Biomedical Ethics, Misc

Do biological relations ground responsibilities between biological fathers and their offspring? Few think biological relations ground either necessary or sufficient conditions for responsibility. Nevertheless, many think biological relations ground responsibility at least partially. Various scenarios, such as cases concerning the responsibilities of sperm donors, have been used to argue in favor of biological relations as partially grounding responsibilities. In this article, I seek to undermine the temptation to explain sperm donor scenarios via biological relations by appealing to an overlooked feature (...) of such scenarios. More specifically, I argue that sperm donor scenarios may be better explained by considering the unique abilities of agents involved. Appealing to unique ability does not eliminate the possibility of biological relations providing some explanation for perceived responsibilities on the part of biological fathers. However, since it is unclear exactly why biological relations are supposed to ground responsibility in the first place, and rather clear why unique ability grounds responsibility in those scenarios where it is exhibited, the burden of proof seems shifted to those advocating biological relations as grounds of responsibility to provide an explanation. Since this seems unlikely, I conclude it is best to avoid appealing to biological relations as providing grounds for responsibility. (shrink)

Care is more than dispensing pills or cleaning beds. It is about responding to the entire patient. What is called “bedside manner” in medical personnel is a quality of treating the patient not as a mechanism but as a being—much like the caregiver—with desires, ideas, dreams, aspirations, and the gamut of mental and emotional character. As automata, answering an increasing functional need in care, are designed to enact care, the pressure is on their becoming more humanlike to carry out the (...) function more effectively. The question becomes not merely whether the care automaton can effect good bedside manner but whether the patient’s response is not feeling deceived by the humanlikeness. It seems the device must be designed either to effect explicit mere human-“likeness,” thus likely undermining its bedside-manner potential, or to fool the patient completely. Neither option is attractive. This article examines the social problems of designing maximally humanlike care automata and how problems may start to erode the human rights of users/patients. The article then investigates the alternatives for dealing with this problem, whether by industrial and professional self-regulation or public-policy initiatives. It then frames the problem in the broader historical perspective in terms of previous bans, moratoria, and other means of control of hazardous and potentially rights-violating techniques and materials. (shrink)

Theaspirationforvolitionalevolution,orhumanevolutiondirectedbyhumansthemselves,has increased in philosophical, scientific, technical, and commercial literature. The prospect of shaping the very being who is the consumer of all other innovations offers great commercial potential, one to which all other innovations would in effect be subservient. Actually an amalgam of projected technical/commercial developments, this prospective innovation has practical and ethical ramifications. However, because it is often discussed in a scientific way (specifically that of evolutionary theory), it first calls for examination in terms of common scientific approaches to (...) evolution. Yet, as evolutionary-theory controversies point up, evolution may be considered as neither a directed nor a directable process – a problem for the ontology of volitional evolution. One challenge for theories and programs aiming to implement the proposed innovation is then whether it is theoretically coherent. While I offer responses to the challenge in the form of objections, these in turn remain problematic. Two central issues of responsible innovation arise: (1) If this prospect were feasible, would it be responsible to implement it, and (2) if it is not even theoretically coherent, is it responsible for innovators, even this early-on, to keep promoting it as if it were? (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing (...) medical professionals’ conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: an “Uber Conscientious Objection in Medicine Committee” —which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population—should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; medical practitioners should advertise their conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners. (shrink)

It has recently been argued that reproductive genetic manipulation technologies like mitochondrial replacement and germline CRISPR modifications cannot be said to save anyone’s life because, counterfactually, no one would suffer more or die sooner absent the intervention. The present article argues that, on the contrary, reproductive genetic manipulations may be life-saving (and, from this, have therapeutic value) under an appropriate population health perspective. As such, popular reports of reproductive genetic manipulations potentially saving lives or preventing disease are not necessarily mistaken, (...) though such terminology still requires further empirical validation. (shrink)

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

Physicians frequently ask whether they should give patients what they want, usually when there are considerations pointing against doing so, such as medicine’s values and physicians’ obligations. It has been argued that the source of medicine’s values and physicians’ obligations lies in what has been dubbed “the internal morality of medicine”: medicine is a practice with an end and norms that are definitive of this practice and that determine what physicians ought to do qua physicians. In this paper, I defend (...) the claim that medicine requires a morality that is internal to its practice, while rejecting the prevalent characterization of this morality and offering an alternative one. My approach to the internal morality of medicine is constructivist in nature: the norms of medicine are constructed by medical professionals, other professionals, and patients, given medicine’s end of “benefitting patients in need of prima facie medical treatment and care.” I make the case that patients should be involved in the construction of medicine’s morality not only because they have knowledge that is relevant to the internal morality of medicine—namely, their own values and preferences—but also because medicine is an inherently relational enterprise: in medicine the relationship between physician and patient is a constitutive component of the craft itself. The framework I propose provides an authoritative morality for medicine, while allowing for the incorporation, into that very morality, of qualified deference to patient values. (shrink)

The term “value of life” can refer to life’s intrinsic dignity: something nonincremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer (...) their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life. (shrink)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

This is the text of a paper (along with appendixes) delivered at the 2019 annual meeting of the Minnesota Philosophical Society on Oct 26 in Cambridge, MN. -/- Beauchamp and Childress’s “Four Principles” (or “Principlism”) approach to bioethics has become something of a standard not only in bioethics classrooms and journals, but also within medicine itself. In this teaching-focused workshop, I’ll be doing the following: (1) Introducing the basics of the “Four Principles” approach, with a special focus on its relation (...) to the common morality and the importance to weighing and balancing of competing norms. (2) Comparing and contrasting this to other potential approaches, such as those provided by virtue ethics, act utilitarianism, casuistry, and competing versions of principles-based ethics. (3) Considering the ways in which the principles-based approach can best be implemented for lower-level, introductory bioethics classes, where the average student may have little background knowledge in either philosophy or medicine. I’ll be presenting sample activities, case studies, and lesson plans. There will be considerable time reserved for discussion at the end, so that participants can exchange ideas relating to the teaching of both bioethics and other varieties of applied ethics. (shrink)

This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary (...) mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice. (shrink)

Recently, I argued that human subjects in artificial wombs (AWs) “share the same moral status as newborns” and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: (A) “Subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns,” and (B) “Subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns.” In response, Elizabeth Chloe Romanis argued that the subject in an AW is (...) “a unique human entity…rather than a fetus or a newborn.” She provides four lines of response to my essay. First, she argues that I have “misconstrued” what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos (existing in vivo) “would also be ‘born.’” But that is absurd. Third, she claims I fail to “meaningfully respond” to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticizes my essay for focusing on subjects of AWs rather than focusing on pregnant persons (who should be at the “centre” of debates over AWs). I respond to each of these charges. In doing so, I reaffirm that (contra Romanis) some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

The goal of this work is to analyse the paradigmatic concept of universal values important for bioethics such as autonomy, beneficence, justice and developing contextual approaches in resolving the moral questions on bioethics. It also aims to reveal and analyse the importance of universal approaches despite the basic non-liminality of a context and subjectivity. Keywords: autonomy, contextualism, subjectivity, universal values, metaethics, normativity.

This work titled "An Ethical Overview on Cloning in Nigeria" analyzed the debate on cloning for which many scholars believe that cloning is not just ethically and morally acceptable, but beneficial in that they allow otherwise infertile couples to have children and permit the study of genetic diseases and indeed genetic development. This work examined cloning from an ethical/moral perspective and held the view that there is everything inherently wrong with the idea of human cloning. As a scientific discovery, it (...) violates the dignity, respect, and value of human life and concluded that cloning coupled with its related procedures, placed the human offspring at risk of genuine harm. Also, it is shown that Cloned offspring's run the risk of misplaced or distorted genealogy. The work relied on library materials, analysis, critical exposition, and evaluative methods to achieve its objectives. (shrink)

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key (...) ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

Se resaltan algunas peculiaridades sobre la manera como la Asociación Médica Mundial enfoca ciertos temas, ya que sus declaraciones y resoluciones reflejan cambios más o menos apreciables, que son manifiestos en los contenidos de ellas y orientan sus políticas. Se hace un comentario comparativo de las versiones de la Declaración de Ginebra de 1948 y 2017 con el Juramento hipocrático teniendo en cuenta las siguientes categorías: Carácter de la declaración; Tiempo verbal; Extensión en apotegmas o sentencias; núcleo epistémico; omisiones; innovaciones; (...) tipo de ethos. Las facultades de Medicina deberían incluir en sus currículos los acentos y contenidos convenientes para que el ethos hipocrático se conserve y la profesión médica pueda seguir gozando de la confianza, el respeto y el honor, que solo se mancillan cuando en la práctica profesional se cede terreno por intereses autónomos y economicistas. Como alternativa orientadora a las declaraciones de Ginebra se sugiere la versión creada por el Value of Life Committee, Inc. (shrink)

Resumen Hermenéutica y toma de decisiones en ética clínica La moderna hermenéutica se interesa por las condiciones de posibilidad de la comprensión humana. Sus aportaciones son de indudable interés para el campo de la ética biomédica, donde médico y paciente tratan de comprenderse mutuamente con el fin de concretar determinado proyecto de cuidados. Sin embargo, esta aproximación está lejos de ser aprovechable para formar una pauta concreta de cara a la toma de decisiones en este campo. La hermenéutica acierta al (...) poner el centro de gravedad en el diálogo, en lugar de en el método, pero olvida que, en Gadamer, el diálogo está dirigido a la verdad. Esto es lo que se tratará de poner de manifiesto en este trabajo, intentado establecer la conexión de dicha noción con las de bien, historia y comunidad. -/- Abstract Modern hermeneutics deals with the conditions of the possibilities of human understanding. Its contributions are particularly pertinent to clinical ethics, where patient and doctor seek to mutually understand one another in order to establish a determined care plan. Nevertheless, this approach is far from useful for the formulation of a concrete standard for decision making in this area. Hermeneutics is effective in putting the focus on dialogue, rather than method. But it overlooks the fact that dialogue, according to Gadamer, is directed towards truth. The present article aims to highlight this point, and seeks to establish the connection between this notion of truth and ideas of good, history and community. -/- Resumo Hermenêutica e a tomada de decisões em ética clínica A hermenêutica moderna interessa-se pelas condições de possibilidade da compreensão humana. Indubitavelmente, os seus contributos são de interesse para a ética biomédica, na qual o médico e o paciente tratam de compreender-se mutuamente a fim de concretizar um determinado projeto de cuidados. No entanto, esta perspectiva está longe de poder ser utilizada como padrão concreto para a tomada de decisões neste campo. A hermenêutica tem razão ao colocar o centro de gravidade no diálogo e não no método, entretanto, esquece-se de que, em Gadamer, o diálogo está orientado para a verdade. É precisamente isso que se pretende evidenciar neste trabalho, procurando estabelecer-se a conexão entre a referida noção de verdade com as noções de bem, história e comunidade. (shrink)

Como es sabido, en el ámbito de la ética biomédica, se han formulado diversas propuestas metodológicas que tratan de ofrecer una serie de pautas para la toma de decisiones. Estas metodologías son útiles, en la medida en que aportan criterios, pero son esencialmente insuficientes. En efecto, tomar una buena decisión requiere un tino especial, que va más allá de la mera técnica, y que tradicionalmente se ha denominado prudencia. No en el sentido más común y periférico de precaución, sino en (...) el sentido más central de phrónesis o prudentía. Aunque no es una noción nueva, sí se trata de una noción que suele aparecer desdibujada, ocupando un lugar equivocado, marginal o indefinido en la teoría de la toma de decisiones biomédicas. A partir de esta constatación se pretende dos cosas. En primer lugar, señalar la necesidad de comprender el papel troncal que tiene la prudencia en el ámbito de la toma de decisiones, para lo que se partirá de algunas de las metodologías más influyentes en nuestro entorno. Y, en segundo lugar, recuperar los colores originales de la noción aristotélica de prudencia. Por razones de espacio, en el presente trabajo la segunda cuestión es sólo parcialmente abordada. (shrink)

In response to Ruud ter Meulen’s contribution, it is argued that, although the relationship between these concepts is both tight and complex, solidarity should be carefully distinguished from justice. Although ter Meulen wants to defend a normative conception of solidarity, the relation to its descriptive component is not always very clear. As a normative concept it should not collapse into that of justice; and as a descriptive notion it is obviously defective. In order to successfully navigate between these unhappy alternatives, (...) ter Meulen rightfully turns to critical theory. But then it is still not entirely clear how the normative considerations that ter Meulen wants to defend follow from this promising framework. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. While hypocrisy (...) is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)

This study in moral, political, and legal philosophy contends that it is morally impermissible to circumcise male minors without a medical indication (nontherapeutic circumcision). Male minors have a moral anticipatory autonomy right-in-trust not to be circumcised. This right depends on norms of autonomy and bodily integrity. These norms generate three direct non-consequentialist arguments against nontherapeutic circumcision: (1) the loss of nonrenewable functional tissue, (2) genital salience, and (3) limits on a parental right to permanently modify their sons' bodies. An indirect (...) argument holds (4) that if it is morally impermissible to remove the female prepuce (clitoral hood), then it is also morally impermissible to remove the male prepuce (foreskin). Although there is debate across medical cultures, a reasonable understanding supports the claim that nontherapeutic circumcision causes some harms and imposes unwarranted risks on male minors. The overall moral case applies to secular circumcisions and, with some qualifications, to religious circumcisions in Judaism and Islam. Arguments of political philosophy that invoke the freedom of religion, toleration, multiculturalism, and social meaning qualify somewhat, but do not eliminate, the case against circumcising male minors without a medical indication. Nevertheless, the arguments deployed in this study do not warrant legal interference at this time with secular and religious practices of nontherapeutic circumcision. (shrink)

Considerations of objective-value freedom and status freedom do impose constraints on policies that restrict access to cigarettes. As to the objective-value freedom, something of value is lost when anti-alcohol policies lead to pub closures interfering with valued life styles, and a similar, though weaker, argument can be made for cigarettes. As to status freedom, non-arbitrariness requires consultation with vulnerable populations to learn what might aid them with smoking cessation.

Bioethicists sometimes defend compromise positions, particularly when they enter debates on applied topics that have traditionally been highly polarised, such as those regarding abortion, euthanasia and embryonic stem cell research. However, defending compromise positions is often regarded with a degree of disdain. Many are intuitively attracted to the view that it is almost always problematic to defend compromise positions, in the sense that we have a significant moral reason not to do so. In this paper, we consider whether this common (...) sense view can be given a principled basis. We first show how existing explanations for the problematic nature of compromise fall short of vindicating the common sense view, before offering our own explanation, which, we claim, comes closer to vindicating that view. We argue that defending a compromise will typically have two epistemic costs: it will corrupt attempts to use the claims of ethicists as testimonial evidence, and it will undermine standards that are important to making epistemic progress in ethics. We end by suggesting that the epistemic costs of compromise could be reduced by introducing a stronger separation between ethical debate aimed at fulfilling the epistemic role of ethics, and ethical debate that aims to directly produce good policy or practice. (shrink)

Thaler and Sunstein advocate 'libertarian paternalism'. A libertarian paternalist changes the conditions under which people act so that their cognitive biases lead them to choose what is best for themselves. Although libertarian paternalism manipulates people, Thaler and Sunstein say that it respects their autonomy by preserving the possibility of choice. Conly argues that libertarian paternalism does not go far enough, since there is no compelling reason why we should allow people the opportunity to choose to bring disaster upon themselves if (...) sometimes they will make the wrong decision. She defends 'coercive paternalism'. The present paper argues that errors in reasoning are not due only to cognitive biases. People also make errors because they have an insufficient level of general intelligence. Intelligence is distributed on a continuum. Those who fall on higher levels of the continuum have greater abilities, in certain contexts, to reason about both their own and others' interests. Coercive paternalism may sometimes be appropriate to prevent less intelligent people from engaging in self-destructive behavior due to errors of reasoning. (shrink)

Dominant views about the nature of health and disease in bioethics and the philosophy of medicine have presumed the existence of a fixed, stable, individual organism as the bearer of health and disease states, and as such, the appropriate target of medical therapy and ethical concern. However, recent developments in microbial biology, neuroscience, the philosophy of cognitive science, and social and personality psychology (Ickes...

Albert Jonsen and Stephen Toulmin have argued that the best way to resolve complex “moral” issues in clinical settings is to focus on the details of specific cases. This approach to medical decision-making, labeled ‘casuistry’, has met with much criticism in recent years. In response to this criticism, Carson Strong has attempted to salvage much of Jonsen’s and Toulmin’s version of casuistry. He concludes that much of their analysis, including Jonsen’s further elaboration about the casuistic methodology, is on the mark. (...) In this essay, the details of Jonsen’s and Toulmin’s version of casuistry and the major criticisms against their approach to clinical decision-making are explicated. Furthermore, it is argued that Strong’s salvage efforts fail to deflect these criticisms. The upshot of this analysis, which includes a few additional criticisms, is that Jonsen’s and Toulmin’s version of casuistry is not an appropriate framework from which to resolve complex “moral” issues in clinical settings. (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the explanation (...) of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis. (shrink)

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Nicole Hassoun and Uriah Kriegel defend the position that infanticide is morally permissible because an infant a few days old does not have a self-concept and thus is not a person. I argue their position is flawed and cannot principally rule out the possible permissibility of slavery.

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)

Body Integrity Identity Disorder (BIID) is a very rare condition describing those with an intense desire or need to move from a state of ability to relative impairment, typically through the amputation of one or more limbs. In this paper, I draw upon research in critical disability studies and philosophy of disability to critique arguments based upon the principle of nonmaleficence against such surgery. I demonstrate how the action-relative concept of harm in such arguments relies upon suspect notions of biological (...) and statistical normality, and I contend that each fail to provide normative guidance. I then propose a critical theory of harm, one marked by substantive engagement with both empirical and reflective inquiry across the sciences, social sciences, and humanities. I conclude by discussing the implications of this theory and how it might enrich ongoing debates in bioethics, philosophy of disability, and the health humanities more broadly. (shrink)

Animal research has long been a source of biomedical aspirations and moral concern. Examples of both hope and concern are abundant today. In recent months, as is common practice, monkeys have served as test subjects in promising preclinical trials for an Ebola vaccine or treatment 1 , 2 , 3 and in controversial maternal deprivation studies. 4 The unresolved tension between the noble aspirations of animal research and the ethical controversies it often generates motivates the present issue of the Cambridge (...) Quarterly of Healthcare Ethics. As editors of this special section, we hope that these original and timely articles will push the professional discussion of animal research ethics in a positive direction that will benefi t research scientists and others interested in moral problems in animal research. We also look forward to a day when animal research will genuinely meet both appropriate scientifi c and appropriate ethical criteria—criteria that themselves can be improved by critical scrutiny. Animal research—that is, the use of live animals as experimental subjects in biomedical and behavioral fi elds of learning—has been deeply entrenched for well over half a century. One signal development was the enactment in the late 1930s of federal product safety legislation in the United States and other nations that required animal testing of food, drugs, and medical devices prior to use by human subjects or consumers. 5 Another development was the publication of codes of research ethics that called for animal research prior to human research. The Nuremberg Code, published by an American military tribunal in 1947–48 after scrutiny of Nazi medical atrocities, stated that experiments involving the use of human subjects should be " based on the results of animal experimentation. " 6 The Declaration of Helsinki, fi rst published in 1964, reaffi rmed this assumption and added, rather imprecisely, that " the welfare of animals used for research must be respected. " 7 Against the background of such statements, the institutionalization and widespread acceptance of animal research in the twentieth century rested on two basic assumptions, one factual and one moral. The factual assumption was that animal research is suffi ciently reliable as a basis for predicting the effects of drugs, products, and other materials on human beings that animal trials can be expected to yield signifi cant scientifi c conclusions and medical benefi ts to humanity. (shrink)

Most bioethicists who address questions to which global justice matters have not considered the significance of the disputes over the correct theory of global justice. Consequently, the significance of the differences between theories of global justice for bioethics has been obscured. In this paper, I consider when and how these differences are important. I argue that certain bioethical problems can be resolved without addressing disagreements about global justice. People with very different views about global justice can converge on the existence (...) of a duty to aid the very badly off — those in absolute poverty — wherever they may be. However, despite agreement on extreme cases, there should be disagreement over the extent of international obligations to those who are only relatively poor. Consequently, different theories of justice will diverge in their implications for a number of important problems in contemporary bioethics. I close by sketching in more detail two contemporary bioethical issues —concerning pharmaceutical patents and the health worker brain drain —and show how responses to them might be developed by cosmopolitan and statist liberals. (shrink)

This introduction begins with two simple case studies that reveal a background of socio-economic complexities that hinder development. The availability of healthcare and the issue of cross-border justice are the key points to be addressed in this study. The chapters consider philosophy, economics, and bioethics in order to provide a global perspective. Two theories come into play in this book—the ideal and non-ideal—which offer insight on why and how things are done.

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider (...) whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

Are universities justified in trying to regulate student use of cognitive enhancing drugs? In this article I argue that they can be, but that the most appropriate kind of regulatory intervention is likely to be voluntary in nature. To be precise, I argue that universities could justifiably adopt a commitment contract system of regulation wherein students are encouraged to voluntarily commit to not using cognitive enhancing drugs. If they are found to breach that commitment, they should be penalized by, for (...) example, forfeiting a number of marks on their assessments. To defend this model of regulation, I adopt a recently-proposed evaluative framework for determining the appropriateness of enhancement in specific domains of activity, and I focus on particular existing types of cognitive enhancement drugs, not hypothetical or potential forms. In this way, my argument is tailored to the specific features of university education, and common patterns of usage among students. It is not concerned with the general ethical propriety of using cognitive enhancing drugs. (shrink)

El presente artículo tiene como objetivo destacar la problemática de las prácticas de extensión o prolongación de los derechos de exclusividad sobre los medicamentos, llevadas a cabo por la industria farmacéutica, una vez el término de protección vía patente está por finalizar. A través de tres escenarios se pone de manifiesto las implicaciones de este fenómeno, destacándose la necesidad de involucrar activamente al Estado para garantizar así unas condiciones equitativas de acceso a los medicamentos.

Bioethische Themen im Neuen Grundgesetz von Ungarn.

Aside from the local (mostly Western) efforts to subject animal experimentation to public scrutiny, the extent of animal experimentation, the acceptance of alternative methods and the fate of animals in laboratories depend on experimenters’ morality (as defined by social psychology), whose shaping is of crucial importance for the future of animal use in science. Meanwhile, sociological and ethnographic research in laboratories demonstrates that in the matter of animal use the experimenters are unreflective, ethically incompetent, and incapable of taking a critical (...) view of the received morality. This appears to result largely from their higher education which is known to cause a regression in moral development, inculcate a routine exploitation and/or objectification of animals, and ignore both the scientific premises and moral consequences of animal subjectivity. From all we know, it is researchers’ morality rather than pressing needs and expectations of humanity that interferes with a major restriction of invasive animal research in general and a wide, proactive acceptance of alternative methods in particular. (shrink)

In a recent paper, Levy, Gadd, Kerridge, and Komesaroff attempt to defend the ethicality of homeopathy by attacking the utilitarian ethical framework as a basis for medical ethics and by introducing a distinction between evidence-based medicine and modern science. This paper demonstrates that their argumentation is not only insufficient to achieve that goal but also incorrect. Utilitarianism is not required to show that homeopathic practice is unethical; indeed, any normative basis of medical ethics will make it unethical, as a defence (...) of homeopathic practice requires the rejection of modern natural sciences, which are an integral part of medical ethics systems. This paper also points out that evidence-based medicine lies at the very core of modern science. Particular arguments made by Levy et al. within the principlist medical ethics normative system are also shown to be wrong. (shrink)

This paper tries to clarify, strengthen and respond to two prominent objections to the development and use of human enhancement technologies. Both objections express concerns about the link between enhancement and the drive for hyperagency. The first derives from the work of Sandel and Hauskeller—and is concerned with the negative impact of hyperagency on social solidarity. In responding to their objection, I argue that although social solidarity is valuable, there is a danger in overestimating its value and in neglecting some (...) obvious ways in which the enhancement project can be planned so as to avoid its degradation. The second objection, though common to several writers, has been most directly asserted by Saskia Nagel, and is concerned with the impact of hyperagency on the burden and distribution of responsibility. Though this is an intriguing objection, I argue that not enough has been done to explain why this is morally problematic. I try to correct for this flaw before offering a variety of strategies for dealing with the problems raised. (shrink)

What I call medically enabled suicides have four distinctive features: 1. They are instigated by actions of a suicidal individual, actions she intends to result in a physiological condition that, absent lifesaving medical interventions, would be otherwise fatal to that individual. 2. These suicides are ‘completed’ due to medical personnel acting in accordance with recognized legal or ethical protocols requiring the withholding or withdrawal of care from patients (e.g., following an approved advance directive). 3. The suicidal individual acts purposefully to (...) ensure that medical personnel will act on these protocols. 4. These suicides do not involve medical personnel providing aid in dying in the standard sense, either through (a) active voluntary euthanasia, or (b) assistance by means of prescriptions, etc. -/- Regardless of how common medically enabled suicides are, they raise compelling questions at the interface of medicine and individual choice. After first clarifying the concept of medically enabled suicide and exploring some of the reasons why it might be attractive to suicidal individuals, I then investigate two apparent dilemmas that medically enabled suicides raise for medical care providers. The first alleges that medical care providers may not contribute to harming their patients, and so they may not contribute to their patients’ suicides. The second alleges that if care providers, as a matter of personal conscience, believe that suicide is wrong, then they may not be compelled to contribute to their patient’s acting wrongly by assenting to the wishes of a patient pursuing medically enabled suicide. Both dilemmas arise from the fact that while medical personnel are bound by widely accepted precepts of medical ethics to honor the competent wishes of their patients, medically enabled suicides entangle them in their patients’ suicidal plans in ways that result in their contributing to those suicides. I conclude that neither dilemma should be resolved in the direction of medical personnel having the right to refrain from involvement in medically enabled suicides. Thus, while we may find medically enabled suicide distasteful or exploitative, a strong case cannot be made that medical personnel refusing to involve themselves in such suicides is ethically permissible. (shrink)

Loss of self is widely regarded to be a consequence of dementia, and this perceived loss presents a variety of problems - not least because a clear understanding of the concept of self is elusive. This paper suggests a way to cut through problems that arise because we rely on conceptions of self in our understanding of the effects of dementia. It is proposed that we can avoid reliance on the concept of self through an approach based in in bio-phenomenology. (...) Such an approach would help us better understand the inner life of those with dementia and assist us to recognize that even in late stage dementia they are semiotic subjects with unique value. (shrink)

Abstract: The study investigates philosophically the issue of human illness and its organic pertinence to the meaning of human life starting from the recognition that the dangerous encounter with the experience of illness is an unavoidable – and as such crucial – experience of the life of any living being. As for us humans, there is probably no mortal man who has never suffered of some – any! – kind of disease from his birth to the end of his life… (...) Illness is therefore an experience or outright a danger of existence and its possibility, as well as a way of being that nobody has ever been and will ever be ontologically or existentially exempted from. So, it may well be “arbitrary” or “accidental” which disease affects which being or person, when and to what degree, in what way, etc., but it is factually unavoidable that in the course of one’s entire life – from its very beginning to its very end – one would never fall ill in some respect. The paper discusses this issue by the ontological investigation of possibility. (shrink)