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
isnt 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

By MARGARET PABST BATTIN
Oxford University Press, 1994. vi + 306 pp. $39.95 cloth, $18.95 paper
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 dissectedin 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 Alzheimers 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 Battins 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 books most original and provocative essays,
The Eclipse of Altruism, Battin discusses the costs of medicines 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 Gilligans two voices, appear here for the first time.

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