1. Case 3.4 Breaking the cigarette habit Twenty-three-year-old Fred Winston had attempted suicide by shooting himself in the head. He was hospitalized with permanent brain damage, which left him largely helpless and his body deformed by muscular contractions. He required assistance for almost every activity. He was usually incontinent, though this was attributed more to a lack of concern than to physical incapacity. In addition, his speech was barely audible, and the combination of brain damage and emotional difficulties resulted in stammering, repetitious speech patterns. Fred failed to eat well, and his primary pleasures seemed to be watching television and smoking cigarettes. After his initial period of hospitalization, those responsible for his nursing care decided to try to limit his smoking "for his own good." Thus, he was often falsely informed that his cigarettes were all gone, or that there were only one or two left and he ought to save them for later, or that no one was available to supervise him while he smoked (a safety requirement necessary because of his limited fine motor control). The nursing staff reasoned that since he did not appear to care about what was in his own best interest, they would have to take measures to limit his smoking even if he protested. When he sensed what was happening, Fred protested as strongly as his limitations would allow. In response to the nurses' explanation that what they were doing was for his own good, he insisted that since there was little hope that his condition would improve, he was entitled to whatever gave him pleasure at the present moment. Given his condition, he maintained, smoking was "for his own good. "But inasmuch as his physical debilities and difficulties with speech limited his capacity to resist or vociferously protest the nurses'behavior, their will prevailed.

2. The Crucial Issue The two sides (These are just the two answers to the question.) 1. Pro: We should allow him to smoke. 2. Con: We are justified in not allowing him to smoke. Issue: What is more important the health consequences of allowing him to smoke or his rights to autonomy and fair treatment unaffected by his disability. Pro Crucial Assumption: His right to autonomy and fair treatment are more important than the bad consequences to his health. Con Crucial Assumption: The bad consequences to his health justify the restriction of his autonomy and treating him differently because of his disability.

3. An argument for the Pro Side Common ground: We allow normal people the autonomy to do all kinds of things that harm their health and pose as much risk as smoking. For example we allow people to sky dive. Connection: If we allow a person's right to autonomy to trump what is best for him, then we should reach the same conclusion in this case since his disability is irrelevant.

4. Objection to the Pro Side Argument Here the Con side must explain why they agreed to the common ground using their assumption. Objection (Alternative Explanation) We allow this only because the bad effects of forcing the person to stop outweigh the benefits of restricting their behavior. In this case because of the docility of the person involved there will be no such bad effects.

5. Response from the Pro Side to Objection They need to change the example to eliminate this other explanation. Even if we could control people so that there were no bad effects from interfering with their liberty and autonomy, by hypnotizing them or brain washing them, we would still find this just as objectionable, if not more.