What do you call a libertarian who doesn’t believe in rights?
John Harris.
What do you call a consequentialist who defends protection of individual rights of choice over coercively -achieved good outcomes?
John Harris.
Introduction
This essay is written to mark and celebrate the 40th anniversary of John Harris’s The Value of Life: An Introduction to Medical Ethics. Footnote 1 That book is a key work—one of so many—by one of the key figures in the establishment and development of the broad field of bioethics, the narrower field of philosophical bioethics, and a wide range of connected areas of education, research, practice, and policy.Footnote 2 Like its author, the book is something of an enigma. Despite its title, it is not actually about the value of life at all. It is about the value, and valuing, of particular forms of existing. Life is neither a necessary nor a sufficient component of the forms of existing that motivate or underpin Harris’s arguments.Footnote 3 Despite its subtitle, furthermore, it is less an introduction to medical ethics and more a series of moral provocations to lend practical understandings sometimes within, but often far beyond, the domain of medicine or even questions concerning health.
I would characterize The Value of Life as a bruising showcase of practical ethics. Its aim is to demonstrate where ethical reasoning takes us, with no airbrushing of discomfiting moral conclusions or ceding of commitments that would defy morality while pretending to do otherwise. In strained metaphor, I would describe it as a tasting menu. As an introduction to practical ethics, it invites readers to sample and sense—and sense check—a range of courses. All contain evocative and provocative ingredients; some unexpected, some surprising in how they are used, and in each instance, there is a demand that the consumer not prejudice their evaluation with instinctive appeals to visceral feelings of yuckiness.Footnote 4
In more “academic” terms, I would say that The Value of Life is an exploratory analysis of applied moral reasoning, aimed primarily toward prescriptive, preclusive conclusions. “I hope to convince;” John writes in the book’s preface, explaining that “that is the point of moral argument, and indeed the point of attempting to grapple with the problems in the first place.”Footnote 5 In its reach, in some senses, The Value of Life searches for and speaks to universal and timeless truths. And it certainly requires no charity to say that the book’s outstanding high value and relevance endure and will long do so. It continues to provoke interest and inform ideas across the world of bioethics, and remains an essential foundational text.
Nevertheless, and of key significance for the current essay, as a work in applied ethics, The Value of Life is first and foremost about practical questions within a politically defined space: the United Kingdom. First and foremost, furthermore, it addresses matters whose relevance was defined by social and political concerns in and of the United Kingdom in the 1980s; including then-prevalent legal and regulatory norms and governance arrangements, and practical controversies and challenges that existed or were anticipated at the time. Insofar as the book is intended to bear on domains of practice, these too are politically defined: it focuses on public policy, including, but not only, health and science policy; and it focuses on healthcare practice, including, but again not only, the statutorily-regulated profession of medicine. Because of all that, The Value of Life does not just focus on the unmediated demands of morality. The book focuses too on how moral obligations require and create political freedoms and obligations. The work done by the moral concept of “the person” is complemented—and complicated—by reference to practical actors’ further conceptual forms, as established by reference to politically defined roles and statuses: John speaks to and draws from the moral significance and moral boundaries of the imperatives and obligations that arise (for instance) for citizens of a nation-state, for established/regulated professionals, for professional regulators, for government institutions and actors, and for the nation-state itself.
The conceptual and normative dynamics arising from the moral requirements of politics, and of politically defined roles and statuses, are a problematically under-explained and under-explored aspect of The Value of Life. The work that they do in, for, and indeed to John’s arguments is enormous. The current essay therefore focuses on the links between moral and political obligations. I aim to draw attention to what is missing and needs explaining in The Value of Life, and even in John’s wider body of work that has focused more fully on the matter. A clearer and more complete account is required of the grounding of political obligation as a moral requirement, and the bearing that this has on what we might call John’s “libertarian credentials”. In The Value of Life, these credentials are found in his emphasis on the prioritization of “moral respect” over “moral concern”, and the emphasis that lends to the value of honoring individual choice. That emphasis is heightened insofar as John argues for choice controversially; for instance, where he argues that morality supersedes obligations that happen to be found (say) in law, public policy, professional regulations, or professionally or socially accepted practices.Footnote 6 However, the key point is that John’s morality demands the legitimacy and requirement of a state and of political obligations. And his moral grounding of the state, which belies the accentuation he places in explaining respect for persons, is reflected much better in concern for persons; even in instances where such concern is honoured through insisting on individual rights of choice.
John Harris’s philosophical positions: contradictions, moral reasons, and theoretical silences
One of the interestingly enigmatic things about John, especially considering the exactitude that he places on being beholden to reason, is the apparent contradictions that he manifests. The appearance of contradiction comes across as a clear theme in a profile piece about John in The Lancet. This happens even in the characterization of John as a person. Bill Albert, an activist within the disability movement who served with John on the UK’s Human Genetics Commission, is quoted as reflecting on John and “a disconnect between his humanity as an individual and a friend, and the inhumanity of some of the things he proposes.”Footnote 7 And we find it too in the characterization of John as a philosopher. The title of the profile, and its opening remarks, place him as a “leading libertarian bioethicist”. Yet by the fifth paragraph, he is being given as a utilitarian. Indeed—for whatever this may be worth—his Wikipedia page (at the time I am writing) says that: “Throughout his career, he has defended broadly libertarian-consequentialist approaches to issues in bioethics.”Footnote 8
When approaching contradictions in John’s work, we need to account for a few things. First, it is important to recognize that John puts philosophical analysis itself to plural and qualitatively distinct purposes, allowing ostensible contradictions that on examination are superficial rather than substantive. But where that cannot account for apparent inconsistency, it bears focusing in on John’s method or approach, noting that he allows for prioritization between ostensibly contradictory moral demands through the application of reason. In unpacking how John understands and applies reason, we can see two points of significant consequence. First, he does not commit to a basic moral (including political) theory. Secondly, he focuses on two targets of moral importance: persons and the good. In The Value of Life, he indicates the pre-eminence of the former in a way that suggests (something like) a commitment to political libertarianism. Yet in insisting, as he also does, that morality requires political institutions and obligations, he reduces his concerns to prioritization of the good, not of persons. This is not to deny tremendous moral importance either of persons or of personal choice as goods within John’s moral argument. But it means that a focus on “John the libertarian” or the primacy of a person’s individually defined choices inhibits scrutiny of where the challenging philosophical legwork lies for John: in explaining the state-sanctioned fetters that his political morality would place on individual freedom. In the following subsections I will attempt to explain these points by outlining three types of moral focus in John’s work that give rise to claims of incoherence. Each of these indicates why and how he should speak more fully and directly—in The Value of Life, but in his wider work too—not just to what we owe each other as matters of interpersonal ethics, but also as questions of externally governed (i.e. regulated) and potentially enforceable political obligation.
Different tasks for moral argument
Before leveling a charge of inconsistency or contradiction at John’s work, it is important to recognize and account for distinctions across his aims regarding what to “do” with moral argument; to see how he sets quite different “tasks” for philosophical bioethics. Most significantly, these vary between his use of moral argument on the one hand as a vehicle for understanding—to test ideas; to explore, explain, and evaluate (potential) decisions, phenomena, practices, and policies—and on the other hand his use of moral argument as part of a conclusive and directive prescription. The distinction here is between arguments on the one hand that address (say) the inherent wrong (or otherwise) of killing, and explain that there is no moral difference between abortion and infanticide, and arguments on the other hand that from an all-things-considered social policy perspective hold that we should (say) not amend criminal and other laws in order to ban abortion or permit infanticide.Footnote 9
Furthermore, and as shown by that example, we see that where John makes prescriptions, the target of these is not just individual persons deciding for themselves. Within John’s work, the prescriptive tasks may be viewed at two levels, concerning respectively advice on what a person should decide on her own behalf, and advice on what should be made to happen—what persons may be assisted, encouraged, pushed, or made to do—by a third party (say a government, a legislator, a professional regulator). At the level of personal decision-making within a universe where morality as interpersonal ethics is the only normative system at play, we may find quite different directions in prescriptive arguments as compared with practices that might be subject to institutional regulation, whether at a societal level, through law and public policy, or within the governance of institutionalized professional domains (such, of course, as medical practice).
The salience of these two prescriptive levels comes in recognition of John’s thinking that such an institutional domain—with the state at its center—is a necessary product of moral obligation. In shorter terms: morality requires the state. John has long argued for obligations on persons to cede agency to the government as a central coordinator, in order then better to effect moral responsibilities that are beyond the reach of persons acting alone. He has done this on the basis that we do not avoid responsibility for doing harm through its being a consequence of our “negative action”.Footnote 10 Perhaps most stridently in The Value of Life, this comes in John’s discussion of euthanasia, where he argues that while voluntary euthanasia is prohibited, deaths that would be avoidable but for fuller resourcing take place at an enormous scale. He writes: “the most massive administration of non-voluntary and involuntary euthanasia is or is a result of government policy or action.”Footnote 11 To be clear, he thus necessarily denies acceptance of some simplistic default to a harm principle that rubber stamps non-intervention as neutral or even morally benign. Rather, he holds that our moral obligations require that we confer benefit to one another, including through the state. As explored further below, “benefit” is very broadly conceived. Its provision necessarily requires the imposition of fetters on individual freedom. That all, in turn, means that even where a particular prescriptive argument concludes that the decision should lie with the individual, that conclusion can only be arrived at (properly) after the reasoner has defined and distinguished what falls within the ambit of political obligation.
John Harris’s method: reasons over basic theory
As well as needing to account for distinct aims that apply across John’s work, concerns about contradiction and inquiry into what might be missing are well addressed with recognition of John’s distinctive method. The bedrock of John’s moral philosophy is a commitment to reason: to understanding what morality demands by evaluating why something matters or not. John is renowned in particular for his skill in generating thought experiments as a means of isolating reasons and reasoning and subjecting them to forensic moral scrutiny. Perhaps the most famous of these is his “survival lottery”, but they pervade his works—including The Value of Life. However, with this focus on reasons, there is an important observation that may be made about the foundations and method of John’s moral argumentation.
In identifying and scrutinizing reasons, John draws from wide-ranging theorists. In doing so, he rests the weight of key moral propositions on the theoretical works that carry them. But at the same time, he is subtly quiet or incomplete about making foundational theoretical commitments. By this, I mean to say that John’s technique in moral argumentation is to identify and isolate reasons in relation to a given question, rather than locate rationales regarding moral evaluation or action guidance by committing to what might be found in some broader, overarching, or underpinning theory. He is not interested in offering—less still defending—the most authoritative overall interpretation of John Locke’s An Essay Concerning Human Understanding and its practical implications. He is simply interested in the concept of the person that he draws from a part of that work. Similarly, he is not concerned with describing and developing a fundamentally Marxian theory of political obligation, but draws on Das Kaptial Volume I to establish the existence of “negative actions” and the structural violence of cruel, indifferent, or neglectful inaction. Similar points may be made, just to lend two more, looking to the allusions John makes to Bentham when characterizing each person’s equal moral worth, or the prominence John gives to Hobbesian rationales for political legitimacy.
My claim here, then, is that John is not committed to a single particular theory or concept of morality (or, which for him must fall under the same, of morally binding political obligation). Rather, he is committed, within whatever specific context, to identifying and drawing from reasons that may derive from any of numerous radically distinct theories. Indeed, I would note in passing, that this is also why John takes so effectively from literature when advancing his arguments: often a pithy articulation from William Shakespeare or Joseph Heller better captures the burden of concern or the silliness in an idea that he is challenging than does a staid move from premise to premise in analytic philosophy.
Nevertheless, at the heart of John’s identification of moral reasons is the idea of conferring benefit, very broadly (or variously) conceived. In cashing this out, John deploys unexplained ideas of objective morality, both in The Value of Life and more widely in his work. And he does so as if there is something in the background that ensures coherence and a measured practical evaluation that may determine correctly how the values at play are best to be applied. However, despite his focus on reasons rooted in the good and on consequences, we do not (obviously) arrive at a system (such as utilitarianism) that allows for a single, unitary measure of good and bad outcomes. In The Value of Life, John says that he does not use “welfare” as “a technical term”:Footnote 12 rather: “it means what it usually means, “the state or condition of doing or being well”, which will include things like happiness, health and living standards.”Footnote 13 In line with this, when explaining what underpins the demands of morality by reference to benefit, John writes in his book How to Be Good:
It is genuinely uncontroversial to believe that preventing harm, ameliorating pain or suffering, saving lives, curing the sick or their opposites are good or bad things to do. Equally, treating others unfairly or unjustly or in ways that attack their dignity and standing as equals in the community are equally uncontroversial ways of doing harm.Footnote 14
With the plurality of distinct moral “pulls” captured (genuinely uncontroversially!) by “the good” or “harm” here, we might do well to place John’s approach and methods within schools of thought associated with Amartya Sen.Footnote 15 Doing that could have us hold that in identifying the demands of morality in contexts of radical moral disagreement (or a zero-sum conflict between two or more robust but distinct and comprehensive moral doctrines), we make a mistake in imagining that all of the answers may be found by first alighting on and defending a single, preclusive one of them (say Locke’s libertarianism, Marx’s socialism, or Bentham’s utilitarianism). For my part, I think that would lend a better explanation of how John’s reasoning works. However, his style seems to indicate an appeal to a greater unitary coherence, wherein any tensions or apparent contradictions in the end all fall together neatly within a harmoniously straightforward concept of reason. Perhaps the starkest single passage on this in The Value of Life is found at the end of his chapters on respect for persons. There, he essentially explains his method of identifying and scrutinizing reasons, and strikingly says:
[T]he elements of a morality must fit together to form a coherent whole. The principles must not be inconsistent with one another and the whole system must form a coherent basis for the decisions of life.Footnote 16
Either way, for John to make good on his commitment to clear and compelling moral reason, the work that supports his claims needs to be seen to be evaluated and accepted. And once more, I would suggest that that entails a need for a much fuller exposition of political obligation and its limits. This needs to include an explanation and defense of actors that might exercise moral agency such as the state and its institutions, public agencies, influential non-public actors (including commercial organizations, maybe even bioethics commentators!), members of established professions and professional organizations, and persons as citizens. In order to provide this, we also need to be clearer on what founds the demands of morality. Within The Value of Life, I will now suggest that not only do we find an absence of such an account, but we find it confused by the emphasis John places on his commitment to respect for persons.
One or two targets of moral importance? Persons versus things that are good
There are qualitative distinctions in the points that are the subject—or, if I may put it this way, the moral source material—of John’s ethical analysis. I do not believe it is too reductive to say that John has two fundamental targets of moral importance. There are persons and analyses of the applied ethics of respecting persons. And there are things that are good (what he calls “dimensions of welfare broadly conceived”Footnote 17) and analysis of the applied ethics of their optimal realization. Apparent contradictions—or even incoherence—emerge in relation to these distinct targets because of seeming tensions between moral obligations in relation to each of them.Footnote 18 But I would argue that the more problematic challenges come because of interconnections that John advances between them. In other words, it is not just the case that we should see friction, for instance, in the prioritization of one target of moral importance over the other: say, a priority of respect for persons over the optimization of good outcomes in the honouring of a refusal of consent to a beneficial intervention. We rather need to see and scrutinize the promotion or protection of one target of moral importance as being rationalized by reference to reasons rooted in the other.
The idea of respect for persons is given as the pre-eminent moral consideration in The Value of Life. A person is a Lockean construct. And the idea of “respect” stands in contrast with “concern”.Footnote 19 While moral concern relates to considerations of a person’s objectively defined interests or welfare, moral respect is about deferring to a person’s subjective wishes. Respect for persons is underpinned by John’s apparent commitment to the superlative value of individual freedom: a person’s freedom to choose rather than have decisions imposed upon them; and a person’s capacity (not) to act morally, and thus to be a moral agent that can act on and for moral reasons. So, notwithstanding John’s disavowal of rights in the preface to The Value of Life, a reader may be forgiven for identifying “John the libertarian” as the author. Nevertheless, in explaining what “respect for persons” means in the first of two chapters on that topic in The Value of Life, John muddies the terminological water by extending the dimensions of “respect for persons” to embrace both respect and concern.
We can unpick this if we approach the question by reference to interconnection. To bring it squarely into a discussion that engages rationales for political obligation, the point is well exemplified by John’s critical works on “moral enhancement” in How to Be Good. John argues against interventions (“enhancements”) that would conduce to less violence and greater social harmony through the creation of unmediated proclivities toward beneficence among persons. His argument against these even being moral enhancements rests on the importance of preserving—safeguarding—moral agency, which necessarily entails scope for moral failure, moral jeopardy, and the base capacity to choose to do bad things. In John’s adopted phrase, we preserve moral choice by securing “the freedom to fall”.Footnote 20 At the individual level, a person can only meaningfully be able to do good, John argues, if they can elect to do so. We do not, therefore, morally enhance persons by “wiring” them so that their actions will be benign or beneficial. They must be able consciously to act on moral reasons. And this matters (so the argument goes) because the universe is a better place with people in it who can (and will) do bad things than it would be where only (or anyway more) good things happen but with no moral impetus behind them.Footnote 21
Building on the points made in the previous subsections of this paper, note that John’s argument applies to persons acting to “enhance” themselves morally, as well as to the state intervening to provide such “enhancements”. This is particularly significant because John advances his position while defending a concept of the state whose authority—moral legitimacy—derives from its protecting the good. He takes the Hobbesian grounding of the moral authority to rule from the state’s assurance of the safety of the people. In so doing, he speaks to the honouring of a social contract that is binding not for being agreed to, but for being based on reasons that are morally compelling and thus which should be agreed to. Notwithstanding any regard for respect for persons, his foundational interest is not in actual consent, or even reluctant acceptance. John argues for the imposition of obligations that bind persons just because that is what morality demands.Footnote 22
The outcome for John (including within The Value of Life) is that practical ethics requires the generation of, and contribution (submission, even) to, systematized conditions that are based on securing the good. This is so (perfectly coherently) while providing and securing space for immoral decision-making and the predictable creation of bad outcomes. “John the Libertarian” presents himself so forcefully because of the emphasis that he places on individual choice. But John does not commit, for instance, to some sort of Robert Paul Wolff defense of anarchism.Footnote 23 He argues for government, and with it the moral requirement of coercion of (some) decisions. While, in The Value of Life, John purports to give priority to respect for persons over concern for persons (and perhaps always means to do so in the context of consent to medical treatment), his arguments lead him variously into the prioritization of the latter too. Even if respect for persons, in his sense, is pre-eminent in particular areas of medical ethics, it is not pre-eminent as a matter of morality overall. As a matter of logic, because morality requires the generation of political obligation, and political obligation may require the ceding of choice without actual consent, the prioritization of respect in a given instance is a matter of residual freedom; not freedom’s priority. Morality itself, as regards persons, is derivative of a moral commitment based after all on concern.
This foundational prioritization of concern, in detail and application, creates problems; if not of coherence then of insufficient explanation. Unpicking and making sense of them requires more on the basis and limits of political obligation within John’s moral reasoning, and a lessening of the emphasis he claims to place on prioritizing respect for persons when his basic concern is (in his specialist sense of the term) moral concern. To say otherwise is to deny, which John will not do, moral obligations to create and submit to a state whose authority rests on a mandate to assure the safety of the people. At the level of morally-legitimate political obligation, in his discussions of politics, John brushes over the gaping complexities in establishing how respect for persons is reducible to, or compatible with, respect for what persons should but do not want.Footnote 24 In short, John speaks to two targets of moral importance: persons and the good. For both, we find moral requirements to recognize the authority of the state. In reconciling apparent tensions, we have recourse to the priority of reasons based on the good (or the safety of the people, or “concern”), which suggests (at best) a misplaced emphasis in the focus on respect for persons. This is no small point given the fundamentality of respect for persons within the whole pitch of The Value of Life’s argument.
This leads me finally to note that when looking to moral commitments—the basis of moral reasons—we can question in other ways the credentials of “John the Libertarian”. For a start, John’s ostensible libertarianism attaches much more rigidly to questions of bodily integrity than it does to questions concerning property, and potentially as well “lifestyle” choices. John trumpets persons-as-patients’ rights to refuse unwanted invasions of the body and advocates for rights to wanted interventions. Those “rights to” ground positive obligations: obligations not just to leave alone, but to provide at cost. This is because of concern for persons, the doctrine of negative actions, and a consequent moral commitment to the pooled provision (for instance) of healthcare. In the greater part, in The Value of Life, John expands on those obligations by reference to what is owed by the state, by public agencies and organizations, by healthcare services and systems, and by doctors. Occasionally he does so by reference to what is owed by citizens. But he is extremely quiet about the costs to individual persons. Yet there are non-trivial, freedom-limiting, logically inevitable costs, most markedly in relation to (disregard for) property rights. For John’s arguments to play out, considerable taxation is in order. He demands huge economic, redistributive commitments. He also is open to justice-based arguments taking precedence over respect for liberty in relation to self-inflicted illness by (in effect) creating unequal rights (or put another way structural disincentives, or in another way punitive disparity in entitlement).Footnote 25 And his arguments require tempers on the concerns that must be honoured in order to act respectfully: they demand an account of what, positively, persons should have a right to, and what persons might be free to do on their own account but not with the pooled resources of the government.
Conclusions
I am not worried through this essay to argue too hard about labels. No one owns the meaning that will be given to terms of art, and I do not care whether John is “strictly” a libertarian (I suspect he does not really care either). But in reading The Value of Life, we find reasoning based on consequences that has much weightier consequence for the prominence of “respect for persons” than John allows, given that he takes the book so far from a medical ethics context. In trying to make sense of this (if sense can be made), I have explained that it is not a mistake to engage in analysis of the works that John cites as influences. But given their obvious clashes with each other, and often with what John himself argues, it is a mistake to draw from his engagement with these too much by way of background or foundational theoretical commitments. John’s focus is on advancing reasons rather than advancing a theory. As such, the salient task in understanding John’s work comes in weaving together the different threads of his argument and then surveying the overall product that emerges. This allows a finer-grained—and more nuanced and sympathetic—picture of John’s moral commitments and thinking than does a reductive position that starts with the claim that “John is a libertarian” or “John is a consequentialist” (or whatever). We start where he starts and go where he takes us. In doing this, we find an aggregation of reasons that are:
-
• Identified and analyzed sometimes just to secure better moral understanding, and sometimes with a view to providing directive prescriptions;
-
• Rooted in quite distinct targets of moral importance (the concept of the person and a pluralist idea of the good);
-
• And, when providing prescriptions, addressing conceptually and practically distinct actors: sometimes persons as moral agents, sometimes persons in normatively-relevant roles (e.g. citizens, patients, doctors, judges), and sometimes public or private institutions or organizations, but all through some ostensibly singular idea of morality.
I have sought in this essay to highlight how the distinctions that arise given these variations allow us to address apparent contradictions, but also to see gaps that need to be filled and misplaced emphases that need to be corrected. This includes the question of whether there is some overarching, single concept of “the good” that can tie it all together (which is the indication of John’s words), or a greater diffusion of radically distinct, mutually contradictory, but individually robust and convincing ideas of the good (which is where I would imagine the logic of John’s reasoning really takes us). For my part, I think this is a project that is necessary if John is to make good on his aims in The Value of Life to convince, and even satisfactorily to grapple with problems and seek to address them through moral argument.
To reiterate, The Value of Life, like John’s work before and since, is not silent on the importance of examining political obligation. Simply, on my reading of his work, more questions are raised than settled. John’s scholarship is a magnet for critiques where he is seen as being controversial. And he is deft at responding. However, a fuller scope for understanding John’s theoretical bases for tying it all together remains in order. I would be delighted to see a book by John Harris that explains why and in what senses obligations arise that come at costs in terms of respect for persons and what they might choose as moral agents, and what impact this has on understandings of freedom; within, but also far beyond, the domain of medical practice.
Epilogue
One of the signal markers of a great book is that each time you read it, no matter how many times you have read it before, it gives you something new and enriching; that you cannot stop learning from it. The Value of Life firmly holds this quality. I first read it when I was an undergraduate Law student, and it was the single most important draw for me into the career that has since followed. That career started with study towards a doctoral thesis entitled The Values of Life and the Law, which required further reading and re-reading of The Value of Life (among many other of John’s works). Later, it was an honour that John agreed to be one of my PhD examiners. And I was delighted, subsequent to that, to hold two research posts across a fantastically happy and beneficial five years, working alongside John and other colleagues in the University of Manchester. For people who heed the maxim “don’t meet your heroes,” I just caution (in accordance with a core Harrisian doctrine noted already in this essay) that our “negative actions” have consequences too, and you risk missing out on a great deal. John’s intellectual influence was matched during those times and since by his generosity and care as a mentor, and above all else his kindness, conviviality, and warmth as a friend. Reading and re-reading his published works, reading drafts of ones in development, hearing his critical comments on my work, and having the opportunity to discuss, debate, and develop different ideas, sit among the most rewarding and fun parts of having the privilege to work in academia.
It has accordingly been an indulgence to be able again to read The Value of Life, to have the opportunity further to advance critical reflections provoked by it, and to explore some of the moral challenges that it raises. To make sense of that book, and John’s work more widely, I have suggested above that we are wrong to take apparent contradictions in John’s argument as (straightforward, anyway) indications of flaws. However, I have argued too that his arguments expose gaps in reasoning that need to be filled. Some of that work, I would suggest (and have suggested to John more than once!), falls on him. However, if the bioethics that John has helped to create is anything, it is a collaborative, applied field. In that sense, the contribution emerges either way. And with that point noted, one measure of the success of The Value of Life comes in reading it now and looking at how its critical contributions to academic, public, professional, and policy discourses have fed into fundamental and radical changes; in thinking and in practice. This goes beyond mere prescience: the book has had impact, including—through its influences on policy and practice—by improving the value of countless lives, far beyond just those of folks who have read and engaged intellectually with, or even heard of, John’s work.
Open access
