Due to the COVID-19 pandemic, cities and states adopted social distancing, social isolation, or quarantine measurements to slow the transmission of the disease. Negative mental health outcomes including depression and anxiety have been associated with social distancing or social isolation. The purpose of the present study was to examine changes in psychological health and physical activity over an 8 week period under social distancing policies during the COVID-19 pandemic.Methods: Ninety individuals participated in this study. Qualifying participants answered questions using an (...) online survey regarding their loneliness, depressive symptoms, anxiety symptoms, mood state, and physical activity over four time points each lasting two weeks.Results: Symptoms of depression and state anxiety were increased in the population when compared to nationwide statistics from before the COVID-19 pandemic. Time point 2, ~1 month into social isolation, showed the most significant effects on mental health. During this time point, 100% of the participants showed symptoms of depression. There were no significant changes in physical activity over the 8 weeks. Loneliness, depressive symptoms, fatigue, and mood state were negatively associated with participation in physical activity. Vigor and state anxiety were associated with participation in physical activity.Conclusion: Social isolation and social distancing practices have had a negative effect on depression, anxiety, and mood over time. It appeared that depressive symptoms and total mood disturbance was elevated during time point two. Depressive symptoms were much higher than average compared to previous epidemiological data. Physical activity amount did not change over time but was associated with poor mental health. (shrink)

This article examines the conceptual impact of equal pay legislation on Canadian trade unionism. Ambiguous, largely voluntary, legislation poses major challenges to unions negotiating wage parity for their members. Furthermore, the movement finds itself caught between conflicting responsibilities as champion of the underpaid and protector of traditional interests. The authors examine this challenge within the context of the historic development, and fundamental principles of trade unionism. They conclude that many of the conflicts discussed arise directly from established union practices and (...) must, therefore, be resolved by the movement and other affected parties together. (shrink)

Open-mindedness is widely valued as an important intellectual virtue. Definitional debates about open-mindedness have focused on whether open-minded believers must possess a particular first-order attitude toward their beliefs or a second-order attitude toward themselves as believers, taking it for granted that open-mindedness is motivated by the pursuit of propositional knowledge. In this article, Rebecca Taylor develops an alternative to knowledge-centered accounts of open-mindedness. Drawing on recent work in epistemology that reclaims understanding as a primary epistemic good, Taylor argues for (...) an expanded account of open-mindedness as an intellectual virtue motivated by the pursuit of both knowledge and understanding. Incorporating understanding allows for a more robust account of open-mindedness that better accommodates common usage, avoids common criticisms, and better explains the widespread acceptance of open-mindedness as an important intellectual virtue. Taylor also identifies the connections between open-mindedness and several other intellectual virtues, including intellectual humility, intellectual courage, and intellectual diligence. (shrink)

Despite some improvements in access to evidence-based medications for opioid use disorder, treatment rates remain low at under a quarter of those with need. High costs for brand name products in these medication markets have limited the volume of drugs purchased, particularly through public health insurance and grant programs. Brand firm anti-competitive practices around the leading buprenorphine product Suboxone — including product hops, citizen petitions and Risk Evaluation and Mitigation Strategy abuses — helped to maintain high prices by extending (...) brand exclusivity periods and hindering generic drug entry. Remedies to address costly anti-competitive activities include adoption of the proposed CREATES Act and modernization of the Hatch-Waxman Act by the Congress, and implementation of substantive modifications to the Food and Drug Administration citizen petition filing procedures. Given the persistence of these abuses, prescriptive changes are favorable to the procedural and clarifying steps thus far favored by the federal government. Extrapolating from the 37% price declines attributable to generic entry for buprenorphine tablets in 2011, our calculations suggest that implementing these remedies to facilitate generic competition with Suboxone film would have resulted in savings of approximately $703 million overall and $203 million to Medicaid in 2017. (shrink)

It's not unusual to hear someone say, ‘I'd rather be dead than have Alzheimer's’. In ‘Alzheimer Disease and Preemptive Suicide’,1 Dena Davis explains why this is a reasonable position. People taking this position will welcome the discovery of biomarkers permitting very early AD diagnosis, Davis suggests, for this will enable more of them to end their lives while they remain motivated and able to do so. At the same time, Davis observes, people would have less reason to resort to the (...) drastic remedy of pre-emptive suicide if they had absolute authority over the medical treatment they received as patients with dementia; but the threat of pre-emptive suicide is not, in my view, a sufficient reason to grant competent individuals that authority.If preclinical diagnosis of AD becomes possible, some pre-emptive suicides will probably occur. There would be no ethical or practical way to ban such suicides, and it would be silly to try. Clinicians will undoubtedly try to discourage people seeking biomarker information in furtherance of a suicide plan, but savvy individuals will simply conceal their true motivation for having the tests. The real problem for people intent on self-destruction is that biomarkers are unlikely to deliver a clear suicide signal.First, as Davis notes, work on biomarkers remains in the research stage. No one yet knows whether biomarker tests will prove accurate enough to warrant clinical use. Second, even clinically accepted biomarker tests will generate imperfect information about future disease. Biomarkers may produce more accurate estimates of a person's risk of developing AD, but like all predictive tests, they will also yield false positive and negative results. The …. (shrink)

Background: Discussion of the influence of money on bioethics research seems particularly salient in the context of research on the ethical, legal, and social implications (ELSI) of human genomics, as this research may be financially supported by the ELSI Research Program. Empirical evidence regarding the funding of ELSI research and where such research is disseminated, in relation to the specific topics of the research and methods used, can help to further discussions regarding the appropriate influence of specific institutions and institutional (...) contexts on ELSI and other bioethics research agendas. Methods: We reviewed 642 ELSI publications (appearing between 2003 and 2008) for reported sources of funding, forum for dissemination, empirical and nonempirical methods, and topics of investigation. Results: Most ELSI research is independent of direct grant-based funding sources; 66% reported no such sources of funding. The National Human Genome Research Institute (NHGRI) is the most dominant source of funding; 16% of publications acknowledged at least one source of NHGRI grant funding. Funding is acknowledged more frequently in empirical than nonempirical publications and more frequently in publications in public health journals than in any other ELSI research dissemination forums. Dominant research topics vary by publication forum and by reported funding. Conclusions: ELSI research is surprisingly independent of direct grant-based funding, yet correlations are apparent between this type of funding and publication placement, topics addressed, and methods used, implying a not insignificant influence on ELSI research agenda setting. However, given the relatively low percentage of publications acknowledging external grant-based funding, as well as other significant correlations between publication placement and topics addressed, additional institutional contexts, perhaps related to professional advancement or valuation, may shape research agendas in ways that potentially exceed the direct influences of grant-based funding in this area. In some cases, grant-based funding may actually counter other potentially problematic institutional influences. (shrink)

During its 2018–2019 term, the United States Supreme Court considered the constitutionality of executing a prisoner with dementia. In Madison v. Alabama, the Court ruled that, in certain circumstances, executing a prisoner with dementia violates the Eighth Amendment’s ban on cruel and unusual punishment. Vernon Madison was sentenced to death for killing a police officer in 1985. After many years on Alabama’s death row, he had a series of strokes and was diagnosed with vascular dementia. In 2016, Madison’s lawyers unsuccessfully (...) sought a stay of execution, arguing that, in light of his cognitive impairments, imposing the death penalty would violate the Constitution. After Alabama set a 2018 execution date, lawyers returned to the state court, arguing that the finding of competence should be reversed because Madison’s cognitive impairments had worsened. When the trial court refused to grant the stay of execution, Madison’s lawyers asked the Supreme Court to review the constitutionality of the state court decision. (shrink)

The principle of procreative beneficence, first suggested by Julian Savulescu, argues that: If couples have decided to have a child, and selection is possible, then they have a significant moral reason to select the child, of the possible children they could have, whose life is expected, in light of the relevant available information, to go best or at least not worse than any of the others. While the validity of this moral principle has been widely contested, in this paper we (...) move away from these issues and grant, for the sake of argument, that PB is a valid moral principle, and that the justification for PB provided by Savulescu and co-authors is sound. We do this in order to explore the implications and consequences of accepting PB and show that even if we put aside questions about the validity and theoretical foundations of this principle, PB has many interesting, astonishing and highly problematic implications that have not been made explicit in the writing of Savulescu and others who support the notion of an obligation to bring to birth the best child possible :204, 2002). We suggest that these implications should be taken into account when considering both the soundness and strength of PB. (shrink)

The Supreme Court has ruled in the case of Y that there is no requirement to seek the approval of the Court of Protection in decisions to withdraw clinically assisted nutrition and hydration from patients in a prolonged disorder of consciousness.1 Mr Y was 52-year-old man who suffered a cardiac arrest after a myocardial infarction as a result of coronary artery disease. It was not possible to resuscitate him for well over 10 min, resulting in severe cerebral hypoxia which caused (...) extensive brain damage. Mr Y’s family and the NHS Trust treating him agreed that Mr Y would not want to be kept alive through the provision of CANH given his poor prognosis. They sought a declaration that it was not mandatory for applications of withdrawal of CANH to come before the court, which was granted by Mrs Justice O’Farrell in the first instance.2 Permission was granted for the appeal to ‘leapfrog’ the Court of Appeal and to proceed to the Supreme Court for consideration. In the interim, Mr Y died after contracting acute respiratory sepsis, but the Supreme Court determined that the appeal should go ahead in light of the general importance of the issues raised. In delivering the opinion of the Supreme Court on 30 July 2018, Lady Justice Black rejected the historical distinction that had been drawn between patients in PDOC and non-PDOC patients, in a way that had justified judicial involvement for patients in PDOC but not for others.3 She was clear that the correct approach to all cases involving CANH was to make a decision based on what was in the best interests of the patient. She further outlined that: > The documentation supplied to us shows that the difficulty that there is in assessing the patient and in …. (shrink)

: Aanerud's project is to develop an account of white antiracist mothering, using a model of maternal duty to raise antiracist white children. The author sets this project in the context of historic constructions of white mothering in the twentieth century and then contrasts the need for an exploration of white mothers raising white children against the literature of white mothers' raising children of color and mothers of color raising their own children, Once this distinction is made, Aanerud uses Collins's (...) account of racial ethnic mothering as a springboard into her discussion of antiracist white mothering of white children. (shrink)

Aanerud's project is to develop an account of white antiracist mothering, using a model of maternal duty to raise antiracist white children. The author sets this project in the context of historic constructions of white mothering in the twentieth century and then contrasts the need for an exploration of white mothers raising white children against the literature of white mothers’ raising children of color and mothers of color raising their own children, Once this distinction is made, Aanerud uses Collins's account (...) of racial ethnic mothering as a springboard into her discussion of antiracist white mothering of white children. (shrink)

Aanerud's project is to develop an account of white antiracist mothering, using a model of maternal duty to raise antiracist white children. The author sets this project in the context of historic constructions of white mothering in the twentieth century and then contrasts the need for an exploration of white mothers raising white children against the literature of white mothers’ raising children of color and mothers of color raising their own children, Once this distinction is made, Aanerud uses Collins's account (...) of racial ethnic mothering as a springboard into her discussion of antiracist white mothering of white children. (shrink)

In this article, we outline a novel approach to understanding the role of responsibility in health promotion. Efforts to tackle chronic disease have led to an emphasis on personal responsibility and the identification of ways in which people can ‘take responsibility’ for their health by avoiding risk factors such as smoking and over-eating. We argue that the extent to which agents can be considered responsible for their health-related behaviour is limited, and as such, state health promotion which assumes certain forms (...) of moral responsibility should be avoided. This indicates that some approaches to health promotion ought not to be employed. We suggest, however, that another form of responsibility might be more appropriately identified. This is based on the claim that agents have prudential reasons to maintain their health, in order to pursue those things which make their lives go well—i.e. that maintenance of a certain level of health is rational for many agents, given their pleasures and plans. On this basis, we propose that agents have a self-regarding prudential responsibility to maintain their health. We outline the implications of a prudential responsibility approach to health promotion. (shrink)

Former NAACP chapter head Rachel Dolezal's attempted transition from the white to the black race occasioned heated controversy. Her story gained notoriety at the same time that Caitlyn Jenner graced the cover of Vanity Fair, signaling a growing acceptance of transgender identity. Yet criticisms of Dolezal for misrepresenting her birth race indicate a widespread social perception that it is neither possible nor acceptable to change one's race in the way it might be to change one's sex. Considerations that support transgenderism (...) seem to apply equally to transracialism. Although Dolezal herself may or may not represent a genuine case of a transracial person, her story and the public reaction to it serve helpful illustrative purposes. (shrink)

Human Rights Education (HRE) has traditionally been articulated in terms of cultivating better citizens or world citizens. The main preoccupation in this strand of HRE has been that of bridging a gap between universal notions of a human rights subject and the actual locality and particular narratives in which students are enmeshed. This preoccupation has focused on ‘learning about the other’ in order to improve relations between plural ‘others’ and ‘us’ and reflects educational aims of national identity politics in citizenship (...) education. The article explores the learning of human rights through narratives in relations, drawing on Hannah Arendt and Sharon Todd. For this re-thinking of relations in learning human rights, the article argues that HRE needs to address both competing historical narratives on the drafting of the Universal Declaration on Human Rights (UDHR) as well as unique life narratives of learners. (shrink)

In Working Virtue: Virtue Ethics and Contemporary Moral Problems, leading figures in the fields of virtue ethics and ethics come together to present the first ...

The validity and utility of the proximate-ultimate distinction in biology have recently been under debate. Opponents of the distinction argue that it rules out individual-level organismic processes from evolutionary explanations, thereby leading to an unfounded separation between organismic causation and evolutionary causation. Proponents of the proximate-ultimate distinction, on the other hand, argue that it serves an important epistemological role in forming different kinds of explanation-seeking questions in biology. In this paper we offer an interpretation the proximate-ultimate distinction not only as (...) a means of forming explanation-seeking questions, but also as a distinction that can help highlight the way in which individual-level organismic processes can be evolutionary causes. We do this by interpreting the distinction between proximate and ultimate causes as a distinction between structuring and triggering causes. (shrink)

Biological ontologies are used to organize, curate, and interpret the vast quantities of data arising from biological experiments. While this works well when using a single ontology, integrating multiple ontologies can be problematic, as they are developed independently, which can lead to incompatibilities. The Open Biological and Biomedical Ontologies Foundry was created to address this by facilitating the development, harmonization, application, and sharing of ontologies, guided by a set of overarching principles. One challenge in reaching these goals was that the (...) OBO principles were not originally encoded in a precise fashion, and interpretation was subjective. Here we show how we have addressed this by formally encoding the OBO principles as operational rules and implementing a suite of automated validation checks and a dashboard for objectively evaluating each ontology’s compliance with each principle. This entailed a substantial effort to curate metadata across all ontologies and to coordinate with individual stakeholders. We have applied these checks across the full OBO suite of ontologies, revealing areas where individual ontologies require changes to conform to our principles. Our work demonstrates how a sizable federated community can be organized and evaluated on objective criteria that help improve overall quality and interoperability, which is vital for the sustenance of the OBO project and towards the overall goals of making data FAIR. Competing Interest StatementThe authors have declared no competing interest. (shrink)

This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about (...) the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position, including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. (shrink)

Recent theoretical models suggest that the difference between human and nonhuman primate life-history patterns may be due to a reliance on complex foraging strategies requiring extensive learning. These models predict that children should reach adult levels of efficiency faster when foraging is cognitively simple. We test this prediction with data on Meriam fishing, spearfishing, and shellfishing efficiency. For fishing and spearfishing, which are cognitively difficult, we can find no significant amount of variability in return rates because of experiential factors correlated (...) with age. However, for shellfish collecting, which is relatively easy to learn, there are strong age-related effects on efficiency. Children reach adult efficiency more quickly in fishing as compared to shellfish collecting, probably owing to the size and strength constraints of the latter. (shrink)

The 'Gamer's Dilemma' is the problem of why some actions occurring in video game contexts seem to have similar, albeit attenuated, kinds of moral significance to their real-world equivalents, while others do not. In this paper, I argue that much of the confusion in the literature on this problem is not ethical but metaphysical. The Gamer's Dilemma depends on a particular theory of the virtual, which I call 'inflationary', according to which virtual worlds are a metaphysical novelty generated almost exclusively (...) by video games. Actions performed in virtual worlds really belong to the kinds of action they appear to—'virtual murder' is a kind of murder. Inflationary theories are contrasted with 'deflationary' theories which, in effect, consider video games purely as systems for generating images, and thus the gamer as a consumer of media images. Inflationary theories struggle to explain why video games produce this unique metaphysical novelty; deflationary theories fail to do justice to the intuition that there is some significant difference between the gamer and the consumer of other media forms. In place of either, I sketch a theory of the gamer as performer, primarily by analogy with stage and cinema actors, which I suggest captures more of the moral complexity of the gamer's action. (shrink)

The postmodern criticism of music analysis remains unwittingly preoccupied with a false image of ‘the Whole’, or with the construction of unity precisely through privileging its opposite. At the centre of this discourse there often emerges a split between two things—analysis/aesthetics, part/whole, subject/object—where the question then becomes one of reconciliation: how can the analytical methods be subsumed into aesthetic discussions of subjectivity to better represent the ‘thing itself’? This problem is now a cross-disciplinary one, with criticism favouring the application of (...) ‘external’ disciplines to complement the ‘internal’ act of music analysis. This article takes Žizek’s comments on the difference between modernism and postmodernism as alienation and separation as its starting point in order to reconsider the effects of the supposedly postmodern concept of interdisciplinarity for music analysis. Through a critique of existing musico-psychoanalytic literature, it demonstrates the ways in which the interdisciplinary relation currently seems to occupy the space of an objet petit a in scholarship that is therefore marked by a failure restricted to the principles of alienation. If read alongside Žižek’s phenomenology of the subject however, rather than become a fetishized unity, this relation could be seen to construct the space for a self-reflexive musical subject, able to avoid false reconciliation through critical self- awareness, and could also therefore hold greater significance for an interdisciplinary musicology. (shrink)

My particular focus in this article is on getting clearer about what Nietzsche’s experimentalism entails. Some immediate resistance may form in response to this proposal, based on my use of the term experimentalism. As Walter Kaufmann has pointed out in a discussion of experimentalism, Nietzsche himself does not discuss his work using this concept; in the original German, Nietzsche uses the terms “Experiment” and “Versuch.”1 In light of this, two main concerns may be raised about my proposal that experimentalism is (...) worth some of our time and attention: whether it is necessary or helpful to focus discussion on yet another “ism” within Nietzsche scholarship and given that experimentalism is not Nietzsche’s.. (shrink)

van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation (...) to VE; and third, the significant risk of perpetuating under-recognised harms associated with unwanted or unconsented VE. I argue that opt-out consent cannot be ethically justified for VE. Its use would result in further weakening of consent practices, circumvention of individuals’ autonomy, and greater harm for women and birthing people. At the outset, it is important to recognise that the authors do not claim that their approach should be applied to VE, merely that their discussion may have relevance to consent for other interventions beyond episiotomy ‘where consent is also frequently lacking, and which are under-researched’, including VE.1 Nonetheless, it is easy to assume that episiotomy and VE are sufficiently similar that their analysis might be transferred wholesale. I disagree. There are similarities: both interventions are performed on ‘the most intimate and socially sensitive body parts’1; …. (shrink)

The claim that we have a moral obligation, where a choice can be made, to bring to birth the 'best' child possible, has been highly controversial for a number of decades. More recently Savulescu has labelled this claim the Principle of Procreative Beneficence. It has been argued that this Principle is problematic in both its reasoning and its implications, most notably in that it places lower moral value on the disabled. Relentless criticism of this proposed moral obligation, however, has been (...) unable, thus far, to discredit this Principle convincingly and as a result its influence shows no sign of abating. I will argue that while criticisms of the implications and detail of the reasoning behind it are well founded, they are unlikely to produce an argument that will ultimately discredit the obligation that the Principle of Procreative Beneficence represents. I believe that what is needed finally and convincingly to reveal the fallacy of this Principle is a critique of its ultimate theoretical foundation, the notion of impersonal harm. In this paper I argue that while the notion of impersonal harm is intuitively very appealing, its plausibility is based entirely on this intuitive appeal and not on sound moral reasoning. I show that there is another plausible explanation for our intuitive response and I believe that this, in conjunction with the other theoretical criticisms that I and others have levelled at this Principle, shows that the Principle of Procreative Beneficence should be rejected. (shrink)

Questions of what a self-driving car ought to do if it encounters a situation analogous to the ‘trolley problem’ have dominated recent discussion of the ethics of self-driving cars. This paper argues that this interest is misplaced. If a trolley-style dilemma situation actually occurs, given the limits on what information will be available to the car, the dynamics of braking and tyre traction determine that, irrespective of outcome, it is always least risky for the car to brake in a straight (...) line rather than swerve. (shrink)

Mathematicians judge proofs to possess, or lack, a variety of different qualities, including, for example, explanatory power, depth, purity, beauty and fit. Philosophers of mathematical practice have begun to investigate the nature of such qualities. However, mathematicians frequently draw attention to another desirable proof quality: being motivated. Intuitively, motivated proofs contain no "puzzling" steps, but they have received little further analysis. In this paper, I begin a philosophical investigation into motivated proofs. I suggest that a proof is motivated if and (...) only if mathematicians can identify (i) the tasks each step is intended to perform; and (ii) where each step could have reasonably come from. I argue that motivated proofs promote understanding, convey new mathematical resources and stimulate new discoveries. They thus have significant epistemic benefits and directly contribute to the efficient dissemination and advancement of mathematical knowledge. Given their benefits, I also discuss the more practical matter of how we can produce motivated proofs. Finally I consider the relationship between motivated proofs and proofs which are explanatory, beautiful and fitting. (shrink)

In 1837, Dirichlet proved that there are infinitely many primes in any arithmetic progression in which the terms do not all share a common factor. Modern presentations of the proof are explicitly higher-order, in that they involve quantifying over and summing over Dirichlet characters, which are certain types of functions. The notion of a character is only implicit in Dirichlet’s original proof, and the subsequent history shows a very gradual transition to the modern mode of presentation. In this essay, we (...) describe an approach to the philosophy of mathematics in which it is an important task to understand the roles of our ontological posits and assess the extent to which they enable us to achieve our mathematical goals. We use the history of Dirichlet’s theorem to understand some of the reasons that functions are treated as ordinary objects in contemporary mathematics, as well as some of the reasons one might want to resist such treatment. We also use these considerations to illuminate the formal treatment of functions and objects in Frege’s logical foundation, and we argue that his philosophical and logical decisions were influenced by many of the same factors. (shrink)

Three approaches to intertextual writing are available to college instructors: mechanical, ethical, and rhetorical. The mechanical approach, a staple of writing instruction, teaches the use of citation styles such as MLA or APA; methods of citing sources; and the conventions of quotation. The ethical approach is primarily concerned with the character of individual writers and their adherence to community standards categorized as “academic integrity.” The great majority of source-based writing instruction attends to one or both of these approaches. A third (...) approach, rhetorical intertextuality, is overshadowed by the ethical concerns that currently permeate educational institutions. Rhetorical intertextuality does promote textual ethics, but in a positive way, through instruction in building meaning in a target text through collaboration with source texts. Rhetorical intertextuality brings the source texts themselves to life and aims to engage the audience in a conversation with target text and source texts. Drawing on Citation Project data, we advocate instruction in intertextual writing that hails students as authors, not transgressors. Rhetorical intertextuality can provide a positive frame for college instruction in intertextual writing, one that facilitates deep engagement with texts; intellectual approaches to paraphrasing and summarizing; and an emphasis on the rhetorical choices that writers make as they encounter and respond to the ideas of others. The objective of such instruction is a dialogic interface between writer, audience, and sources—a conversation. (shrink)

In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and Care (...) Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children. (shrink)

The Principle of Procreative Beneficence claims that we have a moral obligation, where choice is possible, to choose to create the best child we can. The existence of this moral obligation has been proposed by John Harris and Julian Savulescu and has proved controversial on many levels, not least that it is eugenics, asking us to produce the best children we can, not for the sake of that child's welfare, but in order to make a better society. These are strong (...) claims that require robust justification that can be open to scrutiny and debate. This article argues that robust justifications are currently lacking in the work of Savulescu and Harris. The justifications provided for their conclusions about this obligation to have the best child possible rely heavily on Derek Parfit's Non-Identity Problem and the intuitive response this provokes in many of us. Unfortunately Harris and Savulescu do not embrace the entirety of the Non-Identity Problem and the puzzle that it presents. The Non-Identity Problem actually provides a refutation of PPB. In order to establish PPB as a credible and defendable principle, Harris and Savulescu need to find what has eluded Parfit and many others: a solution to the Non-Identity Problem and thus an overturning of the refutation it provides for PPB. While Harris and Savulescu do hint at possible but highly problematic solutions to the Non-Identity Problem, these are not developed or defended. As a result their controversial is left supported by little more than intuition. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...) what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)