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Douglas MacKay [28]Douglas P. MacKay [3]
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Douglas MacKay
University of North Carolina, Chapel Hill
  1.  34
    The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy.Douglas MacKay & Alexandra Robinson - 2016 - American Journal of Bioethics 16 (11):3-12.
    Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is (...)
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  2.  85
    Immigrant Selection, Health Requirements, and Disability Discrimination.Douglas MacKay - 2018 - Journal of Ethics and Social Philosophy 14 (1).
    Australia, Canada, and New Zealand currently apply health requirements to prospective immigrants, denying residency to those with health conditions that are likely to impose an “excessive demand” on their publicly funded health and social service programs. In this paper, I investigate the charge that such policies are wrongfully discriminatory against persons with disabilities. I first provide a freedom-based account of the wrongness of discrimination according to which discrimination is wrong when and because it involves disadvantaging people in the exercise of (...)
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  3.  5
    Four Faces of Fair Subject Selection.Katherine Witte Saylor & Douglas MacKay - 2020 - American Journal of Bioethics 20 (2):5-19.
    Although the principle of fair subject selection is a widely recognized requirement of ethical clinical research, it often yields conflicting imperatives, thus raising major ethical dilemmas regarding participant selection. In this paper, we diagnose the source of this problem, arguing that the principle of fair subject selection is best understood as a bundle of four distinct sub-principles, each with normative force and each yielding distinct imperatives: fair inclusion; fair burden sharing; fair opportunity; and fair distribution of third-party risks. We first (...)
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  4.  78
    Opt-Out and Consent.Douglas MacKay - 2015 - Journal of Medical Ethics 41 (10):1-4.
    A chief objection to opt-out organ donor registration policies is that they do not secure people's actual consent to donation, and so fail to respect their autonomy rights to decide what happens to their organs after they die. However, scholars have recently offered two powerful responses to this objection. First, Michael B Gill argues that opt-out policies do not fail to respect people's autonomy simply because they do not secure people's actual consent to donation. Second, Ben Saunders argues that opt-out (...)
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  5. Are Skill-Selective Immigration Policies Just?Douglas MacKay - 2016 - Social Theory and Practice 42 (1):123-154.
    Many high-income countries have skill-selective immigration policies, favoring prospective immigrants who are highly skilled. I investigate whether it is permissible for high-income countries to adopt such policies. Adopting what Joseph Carens calls a " realistic approach " to the ethics of immigration, I argue first that it is in principle permissible for high-income countries to take skill as a consideration in favor of selecting one prospective immigrant rather than another. I argue second that high-income countries must ensure that their skill-selective (...)
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  6.  26
    The Ethics of Public Policy RCTs: The Principle of Policy Equipoise.Douglas MacKay - 2018 - Bioethics 32 (1):59-67.
    In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a (...)
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  7. Standard of Care, Institutional Obligations, and Distributive Justice.Douglas MacKay - 2015 - Bioethics 29 (4):352-359.
    The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine (...)
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  8.  22
    Government Policy Experiments and the Ethics of Randomization.Douglas MacKay - 2020 - Philosophy and Public Affairs 48 (4):319-352.
    Governments are increasingly using randomized controlled trials (RCTs) to evaluate policy interventions. RCTs are often understood to provide the highest quality evidence regarding the causal efficacy of an intervention. While randomization plays an essential epistemic role in the context of policy RCTs however, it also plays an important distributive role. By randomly assigning participants to either the intervention or control arm of an RCT, people are subject to different policies and so, often, to different types and levels of benefits. In (...)
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  9.  23
    The Duty to Rescue and Investigators' Obligations.Douglas MacKay & Tina Rulli - 2017 - Kennedy Institute of Ethics Journal 27 (1):71-105.
    The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to whom (...)
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  10.  21
    Fair Subject Selection in Clinical Research: Formal Equality of Opportunity.Douglas MacKay - 2016 - Journal of Medical Ethics 42 (10):672-677.
    In this paper, I explore the ethics of subject selection in the context of biomedical research. I reject a key principle of what I shall refer to as the standard view. According to this principle, investigators should select participants so as to minimise aggregate risk to participants and maximise aggregate benefits to participants and society. On this view, investigators should exclude prospective participants who are more susceptible to risk than other prospective participants. I argue instead that investigators should select subjects (...)
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  11.  23
    Government Policy Experiments and Informed Consent.Douglas MacKay & Averi Chakrabarti - 2019 - Public Health Ethics 12 (2):188-201.
    Governments are increasingly making use of field experiments to evaluate policy interventions in the spheres of education, public health and welfare. However, the research ethics literature is largely focused on the clinical context, leaving investigators, institutional review boards and government agencies with few resources to draw on to address the ethical questions they face regarding such experiments. In this article, we aim to help address this problem, investigating the conditions under which informed consent is required for ethical policy research conducted (...)
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  12.  77
    Incentive Inequalities and Freedom of Occupational Choice.Douglas Mackay - 2016 - Economics and Philosophy 32 (1):21-49.
    In Rescuing Justice and Equality, G.A. Cohen argues that the incentive inequalities permitted by John Rawls's difference principle are unjust since people cannot justify them to their fellow citizens. I argue that citizens of a Rawlsian society can justify their acceptance of a wide range of incentive inequalities to their fellow citizens. They can do so because they possess the right to freedom of occupational choice, and are permitted – as a matter of justice – to exercise this right by (...)
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  13.  19
    Calculating Qalys: Liberalism and the Value of Health States.Douglas MacKay - 2017 - Economics and Philosophy 33 (2):259-285.
    The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...)
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  14.  2
    Paying for Fairness? Incentives and Fair Subject Selection.Douglas MacKay & Rebecca L. Walker - 2021 - American Journal of Bioethics 21 (3):35-37.
    In their Target Article, “Promoting Ethical Payment in Human Infection Challenge Studies,” Lynch et al. propose a framework for ethical payment to research participants and apply it to the c...
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  15.  4
    Geographic Location and Moral Arbitrariness in the Allocation of Donated Livers.Douglas MacKay & Samuel Fitz - 2019 - Journal of Law, Medicine and Ethics 47 (2):308-319.
    The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a (...)
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  16. Federalism and Responsibility for Health Care.Douglas MacKay & Marion Danis - 2016 - Public Affairs Quarterly 30 (1):1-29.
    Political philosophers often formulate the problem of distributive justice as the problem of how the government ought to distribute different types of goods—for example, income or health care—to its citizens. They therefore presuppose that the government is a unitary agent that governs its citizens directly. However, although a number of governments are unitary in this way, many are federations, exhibiting a division of sovereignty between two or more levels of government having independent grounds of authority. In contrast to unitary states, (...)
     
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  17.  9
    Health Research Priority Setting: A Duty to Maximize Social Value?Douglas MacKay - 2018 - American Journal of Bioethics 18 (11):25-26.
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  18.  36
    Ending SNAP-Subsidized Purchases of Sugar-Sweetened Beverages: The Need for a Pilot Project.Nicole M. V. Ross & Douglas P. MacKay - 2017 - Public Health Ethics 10 (1).
    Recent efforts by legislative officials and public health advocates to reform the US food stamp program, or Supplemental Nutrition Assistance Program, have focused on restricting the types of foods eligible for purchase with SNAP benefits, specifically sugar-sweetened beverages. We argue that it is, in principle, permissible for the US government to enact a SNAP-specific SSB ban prohibiting the purchase of SSBs with SNAP benefits. While the government has a duty to ensure that citizens meet their nutritional needs, since SSBs provide (...)
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  19.  6
    Returning Incidental Findings in Low‐Resource Settings: A Case of Rescue?Douglas Mackay - 2018 - Hastings Center Report 48 (3):28-30.
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  20.  30
    Incentive Inequalities and Talents: A Reply to Shiffrin.Douglas MacKay - 2013 - Philosophia 41 (2):521-526.
    In a recent article, Seana Valentine Shiffrin offers a distinctive egalitarian critique of the types of incentive inequalities that are permitted by John Rawls's difference principle. She argues that citizens of a well-ordered society, who publicly accept Rawls's two principles of justice and their justifications, may not demand incentives to employ their talents in productive ways since such demands are inconsistent with a major justification for the difference principle: the moral arbitrariness of talent. I argue that there is no such (...)
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  21.  35
    Experienced Utility or Decision Utility for QALY Calculation? Both.Paige A. Clayton & Douglas P. MacKay - 2018 - Public Health Ethics 11 (1):82-89.
    Policy-makers must allocate scarce resources to support constituents’ health needs. This requires policy-makers to be able to evaluate health states and allocate resources according to some principle of allocation. The most prominent approach to evaluating health states is to appeal to the strength of people’s preferences to avoid occupying them, which we refer to as decision utility metrics. Another approach, experienced utility metrics, evaluates health states based on their hedonic quality. In this article, we argue that although decision utility metrics (...)
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  22.  35
    Rawlsian Justice and the Social Determinants of Health.Jayna Fishman & Douglas MacKay - 2019 - Journal of Applied Philosophy 36 (4):608-625.
    In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls's theory of distributive justice in particular, we argue that a full reckoning with the social determinants of health requires a re‐working of Rawls's principles of justice. We argue first that the social bases of health – a Rawlsian conception of the social determinants of health – should be considered a social primary (...)
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  23.  8
    The Oxford Handbook of Research Ethics.Ana S. Iltis & Douglas MacKay (eds.) - forthcoming - New York, NY, USA: Oxford University Press.
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  24.  26
    Basic Income, Cash Transfers, and Welfare State Paternalism.Douglas MacKay - 2019 - Journal of Political Philosophy 27 (4):422-447.
    Journal of Political Philosophy, EarlyView.
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  25. Fair Subject Selection in Clinical and Social Scientific Research.Douglas MacKay - forthcoming - In Ana S. Iltis & Douglas MacKay (eds.), The Oxford Handbook of Research Ethics.
    This chapter provides a critical overview and interpretation of fair subject selection in clinical and social scientific research. It first provides an analytical framework for thinking about the problem of fair subject selection. It then argues that fair subject selection is best understood as a set of four subprinciples, each with normative force and each with distinct and often conflicting implications for the selection of participants: fair inclusion, fair burden sharing, fair opportunity, and fair distribution of third-party risks. It then (...)
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  26.  12
    Nudges, Autonomy, and Organ Donor Registration Policies: Response to Critics.Douglas MacKay - 2017 - American Journal of Bioethics 17 (2):W4 - W8.
  27.  1
    Parenting the Parents: The Ethics of Parent-Targeted Paternalism in the Context of Anti-Poverty Policies.Douglas MacKay - 2019 - In Nicolás Brando & Gottfried Schweiger (eds.), Philosophy and Child Poverty: Reflections on the Ethics and Politics of Poor Children and Their Families. Springer. pp. 321-340.
    Governments often aim to improve children’s wellbeing by targeting the decision-making of their parents. In this paper, I explore this phenomenon, providing an ethical evaluation of the ways in which governments target parental decision-making in the context of anti-poverty policies. I first introduce and motivate the concept of parent-targeted paternalism to categorize such policies. I then investigate whether parent-targeted paternalism is ever pro tanto wrong, arguing that it is when directed at parents who meet a threshold of parental competency. I (...)
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  28.  27
    Patients with Passports: Medical Tourism, Law, and Ethics by I Glenn Cohen.Douglas MacKay - 2016 - Kennedy Institute of Ethics Journal 26 (3):1-10.
    I. Glenn Cohen’s Patients with Passports: Medical Tourism, Law, and Ethics offers a thorough examination of the growing practice of medical tourism, the legal regulations governing it, and the many ethical issues it raises for policy-makers, health care providers, and prospective medical tourists. Demonstrating mastery of the relevant literatures in the social sciences, law, ethics, and political philosophy, Cohen provides a comprehensive overview of the current practice of medical tourism, and offers well-argued, sensible policy advice to guide its reform. Cohen’s (...)
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  29.  6
    Selecting Participants Fairly for Controlled Human Infection Studies.Douglas MacKay, Nancy S. Jecker, Punnee Pitisuttithum & Katherine W. Saylor - 2020 - Bioethics 34 (8):771-784.
    Controlled human infection (CHI) studies involve the deliberate exposure of healthy research participants to infectious agents to study early disease processes and evaluate interventions under controlled conditions with high efficiency. Although CHI studies expose participants to the risk of infection, they are designed to offer investigators unique advantages for studying the pathogenesis of infectious diseases and testing potential vaccines or treatments in humans. One of the central challenges facing investigators involves the fair selection of research subjects to participate in CHI (...)
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  30.  6
    Reconsidering Scarce Drug Rationing: Implications for Clinical Research.Zev M. Nakamura, Douglas P. MacKay, Arlene M. Davis, Elizabeth R. Brassfield, Benny L. Joyner Jr & Donald L. Rosenstein - forthcoming - Journal of Medical Ethics:medethics-2020-106739.
    Hospital systems commonly face the challenge of determining just ways to allocate scarce drugs during national shortages. There is no standardised approach of how this should be instituted, but principles of distributive justice are commonly used so that patients who are most likely to benefit from the drug receive it. As a result, clinical indications, in which the evidence for the drug is assumed to be established, are often prioritised over research use. In this manuscript, we present a case of (...)
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  31.  9
    Weighing Obligations to Home Care Workers and Medicaid Recipients.Paul C. Treacy & Douglas MacKay - 2019 - Nursing Ethics 26 (2):418-424.
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