Press, 1994. vi + 306 pp. $39.95 cloth, $18.95 paper By MARGARET PABST BATTIN

Is there anything more that can be usefully said about ethical decisions at the end of life? Euthanasia, assisted suicide, withdrawal of life-sustaining treatment: these issues have been so exhaustively discussed and dissected- in courtrooms and classrooms, on hospital wards and the television news, by physicians and metaphysicians-that one is sorely tempted to say: I doubt it.

That judgement might be premature, however. For all the sound and fury, the issues certainly have not gone away. ‘The Least Worst Death is a collection of 15 essays written by Margaret Pabst Battin from 1977 to 1992, all of them on ethical decisions surrounding death. With the exception of the introduction, all of the essays have been previously published, most in prominent bioethics journals such as ‘The Hastings Center Report and ‘The Journal of Medicine and Philosophy. Given the way that the debate over these issues has evolved over the past 15 years, and the prominent intellectual role in that evolution that Battin has played, many of the issues discussed here will be well known to scholars in bioethics. Nonetheless, it is hard to imagine them discussed in a more lucid, clear-headed fashion. The familiar topics are all here-slippery slopes, living wills, the distribution of scarce resources, withdrawing and withholding treatment-as well as few relatively unfamiliar ones, such as euthanasia in Alzheimer’s Disease and the role of altruism in medicine. Philosophers who are well-rehearsed in the conceptual aspects of the debate

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over euthanasia and assisted suicide may be interested in Battin’s discussions of the political aspects of the debate, particularly as they have developed in Germany and the Netherlands.

If there is a unifying theme to these essays, it is autonomy, and philosophers who see end-of-life decisions as essentially matters of autonomous choice will find an ally in Battin. This emphasis on autonomy sometimes gives the essays a predictable slant. It is difficult, for example, to oppose the legalisation of euthanasia and assisted suicide on philosophical grounds if the battle lines are drawn along the question of choice. On the other hand, many opponents of legalised euthanasia will freely concede that in individual cases, respect for autonomy and considerations of mercy might well justify euthanasia. Their worry is about the institutional conditions that may make a euthanasia p o l i y open to abuse: understaffed hospitals, inequalities in access to health care, a medical system where doctor and patient are strangers, a method of medical education and training that breeds arrogance and encourages technical expertise over compassion. This is not at all to say that Battin ignores these kinds of questions (or, after the fashion of many philosophers, mentions them only to dismiss them as philosophically uninteresting). But she seems so convinced that respect for autonomy must prevail that one feels obliged to treat her discussions of opposing concerns with some scepticism.

For example, in one of the book‘s most original and provocative essays, ‘The Eclipse of Altruism’, Battin discusses the costs of medicine’s emphasis on primacy of patients’ interests over other moral concerns, pointing out the moral importance of choice and self-sacrifice. One of her consequent suggestions is to revise research guidelines to allow patients to volunteer for dangerous experiments, offering the example of a healthy, 6 1-year-old woman who volunteered for an artificial heart implantation. These revisions would take the choice to undergo risk out of the hands of Institutional Review Boards and place it in the hands of patients. This is the sort of policy that is easy to defend on an abstract, philosophical level, but which downplays the institutional and sociological realities that would make such a policy very dangerous: the power imbalances between physician-researchers and patients, the vulnerability of certain patient populations, the conflict of interest faced by a physician-researcher, who has the duty not only to take care of his patient but also to produce scientifically useful results, and the financial incentives that market capitalism provides for pharmaceutical companies and research institutions to enrol patients in research protocols. MCGILL UNIVERSITY CARL ELLIOTT

Moral Perception and Purticulari& By LAWRENCE A. BLUM Cambridge University Press, 1994. x + 274 pp. E35.00

This book consists of eleven chapters, nine of which were previously published in journals and anthologies. Only Chapter 1, an introduction, and Chapter 11, an essay on Carol Gilligan’s ‘two voices’, appear here for the first time.

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