The protection of human subjects in biomedical research relies on two principal mechanisms: assessing and comparing the risks and potential benefits of proposed research, and obtaining potential subjects' informed consent. While these have been discussed extensively in the literature, no attention has been paid to whether the processes should be different when the objective of an experimental biomedical intervention is to improve individual appearance, performance, or capability rather than to prevent, cure, or mitigate disease . This essay examines this question (...) in order to ensure that subjects in biomedical enhancement research receive adequate protection. (shrink)

There are two critical steps in determining whether a medical experiment involving human subjects can be conducted in an ethical manner: assessing risks and potential benefits and obtaining potential subjects’ informed consent. Although an extensive literature on both of these aspects exists, virtually nothing has been written about human experimentation for which the objective is not to prevent, cure, or mitigate a disease or condition, but to enhance human capabilities. One exception is a 2004 article by Rebecca Dresser on preimplantation (...) genetic modification — one of the most controversial enhancement technologies — in which she states, “Under existing research ethics principles, it would be unethical for investigators to perform modifications exposing embryos expected to develop into healthy children to significant risk in exchange for a possible physical or mental enhancement.” But Dresser does not explain why such an experiment would be unethical under existing principles, and her conclusion is not self-evident. (shrink)

The United States, along with other nations and international organizations, has developed an elaborate system of ethical norms and legal rules to govern biomedical research using human subjects. These policies govern research that might provide direct health benefits to participants and research in which there is no prospect for participant health benefits. There has been little discussion, however, about how well these rules would apply to research designed to improve participants’ capabilities or characteristics beyond the goal of good health. When (...) mentioned at all in the literature, this so-called enhancement research, as opposed to research aimed at diagnosing, preventing, curing, or treating illnesses or medical conditions, is usually dismissed without explanation. (shrink)

“Wrongful birth” is a controversial malpractice action, which has arisen in the past two decades, secondary to an expanding knowledge of human genetics and the constitutionally protected access to abortion. Under the wrongful birth claim, parents of a child with a congenital illness or abnormality may bring suit against a physician who allegedly failed to provide appropriate prenatal counseling or information. Typically, the parents claim that they were inadequately warned of a potential problem in their child, and that this paucity (...) of timely information prevented them from avoiding the pregnancy or from obtaining an abortion. While these cases have arisen in a variety of clinical circumstances, a characteristic example is the obstetrician who fails to offer amniocentesis to a woman of advanced maternal age who subsequently gives birth to a child with Down syndrome. Since the parents were prevented from learning of the abnormality and therefore exercising the option to terminate the pregnancy, they may claim damages for themselves for the wrongful birth of the infant. (shrink)

“Wrongful birth” is a controversial malpractice action, which has arisen in the past two decades, secondary to an expanding knowledge of human genetics and the constitutionally protected access to abortion. Under the wrongful birth claim, parents of a child with a congenital illness or abnormality may bring suit against a physician who allegedly failed to provide appropriate prenatal counseling or information. Typically, the parents claim that they were inadequately warned of a potential problem in their child, and that this paucity (...) of timely information prevented them from avoiding the pregnancy or from obtaining an abortion. While these cases have arisen in a variety of clinical circumstances, a characteristic example is the obstetrician who fails to offer amniocentesis to a woman of advanced maternal age who subsequently gives birth to a child with Down syndrome. Since the parents were prevented from learning of the abnormality and therefore exercising the option to terminate the pregnancy, they may claim damages for themselves for the wrongful birth of the infant. (shrink)

: All three main articles in the issues of the Kennedy Institute of Ethics Journal endorse the view that genetic enhancement should be permitted, including human germ-line genetic enhancement. However, unregulated, wealth-based access to genetic enhancement in general, and germ-line enhancement in particular, would create intolerable risks for society. Although there are a number of practical problems raised by proposals to regulate or restrict access to genetic enhancement, which will make it difficult if not impossible to muster support for any (...) effective restrictions until we begin to experience the societal problems that genetic enhancement will create, it is important to consider now what restrictions would be appropriate, how they would be imposed, and what changes would be needed in existing laws and institutions to facilitate them. Without this type of groundwork, there is no way society will be in a position to act in time. (shrink)

American medicine has long sought to control the standard of care that physicians are expected to provide to their patients. One effort to insulate the standard of care from external interference, called a “safe harbors” approach, would enable physicians to avoid liability for malpractice if they adhered to medical practice guidelines. The idea is to eliminate the “battle of experts” and reduce defensive medicine by requiring judges and juries to accept guidelines as conclusive evidence of the standard of care. Yet (...) current efforts to improve the guideline development process, including the use of evidence-based guidelines, are unlikely to be able to overcome the shortcomings that led a similar safe harbors initiative to fail in the early 1990s. Moreover, there is no adequate justification for conferring this degree of self-regulatory power on the medical profession. (shrink)

The idea that physicians should accept recommendations from learned colleagues on how to practice medicine is probably as old as medicine itself, but beginning around 1990, it took on new urgency in the face of rising health care costs, widespread, unjustifiable variation in practice patterns, concerns about medical errors and quality of care, and what some perceived to be perverse effects of the malpractice system. One solution put forward was practice guidelines, which the Institute of Medicine defined as systematically developed (...) statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. (shrink)

A widely accepted framework governs biomedical research and the practice of medicine in the civilian sector, but no such framework exists to guide the military in how it should treat its own personnel. Civilian bioethical principles are unsuitable because of fundamental differences between civilian and military core values. This paper proposes a framework for military bioethics. It begins by describing core military values, articulating how they differ from civilian goals and values, and explaining how these differences limit the ability of (...) civilian bioethical principles to govern military biomedicine. The paper then puts forward a set of more appropriate principles for the military and discusses how these principles apply in three main areas of controversy within military bioethics: the use of military personnel as research subjects; the deployment use of biomedical agents; and the obligations of military physicians toward their own troops. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:LettersMaxwell J. Mehlman, Susan R. Massey, Ronald M. Green, and Fred RosnerPhysicians and the Allocation of Scarce ResourcesMadam: We read with interest Dr. Pellegrino's commentary on our article in the December 1994 issue of the Kennedy Institute of Ethics Journal, and commend him for pointing out so well the different ways that law and ethics approach the issue of physician allocation of scarce resources.We wish to make one (...) clarification. Dr. Pellegrino states that we propose that fiduciary duties be abolished. Quite the contrary, our position is that fiduciary obligations are essential to the maintenance of trust—which we believe to be an efficient as well as an ethical element of the patient-provider relationship. If fiduciary duties are undercut, as we pointed out they are by the Oregon Medicaid legislation, then some other method of promoting trust must be established, and, as we point out in the article, it is difficult to identify what that method could be.Maxwell J. MehlmanandSusan R. MasseyThe Law Medicine CenterArter & HaddenCase Western Reserve UniversityCleveland, OHSchool of LawCleveland, OHReport of the Human Embryo Research PanelMadam: In the December 1994 issue of the Kennedy Institute of Ethics Journal, I reported on the controversy surrounding the work of the NIH Human Embryo Research Panel and the conclusions reached in its report, which was formally presented to NIH Director Harold Varmus on September 27, 1994. At that time, the report was to be reviewed by the Advisory Committee to the Director (ACD) until its next meeting in early December. I am writing to update your readers on the fate of the Panel's report.On the morning of December 2, 1994, following a previous afternoon of animated discussion, the ACD unanimously accepted the Report of the Human Embryo Research Panel. Panel members and members of the NIH staff who were present and had worked for nearly a year on the Report were gratified by this vote of confidence and by the strong support of NIH Director Harold Varmus.We had little time to enjoy this success. Within a matter of hours, the White House issued a press release in which President Clinton thanked the committee for its work and then, in a remark overruling one of the key recommendations in our report, stated: "I do not believe that federal funds should be used to support the creation of human embryos for research purposes, and I have directed that NIH not allocate any resources for such research." [End Page 83]As a Panel member and active participant in that day's events, my initial response was one of shock. I was particularly distressed that the President and his advisors chose a moment so late in the process to make their views known. Why had we worked for months, I asked, without a word of concern from the White House? Although Panel members were guided primarily by our perceptions of the ethical and scientific issues involved, some were close to the political realities of Washington and would have introduced these concerns into the Panel's deliberations.Within a matter of days, my own sense of outrage had diminished. First of all, it was clear that whatever the personal sources of the President's objections to the Panel's recommendations, this high level political intervention was inevitable. Less than a month before, on November 8, with the election of a majority House and Senate, the political environment for embryo research had changed dramatically. The previous June, 32 congressmen, most of them members of a minority Republican party, had signed a letter protesting the Panel's work. Now, one of the signers of that letter, Newt Gingrich, was destined to be Speaker of the House.Second, it became clear that the damage was not total. The President has forbidden NIH to support work involving the deliberate creation of embryos for research. Without exception, members of the Panel had come to the conclusion that some development of "research embryos" must be permitted to reduce the risks of new assisted reproductive technologies, to enhance scientific knowledge, and to develop new therapies for a range of serious diseases. All these... (shrink)

Opponents of reproductive choice are attempting to limit reproductive decisions based on certain underlying reasons. This commentary explores the rationales for these limitations and the objections to them. It concludes that reasoned-based limitations are unsupportable and unenforceable.

What if science enabled us to live an extended lifespan? Well, not us, but people in the future, and perhaps not everybody in the future, at least not at first. Should we allow and encourage science to develop this capability, or should we try to prevent or inhibit it? John Davis's book New Methuselahs: The Ethics of Life Extension is a thorough exploration of these questions. He presents the arguments for and against developing this capacity, and he considers three perspectives: (...) those of individuals who will be able to extend their lives (the Haves), individuals who will not because they can't afford to (the Have‐nots), and individuals who will not extend their lives because they are opposed to doing so (the Will‐nots). Davis is a philosopher, and the bulk of this book is for the cognoscenti. (shrink)

Patients with insufficient financial resources place physicians in a conflict of interest between the patients' needs and the financial interests of the physician, other patients, and society. Not only must physicians act ethically, but they must avoid liability for violating their legal duties to their patients. The traditional rules of contract and malpractice law that govern the patient-physician relationship do not provide satisfactory guidelines. Better answers are found in the rules of fiduciary law, but only with regard to direct conflicts (...) between patients and physicians and only at the risk of reducing patient access to care. Certain types of legislative action can resolve these conflicts by altering the traditional legal rules, but care must be taken to preserve patient-physician trust, which the legal rules were designed to enhance. (shrink)

The ability of patients to trust physicians to act in their best interests is a critical aspect of a welfare-maximizing relationship. This commentary discusses physician trustworthiness within the framework of the Affordable Care Act and considers steps to reinforce trustworthy behavior.

Purpose: This review identifies the prominent topics in the literature pertaining to the ethical, legal, and social issues raised by research investigating personalized genomic medicine. Methods: The abstracts of 953 articles extracted from scholarly databases and published during a 5-year period were reviewed. A total of 299 articles met our research criteria and were organized thematically to assess the representation of ELSI issues for stakeholders, health specialties, journals, and empirical studies. Results: ELSI analyses were published in both scientific and ethics (...) journals. Investigational research comprised 45% of the literature reviewed and the remaining 55% comprised normative analyses. Traditional ELSI concerns dominated the discourse including discussions about disclosure of research results. In fact, there was a dramatic increase in the number of articles focused on the disclosure of research results and incidental findings to research participants. Few papers focused on particular disorders, the use of racial categories in research, international communities, or special populations. Conclusion: Considering that strategies in personalized medicine increasingly target individuals’ unique health conditions, environments, and ancestries, further analysis is needed on how ELSI scholarship can better serve the increasingly global, interdisciplinary, and diverse PGM research community. (shrink)

: Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, publication standards, and government regulation, but "intrinsic conflicts of interest"—conflicts of interest inherent in all clinical research—have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the tension among professionals' responsibilities to their research and to their patients and both academic and financial (...) incentives. These conflicts should be disclosed to research subjects and managed as assiduously as are financial conflicts of interest. (shrink)

As science learns more about how the brain works, and fails to work, the possibility for developing “cognition enhancers” becomes more plausible. And the demand for drugs that can help us think faster, remember more, and focus more keenly has already been demonstrated by the market success of drugs like Ritalin, which tames the attention span, and Prozac, which ups the competitive edge. The new drug Aricept, which improves memory, most likely will join them. Whether such drugs are good for (...) individuals, or for society, is an open question, one that demands far more public discussion. (shrink)

We present a multiscale integrationist interpretation of the boundaries of cognitive systems, using the Markov blanket formalism of the variational free energy principle. This interpretation is intended as a corrective for the philosophical debate over internalist and externalist interpretations of cognitive boundaries; we stake out a compromise position. We first survey key principles of new radical views of cognition. We then describe an internalist interpretation premised on the Markov blanket formalism. Having reviewed these accounts, we develop our positive multiscale account. (...) We argue that the statistical seclusion of internal from external states of the system—entailed by the existence of a Markov boundary—can coexist happily with the multiscale integration of the system through its dynamics. Our approach does not privilege any given boundary, nor does it argue that all boundaries are equally prescient. We argue that the relevant boundaries of cognition depend on the level being characterised and the explanatory interests that guide investigation. We approach the issue of how and where to draw the boundaries of cognitive systems through a multiscale ontology of cognitive systems, which offers a multidisciplinary research heuristic for cognitive science. (shrink)

This paper presents a version of neurophenomenology based on generative modelling techniques developed in computational neuroscience and biology. Our approach can be described as _computational phenomenology_ because it applies methods originally developed in computational modelling to provide a formal model of the descriptions of lived experience in the phenomenological tradition of philosophy (e.g., the work of Edmund Husserl, Maurice Merleau-Ponty, etc.). The first section presents a brief review of the overall project to naturalize phenomenology. The second section presents and evaluates (...) philosophical objections to that project and situates our version of computational phenomenology with respect to these projects. The third section reviews the generative modelling framework. The final section presents our approach in detail. We conclude by discussing how our approach differs from previous attempts to use generative modelling to help understand consciousness. In summary, we describe a version of computational phenomenology which uses generative modelling to construct a computational model of the inferential or interpretive processes that best explain this or that kind of lived experience. (shrink)

This paper aims to address the relevance of the natural sciences for transcendental phenomenology, that is, the issue of naturalism. The first section distinguishes three varieties of naturalism and corresponding forms of naturalization: an ontological one, a methodological one, and an epistemological one. In light of these distinctions, in the second section, I examine the main projects aiming to “naturalize phenomenology”: neurophenomenology, front-loaded phenomenology, and formalized approaches to phenomenology. The third section then considers the commitments of Husserl’s transcendental phenomenology with (...) respect to the three varieties of naturalism previously discussed. I argue that Husserl rejected strong and weak forms of epistemological naturalism, strong methodological naturalism, and ontological naturalism. The fourth section presents the argument that Husserl endorsed a weak, conditional form of methodological naturalism. This point is illustrated with Husserl’s proposal of “somatology,” a natural science apt to study the corporeality of the lived body. The final section addresses the complementarity and respective limits of the transcendental phenomenological and the natural scientific frameworks. I argue that, on Husserl’s account, the function of transcendental phenomenology with respect to the natural sciences is to provide them with an epistemological foundation and an ontological clarification. I suggest that certain natural sciences can be understood, within the transcendental phenomenological framework, as “sciences of constitution,” that is, as sciences investigating the contribution of real structures acting as conditions of possibility for the occurrence of certain kinds of comprehensive unities in lived experience. (shrink)

The most powerful lesson learned from the 2013-2016 outbreak of Ebola in West Africa was that we do not learn our lessons. A common sentiment at the time was that Ebola served as a “wake-up call”—an alarm which signalled that an outbreak of that magnitude should never have occurred and that we are ill-prepared globally to prevent and respond to them when they do. Pledges were made that we must learn from the outbreak before we were faced with another. Nearly (...) five years later the world is in the grips of a pandemic of the severe acute respiratory syndrome coronavirus 2 that causes coronavirus disease 2019. It is therefore of no surprise that we are now yet again hearing that the COVID-19 pandemic serves as the “wake-up call” we need and that there are many lessons to be learned to better prepare us for future outbreaks. Will anything be different this time around? We argue that nothing will fundamentally change unless we truly understand and appreciate the nature of the lessons we should learn from these outbreaks. Our past failures must be understood as moral failures that offer moral lessons. Unless we appreciate that we have a defect in our collective moral attitude toward remediating the conditions that precipitate the emergence of outbreaks, we will never truly learn. (shrink)

The possible-worlds semantics for modality says that a sentence is possibly true if it is true in some possible world. Given classical prepositional logic, one can easily prove that every consistent set of propositions can be embedded in a ‘maximal consistent set’, which in a sense represents a possible world. However the construction depends on the fact that standard modal logics are finitary, and it seems false that an infinite collection of sets of sentences each finite subset of which is (...) intuitively ‘possible’ in natural language has the property that the whole set is possible. The argument of the paper is that the principles needed to shew that natural language possibility sentences involve quantification over worlds are analogous to those used in infinitary modal logic. (shrink)

Research conducted during epidemics may warrant adaptations or adaptive designs owing to practical constraints, time pressures, uncertainty, the importance of flexibility, and the potential for research to detract from epidemic response. Adapting research entails choosing different research designs or methods if research goals, contexts or constraints justify or require a different approach. Adaptive research, by contrast, is a type of research that prospectively plans for modifications after research has been initiated, while maintaining the validity and integrity of the research. While (...) adaptation and adaptive designs introduce an important degree of flexibility to research conducted during epidemics and help to address research objectives and constraints, adaptation and adaptive designs require close ethical scrutiny and are no different from other research in that they are expected to align with universally accepted ethical standards. Important ethical questions exist regarding the conditions that justify adaptations to research, the kinds of adaptive research designs that can be ethically justified, and how ethics review bodies ought to evaluate such novel approaches to research in epidemic contexts. The five cases included in this chapter prompt reflection on the ethical considerations and implications of adapting research in response to epidemic-related risks and the public health measures deployed in response to those risks, as well as the ethical implications of not adapting research in such contexts. These cases also highlight ethical questions and issues arising during the conduct of adaptive trials, including when treatments under study, treatment doses, sample size, and other study features are reviewed in response to evolving evidence. This chapter invites reflection on these key ethical dimensions when considering adaptive designs and adaptations to standard research procedures during epidemics. What these cases make clear is that adaptive designs and adaptations to research do not reduce the need for rigorous scientific evaluation and adherence to universal ethical standards, and must be explicitly ethically justified and reviewed through transparent and inclusive processes. (shrink)

Maxwell J. Mehlman, Transhumanist dreams and dystopian nightmares: The promise and peril of genetic engineering, Baltimore: Johns Hopkins University Press, 2012, reviewed by Sheryl de Lacey.

Three experiments are reported in which the relationships between task format, item type, and strategy usage were investigated for a two-dimensional relational inference task. Contrary to past findings with linear syllogisms, it was found that parallel presentation (presenting problem statements simultaneously) did not result in any increased use of deduction rule processes compared with serial presentation (presenting problem statements individually). Instead, the results suggested that mental models were used by the majority of subjects, and that multiple models were more likely (...) to be constructed with parallel presentation. It is proposed that, in general, multiple model construction will be more frequent for deduction tasks where the cognitive load is relatively low. Hence, contrary to suggestions by Polk and Newell (1995), reasoning in this way appears to be prevalent and highly robust - where supported by task format - even where the use of this strategy is disadvantageous. (shrink)

The exercise of identifying lessons in the aftermath of a major public health emergency is of immense importance for the improvement of global public health emergency preparedness and response. Despite the persistence of the Ebola Virus Disease outbreak in West Africa, it seems that the Ebola ‘lessons learned’ exercise is now in full swing. On our assessment, a significant shortcoming plagues recent articulations of lessons learned, particularly among those emerging from organizational reflections. In this article we argue that, despite not (...) being recognized as such, the vast majority of lessons proffered in this literature should be understood as ethical lessons stemming from moral failures, and that any improvements in future global public health emergency preparedness and response are in large part dependent on acknowledging this fact and adjusting priorities, policies and practices accordingly such that they align with values that better ensure these moral failures are not repeated and that new moral failures do not arise. We cannot continue to fiddle at the margins without critically reflecting on our repeated moral failings and committing ourselves to a set of values that engenders an approach to global public health emergencies that embodies a sense of solidarity and global justice. (shrink)

Many researchers have suggested that premise interpretation errors can account, at least in part, for errors on categorical syllogisms. However, although it is possible to show that people make such errors in simple inference tasks, the evidence for them is far less clear when actual syllogisms are administered. Part of the problem is due to the lack of clear predictions for the solutions that would be expected when using modified quantifiers, assuming that correct inferences are made from them. This paper (...) presents the expected solutions for Gricean, reversible, and reversible Gricean interpretations, and evaluates these using three datasets (two currently available, and one new). The evidence supported the adoption of reversible and reversible Gricean interpretations, but not Gricean interpretations on their own. These results suggest that the categorical syllogism task tends to induce different quantifier interpretations from those identified in simple inference tasks. (shrink)

Ever since they were first published, the works of Bernard Mandeville have met with a few careful readers as well as with a larger number of stupid or unscrupulous assailants. Both classes are faithfully recorded at the end of F. B. Kaye's splendid edition of The Fable of the Bees , which has helped to revive interest in Mandeville, and which has moulded the current estimate of his ideas: the treatment of Mandeville in such a work as Basil Willey's Eighteenth (...) Century Background is confessedly based almost entirely on Kaye. My purpose in this paper is to suggest some modifications of the account given by Kaye, and to make claims for Mandeville's importance in one particular field, the relation of ethics to politics. (shrink)

Open peer commentary on the article “A Moving Boundary, a Plastic Core: A Contribution to the Third Wave of Extended-Mind Research” by Timotej Prosen. Abstract: We argue that the free-energy principle (FEP) can indeed be used to articulate a conception of the boundaries of cognitive systems that meets the desiderata of third-wave extended-mind research. We point out that Markov blankets under the FEP definitionally constitute the means through which internal and external states are coupled, and so do not isolate systems (...) from their environment. We argue that the nested, multiscale boundaries of the FEP formulation are indeed plastic and open to re-negotiation. Finally, we appeal to the formulation of niche construction under the FEP to argue that the extension of cognitive boundaries in this formulation is both synchronic and diachronic. (shrink)

Health equity is increasingly identified as a principal goal to be achieved through public health policies and activities. However, what is to be measured in the assessment of health equity and how inequities in health ought to be redressed are among the pressing questions that must be answered if health equity is to serve as a meaningful and consistent ethical guide for measurement and intervention in public health. In this article I argue that the concept of health equity, in the (...) form it is predominantly found in public health, suffers from normative indeterminacy and is therefore unlikely to provide actionable normative guidance to public health policy-makers, practitioners and researchers. I argue that the concept of health equity, as it is commonly defined in public health, ultimately rests upon assumptions of a more fundamental, yet tacit, conception of justice to do its normative work. In this vein, I expand upon a critique of Margaret Whitehead’s oft-cited definition of health equity made by James Wilson to raise additional reasons not explored by Wilson, or others, as to why Whitehead’s definition remains inadequate in providing normative guidance to policy-makers, practitioners and researchers in public health. (shrink)

In their target paper, Bruineberg and colleagues provide us with a timely opportunity to discuss the formal constructs and philosophical implications of the free energy principle. I critically discuss their proposed distinction between Pearl and Friston blankets. I then critically assess the distinction between inference with a model and inference within a model in light of instrumentalist approaches to science.

The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...) the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics. (shrink)

Scholars often turn to Livy’s famous digression on Aulus Cossus and the spolia opima (4.17–20) to shed light on his larger political inclinations. These readings generally regard Livy as either an Augustan (or at least a patriotic Roman) or an apolitical skeptic. Yet neither view, I argue, fully explains the Cossus affair. What is needed is an interpretation that recognizes the political nature of the Cossus digression and its skepticism toward Augustus. Attending to Livy’s rhetorical strategy in the digression allows (...) us to see it as an instance of oblique criticism of Augustus and his control over Roman life. The explanatory power of this reading extends to episodes from the life of Romulus as well. I argue Livy uses these stories to make a theoretical argument about the nature of despotism, namely, that it seeks to control narratives of the past just as much as it aims for political domination. (shrink)

Maxwell J. Mehlman, The price of perfection: Individualism and society in the era of biomedical enhancement, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Anita Silvers.

Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whether _existing_ employees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not be _hired_ if they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk being _fired_. The latter seems worse than the former. Hence, (...) objections to vaccination mandates commonly centre on the harms that will be visited on existing employees who are unwilling to be vaccinated. However, because this objection does not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of certain jobs, those making this objection should have less of an objection, or no objection at all (at least on these grounds), to introducing vaccination requirements in some cases for _prospective_ employees. Yet, in this paper, I shall argue that if one has reason to believe vaccination requirements can be justified for prospective employees, one should also believe they are justified for existing employees _despite_ any asymmetry in consequences experienced by the two groups. As a consequence, common objections made against vaccination mandates grounded solely in the harms that may be experienced by existing employees who are unwilling to be vaccinated should be considered unpersuasive. (shrink)

In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public (...) health goals. While Coker makes a convincing case as to why we should find it ethically problematic when governments find themselves in this position and resort to coercion, left outstanding is the question of whether this should preclude governments and health authorities from using coercion if and when they do find themselves in this position. In this paper, I argue that, while we should consider it ethically objectionable when governments resort to coercion because they have neglected a public health threat, its causes, and other possible responses to that threat, this should not then necessarily rule out the use of coercion in such circumstances; that there are ethically objectionable antecedents for why coercion is being considered should not necessarily or automatically cause us to think coercion in such cases cannot be justified. I address an objection to this argument and draw several conclusions about how governments’ use of coercion in public health should be evaluated. (shrink)

The American Journal of Bioethics, Volume 12, Issue 6, Page 15-17, June 2012.