Biomedical Ethics

Should a person who feels his legal age does not correspond with his experienced age be allowed to change his legal age? In this paper, I argue that in some cases people should be allowed to change their legal age. Such cases would be when: 1) the person genuinely feels his age differs significantly from his chronological age and 2) the person’s biological age is recognized to be significantly different from his chronological age and 3) age change would likely prevent, (...) stop or reduce ageism, discrimination due to age, he would otherwise face. I also consider some objections against the view that people should be allowed to change their legal age and find them lacking. (shrink)

Review of Searching Eyes: Privacy, the State, and Disease Surveillance in America – By Amy L. Fairchild, Ronald Bayer, and James Colgrove.

Published in the American Journal of Bioethics.

In this peer commentary on Maura Priest's "Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm", I argue against the "mismatch" model of trans identity. On this model, which is prevalent in institutional and medical contexts, to be trans is to have one's gender identity "mismatch" with one's sexed body.

Informed consent has become the most obvious instantiation of patient autonomy in contemporary medicine, though as a practice it does not encompass all spheres of medicine. While diagnostic radiological procedures carry some risk due to the use of radiation, there is no standardized practice of informed consent in the United States. The authors describe the ethical justification of informed consent, the legal background surrounding it, and a brief history of radiology and radiological protection. They ultimately argue that informed consent should (...) become a common practice in computed tomography given the risks involved due to radiation exposure, especially considering the overuse of this technology, since it respects patient autonomy. (shrink)

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

Este trabajo gira en torno al casuismo. Se hace hincapié en su necesidad para la ética biomédica. A través de su carácter analógico, se pone de manifiesto, a su vez, su dependencia de los principios. Sin embargo, ni principios ni casos bastan por sí solos para iluminar completamente las decisiones biomédicas, que presentan un notable componente de incertidumbre. Una decisión no es un objeto preexistente, sino algo que hay que producir, un operable. Aquí se pone de manifiesto que esta realidad (...) no se puede abordar si no es a través de la noción clásica de prudencia, en el sentido de la phrónesis aristotélica. Una vez esbozada ésta en sus líneas generales, dando cuenta de sus aspectos morales e intelectuales, es posible enfocar de nuevo el casuismo con nueva luz, superar las críticas más importantes y comprender que la relación clínica es también una relación jurídica, por lo que el papel del Derecho, y en particular el de la jurisprudencia, se muestra vital. (shrink)

We argue that moral judgment studies currently conducted utilizing virtual reality (VR) devices must confront a dilemma due to how virtual environments are designed and how those environments are experienced. We begin by first describing the contexts present in paradigmatic cases of naturalistic moral judgments. We then compare these contexts to current traditional (vignette-based) and VR-based moral judgment research. We show that, contra to paradigmatic cases, vignette-based and VR-based moral judgment research often fails to accurately model the situational features of (...) paradigmatic moral judgments. In particular, we compare and contrast six recent VR studies to support our view that only simulations high in context-realism and perspectival-fidelity can produce ‘virtually real experiences.’ After analyzing the constituents of a virtually-real experience, we go on to propose guidelines for the creation of VR studies. These guidelines serve two purposes. First, we aim to increase the ecological validity of such studies in order to advance our understanding of moral judgments. Second, we believe that such guidelines should inform how Institutional Review Boards assess VR research. We show that our guidelines are urgently needed given the current lax review standards in place. (shrink)

We respond to open peer commentaries on our target article, "Health Research Priority Setting: The Duties of Individual Funders".

The vast majority of health research resources are used to study conditions that affect a small, advantaged portion of the global population. This distribution has been widely criticized as inequitable and threatens to exacerbate health disparities. However, there has been little systematic work on what individual health research funders ought to do in response. In this article, we analyze the general and special duties of research funders to the different populations that might benefit from health research. We assess how these (...) duties apply to governmental, multilateral, nonprofit, and for-profit organizations. We thereby derive a framework for how different types of funders should take the beneficiaries of research into account when they allocate scarce research resources. (shrink)

Abstract Background The first live birth following the use of a new reproductive technique, maternal spindle transfer (MST), which is a mitochondrial replacement technique (MRT), was accomplished by dividing the execution of the MST procedure between two countries, the USA and Mexico. This was done in order to avoid US legal restrictions on this technique. -/- Sources of data Academic articles, news articles, documents obtained through freedom of information requests, laws, regulations and national reports. -/- Areas of agreement MRTs are (...) new reproductive techniques that present novel ethical and legal challenges, since genetic material from three people is employed to create a child. -/- Areas of controversy Could the first MST procedure that culminated in a live birth negatively impact reproductive medicine in Mexico? -/- Growing points The USA and Mexico need specific and clear legislation on MRTs, in order for such techniques not to be governed by prior existing legislation on assisted reproduction that is inadequate for dealing with the new challenges that these techniques present. -/- Areas timely for developing research There is a pressing need for work to be done on the international governance of new reproductive techniques. (shrink)

In this paper, I aim to demonstrate that the consequences of the current United States health insurance scheme on both physician and patient autonomy is dire. So dire, in fact, that the only moral solution is something other than what we have now. The United States healthcare system faces much criticism at present. But my focus is particular: I am interested in the ways in which insurance interferes with physician and patient autonomy. I will argue in favor of an expansion (...) of the traditional conception of what I call “medical autonomy” or “healthcare autonomy” and the usual role it plays in bioethical discussions. More generally, I show that in morally designing or evaluating any healthcare system, serious attention should be paid to how this system helps foster what I call active autonomy. (shrink)

Narrative medicine explores the stories that patients tell; this paper, conversely, looks at some of the stories that patients are told. The paper starts by examining the ‘story’ told by the Shambaa people of Tanzania to explain the bubonic plague and contrasts this with the stories told by Ghanaian communities to explain lymphatic filariasis. By harnessing insights from memory studies, these stories’ memorability is claimed to be due to their use mnemonic devices woven into stories. The paper suggests that stories (...) can be unpatronising, informative, and appropriate vehicles for communicating medical information to all age groups across all cultures. (shrink)

In his paper ‘A libertarian case for mandatory vaccination’, Jason Brennan argues that even libertarians, who are very averse to coercive measures, should support mandatory vaccination to combat the harmful disease outbreaks that can be caused by non-vaccination. He argues that libertarians should accept the clean hands principle, which would justify mandatory vaccination. The principle states that there is a (sometimes enforceable) moral obligation not to participate in collectively harmful activities. Once libertarians accept the principle, they will be compelled to (...) support mandatory vaccination. In my paper, I argue that the cases Brennan uses to justify this principle are disanalogous to the case of non-vaccination and that they are not compelling to libertarians. The cases Brennan offers can be explained by a libertarian using the individual sufficiency principle: which states that if an individual’s action is sufficient to cause harm, then there is a (sometimes enforceable) moral obligation not to carry out that action. I argue that this principle is more appropriate to Brennan’s examples, and more appealing to the libertarian, than the clean hands principle. In order to get libertarians to accept the clean hands principle, I present a modified version of one of Brennan’s cases that is analogous to the case of non-vaccination. Using this case, I argue that whether the clean hands principle will justify mandatory vaccination is dependent on whether the herd immunity rate in a given population is approaching a threshold after which a collective risk of harm will be imposed onto others. (shrink)

We can read about the morality of that time in works by authors who describe or criticize the conduct and activity of the members of those classes taking the lead in the morality of that time. Thus, we can find a lot of information about ancient Greece and its morality in Plato’s presentation of Socrates, Peter Abelard presenting the Middle Ages, Erasmus of Rotterdam, Niccolo Machiavelli, Baldesar Castiglione, but even also Slovak authors such as Martin Rakovský and Juraj Koppay presenting (...) very interesting contemporary facts about the Renaissance. (shrink)

The author studies the role of Christianity in two forms of 9th century political ethics in the history of Great Moravia, represented by the Great Moravian rulers Rastislav and Svatopluk. Rastislav’s conception predominantly uses the pre-Erasmian model of political ethics based on the pursuit of welfare for the country and its inhabitants by achieving the clerical-political independence of Great Moravia from the Frankish kingdom and, moreover, by utilising Christianity for the advancement of culture, education, literature, law and legality, as well (...) as by spreading Christian ethics and morality in the form of the Christian code of ethics expressed in ethicallegal documents. Svatopluk’s political conception was a prototype of Machiavellian political ethics, according to which one is, in the interest of the country and its power and fame, allowed to be a lion and/or a fox. Svatopluk abused Christianity in the name of achieving his power-oriented goals. Great Moravia outlived Rastislav; it did not, however, outlive Svatopluk, as, shortly after his death, it broke up and ceased to exist. The author came to the conclusion that Rastislav’s conception was more viable, as its cultural heritage lives on in the form of works by Constantine and Methodius. (shrink)

In this commentary on Yashar Saghai's article "Salvaging the Concept of Nudge" (JME 2013) I discuss his distinction between a 'prod' (which is 'substantially controlling') and a 'nudge' (which is ‘substantially non-controlling’).

The prospect of cognitive enhancement well beyond current human capacities raises worries that the fundamental equality in moral status of human beings could be undermined. Cognitive enhancement might create beings with moral status higher than persons. Yet, there is an expressibility problem of spelling out what the higher threshold in cognitive capacity would be like. Nicholas Agar has put forward the bold claim that we can show by means of inductive reasoning that indefinite cognitive enhancement will probably mark a difference (...) in moral status. The hope is that induction can determine the plausibility of post‐personhood existence in the absence of an account of what the higher status would be like. In this article, we argue that Agar's argument fails and, more generally, that inductive reasoning has little bearing on assessing the likelihood of post‐personhood in the absence of an account of higher status. We conclude that induction cannot bypass the expressibility problem about post‐persons. (shrink)

After 41 years from the approval of the first living will law in 1976 in California, on December 22nd 2017 the bill on “Rules on in- formed consent and advance directives” has been approved in Italy. The applicability of the law highlights a lack of a univocal methodol- ogy regarding the recovery process of the patient’s subjective dimension under a testamentary will; so, it seemed useful to highlight the passages that occur between the drafting and the use of an advance (...) directive in an existential phenomenological prospective. Is the individual who freely drafts an A.D., choosing to decide now for the future, the same per- son for which the provisions were outlined? The goal of this paper is to offer an ethical reading of the ontological issue that illness can raises. (shrink)

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced (...) to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes. (shrink)

Responding to Danaher et al. on self-tracking technologies, I argue that human lived experience is becoming increasingly mediated by generalized, statistical information, which I term our "infotality." Drawing on the work of Foucault, I argue that infotality is historically novel and best understood as the product of biopolitics, healthism, and informatics. I then critique the authors' "stance of cautious openness,” which misunderstands the aims of the technology in question and the fundamental ambiguity of the role information plays in the achievement (...) of human wellbeing. Self-tracking technologies are not primarily designed to change behavior; they are designed to create and sustain the desire for their use. I conclude by suggesting that infotality names a new way to fall for an old ruse: the promise that more information means more wellbeing. (shrink)

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis (...) of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies. (shrink)

Ce dossier traite du concept de responsabilité en tant qu‘il constitue l‘une des bases d‘une réflexion éclairée en ce qui concerne les enjeux éthiques engen- drés par les biotechnologies. Qu‘entend-on par le concept de responsabilité ? L‘être humain est-il responsable des artéfacts qu‘il crée ? Si oui, de quel type de responsabilité s‘agit-il ? N‘est-elle que d‘ordre juridique ? Ou également d‘ordre éthique ou morale ? Comment et qui détermine l‘acceptation ou le re- fus des possibilités que nous offrent les (...) biotechnologies ? Qui est respon- sable des innovations produites par les découvertes des scientifiques, et à l‘égard de qui ? (shrink)

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except perhaps for small (...) co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

G. E. Moore’s critical analysis of right action in utilitarian ethics and his consequentialist concept of right action is a starting point for a theory of moral/right action in ethics of social consequences. The terms right and wrong have different meanings in these theories. The author explores different aspects of right and wrong actions in ethics of social consequences and compares them with Moore’s ideas. He positively evaluates Moore’s contributions to the development his theory of moral/right action.

[Excerpt]: Bioethics has an uneasy relationship with embodiment. Only with vigilance does knowledge of the body as it is lived counterbalance the momentous inertia of knowledge of the body as an object brought about by modern medical sciences. As a field tethered to detached, technical ways of knowing the world, bioethics must toil to treat the body as more than mere material and machine. To be more is, among other things, to be social—to live in the thickets of interdependence and (...) the institutions and practices we build, hone, and defend to facilitate it. I take this tension to define the ultimate stakes of Melinda Hall's The Bioethics of Enhancement: Transhumanism, Disability, and Biopolitics. Hall homes in on transhumanism, the idea that we should embrace technology to vault beyond current human limitations. Yet the work serves as a reminder for all bioethicists and philosophers of how easily one can be led astray by otherwise irreproachable values when they are disconnected from the conditions and realities of human life, including being irremediably interdependent embodied beings. Put more acerbically, the book is a reminder of how thinking goes wrong when divorced from the principal sources out of which human appraisals emerge: our fleshy, messy, social bodies. (shrink)

A number of health care professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone; nor should they suffer any undesirable consequences of such refusal. Those who claim this right err by blurring or conflating three (...) issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true: a conscientious professional should not do her professional duty AND others need not permit or excuse her refusal. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt for that failure. Finally, there are compelling reasons why we could not implement a consistent moral policy giving advocates what they want, likely not even in qualified form. (shrink)

The ethics of betel nut use in Taiwan are examined in this article. It first presents scientific facts about the betel quid, its consumption and negative health consequences and then analyses the cultural background and economic factors contributing to its popularity in Asia. Governmental and institutional attempts to curb betel nut cultivation, distribution and sales are also described. Finally, the bioethical implications of this often ignored subject are considered.

En este artículo expondré un análisis de la valoración negativa de las consecuencias que suelen atribuirse al fenómeno de la medicalización y, partiendo de aquí, mi objetivo básico será mostrar que la medicalización no es en sí mismo un fenómeno negativo. Sólo lo será cuando se obtenga un valor negativo del cálculo entre, por un lado, la efectividad de la propuesta médica para solucionar el problema y, por otro lado, el balance entre los beneficios de dicha propuesta médica y sus (...) posibles efectos secundarios; o bien, cuando se dé un contexto en el que el individuo, ya sea por desinformación o por una restricción externa (paternalismo médico), no tiene la libertad suficiente de escoger entre una propuesta médica y una propuesta no-médica. (shrink)

Several philosophers have recently argued that policies aimed at reducing human fertility are a practical and morally justifiable way to mitigate the risk of dangerous climate change. There is a powerful objection to such “population engineering” proposals: even if drastic fertility reductions are needed to prevent dangerous climate change, implementing those reductions would wreak havoc on the global economy, which would seriously undermine international antipoverty efforts. In this article, we articulate this economic objection to population engineering and show how it (...) fails. We argue, first, that the economic objection paints an inaccurate picture of the complicated relationship between demographic change and economic growth, and second, that any untoward economic effects of fertility reduction can be mitigated with additional policies. Specifically, we argue that supplementing fertility reduction with policies that facilitate the emigration of younger people from developing nations to developed nations could allow for both global reductions in GHG emissions and continued economic stability. Further, we show that moral arguments against such unprecedented increases in immigration are unsuccessful. We conclude that population engineering is a practical and morally justifiable tool for addressing the twin evils of climate change and global poverty. (shrink)

In a paper recently published in this journal, Navin and Largent argue in favour of a type of policy to regulate non-medical exemptions from childhood vaccination which they call ‘Inconvenience’. This policy makes it burdensome for parents to obtain an exemption to child vaccination, for example, by requiring parents to attend immunization education sessions and to complete an application form to receive a waiver. Navin and Largent argue that this policy is preferable to ‘Eliminationism’, i.e. to policies that do not (...) allow non-medical exemptions, because Inconvenience has been shown to maintain exemption rates low while not harming parents by forcing them to do something that goes against their beliefs. We argue that it is at least doubtful that Inconvenience is ethically preferable to Eliminationism: while the latter disregards the value of liberty, Inconvenience disregards the value of fairness in the distribution of the burdens entailed by the preservation of a public good like herd immunity. We propose a variant of Inconvenience, which we call ‘Contribution’, which we think is preferable to the versions of Inconvenience discussed by Navin and Largent in that it successfully strikes a balance between the values of parents’ liberty, fairness and expected utility. (shrink)

Since the human genome was decoded, great emphasis has been placed on the unique, personal nature of the genome, along with the benefits that personalized medicine can bring to individuals and the importance of safeguarding genetic privacy. As a result, an equally important aspect of the human genome – its common nature – has been underappreciated and underrepresented in the ethics literature and policy dialogue surrounding genetics and genomics. This article will argue that, just as the personal nature of the (...) genome has been used to reinforce individual rights and justify important privacy protections, so too the common nature of the genome can be employed to support protections of the genome at a population level and policies designed to promote the public's wellbeing. In order for public health officials to have the authority to develop genetics policies for the sake of the public good, the genome must have not only a common, but also a public, dimension. This article contends that DNA carries a public dimension through the use of two conceptual frameworks: the common heritage framework and the common resource framework. Both frameworks establish a public interest in the human genome, but the CH framework can be used to justify policies aimed at preserving and protecting the genome, while the CR framework can be employed to justify policies for utilizing the genome for the public benefit. A variety of possible policy implications are discussed, with special attention paid to the use of large-scale genomics databases for public health research. (shrink)

As a policy instrument that is deeply rooted in technology assessment, the precautionary principle examines the effects of a given object on humans and the environment. In practice the principle is rarely used to analyze the effects of our safety measures on the object itself or the way it is produced. Yet it is exactly in the effect on the blood procurement system that blood safety regulations based on the precautionary principle have to be particularly careful, as the vast majority (...) of blood products in the Global North are obtained through donations. (shrink)

Some communities that exempt parents from vaccine mandates have recently reformed their exemption policies by eliminating nonmedical exemptions, allowing nonmedical exemptions only for parents who object to vaccination for religious reasons, or making exemptions more difficult to obtain. We argue against eliminating nonmedical exemptions because there are weighty moral reasons to offer these exemptions and because eliminating them will likely have unfortunate social and political consequences. We also argue against allowing nonmedical exemptions only for parents who object to vaccination for (...) religious reasons, on the grounds that doing so is likely to be unfair or ineffective. We conclude that nonmedical exemptions should be available to people who object for both religious and secular reasons, and that the best way to decrease exemption rates is to make the application process more burdensome. We illustrate our arguments with examples of recent policy changes in three US states. (shrink)

At some point in the future – perhaps within the next few decades – it will be possible for foetuses to develop completely outside the womb. Ectogenesis, as this technology is called, raises substantial issues for the abortion debate. One such issue is that it will become possible for a woman to have an abortion, in the sense of having the foetus removed from her body, but for the foetus to be kept alive. We argue that while there is a (...) right to an abortion, there are reasons to doubt that there is a right to the death of the foetus. Our strategy in this essay is to consider and reject three arguments in favour of this latter right. The first claims that women have a right not to be biological mothers, the second that women have a right to genetic privacy, and the third that a foetus is one's property. Furthermore, we argue that it follows from rejecting the third claim that genetic parents also lack a right to the destruction of cryopreserved embryos used for in vitro fertilization. The conclusion that a woman possesses no right to the death of the foetus builds upon the claims that other pro-choice advocates, such as Judith Jarvis Thomson, have made. (shrink)

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem (...) committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

In this article we argue that the social value of health research should be conceptualized as a function of both the expected benefits of the research and the priority that the beneficiaries deserve. People deserve greater priority the worse off they are. This conception of social value can be applied for at least two important purposes: in health research priority setting when research funders, policy-makers, or researchers decide between alternative research projects; and in evaluating the ethics of proposed research proposals (...) when research ethics committees assess whether the social value of the research is sufficient to justify the risks and burdens to research participants and others. In assessing how far a proposed research project will advance the interests of people who are more disadvantaged, research priority setters and RECs should examine the diseases that the research targets and the type of research. Just as certain diseases impose a greater burden on people who are more disadvantaged, so certain types of intervention and forms of research are more likely to benefit people who are more disadvantaged. We outline which populations are likely to be representative of the global worst off and identify what types of health research, and which disease categories, are priorities for these populations. (shrink)

Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies. Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification for current policies of (...) forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries. (shrink)

The practical problem of how to conduct oneself as a Christian and a Philosopher or Bioethicist in public debate an when asked to be engaged in government committees is difficult. One solution that has had some support has been to approach the issues on the grounds of our natural law tradition but understood anthropocentrically – the ultimate end is not communion with God by integral human development. This is often called New Natural Law (NNL). This separation of Philosophy and Theology (...) has had its critics and most notably the current Poe and his immediate predecessor. In their own writing addressed to people of goodwill, they took a different approach that was essentially Christocentric and involving s close partnership between Philosohy and Theology. In my own experience over thirty years of public involvement in Bioethics, I have discovered that the NNL approach has two overwhelming problems. What is offered to the secular dialogue, as an anthropocentric natural law, often sounds false to secular others because we propose something guided by our beliefs, but failing to acknowledge that contribution. However something that I have discovered latterly in that approach is in fact false by our own standards. By the strictures we impose on our contribution we in fact ignore the New Law instituted by Christ, the law of love. The New Natural Law (NNL) Project has proved to be a failure where it has been tried, and, I know realize, was doomed from the outset, because in being anthropocentric it was essentially lacking and the answers that it gave to problems were often unsatisfactory because lacking love and the particular demand of needing to be capable of being oriented towards God, the God of love. The NNL approach tended to produce a casuistry that was too liberal and too lacking in understanding of the essential role that affectivity plays in our lives, created as we are in the imago dei, in the image and likeness of the God of love. Such a morality demands much more than anthropocentricism can demand. In recognizing these difficulties I propose instead a more pragmatic approach that reflects a partnership between Philosophy and Theology as espoused by the Second Vatican Council, and by Pope’s Benedict XVI and Pope John Paul II, and which engages the work of Alasdair MacIntyre and Servais Pinckaers. An approach that I have tried with some success in chairing government committees. (shrink)

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty and blepharoplasty (...) in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based. The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is “yes.” I argue that a patient’s autonomy is not (...) respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient’s previous values must be in that patient’s best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. (shrink)

When it comes to caring about and helping those in need, our imaginations tend to be weak and our motivation tends to be parochial. This is a major moral problem in view of how much unmet need there is in the world and how much material capacity there is to address that need. With this problem in mind, the present paper will focus on genetic means to the enhancement of a moral capacity—a disposition to altruism—and of a cognitive capacity that (...) facilitates use of the moral capacity: the ability to grasp vividly the needs of individuals who are unknown and not present. I will address two questions, with more extensive attention to the first question. First, assuming we had excellent reason to believe that the enhancements were safe, effective, and available to all who desired them, would seeking these enhancements be inherently morally acceptable—that is, free of inherent wrongness? Second, would it be wise for a society to pursue these enhancements? I will defend an affirmative answer to the first question while leaving the second question open. (shrink)