Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Previous edition, 1st, published in 1971.

ABSTRACT An influential argument against the possibility of obligations to oneself states that the very notion of such obligations is incoherent: If there were such obligations, we could release ourselves from them; yet releasing oneself from an obligation is impossible. I challenge this argument by arguing against the premise that it is impossible to release oneself from an obligation. I point out that this premise assumes that if it were possible to release oneself from an obligation, it would be impossible (...) to violate that obligation. I note that there are two interpretations of this assumption, one conceptual and one psychological. I argue that, on both interpretations, the assumption is false—at least according to independently plausible accounts of obligations to oneself and of what it means to waive an obligation. My arguments paint a picture of obligations to oneself that not only challenges the argument against their coherence, but also illuminates these obligations’ relationship to other parts of the moral domain. (shrink)

According to what Douglas calls ‘the consent requirement’, neuro-correctives can only permissibly be provided with the valid consent of the offender who will undergo the intervention. Some of those who endorse the consent requirement have claimed that even though the requirement prohibits the imposition of mandatory neurocorrectives on criminal offenders, it may yet be permissible to offer offenders the opportunity to consent to undergoing such an intervention, in return for a reduction to their penal sentence. I call this the neurocorrective (...) offer. In this chapter I consider the coercion-based objection to the neurocorrective offer, which claims that offenders cannot provide valid consent to undergoing a neurocorrective on the basis of this offer because it is inherently coercive. Having outlined early formulations of this argument, I point out that there are in fact two different versions of this objection, which appeal to different understandings of the concepts of coercion, consent and voluntariness. (shrink)

Many theories of social justice maintain that concern for the social bases of self-respect grounds demanding requirements of political and economic equality, as self-respect is supposed to be dependent on continuous just recognition by others. This paper argues that such views miss an important feature of self-respect, which accounts for much of its value: self-respect is a capacity for self-orientation that is robust under adversity. This does not mean that there are no social bases of self-respect that such theories ought (...) to incorporate. It means that they are different: they consist of the motivational and epistemic resources needed to develop and maintain such robustness. (shrink)

Traditional means of crime prevention, such as incarceration and psychological rehabilitation, are frequently ineffective. This collection considers how crime preventing neurointerventions could present a more humane alternative but, on the other hand, how neuroscientific developments and interventions may threaten fundamental human values.

In this issue, Elizabeth Shaw and Gulzaar Barn offer a number of replies to my arguments in ‘Criminal Rehabilitation Through Medical Intervention: Moral Liability and the Right to Bodily Integrity’, Journal of Ethics. In this article I respond to some of their criticisms.

According to rational will views of paternalism, the wrongmaking feature of paternalism is that paternalists disregard or fail to respect the rational will of the paternalized, in effect substituting their own presumably superior judgments about what ends the paternalized ought to pursue or how they ought to pursue them. Here I defend a version of the rational will view appealing to three rational powers that constitute rational agency, which I call recognition, discrimination, and satisfaction. By appealing to these powers, my (...) version of the rational will view can rank the wrongfulness of paternalistic acts in terms of the extent to which such acts (a) amount to supplanting the paternalized individual’s identity as a rational agent with that of the paternalist, and (b) the degree of mistrust the paternalistic act shows in the paternalized individual’s rational agency. My rational powers account thus provides a more complete account of why paternalism is a powerful, but not decisive or absolute, objection to an act or policy. My rational powers account also provides powerful explanations of why rational suasion deflects charges of paternalism; why consenting to intercessions in one’s rational agency negates paternalism; why we ordinarily believe that strong paternalism is more objectionable than weak paternalism; and why we ordinarily believe that hard paternalism is more objectionable than soft paternalism. (shrink)

In many jurisdictions, an offender’s remorse is considered to be a relevant factor to take into account in mitigation at sentencing. The growing philosophical interest in the use of neurointerventions in criminal justice raises an important question about such remorse-based mitigation: to what extent should technologically facilitated remorse be honoured such that it is permitted the same penal significance as standard instances of remorse? To motivate this question, we begin by sketching a tripartite account of remorse that distinguishes cognitive, affective (...) and motivational elements of remorse. We then describe a number of neurointerventions that might plausibly be used to enhance abilities that are relevant to these different elements of remorse. Having described what we term the ‘moral value’ view of the justification of remorse-based mitigation, we then consider whether using neurointerventions to facilitate remorse would undermine its moral value, and thus make it inappropriate to honour such remorse in the criminal justice system. We respond to this question by claiming that the form of moral understanding that is incorporated into a genuinely remorseful response grounds remorse’s moral value. In view of this claim, we conclude by arguing that neurointerventions need not undermine remorse’s moral value on this approach, and that the remorse that such interventions might facilitate could also be authentic to the recipient of the neurointerventions that we discuss. (shrink)

Thomas E. Hill, Jr.; Servility and Self-Respect, The Monist, Volume 57, Issue 1, 1 January 1973, Pages 87–104, https://doi.org/10.5840/monist197357135.

Contemporary philosophers generally ignore the topic of duties to the self. I contend that they are mistaken to do so. The question of whether there are such duties, I argue, is of genuine significance when constructing theories of practical reasoning and moral psychology. In this essay, I show that much of the potential importance of duties to the self stems from what has been called the “second-personal” character of moral duties—the fact that the performance of a duty is “owed to” (...) someone. But this is problematic, as there is reason to doubt whether a person can genuinely owe to herself the performance of an action. Responding to this worry, I show that temporal divisions within an agent's life enable her to relate to herself second-personally, in the way required by morality. The upshots, I argue, are that we need an intra-personal theory of justice that specifies the extent of a person's authority over herself, and that we need to rethink our theories of moral emotions in order to specify how an individual ought to respond to attacks on her interests and autonomy that she herself perpetrates. (shrink)

In this paper I propose and develop a social account of global autonomy. On this view, a person is autonomous simply to the extent to which it is difficult for others to subject her to their wills. I argue that many properties commonly thought necessary for autonomy are in fact properties that tend to increase an agent’s immunity to such interpersonal subjection, and that the proposed account is therefore capable of providing theoretical unity to many of the otherwise heterogeneous requirements (...) of autonomy familiar from recent discussions. Specifically, I discuss three such requirements: (i) possession of legally protected status, (ii) a sense of one’s own self-worth, and (iii) a capacity for critical reflection. I argue that the proposed account is not only theoretically satisfying but also yields a rich and attractive conception of autonomy. (shrink)

This paper discusses the volenti non fit injuria maxim. The volenti maxim states that a person is not wronged by that to which she consents, provided her consent is valid. I will argue, however, that the volenti maxim does not apply to all instances of valid consent. In some cases the consenter is wronged even if his consent is valid. Valid consent can only release others from consent-sensitive duties, not from consent-insensitive duties. If the consentee flouts a consent-insensitive duty the (...) consentee wrongs the consenter and thereby commits a wrong. (shrink)

Cases of paternalism usually involve disagreement between the paternalist and the paternalized subject. But not all the disagreements that give rise to paternalism are of the same kind and, as a result, not all instances of paternalism are morally on a par. There is, in other words, a moral difference between different kinds of paternalism, which can be explained in terms of the nature of the disagreements that give rise to the paternalism in the first place. This paper offers a (...) novel account of how to characterize the nature of these disagreements such that we can explain this moral difference. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Crime-preventing neurointerventions (CPNs) are increasingly being used or advocated for crime prevention. There is increasing use of testosterone-lowering agents to prevent recidivism in sexual offenders, and strong political and scientific interest in developing pharmaceutical treatments for psychopathy and anti-social behaviour. Recent developments suggest that we may ultimately have at our disposal a range of drugs capable of suppressing violent aggression, and it is not difficult to imagine possible applications of such drugs in crime prevention. But should neurointerventions be used in (...) crime prevention, and may the state ever permissibly impose CPNs as part of the criminal justice process? It is widely thought that preventing recidivism is one of the aims of criminal justice, yet existing means of pursuing this aim are often poorly effective, restrictive of basic freedoms, and harmful. Incarceration, for example, tends to be disruptive of personal relationships and careers, detrimental to physical and mental health, highly restrictive of freedom of movement and association, and rarely more than modestly effective at preventing recidivism. Neurointerventions hold the promise of preventing recidivism in ways that are more effective and more humane, but the use of CPNs in criminal justice raises several ethical concerns. CPNs could be highly intrusive and may threaten fundamental human values, such as bodily integrity and freedom of thought, and humanity has a track record of misguided, harmful, and unwarrantedly coercive use of neurotechnological ‘solutions’ to criminality. This collection brings together original contributions from emerging scholars and internationally renowned moral and political philosophers to address these issues. (shrink)

Criminal offenders are sometimes required, by the institutions of criminal justice, to undergo medical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption that medical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms of medical intervention. I then consider whether it is possible to respond persuasively to this challenge (...) by invoking the right to bodily integrity. I argue that it is not. (shrink)

Tattoos are widely regarded as morally neutral, and the decision to have them as carrying no ethical implications. The aim of this paper is to question this assumption. I argue that decisions to have tattoos involve risks that are not merely prudential—they are normative. The argument starts with a thesis that the power we presently have over our lives is constrained by the need to respect our future selves. If we make a discretionary choice that disregards our future interests and (...) preferences, then, under certain circumstances, we can be morally to blame. I argue that certain decisions to get tattoos fit this description. Therefore, getting some tattoos makes us blameworthy. (shrink)

Recent developments in neuroscience have enabled technological advances to modulate cognitive functions of the brain. Despite ethical concerns about cognitive enhancement, both individuals and society as a whole can benefit greatly from these technologies, depending on how we regulate their use. To date, regulatory analyses of neuromodulation technologies have focused on a technology itself – for instance, the U.S. Food and Drug Administration regulation of a brain stimulation device – rather than the use of a technology, such as the use (...) of a brain stimulation device at work or school. Given that some forms of cognitive enhancement have already started to penetrate the general public’s everyday life, we should begin our discussion on potential regulatory issues regarding their use in various real-world situations. The goal of the article is to fill the gap by providing an analytic framework to examine these regulatory issues. More specifically, it aims to illustrate the issues around respecting autonomy and preventing coercive use of cognitive enhancement. The proposed framework categories the real-world settings where a neuromodulation technology can be used for cognitive enhancement based on two criteria – who is subjected to cognitive enhancement and who imposes cognitive enhancement. Based on this framework, the article analyzes regulatory issues arising out of every combination of subject/imposing party by taking one example case. Focusing on the regulations in the U.S., this analysis shows the current lack of adequate safeguards against the coercive use and calls for more attention from government agencies and researchers to develop sound policies regarding current and potentially more widespread use of cognitive enhancement. (shrink)

The United Nations human rights system has in recent years been divided on the question as to whether coercive care interventions, including coercive psychiatric care, can ever be justified under UN human rights standards. Some within the UN human rights community hold that coercive care can comply with human rights standards, provided that the coercive intervention is a necessary and proportionate means to achieve certain approved aims, and that appropriate legal safeguards are in place. Others have held that coercive care (...) is never justified. Disagreement over this issue has produced an impasse in the UN human rights system. We survey the impasse with particular attention to the legal arguments that inform the divergent positions. In doing so we introduce a distinction among a variety of different ‘abolitionist’ positions regarding coercive care, and draw a distinction between ‘non-consensual’ and ‘coercive’ treatment. We conclude with three proposals for moving beyond the current impasse. (shrink)

Criminologists have long acknowledged the link between a number of cognitive deficits, including low intelligence and impulsivity, and crime. A new wave of research has demonstrated that pharmacological intervention can restore or improve cognitive function, particularly executive function, and restore neural plasticity. Such restoration and improvement can allow for easier acquisition of new skills and as a result, presents significant possibilities for the criminal justice system. For example, studies have shown that supplements of Omega-3, a fatty acid commonly found in (...) food such as tuna, can decrease frequency of violent incidents in an incarcerated population. Research has also begun to explore the use of selective serotonin reuptake inhibitors to reduce impulsivity in some violent offenders. However, there are significant legal and ethical implications when moving from dietary supplements to prescription pharmaceuticals and medical devices for cognitive intervention. This paper will explore the legal and ethical issues surrounding the use of pharmacological intervention on prisoners as an effort to reduce crime and recidivism. (shrink)

While there is much literature on autonomy and the conditions for its attainment, there is less on how those conditions reflect on agents’ ordinary careers. Most people’s careers involve a great deal of subservient activity that would prevent the kind of control over agents’ actions that autonomy would seem to require. Yet, it would seem strange to deny autonomy to every agent who regularly follows orders at work—to do so would make autonomy a futile ideal. Most contemporary autonomy accounts provide (...) purely theoretical analysis without reference to any practical goal that autonomy could serve. These accounts are likely to resolve this issue in one direction: either almost entirely including or excluding subservient workers from autonomy. Either solution would fail to distinguish agents who sufficiently control their lives, in spite of limited subservience, according to their own standards, from agents for whom subservience precludes a fulfilling life. I suggest the solution lies in a return to goal-oriented autonomy accounts, which can use the goal to distinguish when subservience overwhelms autonomy from when subservience and autonomy can coexist. I present an account that anchors autonomy in the happiness that it provides for agents who sufficiently control their lives as determined by their more important prudential standards. On this account, agents in subservient careers can be autonomous if they determine how to make their careers consistent with their happiness. (shrink)

The purpose of this paper is twofold. First, I defend and expand the Fortificationist Theory of Punishment. Second, I argue that this theory implies that non-consensual neurointerventions – interventions that act directly on one’s brain – are permissible. According to the FTP, punishment is justified as a way of ensuring that citizens who infringe their duty to demonstrate the reliability of their moral powers will thereafter be able to comply with it. I claim that the FTP ought to be expanded (...) to include citizens’ interest in developing their moral powers. Thus, states must ensure that their citizens develop their moral reliability, not only because they must enforce their citizens’ compliance with certain duties, but also because states have the duty to maintain the conditions for stability and satisfy their citizens’ interest in developing their moral powers. According to this account of the FTP, if neurointerventions are the only or best way of ensuring that offenders can discharge their fortificational duties, states have strong reasons to provide these interventions. (shrink)

Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a (...) consent to be normatively valid (“take the wronging out of the act”) under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation. (shrink)

Neuroscientific research in relation to antisocial behavior has strongly grown in the last decades. This has resulted in a better understanding of biological factors associated with antisocial behavior. Furthermore several neuroscientific instruments and interventions have been developed that have a relatively low threshold for use in the criminal justice system to contribute to prevention or reduction of antisocial and criminal behavior. When considering implementation in the criminal justice system, ethical aspects of the use of neuroscientific instruments and interventions need to (...) be taken into account. With respect to ethics in relation to neurocriminology much of the literature focuses on identifying and debating risks and value conflicts. This is important and necessary, but the positive contribution of neuroscientific applications may therefore get less attention in the ethical literature. Yet, ethicists can help criminal justice researchers and practitioners to identify ways in which neuroscience could add positively to important values in (young) offender rehabilitation. It is argued that this role of ethicists in interdisciplinary teams deserves more emphasis. As an illustration, this contribution focuses on how neuroscientific knowledge, instruments and interventions may contribute to autonomy of (young) offenders. (shrink)

Many supporters of ‘moral bioenhancement’ (MBE), the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. (...) Considering their efficacy and feasibility, it is strange that these interventions have rarely been proposed or discussed as MBE. I review evidence that each of those interventions can reduce antisocial behaviour, reduce racial bias, increase executive function or increase prosocial traits like fairness and altruism. I then specify and defend realistic, ethically permissible ways to implement these interventions, especially for violent offenders and public servants—the former as rehabilitation and the latter to meet the high standards of their occupations. These interventions could be given to violent offenders in exchange for a reduced sentence or compulsorily in some cases. Potential intervention methods for non-prisoners include increasing the USDA-recommended dose of omega-3, encouraging food companies to supplement their products with omega-3 or trace lithium, requiring MBE for employment as a police officer or political leader, and insurance companies providing discounts for undergoing MBE. In some reasonably limited form, using these interventions may be a good first step to implement the project of MBE. (shrink)

Journal of Social Philosophy, EarlyView.

“Committing a crime might render one morally liable to certain forms of medical intervention”, claims Thomas Douglas, who stated in this context that “compulsory uses of medical correctives could in principle be justified.” This article engages critically with his and other arguments on the use of coercive neurocorrectives for criminal offenders. First, the rehabilitation assumption that includes—for coercive neurocorrectives to work as an alternative to incarceration—that rehabilitation is the “only goal” of criminal punishment is criticized. Additionally this article engages with (...) the theoretical difficulty of solely rehabilitative approaches, and discusses why it is unfortunate to design neurocorrectives so as to be particularly harmful in order to imagine administering them as being a punishment. Second, until we know more about specific neurocorrectives, we are well advised not to undermine the most important objection against coercive neurocorrectives, namely offenders’ human rights. This article argues that the use of coercive neurocorrectives would particularly violate Article 3 of the European Convention on Human Rights which guarantees as an absolute right that “[n]o one shall be subjected to torture or to inhuman or degrading treatment or punishment”, and finally holds that a still weak human right to mental integrity and self-determination should fundamentally come first. (shrink)

Neuroscientific research in relation to antisocial behavior has strongly grown in the last decades. This has resulted in a better understanding of biological factors associated with antisocial behavior. Furthermore several neuroscientific instruments and interventions have been developed that have a relatively low threshold for use in the criminal justice system to contribute to prevention or reduction of antisocial and criminal behavior. When considering implementation in the criminal justice system, ethical aspects of the use of neuroscientific instruments and interventions need to (...) be taken into account. With respect to ethics in relation to neurocriminology much of the literature focuses on identifying and debating risks and value conflicts. This is important and necessary, but the positive contribution of neuroscientific applications may therefore get less attention in the ethical literature. Yet, ethicists can help criminal justice researchers and practitioners to identify ways in which neuroscience could add positively to important values in offender rehabilitation. It is argued that this role of ethicists in interdisciplinary teams deserves more emphasis. As an illustration, this contribution focuses on how neuroscientific knowledge, instruments and interventions may contribute to autonomy of offenders. (shrink)

Inequality causes a variety of social ills, which give egalitarians reasons for concerns of justice. In particular, inequality is deemed to undermine people’s fundamental moral capacity of self-respect. In this paper, we explore the complex relationship between inequality and self-respect from a philosophical and an empirical angle, arguing that a theory of justice should take both into account. To this purpose, we first clarify the normative objection to inequality from the alleged erosion of self-respect. Then, we elaborate on empirical findings (...) showing the crucial role that ‘relative deprivation’ plays in the causal mechanism that connects inequalities to the erosion of self-respect. We conclude that this role is best understood in philosophical terms as a form of deprivation that affects thesignificance that people attach to the value of the choices they make. (shrink)

Is it morally acceptable to instigate criminal offenders to participate in rehabilitative treatment by offering treatment in return for early release from prison? Some theorists have supported such treatment schemes by pointing to the beneficial consequences that follow from the treatment. Others have suggested that the schemes are unacceptably coercive, which implies that consent becomes an illusion. This paper argues that the discussion—with clear parallels to debates of other healthcare treatment offers in medical ethics—has adopted a too narrow focus. By (...) failing to consider the question as a penal theoretical problem, the arguments—both by proponents and critics of coercive treatment—become premature. (shrink)

Human cognitive performance has crucial significance for legal process, often creating the difference between fair and unfair imprisonment. Lawyers, judges, and jurors need to follow long and complex arguments. They need to understand technical language. Jurors need to remember what happens during a long trial. The demands imposed on jurors in particular are sizeable and the cognitive challenges are discussed in this chapter. Jurors are often subjected to both tremendous decision complexity and tremendous evidence complexity. Some of these problems could (...) be ameliorated if we can somehow enhance the cognitive capacities, including attention and memory, of various players in trials. There are multiple ways in which cognition can be improved either by external tools or by an increasing number of biomedical interventions that act directly on the brain. The article surveys a range of beneficial and detrimental effects that substances can have on cognition. (shrink)