A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Not...

Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived (...) risk of a novel vaccination, a system of payment for risk in vaccination may be superior. I defend a payment model against various objections, including that it constitutes coercion and undermines solidarity. I argue that payment can be in cash or in kind, and opportunity for altruistic vaccinations can be preserved by offering people who have been vaccinated the opportunity to donate any cash payment back to the health service. (shrink)

In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue (...) that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: removing a right to conscientious objection; selecting candidates into relevant medical specialities or general practice who do not have objections; demonopolizing the provision of these services away from the medical profession. (shrink)

Principles of distributive justice are normative principles designed to guide the allocation of the benefits and burdens of economic activity.

There has been considerable recent debate on the ethics of human enhancement. A number of prominent authors have been concerned about or critical of the use of technology to alter or enhance human beings, citing threats to human nature and dignity as one basis for these concerns. Frances Kamm has given a detailed rebuttal of Sandel's arguments, arguing that human enhancement is permissible. Nicholas Agar, in his book Liberal Eugenics, argues that enhancement should be permissible but not obligatory. He argues (...) that what distinguishes liberal eugenics from the objectionable eugenic practices of the Nazis is that it is not based on a single conception of a desirable genome and that it is voluntary and not obligatory. This article takes a more provocative position. It aims to argue that, far from its being merely permissible, we have a moral obligation or moral reason to enhance ourselves and our children. Indeed, we have the same kind of obligation as we have to treat and prevent disease. It begins by considering the current interests in and possibilities of enhancement. It then offers three arguments that we have very strong reasons to seek to enhance. (shrink)

Recent advances in the Super Linguistics of pictures have laid the Super Semantic foundation for modelling the phenomena of narrative sequencing and co-reference in pictorial and mixed linguistic-pictorial discourses. We take up the question of how one arrives at the pragmatic interpretations of such discourses. In particular, we offer an analysis of: (i) the discourse composition problem: how to represent the joint meaning of a multi-picture discourse, (ii) observed differences in narrative sequencing in prima facie equivalent linguistic vs pictorial discourses, (...) and (iii) the phenomenon of co-referencing across pictures. We extend Segmented Discourse Representation Theory to spell out a formal Super Pragmatics that applies to linguistic, pictorial and mixed discourses, while respecting the particular ‘genius’ of either medium and computing their distinctive pragmatic interpretations. (shrink)

In this paper, we investigate how data about public preferences may be used to inform policy around the use of controversial novel technologies, using public preferences about autonomous vehicles (AVs) as a case study. We first summarize the recent ‘Moral Machine’ study, which generated preference data from millions of people regarding how they think AVs should respond to emergency situations. We argue that while such preferences cannot be used to directly inform policy, they should not be disregarded. We defend an (...) approach that we call ‘Collective Reflective Equilibrium in Practice’ (CREP). In CREP, data on public attitudes function as an input into a deliberative process that looks for coherence between attitudes, behaviours and competing ethical principles. We argue that in cases of reasonable moral disagreement, data on public attitudes should play a much greater role in shaping policies than in areas of ethical consensus. We apply CREP to some of the global preferences about AVs uncovered by the Moral Machines study. We intend this discussion both as a substantive contribution to the debate about the programming of ethical AVs, and as an illustration of how CREP works. We argue that CREP provides a principled way of using some public preferences as an input for policy, while justifiably disregarding others. (shrink)

Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range (...) of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function. (shrink)

The recent tragic and widely publicised death of Jesse Gelsinger in a gene therapy trial has many important lessons for those engaged in the ethical review of research. One of the most important lessons is that ethics committees can give too much weight to ensuring informed consent and not enough attention to minimising the harm associated with participation in research. The first responsibility of ethics committees should be to ensure that the expected harm associated with participation is reasonable. Jesse was (...) an 18-year-old man with a mild form of ornithine transcarbamylase (OTC) deficiency, a disorder of nitrogen metabolism. His form of the disease could be controlled by diet and drug treatment. On September 13 1999 a team of researchers lead by James Wilson at the University of Pennsylvania's Institute for Human Gene Therapy (IHGT) injected 3.8 X 1013 adenovirus vector particles containing a gene to correct the genetic defect. He was the eighteenth and final patient in the trial. The virus particles were injected directly into the liver. He received the largest number of virus particles in a gene therapy trial.1 Four days later he was dead from what was probably an immune reaction to the virus vector. This was the first death directly attributed to gene therapy. It resulted in worldwide publicity, an independent investigation, the Federal Drug Administration (FDA) suspending all trials at the IHGT, an FDA, and a senate subcommittee investigation. At a special public meeting at the National Institutes of Health (NIH) in December 1999, James Wilson, also the director of the IHGT, said they still did not understand fully what had gone wrong.2 Even though a massive dose had been used, only 1% of transferred genes reached the target cells. (None of the patients in the trial showed significant gene expression. Art …. (shrink)

Dementia affects millions of people throughout the world. Thinking through Dementia offers a critique of the main models used to understand dementia-the biomedical, neuropsychological, and social constructionist. It discusses clinical issues and cases, together with philosophical work that might help us to better understand and treat this illness.

I discuss a puzzle that shows there is a need to develop a new metaphysical interpretation of mathematical theories, because all well-known interpretations conflict with important aspects of mathematical activities. The new interpretation, I argue, must authenticate the ontological commitments of mathematical theories without curtailing mathematicians' freedom and authority to creatively introduce mathematical ontology during mathematical problem-solving. Further, I argue that these two constraints are best met by a metaphysical interpretation of mathematics that takes mathematical entities to be constitutively constructed (...) by human activity in a manner similar to the constitutive construction of the US Supreme Court by certain legal and political activities. Finally, I outline some of the philosophical merits of metaphysical interpretations of mathematical theories of this type. (shrink)

In her excellent and comprehensive article, Friesen argues that utilising personal responsibility in healthcare is problematic in several ways: it is difficult to ascribe responsibility to behaviour; there is a risk of prejudice and bias in deciding which behaviours a person should be held responsible for; it may be ineffective at reducing health costs. In this short commentary, I will elaborate the critique of personal responsibility in health but suggest one way in which it could be used ethically. In doing (...) so, I will introduce the concepts of reasonable risk and golden opportunity. I previously argued that it is both difficult to disentangle responsibility and that we risk prejudice and bias in singling out behaviours that are socially disapproved of.1 So I am sympathetic to Friesen’s concerns. I also discussed another way in which ascribing personal responsibility for health is problematic which Friesen does not discuss and which, in my view, is the most concerning and further supports her arguments. It represents a back door assault on liberalism and neutrality towards concepts of the good life. Even if one were to accurately and in an unbiased way divine the personal contribution to disease, the greatest problem would remain: those who voluntarily take on risk would be penalised. That is, such a system would be risk-averse. Those lives which avoided risk would be prioritised, while those who chose to take on risky activities in their conception of the good life would be penalised. Yet risk is necessary, both for the good life, and social progress. Columbus, Edmund Hilary, Florence Nightingale, Ernest Hemingway and countless monumental figures in human history took risks in order to achieve something great. Should we aim for a society of trembling, teetotalling health nuts? Surely that prospect is horrific. It is horrific because it elevates health …. (shrink)

This paper presents a novel account of focal stress and pitch contour in English dialogue. We argue that one should analyse and treat focus and pitch contour jointly, since (i) some pragmatic interpretations vary with contour (e.g., whether an utterance accepts or rejects; or whether it implicates a positive or negative answer); and (ii) there are utterances with identical prosodic focus that in the same context are infelicitous with one contour, but felicitous with another. We offer an account of two (...) distinct pitch contours that predicts the correct felicity judgements and implicatures, outclassing other models in empirical coverage or formality. Prosodic focus triggers a presupposition, where what is presupposed and how the presupposition is resolved depends on prosodic contour. If resolving the presupposition entails the proffered content, then the proffered content is uninteresting and hence the utterance is in-felicitous. Otherwise, resolving the presupposition may lead to an implicature. We regiment this account in SDRT. (shrink)

Many have argued that individuals should receive income in proportion to their contribution to society. Others have believed that it would be fairer if people received income in proportion to the effort they expend in so contributing, since people have much greater control over their level of effort than their productivity. I argue that those who believe this are normally also committed, despite appearances, to increasing the social product — which undermines any sharp distinction between effort- and productivity-based distributive proposals. (...) However, effort-based proposals do emphasise more the importance of people having control over factors affecting their income. The second set of problems I consider is how to implement policies which hold true to this emphasis. I show that there are major problems with the accuracy of using any objective criteria to measure the level of effort a person is expending. Moreover, once any such criteria are employed the problem of ‘moral hazard’arises because people modify their behaviour in such a way as to maximise their income while minimising their effort. This violates the original motivation for using effort. Because of this and other empirical considerations, I argue that productivity may well be a better criterion on which to distribute income even if one is motivated by the same concerns which have prompted effort-based proposals. (shrink)

The prelims comprise: Introduction Controversial Choices Kinds of Normative Reasons for Action Limits on Respect for Autonomy Children and Controversial Choice Controversial Choices and the Duty to Strive Toward Perfection and Full Autonomy Acknowledgments Notes References.

The aim of this paper is to introduce the instrumental variables technique to the discussion about causal inference in econometrics. I show that it may lead to causally incorrect conclusions unless some fairly strong causal background assumptions are made, assumptions which are usually left implicit by econometricians. These assumptions are very similar to, albeit not identical with, James Woodward's definition of an ‘intervention’. I discuss similarities and differences of the two points of view and argue that—understood as a practical method (...) of causal inference—the set presented here is superior. (shrink)

Enhancing Human Capacities is the first to review the very latest scientific developments in human enhancement. It is unique in its examination of the ethical and policy implications of these technologies from a broad range of perspectives. Presents a rich range of perspectives on enhancement from world leading ethicists and scientists from Europe and North America The most comprehensive volume yet on the science and ethics of human enhancement Unique in providing a detailed overview of current and expected scientific advances (...) in this area Discusses both general conceptual and ethical issues and concrete questions of policy Includes sections covering all major forms of enhancement: cognitive, affective, physical, and life extension. (shrink)

This paper introduces a new hypothesis for the rise of the politically correct left via an analysis of Black America. Drawing on Žižekian and psychoanalytical theory, it explores the ideological role of ‘symptom’ within America’s cultural landscape - of that which states that society ‘doesn’t work’ - by way of examining prominent African American figures and how they relate to this ‘symptom’: Will Smith and the ‘hystericization of the symptom’; Barack Obama and the ‘identification with the symptom’; the PC left (...) and the ‘implementation of the symptom as law’; the far right and the ‘fear of loss of the symptom’; Kanye West, Candace Owens and the ‘rejection of clinging to the symptom’. Additionally, the 90s sit-com The Fresh Prince of Bel-Air and the film Black Panther are analyzed and juxtaposed in order to further illustrate the process by which the recent ideological shift in our cultural and political discourse towards political correctness and identity politics has occurred. (shrink)

The attitudes of Australian practitioners working in clinical genetics and obstetrical ultrasound were surveyed on whether termination of pregnancy (TOP) should be available for conditions ranging from mild to severe fetal abnormality and for non-medical reasons.These were compared for terminations at 13 weeks and 24 weeks. It was found that some practitioners would not facilitate TOP at 24 weeks even for lethal or major abnormalities, fewer practitioners support TOP at 24 weeks compared with 13 weeks for any condition, and the (...) difference in attitudes to TOP between 13 weeks and 24 weeks is most marked for pregnancies which are normal or involve a mild disorder. It is argued that a fetal abnormality criterion for late TOP is inconsistently applied, discriminatory and eugenic. Four possible moral justifications for current practice are examined, each of which would require significant changes to current practice. I argue in favour of a maternal interests criterion for any TOP. (shrink)

Summary: Edward Lanphier and colleagues contend that human germline editing is an unethical technology because it could have unpredictable effects on future generations. In our view, such misgivings do not justify their proposed moratorium.

We review recent research to introduce human brain organoids into the brains of infant rats. This research shows these organoids integrate and function to affect behaviour in rats. We argue that this raises issues of moral status that will imminently arise and must be addressed through functional studies of these new life forms. We situate this research in the broader context of the biological revolution, arguing we already have the technological power to create fully human embodied animals. This raises profound, (...) so far unaddressed ethical issues which call for urgent attention. (shrink)

The Mental Capacity Act, which received Royal Assent in April 2005, will come into force in April 2007. The Act puts into statute the legality of interventions in relation to adults who lack capacity to make decisions on their own behalf. The aim of this paper is to outline the main features of the legislation and its impact on those health care professionals who provide care and treatment for incapacitated adults. The paper sets out the underlying ethical principles that govern (...) interventions under the Act's powers and briefly explores the legal definition of incapacity and the process by which capacity is assessed. It looks at the governing notion of 'best interests' and at the legal indemnity provided by the Act for interventions that are in the best interests of an incapacitated adult. It contains sections on the Act's main innovations, including research involving incapacitated adults, lasting powers of attorney and the new Court of Protection. It also provides information on advance decisions to refuse treatment. (shrink)

ABSTRACT Following Rawls' seminal work, political philosophers and economists have recently shown great interest in different conceptions of equity or justice. Apart from Rawls' own principles, these have included utilitarianism, need and desert, horizontal and vertical equity and envy‐free distributions. None of these conceptions, however, seem to command general consensus; and this paper is an attempt to find out why. The conclusion is reached that they all fail because they do not take account of an essential element of equity: its (...) relationship to the existence or otherwise of choice. An alternative conception is offered, based explicitly on that relationship; it is argued that this conception comes closer to capturing the essence of what is generally meant by the term equity than any of the others considered. (shrink)

John Harris gives a comprehensive and generally valid defense of embryo research. Although nearly all his arguments are valid, one—the argument comparing natural reproduction to embryo research—is problematic in several important ways. I focus here on that argument.

The psychedelic psilocybin has shown promise both as treatment for psychiatric conditions and as a means of improving well-being in healthy individuals. In some jurisdictions (e.g., Oregon, USA), psilocybin use for both purposes is or will soon be allowed and yet, public attitudes toward this shift are understudied. We asked a nationally representative sample of 795 US Americans to evaluate the moral status of psilocybin use in an appropriately licensed setting for either treatment of a psychiatric condition or well-being enhancement. (...) Showing strong bipartisan support, participants rated the individual’s decision as morally positive in both contexts. These results can inform effective policy-making decisions around supervised psilocybin use, given robust public attitudes as elicited in the context of an innovative regulatory model. We did not explore attitudes to psilocybin use in unsupervised or non-licensed community or social settings. (shrink)

Blumenthal-Barby (2024) argues that bioethicists should stop using the concept of "personhood" in both well-established bioethics debates (e.g., regarding cognitive disability) and emerging ones (e...

We advance two objections to the selfish gene theory formulated by Richard Dawkins, which states that natural selection operates on genetic replicators. These objections target three of the essential features of the theory. The first feature is the exclusivity that the theory ascribes to genetic replicators as objects of natural selection. We call it “the exclusivity clause”. The second and third features correspond to two criteria that genetic replicators must satisfy for Dawkins’ theory to hold. We call them “the stability (...) criterion” and “the fidelity criterion”. The first objection we advance is that, given the findings of transgenerational epigenetics, genetic replicators do not appear to satisfy the exclusivity clause and some of them do not seem to meet the stability criterion. The second objection is that the existence of the molecular phenomena known as alternative splicing and trans-splicing seems to entail that many genetic replicators do not satisfy neither the stability criterion nor the fidelity criterion. (shrink)