Earp, Lewis, and Hart argue the pursuit of racial justice requires a summary end to the war on drugs. In surveying the racially disparate harms of an enforcement-oriented, punitive, and ulti...

Since 2015 millions of migrants have paid smugglers to take them across borders. In response, states have increasingly arrested smugglers, hoping to morally condemn smuggling, and to decrease the rate of inward migration. This article argues that, even if a state is justified in morally condemning smuggling, and justified in decreasing inward migration, arresting smugglers is a disproportionate response for reaching these ends.

We punish people who recklessly or deliberately expose others to HIV? Why not try to force HIV-positive individuals to disclose their.

The number of police departments carrying Narcan keeps increasing at a fast pace throughout the U.S., as it is considered an effective measure to fight the opioid epidemic. However, there have been strong oppositions to the idea of the police Narcan use. Still, in 2018, the nation is debating about it. Though not clearly visible to the public, there are important ethical arguments against the police Narcan use which necessarily involve understanding of the ethical roles and responsibilities of police as (...) the law enforcement agency and apprehension of the moral status of a non-therapeutic opioid use. The authors of the paper investigate, primarily, the existing ethical controversies surrounding the police Narcan use while touching upon the issue of the decriminalizing drug policy in the U.S. The authors conclude that the police can carry and administer Narcan without self-contradiction and that the policymakers’ investigation on the drug decriminalization policy should begin with the understanding of the “common morality” of the American public, the ethical view shared and practiced by the greatest number of people. (shrink)

David A. J. Richards, Sex, Drugs, Death and the Law: An Essay on Human Rights and Overcriminalization Totowa, N.J.: Rowman and Littlefield, 1982, xii + 316 pp.

Brian Earp and his colleagues argue in this issue’s target article that racial justice requires ending the War on Drugs. In this they are absolutely correct. Indeed, de...

Does it work? This question lies at the very heart of the kinds of controversies that have surrounded complementary and alternative medicines (such as herbal medicine) in recent decades. In this article, I argue that medical anthropology has played a pivotal and largely overlooked role in taking the sham out of the placebo effect with important implications for what it means to say a therapy or drug `works'. If pharmacologists and clinicians have corporeally located the concept of efficacy in terms (...) of bio-availability, pharmacodynamics and pharmacokinetics, and herbalists in terms of a herbal revitalizing of the body's own vis medicatrix naturae, from the early 20th century onwards medical anthropologists (especially those who became interested in the `savage mind') have built up an equally rigorous theory of symbolic efficacy in terms of narratives, symbols and a kind of cognitive homeostasis. It was precisely as a mediating link between the somatic and the symbolic that I suggest a decriminalized placebo effect (as opposed to suggestion) could emerge in the middle of the 20th century. Taking the example of St John's Wort, I go on to show how notions of symbolic efficacy, spillover placebo efficacy and bio-efficacy co-circulate in recent attempts by herbalists, clinicians and pharmacologists to address the question of whether or not this herbal remedy `works' in the treatment of depression. (shrink)

In “Racial Justice Requires Ending the War on Drugs,” Earp and colleagues argue that the personal use or possession of all currently illicit psychoactive substances should be immediately decriminal...

Le sentenze che oggi vengono pronunciate contro i criminali psicopatici evitano accuratamente di far leva su considerazioni “morali”. Solitamente l’attribuzione di responsabilità morale ai criminali si basa spesso sul concetto cognitivo di infermità mentale, in maniera tale che il giudizio morale sulla condotta morale dei “criminali psicopatici” in questi casi venga tendenzialmente sterilizzato. La posizione che qui vorrei proporre individua oscurità e limiti epistemici nelle teorie e nei metodi correntemente impiegati nelle società occidentali per alleggerire le responsabilità morali, le quali, (...) pertanto, risultano in parte inaffidabili. Per supportare questa conclusione intendo far leva sui miei più recenti studi di carattere cognitivo, vertenti sulla dimensione plurale dei contesti morali, sulla co-evoluzione geni/nicchia cognitiva e sul concetto di libero arbitrio. (shrink)

Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. (...) We also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

There is an important moral difference between laws that criminalize drugs and prostitution and laws that make them illegal in other ways: criminalization violates our moral rights in a way that nonlegalization does not. Criminalization is defined as follows. Drugs are criminalized when there are criminal penalties for using or possessing small quantities of drugs. Prostitution is criminalized when there are criminal penalties for selling sex. Legalization is defined as follows. Drugs are legalized when there are no criminal penalties for (...) manufacturing, selling and possessing large quantities of drugs. Prostitution is legalized when there are no criminal penalties for owning or operating a brothel or escort service, no criminal penalties for working as a paid agent for sex work, and no criminal penalties for paying someone for sex who is above the age of legal employment and sexual consent. The criminalization of drugs and prostitution violate the right of self-sovereignty in depriving individuals of important forms of control over their own minds and bodies, but nonlegalization does not violate this right. It is therefore consistent, as a matter of principle, to advocate decriminalization but to oppose legalization. (shrink)

Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. (...) Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system. (shrink)

Some jurisdictions that have decriminalized assisted dying exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients’ access to this service amount to arbitrary discrimination. (...) Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system. (shrink)

Direitos humanos e o tráfico de drogas : a repercussão do caso "Matemático" nas redes sociais de um debate concreto -- Drogas e governamentalidade : uma análise crítica da recente política criminal legislativa uruguaia -- Entre gritos e jeitinhos : a velha sedução das práticas autoritárias e alguns desafios para uma justiça de transição no Brasil -- "Abolicionismo Real" e liberdade : reflexões em tempos de necessidade de (auto)crítica acadêmica -- Contribuições do abolicionismo de Mathiesen para a realidade punitiva/encarceradora brasileira.

While Chile's partial decriminalization of abortion in 2017 was a long overdue recognition of women's sexual and reproductive rights, nearly four years later the caseload remains well below expectations. This pattern is the product of standing barriers in access to abortion‐related health services, especially at the primary care point of entry. This study seeks to identify and describe these barriers. The findings presented here were obtained through a qualitative, exploratory study based on 19 semi‐structured interviews with relevant actors identified (...) through non‐random sampling and snowballing techniques. Coding was inductive and complemented by semantic content analysis. The authors find that the key barriers in primary care to accessing legal abortion are unfamiliarity with the law, insufficient practitioner training, intersectoral discrimination, and the stigma surrounding abortion. They conclude that the government needs to exercise its constitutional mandate as guarantor of public health and act promptly to safeguard and guarantee the abortion rights of Chilean women. (shrink)

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)

In this "for and against" book, ethicists Lori Watson and Jessica Flanigan debate the criminalization of sex work. Watson argues for a sex equality approach to prostitution in which buyers are criminalized and sellers are decriminalized, known as the Nordic Model. Flanigan argues that sex work should be fully decriminalized because decriminalization ensures respect for sex workers' and clients' rights, and is more effective than alternative policies.

According to today's demands, "crime" and "punishment" first of all need to be considered in the parameters of solving the problems of application of the Criminal Code of Ukraine and prospects for its improvement. The categories of crime and punishment are able to function in the polyscientific space - that is, in the field of not only legal but also philosophical sciences. This circumstance leads to the problem of interdisciplinary correlation of the categories of crime and punishment. The solution to (...) this problem is associated with an important scientific task aimed at bridging the communication gap between lawyers and non-legal scholars who in one way or another address the issue of crime and punishment. In turn, the elimination of communication gaps is of great practical importance, because in the face of increasing integrative trends and processes in cognition and practice, disciplinary isolation prevents the unification of scientific capabilities into a single complex aimed at understanding systemic problems that can not be solved in a disciplinary situation. isolation, in particular related to criminalization and decriminalization, legal forecasting, application and prospects for improving the Criminal Code of Ukraine. According to the results of research in ancient philosophy revealed vectors for the interpretation of crime as dangerous for the state illegal act, which is an act of will, and punishment as a means of preventing crime and retribution. These elements can be regarded as those that, along with other philosophical resources, can be used to identify the content of the categories of crime and punishment, and thus the interdisciplinary correlation of these categories, as those capable of functioning in the multidisciplinary space. (shrink)

A colorful history of utilitarianism told through the lives and ideas of Jeremy Bentham, John Stuart Mill, and its other founders In The Happiness Philosophers, Bart Schultz tells the colorful story of the lives and legacies of the founders of utilitarianism—one of the most influential yet misunderstood and maligned philosophies of the past two centuries. Best known for arguing that "it is the greatest happiness of the greatest number that is the measure of right and wrong," utilitarianism was developed by (...) the radical philosophers, critics, and social reformers William Godwin, Jeremy Bentham, John Stuart and Harriet Taylor Mill, and Henry Sidgwick. Together, they had a profound influence on nineteenth-century reforms, in areas ranging from law, politics, and economics to morals, education, and women's rights. Their work transformed life in ways we take for granted today. Bentham even advocated the decriminalization of same-sex acts, decades before the cause was taken up by other activists. As Bertrand Russell wrote about Bentham in the late 1920s, "There can be no doubt that nine-tenths of the people living in England in the latter part of last century were happier than they would have been if he had never lived." Yet in part because of its misleading name and the caricatures popularized by figures as varied as Dickens, Marx, and Foucault, utilitarianism is sometimes still dismissed as cold, calculating, inhuman, and simplistic. By revealing the fascinating human sides of the remarkable pioneers of utilitarianism, The Happiness Philosophers provides a richer understanding and appreciation of their philosophical and political perspectives—one that also helps explain why utilitarianism is experiencing a renaissance today and is again being used to tackle some of the world's most serious problems. (shrink)

A "slippery slope argument" is a type of argument in which a first step is taken and a series of inextricable consequences follow, ultimately leading to a disastrous outcome. Many textbooks on informal logic and critical thinking treat the slippery slope argument as a fallacy. Walton argues that used correctly in some cases, they can be a reasonable type of argument to shift a burden of proof in a critical discussion, while in other cases they are used incorrectly. Walton identifies (...) and analyzes four types of slippery slope argument. Walton presents guidelines that show how each type of slippery slope argument can be used correctly or incorrectly, using over fifty case studies of argumentation on controversial issues. These include abortion, medical research on human embryos, euthanasia, the decriminalization of marijuana, pornography, and censorship, and banning of American flag burning. (shrink)

Earp et al. provide a robust justification for the decriminalization of drugs based on the systemic racism that fuels the “war on drugs” and the ongoing harms of drug policies to individuals...

In 2015, the Supreme Court of Canada decriminalized euthanasia. Soon after, the College of Physicians and Surgeons of Ontario enacted the Professional Obligations and Human Rights policy and the Medical Assistance in Dying policy. Neither these policies nor the Medical Assistance in Dying Act, the Ontario law permitting euthanasia, contains a conscientious objection clause. Instead, the policies require objecting doctors to provide an effective referral to a doctor who will euthanize the patient. Objecting physicians brought suit against the college. In (...) a recent decision, the Ontario Superior Court of Justice held against the plaintiffs, finding the infringement of the effective referral policy on physicians’ rights to conscience and religious freedom to be appropriate when balanced against a patient’s right to equitable access to health care. Therefore, Catholic physicians in Ontario now must choose to violate either their religious beliefs or their professional obligations. It is imperative that these policies be struck down on appeal, superseded by an amendment, or revised by the college through the addition of a conscience clause. (shrink)

The Western world is experiencing a resurgence of interest in the therapeutic potential of psychedelics, most of which are derived from plants or fungi with a history of Indigenous ceremonial use. Recent research has revealed that psychedelic compounds have the potential to address treatment‐resistant depression and anxiety, as well as post‐traumatic stress disorder and addictions. These findings have contributed to the decriminalization of psychedelics in some jurisdictions and their legalization in others. Despite psychedelics’ opaque legal status, numerous companies and (...) individuals are profiting from speculative investments with few, if any, benefits accruing to Indigenous Peoples. In this paper, we suggest that the aptly named “psychedelic renaissance,” like the European Renaissance, is made possible by colonial extractivism. We further suggest that Indigenous philosophical traditions offer alternative approaches to reorient the “psychedelic renaissance” towards a more equitable future for Indigenous Peoples, psychedelic medicines, and all our relations. (shrink)

In our recent article, together with more than 60 of our colleagues, we outlined a proposal for drug policy reform consisting of four specific yet interrelated strategies: (1) de jure decriminalization of all psychoactive substances currently deemed illicit for personal use or possession (so-called “recreational” drugs), accompanied by harm reduction policies and initiatives akin to the Portugal model; (2) expunging criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs (and releasing those (...) serving time for these offenses), while delivering retroactive ameliorative relief; (3) the ultimate legalization and careful regulation of currently illicit drugs; and (4) the delivery of a new “Marshall Plan” focused on community-building initiatives, expanded harm reduction programs, and social and health care support efforts (Earp et al. 2021). We were gratified to see so many thoughtful commentaries on our proposal, and we respond to them in part in this reply. (shrink)

Psychedelic or ecodelic medicines (e.g., psilocybin, ayahuasca, iboga) for the care and treatment of addiction, post‐traumatic stress disorder, cancer, cluster headaches, anxiety, and depression have surged to the forefront of discussions about mental health in the US, leading to the emergence of well‐capitalized biotech companies offering multimillion‐dollar IPOs. Venture capital website Pitchbook reports “continuing investor interest and growing acceptance of what until recently was seen as a fringe area of medicine.” As scholars, activists, and practitioners who have been healed by (...) these medicines and applaud the recent wave of decriminalization after a long, strange trip of mass incarceration and widespread dangerous misinformation, we look forward to a culture that makes these medicines available in a safe and affordable way that respects the lineages of the knowledges that are essentially and not accidentally bundled with these plants—Indigenous and counterculture wisdoms for whom these medicines were never “fringe,” but always foundational. In place of corporadelia's pursuit of standardization, we emphasize the care and wisdom of the Indigenous and countercultural teachings—traditions that have made psychedelics available to the emerging corporate/research partnership in the first place. These knowledge traditions offer foils to the ongoing translation of university peer‐reviewed research into market copy, technical articles, and IPOs, and the concomitant emergence of psychedelic pundits. In particular, we examine instances where prominent researchers have overstated the findings of existing clinical trials in public‐facing representations of the field. We argue that these corporate priorities and tactics are being aided by a new wave of psychedelic “thought leaders” who seek to delegitimize non‐hierarchical approaches to knowledge production and community support within a psychedelic commons. While prominent psychedelic psychiatrists and behaviorists are focused on rooting out and transforming individual habits of mind, we argue that there is another, latent potential for psychedelics to draw attention to—and transform—the invisible, hegemonic infrastructures and ideologies that subtly naturalize and perpetuate deeply unequal societies. (shrink)

In 2003 and 2004, Aotearoa New Zealand enacted two key laws that regulate two very different ways in which the female body may be commodified. The Prostitution Reform Act 2003 (PRA) decriminalized prostitution, removing legal barriers to the buying and selling of commercial sexual services. The Human Assisted Reproductive Technology Act 2004 (HART Act), on the other hand, put a prohibition on commercial surrogacy agreements. This paper undertakes a comparative analysis of the ethical arguments underlying New Zealand’s legislative solutions to (...) prostitution and commercial surrogacy. While the regulation of prostitution is approached with a Marxist feminist lens with the aim to ensure the health and safety of sex workers, commercial surrogacy is prohibited outright for concerns of negative impacts on present and future persons. I ground the principles of each Act in their ethical foundations and compare these two against one another. I conclude that New Zealand’s legislative approach to regulating the commodification of the female body is ethically inconsistent. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Refusals of Treatment and Requests for DeathTom L. Beauchamp (bio)It would be hard to overestimate the importance of two decisions on physician-assisted suicide delivered recently by the Ninth and Second Circuit Courts (Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc), aff’g 850 F.Supp. 1454 (W.D. Wash. 1994), rev’g 49 F.3d 586 (9th Cir. 1995); Quill v. Vacco, 80 F.3d 716 (2nd Cir. (...) 1996). They are the highest courts yet to render an opinion on this subject, and their decisions have set the stage for the U.S. Supreme Court to take one of two paths: It will either say that (1) all citizens have a liberty interest in physician-assisted suicide, or that (2) each state may set its own policy on such matters. Whichever path is elected, a right to request physician-assisted suicide is a virtual certainty, at least in some states.These opinions are later segments of an evolving legal history in which courts have held that no criminal liability exists for withholding or withdrawing a life-sustaining treatment when physicians are directed to do so by a patient or an authorized surrogate (see Alan Meisel 1992). The decriminalization of suicide and the right to refuse a life-sustaining treatment now appear to be evolving into a rule that a patient has a legal right to control his or her death, or at least to obtain a lethal prescription. We are at a delicate point in this evolving history. Neither in law nor in bioethics is the justification of physician assistance in suicide the received opinion at the present time, but support for physician assistance in dying could soon become the received opinion in both disciplines.The leading edge of the wedge producing these changes has been widespread acceptance of an extensive right to refuse treatment. This right is today axiomatic in even conservative quarters of bioethics, but 20 years ago it was far from axiomatic that all patients have a right to refuse treatment. Few at that time judged that it would be both immoral and illegal for a physician not to forgo treatment in the face of a competent, authoritative refusal of any form of medical service or treatment.The justification for assistance in bringing about death in medicine is an extension of the justification for letting patients die. Letting a patient die by accepting a valid refusal to continue in life is directly analogous to helping a patient die by accepting a valid request for help. The high value we place on [End Page 371] rights of autonomy thereby spills over from the right to refuse to the underexplored right to request active assistance. 1 As the autonomy interest in this choice increases, denial of help to the patient becomes more burdensome.Those who defend the view that euthanasia and physician-assisted suicide are morally prohibited typically assume that assistance involves an act of killing, that acts of killing are impermissible, and that a defensible distinction exists between killing and letting die. However, this distinction has proved difficult to explicate, and the category of killing often seems distant from the problem at hand. For example, it is an eccentric view that a physician who prescribes a lethal medication to a patient thereby kills the patient (or, for that matter, lets the patient die) when the patient voluntarily ingests the medication and dies. So poor are the conceptual understandings of “killing” and “letting die” that conceptual confusion abounds as to which term to use in almost all morally difficult and controversial cases.A common view is that “letting die” is a matter of “ceasing useless treatments” after which patients die (Gaylin, Kass, Pellegrino, and Siegler 1988). This account is attractive, but too narrow. “Letting die” occurs in medicine under at least two circumstances: cessation of treatment because it is useless and cessation of treatment because it has been refused (which can occur even with useful treatments). Neither conceptually nor morally is “ceasing useless treatment” the proper way to state the condition under which many “letting-die” cases occur. It follows that the type of action—killing or letting... (shrink)

Provocative essays on real-world ethical questions from the world's most influential philosopher Peter Singer is often described as the world's most influential philosopher. He is also one of its most controversial. The author of important books such as Animal Liberation, Practical Ethics, Rethinking Life and Death, and The Life You Can Save, he helped launch the animal rights and effective altruism movements and contributed to the development of bioethics. Now, in Ethics in the Real World, Singer shows that he is (...) also a master at dissecting important current events in a few hundred words. In this book of brief essays, he applies his controversial ways of thinking to issues like climate change, extreme poverty, animals, abortion, euthanasia, human genetic selection, sports doping, the sale of kidneys, the ethics of high-priced art, and ways of increasing happiness. Singer asks whether chimpanzees are people, smoking should be outlawed, or consensual sex between adult siblings should be decriminalized, and he reiterates his case against the idea that all human life is sacred, applying his arguments to some recent cases in the news. In addition, he explores, in an easily accessible form, some of the deepest philosophical questions, such as whether anything really matters and what is the value of the pale blue dot that is our planet. The collection also includes some more personal reflections, like Singer’s thoughts on one of his favorite activities, surfing, and an unusual suggestion for starting a family conversation over a holiday feast. Provocative and original, these essays will challenge—and possibly change—your beliefs about a wide range of real-world ethical questions. (shrink)

Domestic courts are often quoting foreign case law on human rights. The conversation pursued through cross-referencing across jurisdictions has added to the globalization of international human rights standards. As the practice is gaining ground and becoming a more permanent feature of domestic judgments, its relevance needs to be examined. A closer look at the practice will bring forth a more realistic understanding of the approaches of domestic courts and the advantages which they offer to the institution. This paper raises few (...) questions on the value and influence of cross-referencing in the area of human rights. Questions in this regard can be posed as to (a) whether cross-referencing is reflective of an emerging consensus on the subject matter? (b) Is it strategic for domestic courts to quote foreign case law? (c) Is the practice of cross-referencing simply a trend or an urge to belong to a community of courts? (d) Is the practice of relevance towards the implementation and advancement of international human rights standards? The topic can shed light on broader themes including the universality of human rights, contestations/disagreements over human rights standards, and the measure of acceptability of international human rights standards within domestic settings. This paper discusses the practice, its role and influence in relation to international human rights standards. Three judgments [of the courts of Nepal, India and Singapore] addressing the human rights and homosexuality agenda have been illustrated for discussion. (shrink)

In the United States today, the use or possession of many drugs is a criminal offense. Can these criminal laws be justified? What are the best reasons to punish or not to punish drug users? These are the fundamental issues debated in this book by two prominent philosophers of law. Douglas Husak argues in favor of drug decriminalization, by clarifying the meaning of crucial terms, such as legalize, decriminalize, and drugs; and by identifying the standards by which alternative drug (...) policies should be assessed. He critically examines the reasons typically offered in favor of our current approach and explains why decriminalization is preferable. Peter de Marneffe argues against drug legalization, demonstrating why drug prohibition, especially the prohibition of heroin, is necessary to protect young people from self-destructive drug use. If the empirical assumptions of this argument are sound, he reasons, drug prohibition is perfectly compatible with our rights to liberty. (shrink)

The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country—after the Netherlands—to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care (...) process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. “Intense” is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one’s power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed. (shrink)

Provocative essays on real-world ethical questions from the world's most influential philosopher Peter Singer is often described as the world's most influential philosopher. He is also one of its most controversial. The author of important books such as Animal Liberation, Practical Ethics, Rethinking Life and Death, and The Life You Can Save, he helped launch the animal rights and effective altruism movements and contributed to the development of bioethics. Now, in Ethics in the Real World, Singer shows that he is (...) also a master at dissecting important current events in a few hundred words. In this book of brief essays, he applies his controversial ways of thinking to issues like climate change, extreme poverty, animals, abortion, euthanasia, human genetic selection, sports doping, the sale of kidneys, the ethics of high-priced art, and ways of increasing happiness. Singer asks whether chimpanzees are people, smoking should be outlawed, or consensual sex between adult siblings should be decriminalized, and he reiterates his case against the idea that all human life is sacred, applying his arguments to some recent cases in the news. In addition, he explores, in an easily accessible form, some of the deepest philosophical questions, such as whether anything really matters and what is the value of the pale blue dot that is our planet. The collection also includes some more personal reflections, like Singer’s thoughts on one of his favorite activities, surfing, and an unusual suggestion for starting a family conversation over a holiday feast. Now with a new afterword by the author, this provocative and original book will challenge—and possibly change—your beliefs about many real-world ethical questions. (shrink)

ABSTRACTSince 2007, when Mexico City decriminalized abortion during the first trimester, a debate has been taking place regarding abortion and the right to conscientious objection. Many people argue that, since the provision of abortions is now a statutory duty of healthcare personnel there can be no place for “conscientious objection.” Others claim that, even if such an objection were to be allowed, it should not be seen as a right, since talk about a right to CO may lead to a (...) slippery slope where we may end up recognizing a right to disobey the law. In this paper, I argue that there is a right to CO and that this may be justified through the notions of autonomy and integrity, which a liberal democracy should respect. However, it cannot be an absolute right, and in the case of abortion, it conflicts with women’s reproductive rights. Therefore, CO should be carefully regulated so that it does not obstruct the exercise o... (shrink)

This essay argues that policies aimed at suppressing drug use exacerbate the nation's opioid problem. It neither endorses drug use nor advocates legalizing the consumption and sale of all substances in all circumstances. Instead, it contends that trying to suppress drug markets is the wrong goal, and in the midst of an addiction crisis it can be deadly. There is no single, correct drug policy; the right approach depends crucially on the substance at issue, the patterns of use and supply, (...) and the jurisdiction's culture, institutions, and material resources. Decriminalization is no panacea for a nation's drug problems. Nevertheless, either de jure or de facto decriminalization of personal drug possession is a necessary condition for mitigating this crisis. (shrink)

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew (...) inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

Popular representations of third-world sex workers as sex slaves and vectors of HIV have spawned abolitionist legal reforms that are harmful and ineffective, and public health initiatives that provide only marginal protection of sex workers' rights. In this book, Prabha Kotiswaran asks how we might understand sex workers' demands that they be treated as workers. She contemplates questions of redistribution through law within the sex industry by examining the political economies and legal ethnographies of two archetypical urban sex markets in (...) India.Kotiswaran conducted in-depth fieldwork among sex workers in Sonagachi, Kolkata's largest red-light area, and Tirupati, a temple town in southern India. Providing new insights into the lives of these women--many of whom are demanding the respect and legal protection that other workers get--Kotiswaran builds a persuasive theoretical case for recognizing these women's sexual labor. Moving beyond standard feminist discourse on prostitution, she draws on a critical genealogy of materialist feminism for its sophisticated vocabulary of female reproductive and sexual labor, and uses a legal realist approach to show why criminalization cannot succeed amid the informal social networks and economic structures of sex markets. Based on this, Kotiswaran assesses the law's redistributive potential by analyzing the possible economic consequences of partial decriminalization, complete decriminalization, and legalization. She concludes with a theory of sex work from a postcolonial materialist feminist perspective. (shrink)

There is an important moral difference between laws that criminalize drugs and prostitution and laws that make them illegal in other ways: criminalization violates our moral rights in a way that nonlegalization does not. Criminalization is defined as follows. Drugs are criminalized when there are criminal penalties for using or possessing small quantities of drugs. Prostitution is criminalized when there are criminal penalties for selling sex. Legalization is defined as follows. Drugs are legalized when there are no criminal penalties for (...) manufacturing, selling and possessing large quantities of drugs. Prostitution is legalized when there are no criminal penalties for owning or operating a brothel or escort service, no criminal penalties for working as a paid agent for sex work, and no criminal penalties for paying someone for sex who is above the age of legal employment and sexual consent. The criminalization of drugs and prostitution violate the right of self-sovereignty in depriving individuals of important forms of control over their own minds and bodies, but nonlegalization does not violate this right. It is therefore consistent, as a matter of principle, to advocate decriminalization but to oppose legalization. (shrink)

A solution to the problem of “overcriminalization” appears to be decriminalization of certain crimes. This Essay focuses on a group of crimes that has been labeled “proxy crimes” as a candidate to be eliminated. What are proxy crimes? Douglas Husak defines them as “offenses designed to achieve a purpose other than to prevent the conduct they explicitly proscribe.” Michael Moore describes them as involving situations where we “use one morally innocuous act as a proxy for another, morally wrongful act (...) or mental state.” Put that way, proxy crimes seem highly problematic, and Larry Alexander and Kimberly Ferzan bluntly put it, “We reject proxy crimes.” This Essay asks whether we should reject proxy crimes by presenting and evaluating Alexander and Ferzan’s treatment of the subject. After describing several different types of crimes that may be characterized as proxy crimes and Alexander and Ferzan’s rejection of most of them and their arguments for doing so, this Essay argues that their rejection of proxy crimes is incomplete, which leaves their theory open to a range of possibilities regarding the proper place of proxy crimes in criminal law. This Essay concludes that getting a handle on the problem of proxy crimes and overcriminalization requires a theory of the state and an articulation of the proper relationship between the state and its citizens that can give guidance on when the state can demand obedience from citizens to support the state and when failures to comply with such demands render one criminally culpable. Without such a theory, proposals to address overcriminalization cannot travel very far. (shrink)

In the Netherlands, euthanasia has been decriminalized. Termination of life on request and assisted suicide are criminal offences under Dutch law; but if physicians comply with the due care requirements of the Euthanasia Act and report their actions in the manner prescribed by law, they will not be prosecuted. One of the requirements relates to the act of euthanasia itself. If this is to be performed with due medical care, the physician relies on the services of a pharmacist. However, the (...) responsibilities of the pharmacist with respect to euthanasia are not laid down in law. At present, Dutch pharmacists have to make do with professional rules that do not offer adequate solutions for the problems that may arise when euthanasia is performed. (shrink)

The idea that immoral conduct ought to be criminalized is already often rejected, But not for precisely the right reasons. Victim-Less crimes ought to be decriminalized not (as h l a hart and j s mill argue) because it is immoral to make crimes of them, But because it is contrary to the nature of the criminal law itself. Acts of private immorality do not violate the rights of the participants; thus they cannot be crimes because there is no crime (...) where there is no deprivation of rights. (staff). (shrink)

Earp and colleagues make a strong case for the complete decriminalization and even the legalization of recreational drug use based on the negative impact of the “War on drugs” on racialized...