Biomedical Ethics, Miscellaneous

The COVID-19 pandemic demonstrated the benefits of international data sharing. Data sharing enabled the health care policy makers to make decisions based on real-time data, it enabled the tracking of the virus, and importantly it enabled the development of vaccines that were crucial to mitigating the impact of the virus. This data sharing is not the norm as data sharing needs to navigate complex ethical and legal rules, and in particular, the fragmented application of the General Data Protection Regulation (GDPR). (...) The introduction of the draft regulation for a European Health Data Space (EHDS) in May 2022 seeks to address some of these legal issues. If passed, it will create an obligation to share electronic health data for certain secondary purposes. While there is a clear need to address the legal complexities involved with data sharing, it is critical that any proposed reforms are in line with ethical principles and the expectations of the data subjects. In this paper we offer a critique of the EHDS and offer some recommendations for this evolving regulatory space. (shrink)

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading the host’s body. Like a (...) disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the ‘normality’ of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease. (shrink)

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in (...) this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England. (shrink)

This chapter examines whether high prices for gene therapies are justified and whether the problems associated with high prices can be solved by the "pay for performance" (P4P) reimbursement model. To this end, we first describe how prices for new drugs, including gene therapies, are set in Germany (section 2.). P4P is then presented as an example of a reimbursement model (section 3.). The subsequent ethical analysis (section 4.) first examines whether P4P models can sustainably guarantee the right to health (...) and healthcare for all people (section 4.1; cf. on the "sustainable right to health" already Alex, 2021). It is then shown that cost-benefit analyses for setting prices for new gene therapies must be viewed critically from an ethical perspective and pose a problem for equity of access and thus also for the sustainable guarantee of a right to health (section 4.2). The final question is whether P4P is compatible with the idea of human dignity (Article 1 I 1 of the German Basic Law) (section 4.3; cf. already König et al., 2020). -/- Alex, K. (2021): Ethical conceptualization of a sustainable right to health(care). In: Schildmann, J. et al. (eds.): Defining the value of medical interventions. Normative and empirical challenges. Kohlhammer, Stuttgart: 29-48. PMID: 36256802 König, J. et al. (2020): Am individuellen Therapieergebnis orientierte Erstattungsverfahren in der Onkologie: ethische Implikationen am Beispiel der CAR-T-Zelltherapie. In: Ethik Med 32: 85–92. doi: 10.1007/s00481-020-00565-3. (shrink)

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should those (...) close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

Introduction: Sexual harassment involves an assortment of coercive behaviors, including physical force, intimidation, and various forms of compulsion, including verbal harassment and forced penetration [1]. Sexual abuse can happen to both men and women. In the United Kingdom(UK), the problem of child sexual abuse (CSA) has epidemic proportions and is a global public health issue [2]. 53,874 incidents were reported under the 2012 Protection of Children from Sexual Offences Act as of 2021 [3]. to their ignorance about puberty, sexuality, and (...) fundamental human biological changes, adolescents have a very difficult time addressing their SRH demands. These underlying causes contribute to high rates of teen pregnancy, STIs, sexual assault, poor negotiating skills, forced marriage, and high fertility rates [4]. -/- Methods: The study used a quantitative technique and a descriptive cross-sectional design. Students at Jahangir Nagar University and the American International University of Bangladesh were the intended target group. Jahangir Nagar University and American International University of Bangladesh served as the study locations. The six-month trial period ran from January 2022 through June 2022. For this investigation, primary sources of data were used. The study unit was the individual student. Non-probability (purposive) sampling techniques were used for the investigation. -/- Results: The majority of survey participants (N=81) 62.2% were aged between 19 and 21 years old, and there was a statistically significant difference in age between students at public and private universities. None of our study participants suffered from any kind of sexual abuse, though they mentioned hearing about it. Regarding the view of sexual abuse, public universities 23% of those polled claimed sexual abuse as a justification for sharing inappropriate photos. At private universities, the response rate for crude jokes is 32.5%. Only the least number of public (2%) and private university (10%) students took part in sexual abuse-related awareness or training programs. Regarding the rights to receive training for prevention and safeguarding from sexual abuse, only 28% of the public and 40% of the private university students replied in affirmative. -/- Conclusion: Sexual harassment is a sensitive issue, though due to various reasons, the rate of reporting and providing justice to the victims is delayed all over the world including Bangladesh. There social, religious, and policy lacking in this context. -/- . (shrink)

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

Research groups around the world are currently busy trying to invent new life in the laboratory, looking for extraterrestrial life, or making machines increasingly more life-like. In the case of astrobiology, any newly discovered life would likely be very old, but when discovered it would be new to us. In the case of synthetic organic life or life-like machines, humans will have invented life that did not exist before. Together, these endeavors amount to what we call the emerging plurality of (...) lives because we see a future where we are surrounded by, and interact with, life of many different origins, as well as entities that we have not traditionally seen as being alive. In the future these entities will likely possess properties that we so far have only associated with living beings, thereby transcending and perhaps blurring the borders between life and non-life. (shrink)

Ethics committees like Institutional Review Boards and Research Ethics Committees are typically empowered to approve or reject proposed studies, typically conditional on certain conditions or revisions being met. While some have argued this power should be primarily a function of applying clear, codified requirements, most institutions and legal regimes allow discretion for IRBs to ethically evaluate studies, such as to ensure a favourable risk-benefit ratio, fair subject selection, adequate informed consent, and so forth. As a result, ethics committees typically make (...) moral demands on researchers: require them to act in a way the committee considers ethically right or appropriate. This paper argues that moral demands are legitimate only if publicly justifiable; and as a result, committee decisions are subject to a public justification requirement. Ethics committees can permissibly request for more information, changes to the research protocol or that the research is delayed or even stopped only if these demands are publicly justifiable. This latter claim is in turn justified on the basis that moral demands to φ are permissible only if we are in a position to know that the addressee ought to φ and that we are in a position to know a proposition only if it is publicly justifiable. This argument suggests that ethics committees must consciously and explicitly appeal to public reasons in their decision-making. In cases where public reasons cannot be offered, committees would not be permitted to reject a given study or make approval conditional on an amendment. (shrink)

The use of machine learning, or “artificial intelligence” (AI) in medicine is widespread and growing. In this paper, I focus on a specific proposed clinical application of AI: using models to predict incapacitated patients’ treatment preferences. Drawing on results from machine learning, I argue this proposal faces a special moral problem. Machine learning researchers owe us assurance on this front before experimental research can proceed. In my conclusion I connect this concern to broader issues in AI safety.

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about (...) who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

This chapter reviews fundamental ethical controversy surrounding the ongoing effort to revise the Uniform Determination of Death Act in the United States. Instead of focusing on the process of the revision itself, the chapter explores the underlying ethical debate over brain death that has been ongoing for many decades and finally culminated in this revision. Three issues are focused: the requirement for consent and personal exemptions before applying brain death for the diagnosis of death; redefining the areas of the brain (...) that have ceased to function in the definition of brain death; and codifying the American Academy of Neurology as the authority to issue the standards of the diagnosis of brain death. The chapter concludes that allowing the personal choice of death determination gives a pragmatic compromise to the disputed definition and practice of diagnosing brain death. So long as all risks and imperfections of the diagnosis are accepted through the consenting process, there is nothing ethically objectionable to continuing the current practice of diagnosing brain death as a successful tool to facilitate heart-beating organ donation without violating the dead-donor rule. By contrast, precluding personal choice and imposing legal restrictions to consent and exemptions would further erode public trust. (shrink)

Many transhumanists see their respective movement as being rooted in ancient ethical thought. However, this alleged connection between the contemporary transhumanist doctrine and the ethical theory of antiquity has come under attack. In this paper, we defend this connection by pointing out a key similarity between the two intellectual traditions. Both traditions are committed to the “radical transformation thesis”: ancient ethical theory holds that we should assimilate ourselves to the gods as far as possible, and transhumanists hold that we should (...) enhance ourselves beyond the physical and intellectual parameters of being human so as to become posthuman. By considering the two views in tandem, we develop an account of the assimilation directive that is palatable to contemporary readers and provide a view of posthumanism worth wanting. (shrink)

Definition of the problem: The connection between time and the good life has already been worked out for a number of medical specialties and practices. However, what role does the temporality of the good life play for medicine as a whole? That is the central question of this article. Arguments: The good life is here understood as a meaningful life. Living meaningfully is only possible through present action. A fulfilled presence in this sense is therefore an essential aspect of the (...) temporality of the good life. Illness tends to prevent a fulfilled presence. In this respect, medical treatments aim to enable a fulfilled presence. A second structure of time, that is central to the good life, consists in the chronobiological rhythms, upon the maintenance and restoration of which health is critically dependent. Conclusion: The temporality of the good life has a twofold relevance for medicine as a whole. First, the purpose of medical treatment is to enable a fulfilled present. Second, this can and should be done by maintaining and restoring chronobiological rhythms. ++++ Der Zusammenhang von Zeit und gutem Leben wurde bereits für eine Reihe medizinischer Disziplinen und Praktiken herausgearbeitet. Doch welche Rolle spielt die Zeitlichkeit des guten Lebens für die Medizin insgesamt? Das ist die leitende Frage dieses Artikels. Dabei wird das gute Leben als sinnvolles Leben verstanden. In diesem Sinne wird für eine zweifache medizinische Relevanz der Zeitlichkeit des guten Lebens argumentiert: Erstens besteht der Sinn medizinischer Behandlungen in der Ermöglichung erfüllter Gegenwart. Zweitens kann und sollte ebendies u. a. durch die Wahrung und Wiederherstellung der chronobiologischen Rhythmen geschehen. (shrink)

In the future, full ectogestation – in which artificial placenta technology would be used to carry out the entirety of gestation – could be an alternative to human pregnancy. This article analyzes some underexplored objections to ectogestation which relate to the possibility for new and continuing forms of social oppression. In particular, we examine whether ectogestation could be linked to an unwarranted de-valuing of certain aspects of female reproductive embodiment, or exacerbate objectionable kinds of scrutiny over the reproductive choices of (...) gestating persons. Without discounting the potential benefits of full ectogestation, we conclude that the socially oppressive potential of ectogestation, on top of other concerns, warrants further critical ethical reflection. (shrink)

Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, however, (...) relates to patients’ non-doxastic attitudes in important ways as well. As such, Hardman suggests that by focusing on belief alone, we sometimes misidentify non-deceptive care as ‘deceptive’. Further, once we consider patients’ beliefs and non-doxastic attitudes, identifying cases of deception becomes more difficult than it may seem. In this essay, I argue that Hardman’s reasoning contains at least three serious flaws. First, his account of deception is underdeveloped, as it does not state whether deception must be intentional. The problem is that if intention is not required, absurd results follow. Alternatively, if intention is required, then identifying cases of deception will be much easier (in principle) than Hardman suggests. Second, Hardman mischaracterises the ‘inverse’ of deceptive care. Doing so leads to the mistaken conclusion that common conceptions of non-deceptive care are unjustifiably narrow. Third, Hardman fails to adequately separate questions about deception from questions about normativity. By addressing these issues, however, we can preserve some of Hardman’s most important insights, although in a much simpler, more principled way. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for this tutorial are (...) the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

Creativity and innovation is very part of human nature (fitrah) which makes human beings different from other beings that are so far found on the planet. The outcome of creativity can be both harmful and beneficial. And most of it depends on the moral standing of those to whom end products of such creativity are available. Islam gives high importance to health and the Muslim civilization that flourished in Bagdad and Spain during the medieval period made original contributions to medical (...) science. The contributions of the scholars of the age were led by religious ethics and spirit in pursuing, using, and creating knowledge. On the other hand, with the advent of modernity, science has received freedom to a greater extent to be ethics-free, neutral, and value- free. This approach has produced new important innovations in medical science and ways of their applications. Some of these innovations and their applications are beneficial and some others are beneficial too if guarded by appropriate ethics, yet some of the applications are questionable. After discussing the ethical repercussions of these innovations and applications, a general ethical framework on the subject is formulated on Islamic guidelines. (shrink)

Clinical Ethics Consultations are an important tool for physicians in solving difficult cases. They are extremely common in North America and to a lesser extent also present in Europe. However, there is little data on this practice in Poland. We present results of a survey of 521 physicians practising in Poland concerning their opinion on CECs and related practices. We analysed the data looking at such issues as CECs’ perceived availability, use of CECs, and perceived usefulness of such support. Physicians (...) in our study generally encounter hard ethics cases, even—surprisingly—those who do not work in hospitals. Most physicians have no CEC access, and those that do still do not employ CECs. However, physicians perceive this form of support as useful—even more so among actual users of CECs. We compared these findings with similar studies from other European countries and the North America. We point out peculiarities of our results as compared to those in other countries, with some possible explanations. We hope the results may encourage regulatory debate on the need to formally introduce CECs into the Polish healthcare system. (shrink)

In response to the spread of COVID-19, governments across the world have, with very few exceptions, enacted sweeping restrictive lockdown policies that impede citizens’ freedom to move, work, and assemble. This paper critically responds to the central arguments for restrictive lockdown legislation. We build our critique on the following assumption: public policy that enjoys virtually unanimous support worldwide should be justified by uncontroversial moral principles. We argue that that the virtually unanimous support in favor of restrictive lockdowns is not adequately (...) justified by the arguments given in favor of them. Importantly, this is not to say that states ought not impose restrictive lockdown measures, but rather that the extent of the acceptance of these measures is not proportionate to the strength of the arguments for lockdowns. -/- We begin by exploring the case for restrictive lockdowns. We first argue that several of the principles that are used to justify the lockdowns yield unexpectedly revisionary implications for other political problems that many would be unwilling to accept. We then outline what we consider the strongest argument for a lockdown—namely, that its net welfare benefits are great enough to defeat the moral presumption against restricting citizens’ civil liberties to move, work, and assemble. However, we give a number of reasons for doubting that the lockdown’s net welfare benefits are, in fact, sufficiently high to defeat the presumption against it. (shrink)

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial (...) womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis. (shrink)

The controversy around the accommodation of conscientious objections in medicine persists, especially for such contentious services as abortions. COs are typically considered in their negativ...

Relational aspects, such as involvement of donor’s relatives or friends in the decision-making on participation in a research biobank, providing relatives’ health data to researchers, or sharing research findings with relatives should be considered when reflecting on ethical aspects of research biobanks. The aim of this paper is to explore what the role of donor’s relatives and friends is in the process of becoming and being a biobank donor and which ethical issues arise in this context. We performed qualitative analysis (...) of 40 qualitative semi-structured interviews with biobank donors and researchers. The results show that relatedness to relatives or other types of close relationships played a significant role in the donors’ motivation to be involved in a biobank, risk-benefit assessment, and decisions on sharing information on research and its results. Interviewees mentioned ethical issues in the context of sharing relatives’ health-related data for research purposes and returning research findings that may affect their relatives. We conclude that the question of what information on family members may be shared with a biobank by research participants without informed consent of those relatives, and when family members become research subjects, lacks a clear answer and detailed guidelines, especially in the context of the introduction of the European Union’s (EU) General Data Protection Regulation. Researchers in Latvia and EU face ethical questions and dilemmas about returning research results and incidental findings to donors’ relatives, and donors need more information on sharing research results with relatives in the informed consent process. (shrink)

Nicholas Agar, Jeff McMahan and Allen Buchanan have all expressed concerns about enhancing humans far outside the species-typical range. They argue radically enhanced beings will be entitled to greater and more beneficial treatment through an enhanced moral status, or a stronger claim to basic rights. I challenge these claims by first arguing that emerging technologies will likely give the enhanced direct control over their mental states. The lack of control we currently exhibit over our mental lives greatly contributes to our (...) sense of vulnerability. I then argue moral status should be viewed in terms of vulnerability. The enhanced will slowly gain the ability to command their mental states, reducing their vulnerability. These radically enhanced beings will have greater capacities, and possibly an inner life more valuable than our own. They will also be less vulnerable, and as a result, their moral status will be subordinate to our own. (shrink)

Infant feeding decisions are highly emotionally charged. I argue elsewhere that many problems surrounding infant feeding decisions result from a moralized context created by mistakes in our assumptions about maternal duties including the mistaken assumption that mothers have a defeasible moral duty to breastfeed. Mothers have a reason, but not a moral duty to breastfeed. Even those who are convinced by my argument in the case of full-term babies, might find it harder to accept in the case of premature babies. (...) It might seem that mothers do have a defeasible moral duty to breastfeed or, as is more likely to be appropriate in such cases, to express breastmilk. Here, I explain why preterm neonates present a tricky case for the right not to breastfeed. I show why, nonetheless, moral pressure for mothers to express breastmilk in the neonatal unit is neither permissible nor pragmatically advisable. I argue that instead we should address structural barriers to providing breastmilk and support donor milk initiatives. (shrink)

The purpose of this article is to discuss the concept and the content of courses on “social ethics”. I will present a dilemma that arises in the design of such courses. On the one hand, they may present versions of “applied ethics”; that is, courses in which moral theories are applied to moral and social problems. On the other hand, they may present generalised forms of “occupational ethics”, usually professional ethics, with some business ethics added to expand the range of (...) the course. Is there, then, not some middle ground that is distinctively designated by the term “social ethics”? I will argue that there is such a ground. I will describe that ground as the ethics of “social practices”. I will then illustrate how this approach to the teaching of ethics may be carried out in five domains of social practice: professional ethics, commercial ethics, corporate ethics, governmental ethics, and ethics in the voluntary sector. My aim is to show that “social ethics” courses can have a clear rationale and systematic content. (shrink)

Concerns about emerging and re-emerging infectious diseases have given a new lease of life to quarantinist measures: a series of time-honoured techniques for controlling the spread of infectious diseases through breaking the chain of human contagion. Since such measures typically infringe individual rights or privacy their use is subject to legal regulations and gives rise to ethical and political worries and suspicions. Yet in some circumstances they can be very effective. After considering some case studies that show how epidemics are (...) unique, fluid and affected by a multitude of contingent factors, it is argued that the legal and ethical guidelines may not always be the best approach to discipline the use of quarantinist measures. An alternative model based on ex-post political accountability for reasonableness is proposed. This model restores the centrality of political decision and expert judgement in situations characterized by high risk, uncertainty and contingency. It is argued that such alternative model affords quicker and more flexible responses to serious outbreaks of infections, while providing adequate protection against abuses. (shrink)

In a recent article, Marilyn Baffoe-Bonnie offers three arguments for conducting CRISPR/Cas9 biotechnology research to cure sickle-cell disease (SCD) based on addressing historical and current injustices in SCD research and care. I show that her second and third arguments suffer from roughly the same defect, which is that they really argue for something else rather than for conducting CRISPR/Cas9 research in particular. For instance, the second argument argues that conducting this gene therapy research would improve the relationship between SCD sufferers (...) (who are mostly of African descent) and health care providers. But really what is essential in improving this relationship is for those providers to genuinely care and be concerned, and this could be lacking even with the CRISPR research being done. Indeed, this relationship could be improved even without that research being done, as long as there is genuine concern. Thus, this argument actually argues for the need for genuine concern. As for the third argument, one (of two) problems arises because it claims that CRISPR research for SCD should be pursued because the benefits would be shared by even non-research-participants, as non-participants would be encouraged. However, this argues for any research for SCD, not for CRISPR research in particular. I conclude that a better justice-based argument will use only Baffoe-Bonnie’s first argument, which is based on historic neglect of an actual cure for SCD (going beyond merely management or transplant therapies). (shrink)

This paper traces two contradicting beliefs about death and immortality in the writings of Rabbi Hayyim Hirschensohn, and examines these opposing beliefs in his Halakhic ruling, in the case of Autopsies. The paper opens by conceptualizing two possible attitudes regarding the relation between this-world and the ʽother-world’, and by analyzing two main beliefs regarding death and immortality in their relation to the body-spirit distinction (the naturalistic and the spiritualistic approach). It demonstrates how Hirschensohn was holding these two different views. The (...) paper then moves to examine whether his halakhic ruling may help us in understanding which approach was Hirschensohn’s favorable belief, by investigating his halakhic ruling regarding autopsies. Hirschensohn permits to perform such surgeries, however subject to some halakhic limitations. The paper concludes that the naturalistic belief regarding death appears to be the more dominant one in his thought. Finally, I point out a few consequences of this paper, for addressing some contemporary ethical dilemmas regarding human corpses. (shrink)

Brummett and Salter propose a useful and timely taxonomy of clinical ethics expertise (2019). As the field becomes further “professionalized” this taxonomy is important, and the core of it is right. It needs some refinement around the edges, however. In their conclusion, Brummett and Salter rightly point out that there is a significant difference between the ethicist whose recommendations are procedure- and process-heavy, consensus-driven, and dialogical and the authoritarian ethicist whose recommendations flow from “private moral views” (Brummett and Salter, 2019). (...) This admission doesn’t go far enough. Brummett and Salter’s taxonomy fails to capture the notion that offering recommendations whose normative force is moral is different in kind from recommendations whose normative force is non-moral, such as those recommendations that are free of moral content or justified by convention. The difference is in kind, not scale. I argue further that clinical ethics expertise, if possible, consists at least in offering recommendations whose normative force is moral. These two claims imply that the taxonomy fails to cut clinical ethics expertise at the joints: the ethicist who offers justified non-moral normative recommendations is a different kind of ethicist from the one who offers justified moral normative recommendations, yet both are categorized as clinical ethics experts. I finish by offering a refinement of the taxonomy that more precisely categorizes clinical ethicists. (shrink)

Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has (...) a dubitable claim to be medically beneficial, is rarely clinically indicated, and that conscientious objections should be accepted in these circumstances. We also show that reliance on personal beliefs is difficult to avoid if any form of objection is to be permitted, even if it is based on criteria such as the principles and values of the profession or the scope of professional practice. (shrink)

In the United States, roughly 1 out of 4 births takes place at a hospital certified as Baby-Friendly. This paper offers a multi-disciplinary perspective on the Baby-Friendly Hospital Initiative (BFHI), including empirical, normative, and historical perspectives. Our analysis is novel in that we trace how medical practices of “quality improvement,” which initially appear to have little to do with breastfeeding, may have shaped the BFHI. Ultimately, we demonstrate that a rich understanding of the BFHI can be obtained by tracing how (...) norms of gender/motherhood interact with, and are supplemented by, other normative, historical, and institutional realities. We conclude with suggestions for practical revisions to the BFHI. (shrink)

Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. First, we review the nature and scale of the (...) problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress’ four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress’ four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to. (shrink)

In ’Abortion and deprivation: a reply to Marquis’, Anna Christensen contends that Don Marquis’ influential ’future like ours’ argument for the immorality of abortion faces a significant challenge from the Epicurean claim that human beings cannot be harmed by their death. If deprivation requires a subject, then abortion cannot deprive a fetus of a future of value, as no individual exists to be deprived once death has occurred. However, the Epicurean account also implies that the wrongness of murder is also (...) not grounded in the badness of death, which is strongly counterintuitive. There is an alternative: we can save our intuitions by adopting a more moderate Epicurean account such as that proposed by David Hershenov, who grounds the wrongness of killing in the prevention of the benefit of further good life rather than in the badness of death. Hershenov’s account, however, is equally applicable to Marquis’ argument: abortion similarly prevents a fetus from enjoying the benefit of a future like ours. Consequently, we conclude that Christensen’s criticism of Marquis’ argument fails to undermine his reasoning. (shrink)

The idea that healthcare should become more person-centred is extremely influential. By using recent English policy developments as a case study, this article aims to critically analyse an important element of person-centred care, namely, the belief that to treat patients as persons is to think that care should be ‘co-produced’ by formal healthcare providers and patients together with unpaid carers and voluntary organizations. I draw on insights from political philosophy to highlight overlooked tensions between co-production and values like equality and (...) liberty. Regarding equality, I argue that co-production compounds both problems of gender inequality in the distribution of care labour and the challenges associated with securing equal access to care. Turning to liberty, I identify important commonalities between co-production and republicanism in political philosophy, given their shared insistence on common citizens’ civic virtue. Then, I use against co-production some liberal arguments against republicanism, to highlight a problem of over-demandingness. In bringing my argument to a close, however, I wish to caution against hastily rejecting co-production as a policy programme. (shrink)

Resumen: Todo hecho debe ser narrado para ser objeto de examen valorativo. Pero este examen depende, en parte, de cómo aquél sea narrado. Algunos autores han señalado el valor democrático que posee el enfoque narrativo, en la medida en que permite que una narración sea construida a partir de diferentes puntos de vista. El problema es que estos puntos de vista pueden conducir a soluciones alternativas o incluso antagónicas, fenómeno no infrecuente en una sociedad multicultural como la nuestra. Desde un (...) punto de vista estrictamente narrativo, el mejor relato es el más persuasivo. Pero esto nos aboca al relativismo, puesto que la eficacia de un relato está en función del auditorio ante el que se argumenta. En este trabajo se ha intentado poner de manifiesto que sólo se alcanza a comprender la verdadera contribución de la narrativa si nos situamos, no tanto en el plano de los hechos, como en el plano de la normatividad. La tesis que aquí se sostiene es que la utilidad del enfoque narrativo está en función del valor arquetípico del modelo o estándar de conducta que eventualmente contenga una determinada narración. Entronca así directamente con la noción de razón práctica, más allá de sus específicos puntos de conexión con algunas de las metodologías bioéticas más importantes. Abstract: Every fact must be narrated in order to be subject of value judgement. But this value judgement depends partly on how that fact is narrated. Some authors have highlighted the democratic value of the narrative approach, because of its admission of different points of view to construct a story. The problem is that these points of view can easily lead to alternative solutions o even opposing ones. This phenomenon is not rare in our multicultural society. From an strictly narrative point of view, the best story is the most persuasive. But this lead us to relativism, because the efficacy of an story relies on the audience towards the argumentation is developed. In this work we have tried to bring to light that the genuine contribution of the narrative approach is not achieved if we stay on the level of facts and we do not pass to the level of normativity. We suggest the thesis that the utility of narrative approach is a function of the archetypical standard of behavior that a story may content. So this approach, beyond its specific connections with some of the most prominent bioethical methodologies, become directly connected with the notion of practical reason. (shrink)

The altered nuclear transfer-oocyte assisted reprogramming (ANT-OAR) proposal has serious scientific and philosophical flaws, and it is not a morally acceptable means of obtaining embryonic stem cells. Note that this is the final preprint of an article that was published in the newspaper Science and Theology News in June 2006.

This essay aims to tell the story of the “altered nuclear transfer-oocyte assisted reprogramming,” or ANT-OAR, proposal—from its conception by Professor William Hurlbut of the President’s Council on Bioethics—to its adoption and promotion by a group of conservative, mostly Catholic philosophers, theologians and scientists—to its eventual demise in Congress. It also will give some reflections on how ANT-OAR promotes a genetically deterministic view of the human organism and can lead down a slippery slope into a future in which human cloning (...) and human genetic engineering are more acceptable. For these reasons, it will be argued, ANT-OAR should be opposed by all who are against human genetic modification regardless of their political orientation. (shrink)

It is commonly argued that a serious right to life is grounded only in actual, relatively advanced psychological capacities a being has acquired. The moral permissibility of abortion is frequently argued for on these grounds. Increasingly it is being argued that such accounts also entail the permissibility of infanticide, with several proponents of these theories accepting this consequence. We show, however, that these accounts imply the permissibility of even more unpalatable acts than infanticide performed on infants: organ harvesting, live experimentation, (...) sexual interference, and discriminatory killing. The stronger intuitions against the permissibility of these ‘pre-personal acts’ allow us to re-establish a comprehensive and persuasive reductio against psychological accounts of persons. (shrink)

The authors respond to a wide range of objections defending our argument that some forms of behaviour modification utilising advances in the cognitive sciences are desirable and need not necessarily undermine autonomy or freedom.

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens (...) they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

Biomedical technologies can increasingly be used not only to combat disease, but also to augment the capacities or traits of normal, healthy people – a practice commonly referred to as biomedical enhancement. Perhaps the best‐established examples of biomedical enhancement are cosmetic surgery and doping in sports. But most recent scientific attention and ethical debate focuses on extending lifespan, lifting mood, and augmenting cognitive capacities.