Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

The view that research with competent adults requires valid consent to be ethical perhaps finds its clearest expression in the Nuremberg Code, whose famous first principle asserts that “the voluntary consent of the human subject is absolutely essential.” In a similar vein, the United Nations International Covenant on Civil and Political Rights states that “no one shall be subjected without his free consent to medical or scientific experimentation.” Yet although some formulations of the consent principle allow no exceptions, others hold (...) that informed consent is not always strictly necessary for ethical research. The U.S. federal regulations known as the “Common Rule,” which govern research with human subjects, lists several conditions for waiving consent. However, neither guidance documents on the ethics of clinical research nor the literature in bioethics contains a general justification of research without consent. The purpose of this paper is to advance a justificatory framework that will explain why research without consent is permissible in paradigmatic cases and that can be useful in analyzing cases about which there is disagreement. We argue that research without consent can be justified on two grounds: if it stands to infringe no right of the participants and obtaining consent is impracticable, or if the gravity of the rights infringement is minor and outweighed by the expected social value of the research and obtaining consent is impracticable. (shrink)

The right to withdraw from participation in research is recognized in virtually all national and international guidelines for research on human subjects. It is therefore surprising that there has been little justification for that right in the literature. We argue that the right to withdraw should protect research participants from information imbalance, inability to hedge, inherent uncertainty, and untoward bodily invasion, and it serves to bolster public trust in the research enterprise. Although this argument is not radical, it provides a (...) useful way to determine how the right should be applied in various cases. (shrink)

In this short response to Kerstein and Bognar, we clarify three aspects of the complete lives system, which we propose as a system of allocating scarce medical interventions. We argue that the complete lives system provides meaningful guidance even though it does not provide an algorithm. We also defend the investment modification to the complete lives system, which prioritizes adolescents and older children over younger children; argue that sickest-first allocation remains flawed when scarcity is absolute and ongoing; and argue that (...) Kerstein and Bognar are mistaken to base their allocation principles on differences in personhood. (shrink)

In this book, Alan Wertheimer seeks to identify when a transaction or relationship can be properly regarded as exploitative--and not oppressive, manipulative, or morally deficient in some other way--and explores the moral weight of taking ...

: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

What is the basis for arguing that a volunteer army exploits citizens who lack civilian career opportunities? How do we determine that a doctor who has sex with his patients is exploiting them? In this book, Alan Wertheimer seeks to identify when a transaction or relationship can be properly regarded as exploitative--and not oppressive, manipulative, or morally deficient in some other way--and explores the moral weight of taking unfair advantage. Among the first political philosophers to examine this important topic (...) from a non-Marxist perspective, Wertheimer writes about ordinary experience in an accessible yet philosophically penetrating way. He considers whether it is seriously wrong for a party to exploit another if the transaction is consensual and mutually advantageous, whether society can justifiably prohibit people from entering into such a transaction, and whether it is wrong to allow oneself to be exploited. Wertheimer first considers several contexts commonly characterized as exploitive, including surrogate motherhood, unconscionable contracts, the exploitation of student athletes, and sexual exploitation in psychotherapy. In a section outlining his theory of exploitation, he sets forth the criteria for a fair transaction and the point at which we can properly say that a party has consented. Whereas many discussions of exploitation have dealt primarily with cases in which one party harms or coerces another, Wertheimer's book focuses on what makes a mutually advantageous and consensual transaction exploitive and analyzes the moral and legal implications of such exploitation. (shrink)

This book assembles the contributions of a distinguished group of scholars concerning the ethics of consent in theory and practice.

These paperback editions preserve the original texts of these important books while presenting them in durable paperback editions.

The need for a shift toward healthier and more sustainable diets is evident and is supported by universalized standards for a “planetary health diet” as recommended in the recent EAT-Lancet report. At the same time, differences exist in tastes, preferences and food practices among diverse ethnic groups, which becomes progressively relevant in light of Europe’s increasingly multi-ethnic cities. There is a growing tension between current sustainable diets standards and how diverse ethnic resident groups relate to it within their ‘culturally appropriate’ (...) foodways, raising questions around inclusion. What are dynamics of inclusiveness in migrant food practices? And what does this mean towards the transition to healthy and sustainable food? We study this question among Syrian migrants with different lengths of stay in the Netherlands. Our theoretical framework is based on practice theories, which emphasize the importance of socio-material context and of bodily routines and competences. We use qualitative methods, combining in-depth semi-structured life-history interviews with participant observation. Our findings indicate that inclusiveness takes different forms as migrants’ food practices and the food environment change. Regarding health and sustainability in food practices, understandings and competences around particularly fresh food change over time among both short- and long-term migrants, replacing making things from scratch with seasonal products with buying more processed products and out-of-season vegetables and fruits. We conclude that the performances of food practices and their configurations in food environments and lifestyles are dynamic and cannot unequivocally be interpreted as in- or exclusive, but that a more nuanced understanding is required. (shrink)

Introduction -- Facing up to paternalism in research ethics -- Preface to a theory of consent transactions in research : beyond valid consent -- Should we worry about money? -- Exploitation in clinical research -- The interaction principle.

When does a woman give valid consent to sexual relations? When does her consent render it morally or legally permissible for a man to have sexual relations with her? Why is sexual consent generally regarded as an issue about female consent? And what is the moral significance of consent? These are some of the questions discussed in this important book, which will appeal to a wide readership in philosophy, law, and the social sciences. Alan Wertheimer develops a theory of (...) consent to sexual relations that applies to both law and morality in the light of the psychology of sexual relations, the psychology of perpetrators, and the psychology of the victims. He considers a wide variety of difficult cases such as coercion, fraud, retardation, and intoxication. We can all agree that 'no' means 'no'. This book suggests that the difficult question is whether 'yes' means 'yes'. (shrink)

When does a woman give valid consent to sexual relations? When does her consent render it morally or legally permissible for a man to have sexual relations with her? Why is sexual consent generally regarded as an issue about female consent? And what is the moral significance of consent? These are some of the questions discussed in this important book, which will appeal to a wide readership in philosophy, law, and the social sciences. Alan Wertheimer develops a theory of (...) consent to sexual relations that applies to both law and morality in the light of the psychology of sexual relations, the psychology of perpetrators, and the psychology of the victims. He considers a wide variety of difficult cases such as coercion, fraud, retardation, and intoxication. We can all agree that 'no' means 'no'. This book suggests that the difficult question is whether 'yes' means 'yes'. (shrink)

critical analyses of the arguments and attitudes favoring the various popular datings of the inception of a human being's life.

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.

In “Assessing the Remedy: The Case for Contracts in Clinical Trials,” Sarah Edwards (2011) proposes that research participants acquire contractual obligations to investigators, thus opening the doo...

What is the basis for arguing that a volunteer army exploits citizens who lack civilian career opportunities? How do we determine that a doctor who has sex with his patients is exploiting them? In this book, Alan Wertheimer seeks to identify when a transaction or relationship can be properly regarded as exploitative--and not oppressive, manipulative, or morally deficient in some other way--and explores the moral weight of taking unfair advantage. Among the first political philosophers to examine this important topic (...) from a non-Marxist perspective, Wertheimer writes about ordinary experience in an accessible yet philosophically penetrating way. He considers whether it is seriously wrong for a party to exploit another if the transaction is consensual and mutually advantageous, whether society can justifiably prohibit people from entering into such a transaction, and whether it is wrong to allow oneself to be exploited.Wertheimer first considers several contexts commonly characterized as exploitive, including surrogate motherhood, unconscionable contracts, the exploitation of student athletes, and sexual exploitation in psychotherapy. In a section outlining his theory of exploitation, he sets forth the criteria for a fair transaction and the point at which we can properly say that a party has consented. Whereas many discussions of exploitation have dealt primarily with cases in which one party harms or coerces another, Wertheimer's book focuses on what makes a mutually advantageous and consensual transaction exploitive and analyzes the moral and legal implications of such exploitation. (shrink)

Trauma is a universal human experience. While each person responds differently to trauma, its presence in our lives nonetheless marks a continual thread through human history and prehistory. In Critical Trauma Studies, a diverse group of writers, activists, and scholars of sociology, anthropology, literature, and cultural studies reflects on the study of trauma and how multidisciplinary approaches lend richness and a sense of deeper understanding to this burgeoning field of inquiry. The original essays within this collection cover topics such as (...) female suicide bombers from the Chechen Republic, singing prisoners in Iranian prison camps, sexual assault and survivor advocacy, and families facing the devastation of Hurricane Katrina. As it proceeds, Critical Trauma Studies never loses sight of the way those who study trauma as an academic field, and those who experience, narrate, and remediate trauma as a personal and embodied event, inform one another. Theoretically adventurous and deeply particular, this book aims to advance trauma studies as a discipline that transcends intellectual boundaries, to be mapped but also to be unmoored from conceptual and practical imperatives. Remaining embedded in lived experiences and material realities, Critical Trauma Studies frames the field as both richly unbounded and yet clearly defined, historical, and evidence-based. (shrink)

It is widely assumed that it is ethical to conduct research with human subjects only if the research has social value. There are two standard arguments for this view. The allocation argument claims that public funds should not be devoted to research that lacks social value. The exploitation avoidance argument claims that subjects are exploited if research has no social value. The primary purpose of this article is to argue that these arguments do not succeed. The allocation argument has little (...) relevance to commercial research. Social value is not necessary to avoid exploitation if subjects benefit from participation. Although the standard arguments for a social value requirement do not succeed, that view might be justified in a different way. It might be justified by appeal to the importance of social trust or the integrity of physician investigators. It is possible but doubtful that these arguments succeed. (shrink)

Univocalist analyses of the modal auxiliary verbs ('ought'/'must'/'can') and the adjective 'right'/'wrong'.

Our culture is conflicted about morally judging and condemning. We can't avoid it altogether, yet many layfolk today are loathe to do it for reasons neither they nor philosophers well understand. Their resistance is often confused (by themselves and by theorists) with some species of antiobjectivism. But unlike a nonobjectivist, most people think that (a) for us to judge and condemn is generally (objectively) morally wrong , yet (b) for God to do so is (objectively) proper, and (c) so too (...) for certain persons in certain relations (e.g., self-condemnation, parental child rearing.) Certainly, religious (e.g., Christian) critics of judging and condemning without doubting the objective truth of their tradition's core moral teachings. Most puzzling is that (a) merely judging and condemning in one's heart may be improper, and (b) someone else with no more evidence or expertise might properly judge and condemn the same action. The answer is in condemning's complex structure of presuppostions. Condemning and judging are acts, and attitudes initiated by the act. Condemnation is motivated by two judgments presumed to justify it, a criticism of a target, and a judgment that the criticism justifies some negative response toward the target. Unlike nonpunitive penalties, punishments are motivated and explained by condemnation. Condemnation is an act of a hostile will, wishing some evil for its target, not (just) as a means to some good. Its root is in damning, an act akin to cursing. It declares a degraded status. The hostility makes it harder to justify condemnation than criticism, and punishment than nonpunitive penalties. Condemning claims objectivity and authority. It involves reflexive evaluation, regarding itself justified, approving its hostile feelings toward the target. Condemners presume themselves entitled to sit in judgment, pass judgment, and cast the condemned down. Those presumptions inhere in sitting in judgment, assuming jurisdiction. Unlike mathematical or scientific judgments, passing moral judgment seems to be a political act subject to extraepistemic constraints. "Who are you to judge?" may properly challenge your right to pass judgment. (shrink)

There is increasing recognition that sustainable diets need to be ‘culturally appropriate’. In relation to food consumption, however, it is often unclear what cultural appropriateness–or related terms, such as cultural or social acceptability–actually means. Often these terms go undefined, and where definitions are present, they vary widely. Based on a systematic literature review this paper explores how cultural appropriateness of food consumption is conceptualised across different research literatures, identifying six main themes in how cultural appropriateness is understood and applied. The (...) paper then critically analyses these themes in relation to sustainable food system transformation. We explore how the themes conceptualise change, finding that cultural appropriateness is viewed in two main ways: either as a relatively static obstacle to be overcome, or as a dynamic and negotiated process. Both perspectives, we argue, entail different scientific, practical and political effects. Each perspective offers particular affordances for understanding and governing sustainable food system transition, although between perspectives there is likely to be a trade-off between theoretical sophistication and practical operationalizability. Based on this analysis we argue that researchers, policymakers and practitioners should be explicit about their commitment to a particular understanding of cultural appropriateness, as this will have implications for scientific and societal applications of their work. This is particularly the case, we suggest, in relation to the transdisciplinary collaborations necessary to effectively address the ‘wicked problem’ of food system sustainability. We conclude by offering a tentative general definition of cultural appropriateness as it relates to food consumption. (shrink)

Gesundheit and colleagues offer dramatic examples of the medical treatment of terrorists but then pose the suggestion that those who engage in terrorism forfeit their right to medical care, and, consequently, that physicians have no obligation to treat them. Their argument presupposes that a physician’s obligation to provide medical care depends on the patients’ right to health care. Therefore, someone who commits heinous and abhorrent acts thereby waives the right to health care and the physicians’ duty to provide health care (...) might consequently be absolved. This view may appeal to physicians who have experienced the complexity and discomfort of treating someone whose morality or even humanity they question, such as a rapist, a serial killer, or a perpetrator of genocide. However we have grounds to believe that the duty of physicians to treat is not based on the moral worth of patients, but rather on the duties that physicians have, and this notion renders any concern about the unacceptability of any person’s behavior irrelevant in determining whether to provide treatment. We will first argue that not all duties are directly derived from rights, and then illustrate how deontological views, along with common views on the role morality of physicians, provide a basis for offering indiscriminate medical care. Second, we will discuss the physician’s role in the context of war, and offer one compelling moral reason on the basis of which warfare norms do indeed obligate physicians to extend their duty to care toward enemies, terrorists included, independently of whatever right they maintain. (shrink)

What I call ‘the standard view’ claims that IRBs should not regard financial payment as a benefit to subjects for the purpose of risk/benefit assessment. Although the standard view is universally accepted, there is little defense of that view in the canonical documents of research ethics or the scholarly literature. This paper claims that insofar as IRBs should be concerned with the interests and autonomy of research subjects, they should reject the standard view and adopt ‘the incorporation view.’ The incorporation (...) view is more consistent with the underlying soft-paternalist justification for risk-benefit assessment and demonstrates respect for the autonomy of prospective subjects. Adoption of the standard view precludes protocols that advance the interests of subjects, investigators, and society. After considering several objections to the argument, I consider several arguments for the standard view that do not appeal to the interests and autonomy of research subjects. (shrink)

John McMillan's article raises numerous important points about the ethics of surgical castration of sex offenders.1 In this commentary, we focus solely on and argue against the claim that the offer of release from detention conditional upon surgical castration is a coercive offer that compromises the validity of the offender's consent. We take no view on the question as to whether castration for sex offenders is ethically permissible. But, we reject the claim that it is ethically permissible only if competing (...) ethical considerations outweigh worries about coercion. For in the situation described, the proposal is not coercive at all.McMillan states that if offenders agree to castration because they fear long-term detention, then ‘it seems, intuitively, as if agreeing to be castrated under these conditions makes the decision coerced in some way.’1 He adds that if castration is ‘the only way that they will be released back into the community, the status of this decision as a genuine expression of their autonomy is questionable.’1 In defence of his claim, he uses two analogies that he borrows from Joel Feinberg. First, if a governor offers to commute a death sentence if the prisoner agrees to participate in a medical experiment, then ‘it's clear that the governor is coercing the prisoner.’1 Second, if a millionaire offers to give a woman $1 000 000 …. (shrink)