Vaccine mandates can take many forms, and different kinds of mandates can implicate an array of values in diverse ways. It follows that good ethics arguments about particular vaccine mandates will attend to the details of individual policies. Furthermore, attention to particular mandate policies—and to attributes of the communities they aim to govern—can also illuminate which ethics arguments may be more salient in particular contexts. If ethicists want their arguments to make a difference in policy, they should attend to these (...) kinds of empirical considerations. This paper focuses on the most common and contentious vaccine mandate reform in the contemporary United States: the elimination of nonmedical exemptions (NMEs) to school and daycare vaccine mandates. It highlights, in particular, debates about California's Senate Bill 277 (SB277), which was the first successful recent effort to eliminate NMEs in that country. We use media, secondary sources, and original interviews with policymakers and activists to identify and evaluate three ethics arguments offered by critics of SB277: parental freedom, informed consent, and children's rights to care and education. We then turn to one ethics argument often offered by advocates of SB277: harm prevention. We note, however, that three arguments for mandates that are common in the immunization ethics literature—fairness/free-riding, children's rights to vaccination, and utilitarianism—did not play a role in debates about SB277. (shrink)

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online (...) survey to assess Michigan public-school employees (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors. (shrink)

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness (...) accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation. (shrink)

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness (...) accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation. (shrink)

Background Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. -/- Purpose To attend to the activity and dispositions of the public health staff who provide “waiver education”. -/- Method This study reports results of focus (...) group interviews with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. -/- Findings Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. Discussion These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally. (shrink)

:This article takes up a game-theoretic perspective on California’s recently passed bill that closes all nonmedical exemptions for school-mandated vaccination. Such a perspective characterizes parental decisions to vaccinate their children as a collective action problem and reveals the presence of an incentive to free ride—to enjoy the benefits of others’ efforts to vaccinate their children without vaccinating one’s own. This article defends California’s legislation as a reasonable means of overcoming the free rider problem and of ensuring that the (...) burdens of vaccination are shared equally. (shrink)

Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate because they were threatened with dismissal. Other (...) heavy-handed interventions have failed to move most such parents. When Washington state made nonmedical exemptions more difficult to obtain, nearly two-thirds of vaccine refusers were unmoved and their children remained unvaccinated. Even if dismissal threats led some parents to accept vaccines, this alone would not justify a dismissal policy. The benefits would still have to be weighed against the risks of dismissing those families who do not change their minds. (shrink)

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions (...) are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified. (shrink)

This paper provides an interpretation of the licensing provisions envisaged under the Human Fertilisation and Embryology Act 1990 as a model for a rule and exemption-based procedural strategy for the adjudication of potential ethical controversies, and it offers an account of the liberal-democratic legitimacy of the procedure’s outcomes as well as of the legal procedure itself. Drawing on a novel articulation of the distinction between exceptions and exemptions, the paper argues that such a rule and exemption mechanism, while not (...) devoid of attractions, is not immune from the criticisms often levied against procedural approaches to the management of pluralism: it either has to fall back on substantive justification in ways that are not helpful when trying to arbitrate a moral controversy, or it appears justificatorily groundless. (shrink)

Religious exemptions have a long history in American law, but have become especially controversial over the last several years. The essays in this volume address the moral and philosophical issues that the legal practice of religious exemptions often raises.

The Moral Conscience principle claims that a conflict between the demands of a law and the demands of an individual’s sincere moral conscience provides her with a defeasible moral entitlement to an exemption. This chapter argues that this principle is vulnerable to an unfairness objection. There is nothing special about moral conscience that would justify granting an exemption, it claims, that is not shared by a variety of non-moral projects. Thus, there is no principled moral reason for a defeasible entitlement (...) to moral conscience-based exemptions that is not an equally good reason for a defeasible entitlement to non-moral project-based exemptions. Since the chapter assumes that people are not defeasibly entitled to such project-based exemptions, it advocates scepticism about the Moral Conscience principle. (shrink)

Distinguishing between excuses and exemptions advances our understanding of a standard range of problem cases in debates about epistemic norms. But it leaves open a problem of accounting for blameless norm violation in ‘prospective agents’. By shifting focus in our theory of excuses from rational excellence to norms governing the dispositions of agents, we can account for a fuller range of normative phenomena at play in debates about epistemic norms.

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. (...) would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was (...) discussed in committee meetings. In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

abstract The most well‐known liberal‐egalitarian defence of cultural rights, provided by Will Kymlicka, presents culture as a primary good, and thus a resource that ought to be distributed according to some fair egalitarian criteria. Kymlicka relies on the intuition that inequalities between persons that are the result of brute luck rather than personal choice are unjust in making the case for various multicultural rights. This article makes two main claims. First, the standard luck egalitarian intuition on which Kymlicka's argument relies (...) cannot justify what he calls ‘polyethnic rights,’ in particular cultural and religious exemptions from generally applicable laws. Second, I argue that such exemptions are justifiable by appealing to the public value of fair equality of opportunity, properly construed. (shrink)

Granting differential treatment is often considered a way of placing some groups in a better position in order to maintain or improve their cultural, economic, health-related or other conditions, and to address persistent inequalities. Critics of multiculturalism have pointed out the tension between protection for groups and protection for group members. The ‘rule-and-exemption’ approach has generally been conceived as more resistant to such criticism insofar as exemptions are not conceded to minorities or ethical and religious groups as such, but (...) to individuals who are part of those groups. However, I show that when a government grants an exemption, it inevitably provides a definition of the relevant group in question, and the tendency is to take cultural membership as ‘given’ or as defined by group spokespersons. I discuss some problems related to these definitions and defend instead a definition based on shared group interests. (shrink)

Self-exempting conciliationism is the view that it is rational to give weight to the opinions of peers in disagreement, except in disagreements about how to respond to disagreement. The special treatment of disagreements about disagreement, which is important to avoid self-undermining, seems arbitrary. Two arguments against this objection were put forward. Elga [3] aims to show that there is an independent motivation for conciliationism to be self-exempting. Pittard [5] argues that the special treatment is not arbitrary because the concern for (...) epistemic deference motivates conciliatory responses only in ordinary disagreements, but not in disagreements aboutdisagreement. I will argue that both replies fail—none of them can provide a consistent justification for why one ought to be conciliatory in disagreements except in cases of disagreement about disagreement. (shrink)

The aim of this paper is to demonstrate that there are significant ethical problems with nonmedical sex selection, and that prohibitive legislation is justified. The central argument put forward is that nonmedical sex selection is a sexist practice which promotes socially restrictive conceptions of sex, gender and family. Several steps are taken to justify this position: background information on technology and legislation is provided, the neoliberal position that is supportive of nonmedical sex selection is described, and preliminary (...) reasons for rejecting this approach are given. A detailed description of how a harm/benefit based analysis contributes to the argument against nonmedical sex selection, and how it successfully counters most criticism, is provided. The paper concludes by suggesting that virtue ethics further strengthens the moral argument against nonmedical sex selection. (shrink)

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was (...) discussed in committee meetings. In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

This study examines the procedural ethical considerations surrounding religious exemptions to Covid vaccine mandates, specifically focusing on immigrant healthcare personnel (HCP) and HCPs of color. It emphasizes communication issues with applicants by investigating exemption applications and their accompanying guidelines. While there is extensive literature on the ethical implications of religious exemptions, a notable gap remains in addressing the procedural aspects of religious exemption applications and their reviewing processes. The study scrutinized religious exemption application forms and accompanying guidelines from (...) 32 selected non-teaching and teaching hospitals for the years 2022–2023. The findings highlight significant variability in exemption application criteria and processes across institutions. Importantly, many application forms lacked comprehensive procedural information, which may result in subjective evaluations and potential misinterpretations of non-Western and non-mainstream religious beliefs, especially those of immigrant HCPs and HCPs of color. The study proposes various strategies to advocate for more equitable and transparent procedures, underlining the significance of diversity, equity, and inclusion in the religious exemption review process for vaccine mandates. (shrink)

Exemptions from laws of general application are sometimes granted on the basis of an individual’s unwillingness to comply with the law. Most such volitional exemptions involve a conflict between the law and the demands of an individual’s religious or secular moral convictions. I argue here that a limited number of volitional exemptions can be justified on the basis of a futility principle. When otherwise morally permissible penalties for violating the law cannot be expected to induce the compliance (...) of an intransigent minority, the penalties are futile, and the state has some principled reason to exempt the minority from the law’s requirements. Since the futility principle only applies to some cases of conscientious objection, it differs in important ways from justifications grounded in a general entitlement to religious or moral exemptions. (shrink)

ABSTRACT Because Pastafarianism – or the Church of the Flying Spaghetti Monster – is a parodic religion, common sense suggests its ‘adherents’ should not receive exemptions. However, the prima facie case for excluding Pastafarians is complicated by the fact that many assert their religion is as legitimate as any other religion and that their beliefs are genuine. Indeed, Pastafarians have already obtained exemptions in various countries. Taking the dominant liberal egalitarian, integrity‐based approach to exemptions, this article investigates (...) whether there is a principled, objective basis for excluding Pastafarians that accounts for their assertions. To that end, I examine four tests: a religion, seriousness, obligation, and sincerity test. I assess whether each test can actually exclude Pastafarians, and if it could, can it do so in a way that is consistent with liberal egalitarian commitments. I argue that only a sincerity test – based on consistent behaviour and a willingness to bear the costs of one's beliefs – satisfies both of these conditions, but, on a weak and contingent basis. (shrink)

To what extent does the case for exemptions from laws to accommodate religious commitments rest specifically on egalitarian arguments? To what extent should specifically egalitarian or anti-discrimination concerns be used to determine when such exemptions should be granted? This Article considers both of these questions. It argues that while egalitarian considerations have a role to play in both the general justification and case-by-case evaluation of exemption claims, neither the justification, nor the evaluation of exemptions, properly rests solely (...) on specifically egalitarian considerations. At the level of justification, there is an important, independent role for something akin to the principle of respect for conscience recently put forward by Martha Nussbaum; and, when citizens come to evaluate particular claims for exemptions, the anti-discrimination approach put forward by Christopher Eisgruber and Lawrence Sager in the context of the U.S. and its constitutional tradition is more plausibly seen as a complement to the “balancing test” which has been used historically rather than as an alternative to it. (shrink)

According to the standard liberal egalitarian approach, religious exemptions from generally applicable laws can be justified on the grounds of equal respect for each citizen’s conscience. I contend that claims of conscience cannot justify demands for exemptions, since they do not meet even the most inclusive standards of public justification. Arguments of the form ‘My conscience says so’ do not explicate the rationale behind the practices that the claimants seek to protect. Therefore, such arguments do not constitute even (...) pro tanto reasons for exemptions. Rather, they are what Francis Bacon called idola fori – ‘idols of the marketplace’– conventional justifications that are deemed rational and even self- evident, while in fact they are not. (shrink)

When generally applicable rules clash with one’s cultural, religious or moral commitments, should exemptions be granted? The debate on exemptions raises the question both of what it means to treat people equally and of what it means to protect diversity adequately. The objective of this paper is to defend the no-exemption argument and to make it a more attractive position for liberals. I first argue that exemptions violate the principle of equal treatment because they rely on distinctions (...) that cannot be neutrally justified. I then argue that diversity can be adequately accommodated if we use a more demanding interpretation of the justification of generally applicable rules. There should be no exemption to fully justified rules, but rules are only fully justified when the particular demands that they impose on individuals are justified, i.e. when they are either neutral or pass both a Necessity Test and a Sufficiency Test. When rules are not fully justified, they should be repealed or modified. Based on this focus on the demands of rules, equality can be reconciled with an adequate accommodation of diversity. (shrink)

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in (...) which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

Mental retardation is an invented bureaucratic category, currently undergoing radical rethinking and likely renaming, that includes many who have biologically based brain disorders, but is itself determined on functional criteria that are purely arbitrary. People with MR are socially vulnerable and thus are more likely to be "naíve confessors," "naíve defendants," and "naíve offenders." That is most likely the rationale and justification for the Supreme Court's decision, in Atkins v. Virginia, to exempt the class from execution. Although the decision is (...) to be applauded as a step in a more humane direction, it is problematic to use an indirect, artificial, and insufficiently inclusive category to determine who should or should not be executed. Limited social intelligence is a characteristic of a wide range of brainbased syndromes and disorders, including many who fall above the upper IQ limit and, thus, are ineligible for the MR label and the legal protections associated with it. A more equitable, and logical, policy would be to extend execution exemption to all who demonstrate the same kinds of vulnerabilities, especially if they can be linked to some brain-based medical condition, regardless of whether one qualifies for the label of MR. (shrink)

In this article, I defend the view that conscience exemption clauses for medical practitioners (doctors, nurses, technicians, pharmacists) should be limited by patient protection clauses. This view was also defended by Mark Wicclair, in his book on conscience exemptions in medicine (Cambridge UP, 2011). In this article, I defend Wicclair’s view by supplementing it with Hegelian ethical theory and feminist critical theory. Conscience exemptions are important to support as a matter of human rights. They support an individual’s right (...) to protect their deepest value-commitments. A true understanding of conscience is dialectical, however, and it requires patient protection clauses because they, too, protect individuals in their deepest value-commitments. In this article, I show that the defense of patient protection clauses is historically supported by the theory of “conscience [Gewissen]” developed by G.W.F. Hegel in the nineteenth century (mostly in the Phenomenology of Spirit (1807)). (shrink)

Justifying religious exemptions is a complicated matter. Citizens ask to not be subject to laws that everyone else must follow, raising worries about equal treatment. They ask to be exempted on a religious basis, a basis that secular citizens do not share, raising worries about the equal treatment of secular and religious citizens. And they ask governmental structures to create exceptions in the government’s own laws, raising worries about procedural fairness and stability. We nonetheless think some religious exemptions (...) are appropriate, and in some cases, that exemptions are morally required. So how are we to determine when religious exemptions are justified? This article employs a public reason framework to provide an answer. I show how to publicly justify religious exemptions. My thesis is that a citizen merits a religious exemption under four conditions: if she has sufficient intelligible reason to oppose the law, if the law imposes unique and substantial burdens on the integrity of those exempted that are not off-set by comparable benefits, if the large majority of citizens have sufficient reason to endorse the law, and if the exempted group does not impose significant costs on other parties that require redress. If these conditions are met, then legislative and/or judicial bodies should carve out an exemption for those requesting them. (shrink)

All of the 50 states of the United States have laws governing childhood vaccinations; 48 allow for religious exemptions, while 19 also offer exemptions based on some sort of personal philosophy. Recent disease outbreaks have caused these states to reconsider philosophical exemptions. However, we cannot, consistent with the U.S. Constitution, give preference to religion by creating religious exemptions only. The Constitution requires states to put religious and nonreligious claims on equal footing. Given the ubiquity of nonreligious (...) objections to vaccination, I conclude that the best response is to remove all exemptions, as two states have already done. But removing exemptions should not end our concern for children. Removing exemptions only bars children from public schools; it still leaves them unvaccinated, a danger to others, and reliant on whatever nonpublic schooling is available. If public school attendance is not enough of an incentive for vaccine reluctant parents, perhaps we should look into stronger measures. (shrink)

In the last chapter of her book Liberalism's Religion [2017], Cécile Laborde argues that it is the practices and beliefs aimed at protecting individual integrity that can be candidates for exemptions. It therefore proposes two tests (sincerity and acceptability) in order to assess the link between these beliefs and practices and the individual’s integrity and considers the setting up of a deliberative process. We argue in this article that these two tests and the establishment of a deliberative process are (...) not feasible because they do not take into account, or they even participate in the invisibilization of the voices of women of Muslim faith in the public sphere within Western liberal societies. Our criticism is thus formulated in three points. First, we question the thick sincerity test and the assessment of the coherence between the beliefs/practices of an individual and his integrity, while different public spaces of Western liberal democracies invisibilize Muslim women and make their voice inaudible. We then examine the thin acceptability test, in a context of securitization of Islam and Muslims, allowing the reproduction of discourses racializing Islam and culturalizing gender oppression. Finally, we argue that thinking about the process of democratic deliberation involves reporting on the forms of epistemic injustice and moral injury that occur against minority groups – especially Muslim women. This criticism will be illustrated by excerpts from Swiss parliamentary debates as part of the parliamentary initiative against face concealment. (shrink)

Within the health care industry, the move from regulatory cost controls to market competition has generated rapid and dramatic restructuring of providers. To enhance their competitive positions in the evolving market, many health care organizations are pursuing the ownership and integration of all elements and stages of health care delivery and payment, with the goal of increasing access to capital and lowering costs through administrative efficiencies and economies of scale. As of July 1994, 24 percent of hospitals were members of (...) an integrated delivery system, and 47 percent were involved in IDS development.IDSs pose a singular challenge to the Internal Revenue Service. The IRS recognizes that its traditional policies for granting tax exempt status are not flexible enough for the competitive and rapidly changing health care market. In recent years, the IRS has taken a more active role in scrutinizing emerging health care institutions seeking taxexempt status. (shrink)

DeMarco and colleagues present a compelling method of dealing with medical risks for which there is equipoise which might be implicated in a given research protocol. This commentary examines how the proposed model should inform the disclosure of other, non-medical risks. Since equipoise is a fairly unclear notion for non-medical risks (since there is little sense of professional uncertainty regarding these risks), this could lead to the inclusion of nearly unlimited non-medical risks. To account for these risks more reasonably, I (...) will argue that a strong participant-researcher relationship is vital to determine if there are any particular non-medical risks that might be uncertainly implicated in a given research program. (shrink)

I focus on some controversial features of Peter Balint’s stimulating and provocative reassessment of the place of toleration in contemporary diverse societies. First, I question his argument that we must enlarge the concept of toleration to include indifference and approval if toleration is to be compatible with state neutrality. Secondly, I suggest that his idea of active neutrality of intent risks encountering the same difficulties as neutrality of outcome, although these will be mitigated the more the state’s neutrality takes a (...) ‘hands-off’ form. Thirdly, while accepting his claim that exemptions depart from neutrality insofar as they attribute a significance to religious and conscientious convictions that they deny to mere preferences, I argue that that departure is not arbitrary and remains within the spirit of neutrality of intent. (shrink)

In my paper “Parental Love and the Ethics of Sex Selection,” published in the previous issue of the Cambridge Quarterly of Healthcare Ethics, I set out to determine whether a plausible argument could be constructed in support of a common intuition about the ethics of sex selection. The intuition in question is that sex selection for nonmedical reasons is incompatible with a proper parental love: that is, with the sort of love that a parent ought to have for her (...) child or, equivalently, with the sort of love that someone accurately describable as a good parent will have for her child. I concluded that there is a prima facie compelling argument that fits the bill, though I did little more than introduce and set that argument out. In the current paper, my aim will be to subject it to closer scrutiny, by considering a number of possible objections to it. I will start by asking why the argument should be thought to apply only to sex selection for nonmedical reasons and not to cases in which selection is employed in order to prevent the birth of children with serious sex-linked genetic conditions. (shrink)

While supporters argue that exemptions are needed to equalize opportunities, critics claim they are unwarranted in principle and discriminatory in practice: equal treatment requires only facial neutrality whereas exemptions treat citizens unequally insofar as individuals with idiosyncratic commitments similarly burdened by general rules are rarely given an exemption.The upshot of this critique is that the burdens of cultural and religious commitments ought to be treated as expensive tastes. I argue that religious and cultural commitments cannot be reduced to (...) expensive tastes that can be revised in the face of resource expectations and that, for this reason, opportunities are not equal when minorities must choose between adherence to such commitments and availing of valuable opportunities, when members of more dominant communities need not. I also explain why treating religious and cultural commitments in this way does not entail the adoption of a primordial view of culture that puts these commitments beyond revision and choice. (shrink)

Exemption from blameworthiness is often bound to implicit or explicit claims of diminished agency, or even non-agency. This poses a dilemma in navigating moral relationships affected by mental illness. While it is crucial for assessments of responsibility to be responsive to the significance of mental illness, must this responsiveness come at a cost to symmetrical moral relations? In this paper we argue, contra recent critiques, that Strawsonian accounts of responsibility are able to navigate this dilemma, and can accommodate significant exculpation (...) on the basis of mental illness while maintaining symmetrical relations. We understand this to be part of the larger recognition that while we have certain fundamental entitlements within our moral relationships, it is also possible to be over-entitled, and to expect too much of others. Our account draws, in particular, on the moral significance of difficulty. Difficulty is inherently scalar, and in drawing on this explanatory framework we explicate a theory of both excuse and exemption by degree. We argue for a significant realm of excuse on the basis of mental illness that is fully compatible with symmetrical relations. However, we also acknowledge the limits of this accommodation on Strawsonian grounds, and argue that these limits are justified and appropriate. (shrink)

Richard Posner avers in his A Failure of Capitalism that managers bear no moral responsibility for the financial crisis. This view has numerous supporters in economics and philosophy, and I shall call it the ‘exemption view’. In this paper, I criticise four arguments for the exemption view and propose a superior alternative, the ‘participation view’. The participation view claims that managers can be co-responsible for harm, even if their actions were not necessary or sufficient conditions for its occurrence. The paper (...) spells out three conditions for moral responsibility according to the participation view. (shrink)

Pamela Hieronymi has authored a very insightful book that focuses on one of the most influential articles in 20th century philosophy: P. F. Strawson’s ‘Freedom and Resentment’ (1962). Hieronymi’s principal objective in Freedom, Resentment, and the Metaphysics of Morals is to reconstruct and evaluate the central argumentative strategy in Strawson’s essay. The author’s aim is ‘to show that it can withstand the objections that are both the most obvious and the most serious, leaving it a worthy contender’ (3). In the (...) present commentary, I summarize the main results of Hieronymi’s analysis. I engage with the book’s main themes, noting in due course certain unclarities and some shortcomings, while emphasizing the many valuable insights it offers. (shrink)

The Japanese Medical Act section 21 states that doctors must report unnatural deaths to the police, even though the term “unnatural death” is not defined by law. However, many doctors are reluctant to report potential therapeutic deaths . The Japanese Society of Legal Medicine has submitted guidelines for unnatural death, including PTD. These define a PTD as an unexpected death, the cause of which is unknown, but which is potentially related to medical practice. Such deaths are “reportable” to the coroner (...) in the UK. In this study, we addressed the question of whether physicians would report each of eight hypothetical PTDs. Although the clinical societies declare that doctors must report deaths due to gross negligence, 60% of the participants said that they would not report gross negligence involving an overdose in cases where they had obtained informed consent or had provided an explanation after the death occurred. This can be accounted for by the mistaken belief on the part of the participants that obtaining informed consent exempts Japanese physicians from the duty of reporting PTDs. The attitude of Japanese physicians is caused by the death investigation system, which is designed to discover whether a crime has been committed rather than focusing on the cause of death. Accordingly, the Japanese Government has decided to commission a pilot study from an independent organisation in which medical specialists will investigate PTDs in order to prevent deaths occurring as a result of gross negligence. (shrink)

Religious exemptions present an anomaly in American law. Under the power of religious exemptions, individuals and organizations whose actions violate civil and criminal laws are exempt from those l...