The rare but severe cerebral venous thrombosis occurring in some AstraZeneca vaccine recipients has prompted some governments to suspend part of their COVID-19 vaccination programmes. Such suspensions have faced various challenges from both scientific and ethical angles. Most of the criticisms against such suspensions follow a consequentialist approach, arguing that the suspension will lead to more harm than benefits. In this paper, I propose a rights-based argument against the suspension of the vaccine rollouts amid this highly time-sensitive combat of COVID-19. (...) I argue that by suspending a vaccine rollout, a government infringes people's right to take the risks they deem worth taking for their health. I also consider four potential objections to my argument and explain why none of them undermines my argument. (shrink)

The COVID-19 pandemic during 2020–2022 raised ethical questions concerning the balance between individual autonomy and the protection of the population, vulnerable individuals and the healthcare system. Pediatric COVID-19 vaccination differs from, for example, measles vaccination in that children were not as severely affected. The main question concerning pediatric vaccination has been whether the autonomy of parents outweighs the protection of the population. When children are seen as mature enough to be granted autonomy, questions arise about whether they have the (...) class='Hi'>right to decline vaccination and who should make the decision when parents disagree with each other and/or the child. In this paper, I argue that children should be encouraged to not only take responsibility for themselves, but for others. The discussion of pediatric vaccination in cases where this kind of risk–benefit ratio exists extends beyond the 2020–2022 pandemic. The pandemic entailed a question that is crucial for the future of public health as a global problem, that is, to what extent children should be seen as responsible decision-makers who are capable of contributing to its management and potential solution. I conclude that society should encourage children to cultivate such responsibility, conceived as a virtue, in the context of public health. (shrink)

Reigning regulatory frameworks for biomedical research impose on researchers and research ethics committees an obligation to protect research participants from risks that are unnecessary, disproportionate to potential research benefits, and non-minimized. Where the research has no potential to produce results of direct benefit to the subjects and the subjects are unable to give consent, these requirements are strengthened by an additional condition, that risks should not exceed a certain minimal threshold. In this article, I address the question of (...) whether there should be limits of permissible risks in non-therapeutic research involving competent and healthy subjects. Some commentators argue that competent and informed individuals should have a right to participate even in extremely risky research and that research ethics committees should never reject studies because they are too dangerous. To use David Shaw's expression, competent volunteers should have ‘a right to participate in high-risk research’. I argue that this idea is ill-founded, as it does not take into account the social mission and complex collaborative nature of research practice as well as the inequity of power between researchers and subjects. Imposition of limits on permissible risks for healthy volunteers is justified by the need to protect research enterprise and the need to protect the weaker party, namely the subjects. Also, I suggest that the best way to set boundaries on research risks is to leave the judgment of risk acceptability to research ethics committees. (shrink)

The increasing awareness of personal health responsibility had led to the claim that patients with ‘self-inflicted’ conditions have less of a right to treatment at the public's expense than patients whose conditions arose from ‘uncontrollable’ causes. This paper suggests that regardless of any social decision as to the limits and scope of individual responsibility for health, the moral framework for discussing this issue is equality. In order to reach a consensus, discourse should be according to the common basis of (...) all theories of justice, Aristotle's formal principle of justice: ‘equals must be treated equally and unequals must be treated unequally, in proportion to the relevant inequality’. This paper deals with the question of whether and under what circumstances risk-taking behaviour could be regarded as a ‘relevant inequality’ with respect to the right to health care. Following a discussion of the relevant inequalities in health care, the conclusion is reached that the fact that the condition was avoidably caused by the patient and is therefore his or her fault can not be regarded necessarily as a relevant inequality. Therefore, the issue is one of societal support for health care; after defining relevant inequalities in this respect, the paper attempts to apply them to self-inflicted conditions. This analysis reveals that, in theory, it may be just to restrict societal support in such cases. However, the application of this conclusion requires proof of many factual claims—for which there is often very limited evidence. (shrink)

There is much philosophical literature on the duty to rescue. Individuals who encounter and could save, at relatively little cost to themselves, a person at risk of losing life or limb are morally obligated to do so. Yet little has been said about the other side of the issue. There are cases in which the need for rescue could have been reasonably avoided by the rescuee. We argue for a duty to take rescue precautions, providing an account of the (...) circumstances in which it arises. This novel duty has important implications for public policy. We apply it to the situation of some of the uninsured in the United States. Given the US clinician's duty to provide emergency care to all people regardless of ability to pay, some of the uninsured have a moral duty to purchase health insurance. We defend the duty against objections, including the possibility that a right to rescue can be waived, thus undermining a duty to take rescue precautions, that the duty of many professionals is voluntarily incurred, and that a distinction between actively assumed and passively assumed risks matters morally. (shrink)

Most ethics committees which review research protocols insist that potential research participants reserve unconditional or absolute ‘right’ of withdrawal at any time and without giving any reason. In this paper, I examine what consent means for research participation and a sense of commitment in relation to this right to withdraw. I suggest that, once consent has been given (and here I am excluding incompetent minors and adults), participants should not necessarily have unconditional or absolute rights to withdraw.This does (...) not imply that that there should be a complete absence of rights, or, indeed, an abandonment of the right to withdraw. The point of this paper is to show that the supposed unconditional or absolute nature of these rights may be self‐defeating and so fail to respect the autonomy of participants. In addition, and on a more positive note, I suggest that, attaching certain conditions on the right to withdraw, may better respect the autonomy of these participants by underlining the idea that autonomy is more than mere whim or indifference to the fate of others. On the contrary, research staff are currently unable to ‘push’ participants, who may merely have logistical difficulties unrelated to the research itself, but who really want to stay the course, for fear of coercing them. Furthermore, researchers now try to ‘screen out’ people they think may be unreliable to protect the science of the study and so groups at risk of dropping out may be unfairly denied access to research treatments. I conclude that on‐going negotiation between the relevant parties could be on balance the only truly acceptable way forward but concede certain important limitations to take into account. (shrink)

Lack of supportive workplaces may be depriving babies and mothers of the health advantages of breastfeeding. This citizen science pilot project set out to engage women in photographing and sharing information on the available facilities for breastfeeding and expressing and storing breastmilk in Australian workplaces. While some useful insights were gained, the project failed in the sense that 234 people ‘liked’ the project Facebook page set up to recruit participants, but only nine photographs were submitted. The heaviest loss of participation (...) occurred after the ethics committee requirements were explained, in particular, the requirement for employer consent to take a photograph, or alternatively, for a participant to agree to bear the risk of taking a photo without permission. The ethics committee also made stipulations about the formality of language to be used. Thus, the project’s potential role as an enabler for health action was neutered. We argue that the ethics requirements worked contrary to our purpose and possibly acted to reinforce the powerlessness some women experience at work. (shrink)

Procreation with donor gametes is widespread and commonly accepted, but it involves ethical questions about the child's best interest. Understanding the historical structures of the moral discussion of gamete donation may contribute to reflecting on the child's best interest. This is why I have analysed the debate on gamete donation in the Netherlands, and this analysis has uncovered some striking discontinuities. Notions of the child's best interest have undergone a radical swing. In the past, it was considered acceptable to conceal (...) the truth about the child's biological origin, but in the past two decades the general opinion has changed to the common belief that this information should be shared with the child. This changed notion of the child's best interest will be analysed using a framework encompassing three views of the child, which derive from the debate on children's rights. These three views each provide a different interpretation of the child's moral and political status. I conclude that the changed notion of the child's best interest results from a view of the child that focuses on autonomy and citizenship, and which frames the child's interests according to its legal status. I comment on this view and I champion an alternative one, namely ‘the embedded child’. This is a relational view based on care ethics that goes beyond what can be articulated in law, and that will help to establish a more balanced interpretation of the child's best interest at the practice and policy levels of gamete donation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Significant Interests and the Right to KnowReuven Brandt (bio)1. IntroductionDaniel Groll's book Conceiving People (2021) attempts a novel and insightful defence of why individuals ought to choose open over anonymous gamete donation, barring any special circumstances. In broad strokes, the overall argument proceeds by defending three main claims: (1) that failing to disclose to children that they are donor-conceived is morally problematic, (2) that children who are informed (...) that they are donor-conceived (either intentionally by their social parents or otherwise) are likely to have a worthwhile, significant, subjective interest1 in having knowledge about their gamete donor(s), and (3) that parents have a duty to advance their children's worthwhile subjective significant interests. Groll's account departs from other criticisms of anonymous gamete donation in that it does not rest on the view that knowledge about one's genetic progenitors is essential to self-knowledge, identity formation, or other elements of wellbeing for creatures like us. The view thus attempts to avoid the pitfalls plaguing other criticisms of anonymous gamete donation, which tend to rely on controversial (and likely false) claims of genetic essentialism and/or genetic exceptionalism.Groll's thesis rests on the much more modest (and likely correct) claim that seeking information about one's genetic progenitors is one of many permissible, fruitful, and valuable routes to identity formation. According to Groll, it just so happens that a large portion of donor-conceived individuals aware of the absence of biological ties to one or more social parents choose this route to identity formation. And this empirical fact combined with plausible views about parents' obligations to promote their offspring's wellbeing gives prospective pro-creators strong reason to choose open donors over anonymous donors.Although many aspects of the picture Groll paints are attractive, I remain unconvinced that the overall argument succeeds. My criticism of the argument is multipronged. I am skeptical that failing to disclose to a child that they were donor-conceived and/or failing to disclose information to a child that they are [End Page 201] likely to find important violates the parental duty to build intimate relationships with one's offspring. This shifts the force of Groll's argument to the empirical claim that donor-conceived children are likely to have a significant subjective interest in knowing information about their biological relations. As I will show, the empirical evidence for this claim is not as strong as Groll presumes. In the absence of a deontic argument for disclosure, Groll must provide more robust empirical evidence that anonymous gamete donation is likely to result in off-spring with their weighty interests frustrated, or else argue that the risk is not worth taking. These are not fatal flaws but show that more empirical and normative work needs to be done to defend this line of argument.A more serious set of worries arise in response to Groll's claim that the interest that donor-conceived individuals have in genetic information is likely to be significant. Little is said about what constitutes a significant interest, except that interests fall along a linear spectrum and that the significance of an interest is a factor of "the space, so to speak, it takes up in a person's mental economy (do they think about it a lot?) and the extent to which they organize their lives around it" (2021, 63). My worries here are three-fold. First, it is unclear whether the empirical data support the claim that donor-conceived individuals are likely to have an interest in genetic knowledge that is significant in the sense that it occupies a large portion of their mental energy and is a locus around which they organize their lives. Second, there is scant discussion about whether an interest can become morally problematic (and so no longer worthwhile on Groll's account) if it is given too much weight. I will argue that a plausible reading of Groll's account requires that we treat overvalued interests as no longer worthwhile. Consequently, Groll's argument risks presuming the kind of genetic chauvinism—the view that genetic knowledge is essential to wellbeing—that he seeks to reject. Third, if... (shrink)

Does a human right to healthcare imply individual obligations to healthy behavior? Or put another way: Is a self-induced condition a relevant criterion for some sort of restriction of this right—like withholding or modifying treatment in circumstances where choices have to be made? For instance, should a drunk driver bear the costs of medical care that he needs after a car accident he has caused? Should there be a difference in healthcare entitlements between the smoker with a heart (...) attack who is seriously overweight and the 60-year old man who has always taken excellent care of himself and is suddenly stricken by leukemia? And how should we think about the risk-taking behavior of all the persons going on a skiing holiday or an exotic hiking trip? a. (shrink)

Lachlan Umbers defends democracy against Jason’s Brennan’s competence objection, by showing that voting even incompetently does not violate the rights of others, as the risk imposed is negligible, and furthermore lower than other permissible actions, e.g. driving. I show there are costs in taking this line of argument. Accepting it would make arguing for the duty to vote more difficult in two ways: since voting incompetently is permissible, and not voting imposes less risk than not voting, then not voting is (...) permissible; in terms of fairness, voting incompetently is worse than not voting, if voting incompetently is permissible, then there cannot be a fairness-based duty to vote. (shrink)

The European Union is currently challenged by right-wing populism and economic stress. To understand the nature of these challenges, we need to take an interdisciplinary approach in which empirical studies of politics are combined with studies of the normative implications of European policy-making. To this end, I draw attention to the right to free movement, which is pivotal both for European politics and liberal political philosophy. I show that even though transnational rights, such as the free movement (...) for people, products and money, are normatively sound and desirable, enhancement of free movement may challenge the heterogeneity among the national models of rights and societal commitments. The risk is that the national institutions as a political arena face difficulties in coping with current political challenges such as right-wing radicalism, social inequality, environmental regulation, immigration and financial insecurity. On the other hand, I argue that we should be aware that the transnational rights might in some countries enhance human rights, which national parliaments have not been able to accommodate. (shrink)

ABSTRACT:A key factor in the decision to convert a publicly owned company to private status is the expectation that value will be created, providing the firm with rent. These rents have implications regarding the property rights of the firm’s capital-contributing constituencies. We identify and analyze the types of rent associated with the newly private firm. Compared to public firms, going private allows owners the potential to partition part of the residual risk to bond holders and employees, rendering them to be (...) co-residual risk bearers with owners. We propose that new promotion-based contracts with bond holders and employees, reflecting their particular investments, be negotiated as the firm migrates from public to private status. These contracts should acknowledge the firm’s intent to maximize shareholder value and its need to take the risks necessary to do so, but support that the firm’s survival not be undermined due to its possibly opportunistic owners. (shrink)

Eighty percent of (commercial) genetically engineered seeds (GES) are designed only to resist herbicides. Letting farmers use more chemicals, they cut labor costs. But developing nations say GES cause food shortages, unemployment, resistant weeds, and extinction of native cultivars when “volunteers” drift nearby. While GES patents are reasonable, this paper argues many patent policies are not. The paper surveys GE technology, outlines John Locke’s classic account of property rights, and argues that current patent policies must be revised to take (...) account of Lockean ethical constraints. After answering a key objection, it provides concrete suggestions for implementing its ethical conclusions. (shrink)

Robert Nozick has suggested that risky actions are a problem for a moral view based on rights. We ordinarily think that some actions are too dangerous to be permissible, taking into account both the harm risked and the degree of the risk. Other actions, although they run some risk of serious harm, are thought permissible. The problem is to draw this distinction in a principled way by looking to rights.I think that Nozick's argument about risk can be answered but a (...) different argument has convinced me that the rights view cannot handle risk in a satisfactory way. The inability is a function of the basic nature of the view. (shrink)

I argue that riskier killings of innocent people are, other things equal, objectively worse than less risky killings. I ground these views in considerations of disrespect and security. Killing someone more riskily shows greater disrespect for him by more grievously undervaluing his standing and interests, and more seriously undermines his security by exposing a disposition to harm him across all counterfactual scenarios in which the probability of killing an innocent person is that high or less. I argue that the salient (...) probabilities are the agent’s sincere, sane, subjective probabilities, and that this thesis is relevant whether your risk-taking pertains to the probability of killing a person or to the probability that the person you kill is not liable to be killed. I then defend the view’s relevance to intentional killing; show how it differs from an account of blameworthiness; and explain its significance for all-things-considered justification and justification under uncertainty. (shrink)

Institutional review boards (IRBs) have a reputation for impeding research. This reputation is understandable inasmuch as many studies are poorly designed, exploit participants, or do not ask a relevant question , and it is entirely proper that IRBs should reject such proposals. However, IRBs also frequently reject or tamper with perfectly sound and relevant studies in the name of protecting participants from harm, in accordance with the widely accepted message that “clinical research is justified only when participants are protected from (...) excessive risks”. Here, I argue that IRBs should never reject a study because it poses too high a risk to participants, and that their role should be confined to ensuring that risks and any potential benefits are fully explained to potential participants. Everyone should have the right to participate in research without paternalistic decisions about risk being made on their behalf. (shrink)

States are in the process of creating controversial legislation aimed at subjecting ‘harmful’ online communication on social media and search engines to new regulatory regimes. Critics argue that these measures are serious threats to the right to freedom of expression and freedom from surveillance. This article first draws on elements of systems theory to reframe the right to freedom of expression in democracy as a means of protecting the value of generalised second-order observation. Taking the UK’s Online Safety (...) bill as the paradigm example of the new laws, the article analyses the concept of harmful communication at three levels: society, organisation, and subject. It identifies a shift in the law’s epistemic approach to communication, by which individuals are reconfigured from agential subjects into contingent users, whose capacities are determined by the structure of online communication platforms. In this configuration, norms previously considered indispensible are relegated to second-order effects of the affordances of media. Arguing that it is insufficient to merely reaffirm subjective rights in light of this shift, the article suggests systems theoretical analysis as a means of identifying lines of critique. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind the (...) Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

It has been argued that, when there is a probable imminent risk of loss of children’s fertility, their parents should take active steps to preserve their reproductive potential if possible – or even that children have a right to such interventions being undertaken on them on their behalf, as an expression of their right to an open future. In this chapter, I explore these proposals and some of their implications. I place the discussion of fertility preservation for (...) children into the more general context of the choices that parents might have to help keep their children’s future reproductive (and parenting) choices open. I discuss the role of desert and fairness in arguments for fertility preservation and their relevance for framings of infertility in general, as well as the relation between having a (slight) possibility to reproduce and becoming a parent. (shrink)

The technological solutions adopted during the current pandemic will have a lasting impact on our societies. Currently, COVID-19 health status certificates are being deployed around the world, including in Europe, the United States and China. When combined with identity verification, these digital and paper-based certificates allow individuals to prove their health status by showing recent COVID-19 tests results, full vaccination records or evidence of recovery from COVID-19. Most countries in the Global South, where vaccination rates are low, have not yet (...) fully implemented such certificates, although several initiatives are currently underway. That is, for instance, the case in the African Union. Yet, it is not sufficient to develop technical solutions for the verification of COVID-19 health status. Because technologies do not evolve in a legal vacuum, the existing laws and regulations must be respected. The risks of implementing such technologies must be anticipated and mitigated as much as possible before any large-scale deployment. Risk mitigation should also underpin strategies throughout the deployment of these certificates. This article evaluates the key legal implications of COVID-19 health status certificates for data privacy and human rights. In doing so, it contributes to the current debates, thus informing policymakers in this area of vital national and international interest. (shrink)

Evidence that women voluntarily expose themselves to some threats more than men do challenges the generalizability of the claim that women exceed men in self-protective responses. Examples include women's higher rates of living organ donation and rescuing Jews during the holocaust. In general, women's efforts to keep other people alive can take precedence over their efforts to protect themselves.

Beginning with an analysis of the "reluctant gambler problem"—in which the notion of guiding one's life by probability seems to conflict with the preferences of rational people—we draw a distinction between rule and act probabilism. Arguing that humans are rule probabilists by default, we show that reluctant gamblers can be viewed as rule probabilists. If so viewed, their reluctance to gamble is consistent with their rational use of probability judgments to guide their lives.The distinction between rule and act probabilism suggests (...) a way to analyze the risks stemming from the September 11 terrorist attacks. Assessing the risks posed by the new reality of terrorism in the U.S. in light of the rule versus act probabilist distinction shows the risks Americans face from a terrorist attack are essentially the same as they were before September 11, 2002. Yet empirical investigation indicates Americans exaggerate their personal risks from terrorism.The perception that the risks of terrorism mushroomed on September 11 is partially explained by the 24-hour news stations' TV coverage and the current administration's "interest" in diverting attention from their own questionable practices. While the risks of terrorism are not appreciably higher than they were prior to September 11, they might be further reduced. Unfortunately, our government's strategy to reduce the risks of terrorist strikes involves weakening the Constitution. Americans face the question how much it is appropriate to pay—in diminished rights and liberties—to reduce a risk that is essentially the same as it was prior to the attacks. (shrink)

The rise to taking over state power after elections of 2014 by majoritarian forces in India has since witnessed weakening of institutions of governance. The ruling Bhartiya Janata Party has returned to power with an enhanced parliamentary majority in the 2019 elections. The rise of hindutva, the Hindu nationalist political philosophy of the formations comprising the BJP and the Sangh parivaar or affiliates of the right wing Rashtriya Swayamsevak Sangh, has reshaped the discourse on the “idea of India”. Under (...) the extensive reframing in majoritarian nationalist terms of Indian political verities, it is conceivable that the Indian military, widely regarded as a professional, apolitical and secular force, will also be impacted. There has been little academic scrutiny of the possible influence of majoritarianism on the Indian military. The paper examines impact of the onset of majoritarianism democracy on India’s military by taking a close look at the movement in civil-military relations under the BJP government. There is a shift in civil-military relations from objective civilian control, that enhances professionalism and keeps the military apolitical, to subjective civilian control, wherein the military is co-opted through subscribing to the ideologybased security perspective of the ruling party. This shift poses for the military a risk of losing their a political ethic. Erosion of the apolitical ethic of the military will open up the military’s secular ethic to modification. The conclusions are both relevant for policy and theory. The relevance for policy lies in the need for the Indian state and the military to preserve professionalism by persisting with the objective civilian control model. The theoretical relevance is in discerning limits to the concept of obedience of the military to the civilian political rulers. Where there is a threat from a political ideology or its penetration into the military’s intellectual domain with the potential to dilute the military’s professionalism, the military needs to pushback for the sake of national security. (shrink)

Clozapine is a very effective drug with both significant benefits and significant risks in treatment-resistant schizophrenia. Informed consent is generally accepted as both desirable and necessary in order to ensure that the patient’s human rights and dignity are respected. Disclosure is a key element of informed consent. It is unclear if the adequate documentation of disclosure is standard practice before initiation of clozapine. The aim of this study was to assess the adequacy of the documentation of disclosure in consent (...) to clozapine treatment in an adult mental health service and to develop guidelines on disclosure. The method was a retrospective analysis of charts of patients given clozapine who received the drug through the pharmacy of a single North Dublin psychiatric hospital. Results show that current practice has evident gaps. The professional, ethical and legal issues are discussed. (shrink)

On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of active assistance (...) to die through a lethal injection administered by a doctor. This brief report discusses the ruling in the light of the broader sociopolitical and historical context of the German end-of-life debate. (shrink)

The pressure to obey : what would you do? -- Obedience and disobedience : when is which right? -- Breaking the habit : it takes more than you think -- Finding your voice : saying "no" so you are heard -- Understanding the true risks of saying "yes" -- The dynamics of authority and obedience -- Changing the dynamics -- The crucial lessons from guide dog training -- The price of teaching obedience too well -- Teaching intelligent disobedience (...) : where do the lessons begin? -- Doing right at work : saving lives and accomplishing missions. (shrink)

In this paper, we argue that patients who are subjects of Artificial Intelligence (AI)-supported diagnosis and treatment planning should have a right to a second opinion, but also that this right should not necessarily be construed as a right to a physician opinion. The right to a second opinion could potentially be satisfied by another independent AI system. Our considerations on the right to second opinion are embedded in the wider debate on different approaches to (...) the regulation of AI, and we conclude the article by providing a number of reasons for preferring a rights-based approach over a risk-based approach. (shrink)

In this paper the coherence of the precautionary principle as a guide to public health policy is considered. Two conditions that any account of the principle must meet are outlined, a condition of practicality and a condition of publicity. The principle is interpreted in terms of a tripartite division of the outcomes of action . Such a division of outcomes can be justified on either “consequentialist” or “deontological” grounds. In the second half of the paper, it is argued that the (...) precautionary principle is not necessarily opposed to risk–cost–benefit analysis, but, rather, should be interpreted as suggesting a lowering of our epistemic standards for assessing evidence that there is a link between some policy and “special bad” outcomes. This suggestion is defended against the claim that it mistakes the nature of statistical testing and against the charge that it is unscientific or antiscientific, and therefore irrational. (shrink)

A natural view in distributive ethics is that everyone's interests matter, but the interests of the relatively worse off matter more than the interests of the relatively better off. I provide a new argument for this view. The argument takes as its starting point the proposal, due to Harsanyi and Rawls, that facts about distributive ethics are discerned from individual preferences in the "original position." I draw on recent work in decision theory, along with an intuitive principle about risk-taking, to (...) derive the view. (shrink)

This paper discusses the establishment of a governance framework to secure the development and deployment of “good AI”, and describes the quest for a morally objective compass to steer it. Asserting that human rights can provide such compass, this paper first examines what a human rights-based approach to AI governance entails, and sets out the promise it propagates. Subsequently, it examines the pitfalls associated with human rights, particularly focusing on the criticism that these rights may be too Western, too individualistic, (...) too narrow in scope and too abstract to form the basis of sound AI governance. After rebutting these reproaches, a plea is made to move beyond the calls for a human rights-based approach, and start taking the necessary steps to attain its realisation. It is argued that, without elucidating the applicability and enforceability of human rights in the context of AI; adopting legal rules that concretise those rights where appropriate; enhancing existing enforcement mechanisms and securing an underlying societal infrastructure that enables human rights in the first place, any human rights-based governance framework for AI risks falling short of its purpose. (shrink)

This chapter addresses a general question: What is responsible risking? It explores the notion of "responsible risking" as a thick moral concept, and it argues that the notion can be given moral content that could be action-guiding and add an important tool to our moral toolbox. To impose risks responsibly, on this view, is to take on responsibility in a good way. A core part of responsible risking, this chapter argues, is some version of a Forethought Condition. Such (...) a condition requires us to not make decisions or plans such that we could not deliver on our responsibility obligations. This chapter argues that three moral obligations can be derived from descriptive notions of responsibility. They are (1) the control condition, (2) the responsibility to fix condition, and (3) the responsibility to explain condition. The idea is that in order to impose risks responsibly we ought not act in ways that undermine our ability to remain in control over the risks, undermine our ability to sort out negative outcomes by reparations or compensation, or undermine our prospects of providing an explanation for our actions that also makes sense in hindsight and to those affected. This idea is then tried out on the case of germline gene editing. It is argued that such a moral notion of responsibility is also action-guiding when we do not know for certain what is the morally right or obligatory action all-things-considered due to epistemic gaps. (shrink)

A growing number of decision theorists have, in recent years, defended the view that rationality is permissive under risk: Different rational agents may be more or less risk-averse or risk-inclined. This can result in them making different choices under risk even if they value outcomes in exactly the same way. One pressing question that arises once we grant such permissiveness is what attitude to risk we should implement when choosing on behalf of other people. Are we permitted to implement any (...) of the rationally permissible risk attitudes, is there some specific risk attitude that is required when choosing for others, or are we required to defer to the risk attitudes of the people on whose behalf we are choosing? This article elaborates on this question, explains its wider practical and theoretical significance, provides an overview of existing answers, and explores how to go about providing a more systematic account of how to choose on behalf of others in risky contexts. (shrink)

Contrary to the widely accepted consensus, Christopher Heath Wellman argues that there are no pre-institutional judicial procedural rights. Thus commonly affirmed rights like the right to a fair trial cannot be assumed in the literature on punishment and legal philosophy as they usually are. Wellman canvasses and rejects a variety of grounds proposed for such rights. I answer his skepticism by proposing two novel grounds for procedural rights. First, a general right against unreasonable risk of punishment grounds rights (...) to an institutionalized system of punishment. Second, to complement and extend the first ground, I more controversially propose a right to provision of the robust good of security. People have a right to others' protecting for avoiding wrongfully harming them: when I take an action that is reasonably expected to threaten the protected interests of others, I must take appropriate care to avoid setting back those interests. Inflicting punishment on someone--intentionally harming them in response to a violation--is prima facie wrongful, so I can only count as taking appropriate care in punishing when I follow familiar procedures that reliably and redundantly test whether they are liable to such punishment, i.e. whether they have forfeited their right against punishment through a culpable act. (shrink)

A critique is made of Bernard Rollin''s examination of the ethics of cloning adult mammalian cells. The primary concern is less to propound an anticloning or procloning position than to call for full exploration of the ethical complexities before a rush to judgment is made. Indeed, the ethical examination in question rushes toward an ethical position in such a way that does not appear consistent with Rollin''s usual methodology. By extending this methodology – which entails full weighing of benefits and (...) costs – it becomes apparent that there are real potential risks to this type of cloning in both animals and humans, besides the possible benefits, and that the scientific, political, philosophical, and broader academic communities should explore these risks and benefits extensively. Rollin''s usual methodological call for hesitation before risks would translate into hesitation before the ethical risks of adult mammalian cell cloning instead of his paper''s curiously laissez-faire stance. (shrink)

The question of when it is permissible to inflict risks on others without their consent is one that we all face in our everyday lives, but which is often brought to our attention in contexts of technological innovation and scientific uncertainty. Xenotransplantation, the transplantation of organs or tissues from animals to humans, has the potential to save or improve the lives of many patients but gives rise to the possibility of infectious agents being transferred from donor animals into the (...) human population. As well as being an important ethical issue in its own right it therefore provides a useful vehicle for exploring the more general question of how to balance the benefits of a practice against the risks to third parties. This paper focuses on the Rawlsian, justice-based analysis of the risks of xenotransplantation proposed by Robert Veatch. It argues that Veatch is right to take considerations of distributive justice into account, but that his particular approach is flawed. It is hoped that consideration of Veatch’s arguments, and of the underlying assumptions will suggest better ways of executing a justice-based approach. (shrink)

We discuss ethical aspects of risk-taking with special focus on principlism and mid-level moral principles. A new distinction between the strength of an obligation and the degree to which it is valid is proposed. We then use this distinction for arguing that, in cases where mid-level moral principles come into conflict, the moral status of the act under consideration may be indeterminate, in a sense rendered precise in the paper. We apply this thought to issues related to pandemic influenza vaccines. (...) The main conclusion of the paper is that on a principlist approach some acts may be neither right nor wrong (or neither permissible nor impermissible), and we claim that this has important implications for how we ought to make decisions under risk. (shrink)

This thesis takes up a rights-based perspective to discuss a number of issues related to the problem of permissible harm. It appeals to a person’s capacity to shape her life in accordance with her own ideas of the good to explain why her death can be bad for her, and why each of us should have primary say over what may be done to her. The thesis begins with an investigation of the badness of death for the person who dies. (...) If death is bad for us, this helps explain the wrongness of killing. The thesis defends the deprivation account—i.e. the idea that death is bad for us when and because it deprives us of good life—against two Epicurean challenges. It adds that death is also bad when and because it thwarts our agency. Next, the thesis deals with the logic of our moral rights to non-interference. It proposes a conception of rights according to which the stringency of our rights derives from and is justified by the rational aspect of our human nature. It argues that this conception of moral rights solves the paradox of deontology. While our rights to non-interference are stringent, they are not absolute. The thesis considers two possible exceptions to the general rule that it is impermissible to harm an innocent person against her consent. First, using an actual case from WWII, it investigates the circumstances under which a government may expose some parts of its population to an increased risk of harm in order to decrease the risk to others. Second, it considers the permissibility of self-defence against an innocent threat. It argues that the potential victim of an innocent threat has a justice-based reason to treat her own interests as on a par with those of the threat. (shrink)

Background: Shortage of donor organs is one of the major problems for liver transplant programmes. Living liver donation is a possible alternative, which could increase the amount of donor organs available in the short term.Objective: To assess the attitude towards living organ donation in the general population to have an overview of the overall attitude within Germany.Methods: A representative quota of people was evaluated by a mail questionnaire . This questionnaire had 24 questions assessing the willingness to be a living (...) liver donor for different potential recipients. Factors for and against living liver donation were assessed.Results: Donating a part of the liver was almost as accepted as donating a kidney. The readiness to donate was highest when participants were asked to donate for children. In an urgent life-threatening situation the will to donate was especially high, whereas it was lower in the case of recipient substance misuse. More women than men expressed a higher disposition to donate for their children. Sex, religion, state of health and age of the donor, however, did not influence other questions on the readiness to consider living organ donation. The will for postmortem organ donation positively correlated with the will to be a living organ donor.Conclusions: The motivation in different demographic subgroups to participate in living liver transplantation is described. Differences in donation readiness resulting from the situation of every donor and recipient are thoroughly outlined. The acceptance for a living liver donation was found to be high – and comparable to that of living kidney donation. (shrink)

Many of us believe (1) Saving a life is more important than averting any number of headaches. But what about risky cases? Surely: (2) In a single choice, if the risk of death is low enough, and the number of headaches at stake high enough, one should avert the headaches rather than avert the risk of death. And yet, if we will face enough iterations of cases like that in (2), in the long run some of those small risks (...) of serious harms will surely eventuate. And yet: (3) Isn't it still permissible for us to run these repeated risks, despite that knowledge? After all, if it were not, then many of the risky activities that we standardly think permissible would in fact be impermissible. Nobody has yet offered a principle that can accommodate all of 1-3. In this paper, I show that we can accommodate all of these judgements, by taking into account both ex ante and ex post perspectives. In doing so, I clear aside an important obstacle to a viable deontological decision theory. (shrink)

This paper presents BP’s approach to ethical corporate governance. The author suggests that corporate social responsibility is in the interests of both business and the people at large. In this context co‐operation between business, NGOs and activity is the best way to proceed, with each party focusing on their own field of engagement; doing business in a way that respects human rights for the companies, and campaigning and advocacy for the NGOs. Increasing transparency and risks to reputation require business (...) to take social responsibility seriously. It is also crucial, however, to examine the boundaries of business responsibility. The challenge is to address these issues and to co‐operate with other parties such as NGOs to provide clear guidelines within specific time frames. This requires bold leadership on all sides. (shrink)

This paper presents BP’s approach to ethical corporate governance. The author suggests that corporate social responsibility is in the interests of both business and the people at large. In this context co‐operation between business, NGOs and activity is the best way to proceed, with each party focusing on their own field of engagement; doing business in a way that respects human rights for the companies, and campaigning and advocacy for the NGOs. Increasing transparency and risks to reputation require business (...) to take social responsibility seriously. It is also crucial, however, to examine the boundaries of business responsibility. The challenge is to address these issues and to co‐operate with other parties such as NGOs to provide clear guidelines within specific time frames. This requires bold leadership on all sides. (shrink)

InWorld Poverty and Human Rights, Thomas Pogge presents a range of attractive policy proposals—limiting the international resource and borrowing privileges, decentralizing sovereignty, and introducing a “global resources dividend”—aimed at remedying the poverty and suffering generated by the global economic order. These proposals could be motivated as a response topositive dutiesto assist the global poor, or they could be justified onconsequentialistgrounds as likely to promote collective welfare. Perhaps they could even be justified onvirtue-theoreticgrounds as proposals that a just or benevolent person (...) would endorse. But Pogge presents them as a response to the violation ofnegative duties; this makes the need for such remedial policies especially morally urgent—on a par with the obligations of killers to take measures to stop killing.In this essay, I focus on the claim that responsibility for world poverty should be conceived in terms of a violation of negative duties. I follow Pogge in distinguishing two questions (p. 134): What kind of duties (positive or purely negative?) would we be subject to in a just global society where everyone fulfilled their duty and there was no significant risk of injustice? And what kind of duties (positive or purely negative?) do we face given that our global society falls short of the just society?I tackle these questions in reverse order below. I argue, in contrast to Pogge, that positive duties are relevant to our answers to both questions. (shrink)