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DIFFICULT CHOICES / Vol. 74, No. 1 (Spring 2007)

Arien Mack, Editor

A difficult choice is a choice that is hard because of its inherent content -whether or not to permit euthanasia, for example. It is a choice that often involves choosing between alternatives, either of which results in sacrificing something one believes in. It is an issue in which the authors discuss difficult choices and try not to spell out why they are difficult and how such choices might be made. Some of the papers look at a particular difficult choice, like organ allocation or humanitarian intervention, while others deal with more general issues and help to shed light more generally on the nature of difficult choices.

In this essay, the author deals with two issues--constitution-making and constitutional interpretation. His basic suggestion is that people can often agree on constitutional practices, and even on constitutional rights, when they cannot agree on constitutional theories. He asserts that well-functioning constitutional orders try to solve problems through incompletely theorized agreements. The author concludes that incompletely theorized agreements help illuminate an enduring constitutional and indeed social puzzle: how members of diverse societies can work together on terms of mutual respect amid sharp disagreements about both the right and the good.

In this essay, the author explores the concept of identity disregard according to Amartya Sen. According to the author, some groups are defined by the value commitments their members support. He asserts that an agent who belongs to such a group has an identity that supports fairly substantive value commitments. He doubts that it is true in the case of embracing a Muslim identity anymore than it is in the case of adopting a Jewish identity. In addition, the author observes that identifying with a group is neither necessary nor sufficient for having such value commitments.

In this article, the author explores what makes choices difficult above and beyond the difficulty of expected-value calculation. The author considers a choice difficult to the extent that it poses a special, non calculative challenge to the choosing agent, either in virtue of certain characteristics of the choice itself or of the agent facing it. She argues that from the point of view of the psychologist, the description of the behavior of Israeli Prime Minister Ehud Olmert clearly indicates that the choice to appoint a state commission of inquiry was to the prime minister more difficult than the choice to go to war.

This article discusses the practice of battlefield euthanasia during Hurricane Katrina in 2005. The author argues that circumstances that may be unheard of in civilian medical care are tragically more familiar in military medicine. He shows that conditions arising on the battlefield can mirror conditions that could have arisen during Katrina. Building on that discussion, the author develops and defends a professional standard for assessing the conduct of health care professionals who are, in this way, in extremis.

In this essay, the author attempts to defend a complete account of the morality of organ allocation in conditions of scarcity. But the author defends one criterion or the relevance of one consideration--liability to attack in war. According to the author, if he is right that this consideration is significant and ought to have a role in decisions about allocation, then at least some of the views presented are unacceptable. He argues that an understanding of the justification for self-defense has no plausibility outside the context of war.

The article addresses some issues concerning the prioritization of health care resources and rationing in the US According to the author, several comments will help to clarify this conception of rationing. First, at the patient care level, rationing of limited healthcare resources more commonly takes the form of failure to offer benefits. Second, much rationing goes unnoticed by physicians as well because they merely understand it as good clinical care. He also explains that rationing can take place at different levels in the healthcare system, and be more or less direct.

The article discusses the phenomenology of torture. It is divided into three sections. The first discusses why the author finds the issue of torture both compelling and yet intellectually and morally perplexing. The second section is built around his belief that the word torture tends basically to be a placeholder. The last section takes a considerably different tack, and it may be in tension with the thrust of the second section and its emphasis on specificity and concrete acts. The author wants to raise the possibility that torture is less about concrete acts than about the creation of a phenomenological reality of total control.

This essay attempts to understand decisions about humanitarian intervention from the narrow perspective of looking at the proximate considerations attendant to the intervention itself. The author focuses on the priority of ground-level implementation and the recognition of the integral relationship between military action and reconstruction. He argues that since what is confronted on the ground will be determinative, it is important to see if the decisions from above can be better connected to the realities. In addition, the author asserts that it should be painfully obvious that the prospect of humanitarian intervention engages all sorts of competing factors, principles, interests, and motivations.

The article looks at the conditions of humanitarians who live under difficult circumstances. The author begins with two of the many possible personal stories she could cite to raise one difficult choice that frequently confronts international humanitarian agencies. The author argues that the decision of whether to enter, or stay, in compromised and compromising political and military settings is one that must regularly be faced.

This essay explains the concept of a choiceless choice in whistle-blower narratives. The author seeks to understand the whistle-blower, one who speaks out against illegal or unethical practices in the organization where he or she works. Because the author spent most of his time listening to whistle-blowers talk with each other, the essay is a narrative analysis: an account of the structure of stories of whistle-blowers. He argues that the concept is as close as many whistle-blowers get to evaluating their own narratives.


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