A brief critical notice of _What Is a Person?_ by Nancy Jecker and Caesar Atuire focusing on their relational account of what gives human beings a dignity.

Lange argues that the gestationalist approach to moral parenthood fails due to its implausible reliance on a ‘valuable intimate personal relationship between newborn and gestational procreator’ at birth.1 However, his dismissal of the moral significance of the maternal–fetal connection depends largely on inappropriate analogies to other forms of relationship. Further, Lange targets a very specific framing of the gestationalist view, overlooking the significance that many gestationalist accounts grant to maternal interests and experiences. Finally—perhaps due to this asymmetric focus—the version of (...) the Harm Argument with which he engages also fails to recognise as morally significant the harm of forced separation for parents (and especially gestational mothers). When investigating the purported value of the maternal–newborn relationship, Lange argues (plausibly) that the newborn’s experiences are so limited as to cast doubt on the non-instrumental value of this relationship for the newborn, and on the likelihood of harm to the newborn as a result of the interruption of this relationship. However, Lange grants little significance to the gestational mother’s experience of this relationship or her affect towards the fetus/newborn. He does not engage with literature on the epistemically transformative experience of pregnancy,2 nor, strikingly, does he discuss the possible significance of maternal love at birth. In fact, his paper mentions …. (shrink)

Epitomised by tedium and existential vacuity, ennui insidiously permeates the psyche of healthcare professionals, often eluding detection. Its etiological roots extend beyond its salient exploration in French literature, harking back to the early Christian treatises on acedia or spiritual desuetude.1 Throughout the centuries, ennui has undergone a substantive evolution, mirroring the vicissitudes in cultural cognition and existential sentiment. Spanning from the discourse in medieval monasticism to cogitations during the Renaissance and Enlightenment epochs, ennui has metamorphosed into a pivotal motif across (...) the literary, philosophical and theological spectra.2 This intricate concept, embodying a profound and variegated historical lineage, has been meticulously dissected and recontextualised by a cadre of preeminent thinkers and literary connoisseurs. In the contemporary medical ethics landscape, ennui emerges from labyrinthine historical antecedents, manifesting as profound existential drift among healthcare professionals. This state, marked by discord between self and purposive existence, leads to disengagement and disillusionment, challenging practitioners’ resilience and ethical decision-making capacities. Ennui ignites introspection but insidiously undermines their engagement and fervour, casting a shadow over professional zeal and mental fortitude. In their reflections, existential philosophers like Søren Kierkegaard and Albert Camus, diverging from Pascal’s theological exegesis, explored quintessential human experience and essence leitmotifs. Their analyses of despair and the absurd show parallels with ethical dilemmas and complexities in medical practice. …. (shrink)

Ectogestation technology, when feasible, will permit fetal development within an artificial womb. Ectogestation is termed ectogenesis when it is full (gestation occurs exclusively within an artificial womb post in vitro fertilisation) or partial (artificial gestation occurs during the course of in vivo gestation, post a caesarean-like fetal transfer). In what follows, I explore the implications for the gestational versus moral parenthood debate recently spotlighted by Benjamin Lange1 for various alternative uses of ectogestation compared to the baseline case of in vivo (...) gestation. I contrast ectogestation in four different contexts with in vivo gestation followed by vaginal delivery. I document the relevant outcomes, burdens and harms in particular, to the gestating mother, the biological father, the fetus and the child into whom it will develop. The focus on harms in considering intraparental claims to parenthood follows Lange’s focal article1: importantly, however, I focus not on harms from separation from the gestational procreator (as in adoption cases) but instead on harms arising from the use of ectogestation in various forms. I note at the outset, how, for each case discussed below, I indicate opportunities for each biological parent to establish voluntarism-based claims to moral parenthood. In the analyses, except where specifically noted, the default implication is that it is …. (shrink)

Although this editorial will be published in the February 2025 issue of the Journal of Medical Ethics, I am writing it in the run up to the Christmas and the winter holidays, after a busy term, and this is, for some of us, a time to reflect on the past year (although as an academic the year is only half-way through!). It is also the journal’s 50th anniversary in 2025. This prompts further reflection, thinking about how and why the journal (...) started, where its focus has been and what the future holds for both the journal and the field of medical ethics more broadly. Healthcare, those who work in it and the systems in which it is delivered, are facing pressures and challenges of huge global proportions, global conflict, the climate crisis and, in England, ongoing austerity all exacerbate existing health inequities. The stark disparities in healthcare access between the global south and north, and within countries such as the UK, raise profound questions of social justice. The JME has addressed many of these in articles and editorials over the years. As well as these current concerns, critical issues at the beginning and end of life are still as pertinent today as they were when the journal was first published in 1975. Looking at the running order for this issue, many of the papers consider issues and dilemmas that would have been familiar to …. (shrink)

This essay discusses the ethical challenges and dilemmas in allocating scarce medical resources during the COVID-19 pandemic, using the German legislative process as a starting point. It is guided by the right to non-discrimination of people with disability and generally contrasts utilitarian and rights-based principles of allocation. Three approaches that were suggested in the German discussion, are presented, the lottery principle, the first come first served principle and the probability to survive principle. Arguments in favour and against each principle are (...) discussed. The focus is on the utilitarian probability to survive principle, which was adopted in German legislation in 2022, and its discriminatory potential against people with disability. The essay suggests ways to mitigate the concerns of discrimination related to the probability to survive principle. It concludes that resolving the triage dilemma requires a balanced approach between utilitarian and rights-based concerns, which promotes both maximising the number of patients surviving and the right not to be discriminated against and be treated equally. It calls for a further debate on how many ethical values such as equity, fairness and non-discrimination we are willing to sacrifice for a higher number of survivors and when we are willing to sacrifice survivors to secure ethical values. (shrink)

Parenting our biological children is a centrally important matter, but how, if it all, can it be justified? According to a contemporary influential line of thinking, the acquisition by parents of a moral right to parent their biological children should be grounded by appeal to the value of the intimate emotional relationship that gestation facilitates between a newborn and a gestational procreator. I evaluate two arguments in defence of this proposal and argue that both are unconvincing.

I am grateful to James Cordeiro, Timothy Murphy, Heloise Robinson and Teresa Baron for their perceptive and stimulating comments on my article in this journal. 1 In what follows, I seek to respond to some of the main points raised in each commentary. Cordeiro examines the implications of various forms of ectogestation for the gestational versus moral parenthood debate by contrasting it with in vivo (natural) gestation. 2 His analysis considers the gestating mother’s and biological father’s parenthood claims in light (...) of various outcomes and the burdens and harms ectogestation may impose on them and on the fetus and newborn. I think his analysis helps to illustrate that—even if gestation does not necessarily give rise to a non-instrumentally valuable good in the form of an intimate relationship—corresponding pro tanto claims to moral parenthood might be settled by appeal to harms of ectogestation itself or voluntaristic considerations. Murphy... (shrink)

Hamas militants have raped and mutilated the bodies of dozens of men and women in Israel during their attack and captivity in Gaza. The exact extent of these atrocities, however, is unknown. For reasons of this sort and others, prosecuting sexual abusers during armed conflicts is notoriously difficult. In an attempt to make a legal case against Hamas militants, the Israeli authorities have recently ordered civilian hospitals to breach medical confidentiality and report unidentified data of patients who have suffered bodily (...) mutilation and sexual abuse during the Hamas attack or during captivity in Gaza. Patients were not informed about this policy. This article first establishes a case for why medical confidentiality is such an important existential and normative value. In this light, it then argues that the Israeli policy is morally unjustified. (shrink)

The development of vaccines against SARS-CoV-2 (COVID-19) presented a unique set of challenges. There was a global need for safe, effective vaccines against a new virus. In response to the development of vaccines for COVID-19 (some of which used novel technologies), there was a proliferation of no-fault compensation schemes (NFCS) for COVID-19 vaccine injuries. We identified 28 national vaccine injury NFCS operating in December 2019. Just 2 years later, over 130 countries had some NFCS coverage for COVID-19 vaccines. This rapid (...) expansion was primarily driven by the creation of three multinational schemes. The COVID-19 Vaccines Global Access (COVAX) scheme covers vaccines given under the COVAX framework in 92 low and middle-income countries across the globe. The African Vaccines Acquisition Trust (AVAT) scheme covers vaccines administered under the AVAT framework in 36 African and Caribbean countries. The UNICEF scheme covers vaccines administered by UNICEF in 18 Asian countries.Because of the sudden expansion of no-fault compensation for vaccine injury, especially in developing economies, more research on the foundations, procedures and outcomes of NFCS is needed. In this article, we examine how these NFCS meet the needs of individual claimants and society more widely. To do so, we first review the rationales offered to support the creation of vaccine injury NFCS. We then argue that, in order to achieve their function as compensation mechanisms, NFCS should be accessible and offer substantive and procedural justice to claimants. Finally, we focus on transparency and accountability as necessary requirements to allow scrutiny over existing NFCS and their wider impacts. (shrink)

We respond to David Wilkinson’s arguments against our view of the ethicality of doctors’ strikes and our claim that the 2023–2024 UK doctors’ strikes are morally permissible and arguably supererogatory.Wilkinson proposes that in specialist outpatient settings, striking doctors should help arrange their own cover to prevent disproportionate harm to patients and to abide by the principles of non-maleficence and fiduciary duty. This hasn’t happened during the 2023–2024 UK doctors’ strikes; therefore, in his view, these strikes are morally impermissible. We reject (...) Wilkinson’s proposal on the grounds that the risk of disproportionate harm is adequately mitigated by existing arrangements and his interpretations of non-maleficence and fiduciary duty are overly demanding.We agree with Wilkinson that strikes put particularly high pressure on covering doctors in chronically under resourced specialisms. But this doesn’t justify calling off or depowering doctors’ strikes because, without effective strikes, under-resourcing is likely to continue and, ultimately, cause even more harm.Wilkinson argues that doctors cannot justifiably strike in the interests of public health because they don’t have a broad duty to public health. We think they do have such a duty; however, we argue that doctors can justifiably strike in the interest of public health whether they have such a duty or not.Finally, we defend our claim that doctors’ strikes can be supererogatory from Wilkinson’s objections that there may be no such thing as supererogatory action and that our view absurdly entails that strikes can be supererogatory despite placing unfair demands on others. (shrink)

Residency selection is a challenging process for medical students, one further complicated in the USA by the recentDobbs v Jackson Women’s Health Organization(Dobbs) decision over-ruling the federal right to abortion. We surveyed medical students to examine howDobbsis influencing the ideological, personal and professional factors they must reconcile when choosing where and how to complete residency.Between 6 August and 22 October 2022, third-year and fourth-year US medical students applying to US residency programmes were surveyed through social media and direct outreach to (...) medical schools. Analysis of quantitative and qualitative data from 494 responses was performed to assess downstream effects ofDobbson residency applicants’ family, health and career choices.Most respondents said changes in abortion access would likely or very likely influence their decision regarding location of considered residency programme (76.9%), where to start a family (72.2%) and contraceptive planning for them or their partner (57.9%). Cis-gender females were more influenced byDobbsregarding where (5 (4, 5) p<0.001) and when (3 (3, 5) p<0.001) to start a family. In qualitative responses, medical trainees highlighted the importance of abortion access for their patients, themselves and their loved ones.Medical trainees are incorporating state abortion access into their residency programme choices. Future physicians care about both the quality of care they will be able to provide and their own health. For personal and professional reasons, reproductive healthcare access is now a key factor in residency match decisions. (shrink)

The upper time limit on growing embryos in culture for research could be revised, following a new recommendation by the Human Fertilisation and Embryology Authority (HFEA), the regulator of embryo research and fertility treatments in the UK. The recommendation was agreed at a meeting of the HFEA Authority, as part of wider discussions about modernising fertility law in the UK.1 Under the Human Fertilisation and Embryology Act 1990 (as amended), embryos which have been donated or created for research may be (...) grown in culture for up to 14 days or until the appearance of the primitive streak (whichever occurs sooner).2 This rule is widely replicated in other jurisdictions which permit the use of embryos in research.3 When this rule was adopted nearly 35 years ago, there was no prospect of sustaining embryos in vitro for more than a few days, and until recently, it has not posed a significant barrier to research.4 However, pressure to review the limit has grown following the publication of two studies in 2016 which demonstrated the technical feasibility of growing embryos to and potentially beyond the 14-day-limit.5 6 Proponents of changing the limit point to possible benefits of allowing …. (shrink)

Some commentators confer the right to children on those who gestate them because of the personal intimate relationship they say obtains in gestation.1 Benjamin Lange criticises two variants of that argument.2 He argues against the view that gestation creates a sui generis relationship that in its distinctiveness confers the right to the child on its gestator and the right of the child to its gestator. He also argues against the view that gestation involves a relationship whose dissolution necessarily causes morally (...) significant harm. I do not dispute these lines of reasoning, but the analysis goes further than Lange indicates. The reasons that Lange deploy to reject the relationship involved in gestation as conferring any kind of proprietary right to children also undercut that relationship as a ground of a presumptive duty towards those children. In the first instance, Lange disputes the idea that gestation produces a non-instrumental good that both the gestator and child have an interest in maintaining. In part, he argues that this kind of relationship lacks the emotional complexity, intimacy and intensity that underwrite other kinds of relationships, namely the very qualities that constitute the value of those relationships. More tellingly, he says, there is no unambiguous evidence that …. (shrink)

Those giving birth within modern maternity systems are recognised as facing a number of barriers to person-centred care. In this paper, I argue that in order to best facilitate the conditions for positive change, work needs to be done to provide a more granular articulation of the specific barriers. I then offer a nuanced and contextually aware articulation of one key component of the overall failure to ensure person-centred care: medical authority and the expectation of conformity. Articulating these barriers with (...) increased specificity is valuable, as it creates a stronger foundation from which to challenge existing problems which serve to constrain the autonomy of birthing individuals. The analysis offered in this paper also underscores the need for change at an institutional, rather than individual, level. (shrink)

In this article, our aim is to show why increasing the effectiveness of detecting doping fraud in sport by the use of artificial intelligence (AI) may be morally wrong. The first argument in favour of this conclusion is that using AI to make a non-ideal antidoping policy even more effective can be morally wrong. Whether the increased effectiveness is morally wrong depends on whether you believe that the current antidoping system administrated by the World Anti-Doping Agency is already morally wrong. (...) The second argument is based on the possibility of scenarios in which a more effective AI system may be morally worse than a less effective but non-AI system. We cannot, of course, conclude that the increased effectiveness of doping detection is always morally wrong. But our point is that whether the introduction of AI to increase detection of doping fraud is a moral improvement depends on the moral plausibility of the current system and the distribution of harm that will follow from false positive and false negative errors. (shrink)

In his article entitled ‘Moral parenthood: not gestational’, Benjamin Lange makes the following central and narrow claim: that moral parenthood cannot be defended fully based on an ‘emotional relationship’ facilitated by gestation.1 By ‘moral parenthood’, Lange appears to mean a moral right to parent the child. The ‘emotional relationship’ under scrutiny seems to be a form of intimate relationship during pregnancy involving an emotional attachment between the pregnant woman (or, in Lange’s terminology, the ‘gestational procreator’) and the newborn. In other (...) words, Lange critiques the view that a moral right to parent a child can be grounded in an emotional relationship, as developed during pregnancy, between the mother and child. Lange discusses the possible emotions of both of them, during pregnancy, and at the time of birth. He notes some problems in seeing this relationship as one that has sufficiently weighty moral importance: it is asymmetrical, for example, and the relationship is not obviously reciprocal. The central claim here is in fact quite easily convincing. It is quite right that emotions alone should not ground a moral right to parent a child. Lange accepts for example that ‘gestational procreators are usually highly emotionally invested in their pregnancy’ (p3),1 and this ‘usually’ …. (shrink)

BackgroundInstitutional review boards (IRBs) have been criticised for delays in approvals for research proposals due to inadequate or inexperienced IRB staff. Artificial intelligence (AI), particularly large language models (LLMs), has significant potential to assist IRB members in a prompt and efficient reviewing process.MethodsFour LLMs were evaluated on whether they could identify potential ethical issues in seven validated case studies. The LLMs were prompted with queries related to the proposed eligibility criteria of the study participants, vulnerability issues, information to be disclosed (...) in the informed consent document (ICD), risk–benefit assessment and justification of the use of a placebo. Another query was issued to the LLMs to generate ICDs for these case scenarios.ResultsAll four LLMs were able to provide answers to the queries related to all seven cases. In general, the responses were homogeneous with respect to most elements. LLMs performed suboptimally in identifying the suitability of the placebo arm, risk mitigation strategies and potential risks to study participants in certain case studies with a single prompt. However, multiple prompts led to better outputs in all of these domains. Each of the LLMs included all of the fundamental elements of the ICD for all case scenarios. Use of jargon, understatement of benefits and failure to state potential risks were the key observations in the AI-generated ICD.ConclusionIt is likely that LLMs can enhance the identification of potential ethical issues in clinical research, and they can be used as an adjunct tool to prescreen research proposals and enhance the efficiency of an IRB. (shrink)

Doctors’ strikes are legally permissible in the UK, with the situation differing in other countries. But are they morally permissible? Doug McConnell and Darren Mann have systematically attempted to dismiss the arguments for the moral impermissibility of doctors’ strikes and creatively attempted to provide further moral justification for them. Unfortunately for striking doctors, they fail to achieve this. Meanwhile, junior doctors’ strikes have continued in the UK through 2023 and have now extended into 2024. In this response, which focuses on (...) the UK situation and specifically junior doctors’ strikes in the National Health Service (NHS) in England, I will demonstrate a central problem with their arguments—namely that they underplay the harms caused by prolonged doctors’ strikes by ignoring the harms to patients with cancer. This weakens their conclusion that strikes are morally permissible in terms of the conditions and thresholds they set. I then provide a psychological critique of their justification for strikes in terms of the interests of the public. It follows that invoking the controversial concept of supererogatory action is ungrounded but also absurd when you consider time-critical cancer care. If those representing striking doctors wish to maintain a modicum of moral respectability, they should mitigate for patients with cancer and negotiate reasonably and with urgency. (shrink)

We recently suggested that there are both pragmatic and normative reasons to classify pregnancy as a disease. Several scholars argued against our claims. In this response, we defend the disease view of pregnancy against their criticism. We claim that the dysfunctional account of disease that some of our critics rely on has some counterintuitive results. Furthermore, we claim that our critics assume what needs to be argued that the primary function of our sexual organs is to reproduce. Since only a (...) small percentage of sexual intercourse leads to pregnancy, it is far from obvious that reproduction is the primary biological function of our sexual organs. We also claim that while taking pregnancy itself as a reference class could avoid the conclusion that pregnancy is a disease, the strategy is problematic since it renders the Boorsean approach to disease and health circular and effectively deprives it of any utility in determining whether a particular phenomenon is a disease or not. (shrink)

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading the host’s body. Like a (...) disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the ‘normality’ of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease. (shrink)