Common sense tells us that in certain circumstances, helping someone is morally obligatory. That intuition appears incompatible with Kant's account of beneficence as a wide imperfect duty, and its implication that agents may exercise latitude over which beneficent actions to perform. In this paper, I offer a resolution to the problem from which it follows that some opportunities to help admit latitude and others do not. I argue that beneficence has two components: the familiar wide duty to help (...) others achieve their ends and a narrow duty to avoid indifference to others as end-setters. Although we are not always required to help, we are always required not to be indifferent. When helping someone is the only way not to be indifferent to a person, helping him/her is obligatory. My account avoids certain difficulties with other proposed solutions and can also address an important concern about proximity. (shrink)

A background assumption in much contemporary political philosophy is that justice is the first virtue of social institutions, taking priority over other values such as beneficence. This assumption is typically treated as a methodological starting point, rather than as following from any particular moral or political theory. In this paper, I challenge this assumption. To frame my discussion, I argue, first, that justice doesn’t in principle override beneficence, and second, that justice doesn’t typically outweigh beneficence, since, in (...) institutional contexts, the stakes of beneficence are often extremely high. While there are various ways one might resist this argument, none challenge the core methodological point that political philosophy should abandon its preoccupation with justice and begin to pay considerably more attention to social beneficence—that is, to beneficence understood as a virtue of social institutions. Along the way, I also highlight areas where focusing on social beneficence would lead political philosophers in new and fruitful directions, and where normative ethicists focused on personal beneficence might scale up their thinking to the institutional case. GPI Working Paper No. 11-2022. (shrink)

Beneficence is usually regarded as adequate when it results in an actual benefit for a beneficiary and satisfies her self-chosen end. However, beneficence that satisfies these conditions can harm beneficiaries' free agency, particularly when they are robustly dependent on benefactors. First, the means that benefactors choose can have undesirable side-effects on resources that beneficiaries need for future free action. Second, benefactors may undermine beneficiaries' ability to freely deliberate and choose. It is therefore insufficient to satisfy someone's self-chosen ends. (...) Instead, good beneficence depends on whether the benefactor avoids undue influence over a beneficiary's deliberation and whether the choice of means is compatible with the beneficiary's conception of her good. Consequently, benefactors must have substantial respect for a beneficiary's free agency and the practical competence to choose means that take into account the beneficiary's conception of her good and the wider set of circumstances that influence her life. (shrink)

Imagine a world where everyone is healthy, intelligent, long living and happy. Intuitively this seems wonderful albeit unrealistic. However, recent scienti c breakthroughs in genetic engineering, namely CRISPR/Cas bring the question into public discourse, how the genetic enhancement of humans should be evaluated morally. In 2001, when preimplantation genetic diagnosis (PGD) and in vitro fertilisation (IVF), enabled parents to select between multiple embryos, Julian Savulescu introduced the principle of procreative bene cence (PPB), stating that parents have the obligations to choose (...) the child that is expected to have the best life. In this paper I argue that accepting the PPB and the consequentialist principle (CP) that two acts with the same consequences are morally on par, commits one to accepting the parental obligation of genetically enhancing one's children. (shrink)

What are we morally required to do for strangers? To answer this question – a question about the scope of requirements to aid strangers – we must first answer a question about justification: why are we required to aid them (when we are)? The main paper focuses largely on answering the question about justification, but does so in order to arrive at an answer to the question about scope. Three main issues are discussed. First, to what extent should requirements of (...) beneficence – requirements to benefit other people – be seen as generated by people’s rights to receiving aid? Secondly, what is the relationship between requirements of beneficence that apply to us collectively and requirements of beneficence that apply to each of us individually? According to Liam Murphy, our obligations to help distant strangers are fundamentally collective obligations, and any individual obligations we bear are consequently obligations to discharge our “fair share” of these collective obligations. I shall argue that, on the contrary, there are large-scale collective obligations of beneficence that derive from more fundamental individual obligations. My third issue concerns the moral significance of citizenship. What morally relevant difference is there between strangers who are compatriots and those who are not? (shrink)

This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely “imperfect” duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political philosophy (...) has at times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of “specific” beneficence that should be reflected in a society’s health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature. (shrink)

It is plausible to think that it is wrong to cure many people’s headaches rather than save someone else’s life. On the other hand, it is plausible to think that it is not wrong to expose someone to a tiny risk of death when curing this person’s headache. I will argue that these claims are inconsistent. For if we keep taking this tiny risk then it is likely that one person dies, while many others’ headaches are cured. In light of (...) this inconsistency, there is a conflict in our intuitions about beneficence and chance. This conflict is perplexing. And I have not been able to find a satisfactory way of resolving it. Perhaps you can do better? (shrink)

The argument of Julian Savulescu’s 2001 paper, “Procreative Beneficence: Why We Should Select the Best Children” is flawed in a number of respects. Savulescu confuses reasons with obligations and equivocates between the claim that parents have some reason to want the best for their children and the more radical claim that they are morally obligated to attempt to produce the best child possible. Savulescu offers a prima facie implausible account of parental obligation, as even the best parents typically fail (...) to do everything they think would be best for their children let alone everything that is in fact best for their children. The profound philosophical difficulties which beset the attempt to formulate a plausible account of the best human life constitute a further independent reason to resile from Savulescu’s conclusion. Savulescu’s argument also requires parents to become complicit with racist and homophobic oppression, which is yet another reason to reject it. Removing the equivocation from Savulescu’s argument allows us to see that the assertion of an obligation to choose the “best child” has much more in common with the “old” eugenics than Savulescu acknowledges. (shrink)

This article proposes that, in line with moral-cosmopolitan theorists, affluent nations have an obligation, founded in justice and not merely altruism or beneficence, to share the responsibility of the burden of public health implementation in low-income contexts. The current Ebola epidemic highlights the fact that countries with under-developed health systems and limited resources cannot cope with a significant and sudden health threat. The link between burden of disease, adverse factors in the social environment and poverty is well established and (...) confirmed by the 2008 World Health Organization (WHO)’s Social Determinants of Health Commission report. Well-resourced nations generally consider that they have some humanitarian obligation to assist where possible, but this obligation is limited. The following questions are considered: Is reliance on the principle of beneficence to address the global disparities in the social determinants of health and life expectancy at birth good enough? Do well-resourced nations have some obligation from justice, which is stronger than from beneficence, and which cannot be as easily cast aside or diminished, to address these issues? In a globalised world, shaped by centuries of historical injustice and where first-world economies are now so intertwined and reliant on third-world labour, beneficence is not a strong enough principle on which to base an obligation to achieve the WHO vision of ‘health equity through action on the social determinants of health’. (shrink)

What is a duty of justice? And how is it different from a duty of beneficence? We need a clear account of the contrast. Unfortunately, there is no consensus in the philosophical literature as to how to characterize it. Different articulations of it have been provided, but it is hard to identify a common core that is invariant across them. In this paper, I propose an account of how to understand duties of justice, explain how it contrasts with several (...) proposals as to how to distinguish justice and beneficence, respond to some objections and suggest further elaborations of it. The conceptual exploration pursued in this paper has practical stakes. A central aim is to propose and defend a capacious concept of justice that makes a direct discussion of important demands of justice (domestic and global) possible. Duties of justice can be positive besides negative, they can be imperfect as well as perfect, they can range over personal besides institutional contexts, they can include multiple associative reasons such us non-domination, non-exploitation and reciprocity, and they can even go beyond existing national, political, and economic associative frameworks to embrace strictly universal humanist concerns. We should reject ideological abridgments of the concept of justice that render these possibilities, and the important human interests and claims they may foster, invisible. (shrink)

Insufficient vaccination coverage is an important public health problem in many countries, since it leads to the loss of herd protection and the resurgence of previously exterminated diseases. However, policies of mandatory childhood vaccination capable of raising vaccination rates continue to be controversial. In this article I review the arguments for mandatory childhood vaccination, setting out the strongest teleological argument in favour, and then critically examining the two strongest potential objections: paternalism and the parental prerogative. I argue that the challenge (...) of paternalism fails because it confuses the identities of those subject to restricted liberty and those who autonomously dissent, and because non-vaccination imposes risks on others. I argue that the challenge of a parental prerogative fails because it cannot be intuitively or theoretically supported in a form that would make it permissible to impose risks on others. I conclude that in lieu of further and more plausible objections at least some policies of mandatory childhood vaccination are morally permissible. (shrink)

There can be situations in which, if I contribute to a pool of resources for helping a large number of people, the difference that my contribution makes to any of the people helped from the pool will be imperceptible at best, and maybe even non-existent. And this can be the case where it is also true that giving the same amount directly to one of the intended beneficiaries of the pool would have made a very large difference to her. Can (...) non-contribution to the pool be morally justified on this ground? I argue that it cannot. For, first, this line of thought leaves unaffected any reasons for holding that failing to perform the direct action of benefiting someone greatly would be wrong. But the pooling system of helping people is often better than a system separating the help which is given — better because of the perceptible difference it makes to its beneficiaries. If so, failing to contribute to the pool will be at least as wrong as failing to have helped directly would have been. The paper clarifies and defends an argument of this form, showing how it can be formulated in a way that avoids apparent counterexamples, and identifying the assumptions on which it rests. (shrink)

Scholars who favor shareholder primacy usually claim either that managers should not fulfill corporate duties of beneficence or that, if they are required to fulfill them, they do so by going against their obligations to shareholders. Distinguishing between structurally different types of duties of beneficence and recognizing the full force of the normative demands imposed on managers reveal that this view needs to be qualified. Although it is correct to think that managers, when acting on behalf of shareholders, (...) are not required to fulfill wide duties of charity, they are nevertheless required to fulfill a variety of narrow duties of beneficence. What is more, the obligation to fulfill these duties arises precisely because they are acting on behalf of shareholders. As such, this article 1) refines our understanding of the duties of corporate beneficence and 2) helps to identify which duties of beneficence are imposed on managers when they are acting on behalf of shareholders. (shrink)

We discuss Kant’s conception of beneficence against the background of the overdemandingness debate. We argue that Kant’s conception of beneficence constitutes a sweet spot between overdemandingess and undemandingess. To this end we defend four key claims that together constitute a novel interpretation of Kant’s account of beneficence: 1) for the same reason that we are obligated to be beneficent to others we are permitted to be beneficent to ourselves; 2) we can prioritise our own ends; 3) it (...) is more virtuous to do more rather than less when it comes to helping others; and 4) indifference to others is vicious. Finally, we explain how this represents a system of duties that gives our personal ends a moral standing without unacceptably moralising them. (shrink)

To capture genuine utilitarian tendencies, (Kahane et al., Psychological Review 125:131, 2018) developed the Oxford Utilitarianism Scale (OUS) based on two subscales, which measure the commitment to impartial beneficence and the willingness to cause harm for the greater good. In this article, I argue that the impartial beneficence subscale, which breaks ground with previous research on utilitarian moral psychology, does not distinctively measure utilitarian moral judgment. I argue that Kantian ethics captures the all-encompassing impartial concern for the well-being (...) of all human beings. The Oxford Utilitarianism Scale draws, in fact, a point of division that places Kantian and utilitarian theories on the same track. I suggest that the impartial beneficence subscale needs to be significantly revised in order to capture distinctively utilitarian judgments. Additionally, I propose that psychological research should focus on exploring multiple sources of the phenomenon of impartial beneficence without categorizing it as exclusively utilitarian. (shrink)

There is virtually no philosophical consensus on what, exactly, imperfect duties are. In this paper, I lay out three criteria which I argue any adequate account of imperfect duties should satisfy. Using beneficence as a leading example, I suggest that existing accounts of imperfect duties will have trouble meeting those criteria. I then propose a new approach: thinking of imperfect duties as duties held by groups, rather than individuals. I show, again using the example of beneficence, that this (...) proposal can satisfy the criteria, explaining how something can both have the necessity characteristic of duty, while also allowing agents the latitude which seems to attach to imperfect duties. (shrink)

My objective of this paper is to suggest and workout a more credible form of the Principle of Beneficence from the common essential elements of the three major ethical theories (Deontology, Utilitarianism and Virtue Ethics) that will try to overcome the over-demanding objection of Utilitarianism and the rigorism of Kant’s Deontology. After analyzing these three moral systems, I find that beneficence lies within the very essence of humanity. Human beings are superior to other creatures in the world due (...) to rationality and humanity. From the humanitarian ground, a common goodness lies within every human. Beneficence, as a moral principle, is derived from this inner humanity of every individual. Despite their initial differences, utilitarianism, deontology and virtue ethics recognize this fundamental humanitarian disposition of doing good for all as a part of being a morally better person. The principle of beneficence as I suggest, is different from its consequential utilitarian notion suggested by Mill. This version of beneficence is more credible as it does not impose excessive demands upon an individual to develop any maximum beneficial outcome following utilitarian calculation of beneficence over cost, and it also strives to overcome the rigorous duty-based theory of Kantian deontology by appealing to the fundamental virtue of humanity. Finally, the credibility of this form of beneficence comes from the underlying transcendental humanism which is the chief feature of Indian tradition. (shrink)

Do adult children have a particular duty, or set of duties, to their aging parents? What might the normative source and content of filial obligation be? This chapter examines Kant’s duty of beneficence in The Doctrine of Virtue and the Groundwork, suggesting that at its core, performance of filial duty occurs in response to the needs of aging parents. The duty of beneficence accounts for inevitable vulnerabilities that befall human rational beings and reveals moral agents as situated in (...) communities of dependence and mutual aid. Other accounts of filial obligation, such as those based on a notion of gratitude, virtue, or friendship, generate various difficulties and fail to adequately address and emphasize four morally significant features of the adult child/ aging parent relationship. First, the relationship between adult children and their aging parents is one of dependency created by the increasing frailty and need of those parents. Second, the obligations that adult children have to aging parents take place in the context of a relationship not voluntarily assumed, but not coerced. Third, given a cultural tendency toward paternalistic care of elderly individuals, the content of filial obligation should safeguard against such treatment. Fourth, because dependency relations between adult children and aging parents can involve an immense degree of sacrifice on the part of the caretaker, an acknowledgment of duties should be accompanied by a concurrent acknowledgment of the necessary limitation of duties. Addressing these four issues is essential in offering a coherent account of the normative source, content, nature, and scope of adult children’s duty to care for their aging parents. This essay demonstrates that the Kantian duty of beneficence, when functioning as the philosophical foundation of filial obligation, allows for ample light to be shed upon and for proper analysis to take place of these four issues. (shrink)

A life without liberty and material resources is not a good life. Equally, a life devoid of meaningful social relationships—such as friendships, family attachments, and romances—is not a good life. From this it is tempting to conclude that just as individuals have rights to liberty and material resources, they also have rights to access meaningful social relationships. I argue that this conclusion can be defended only in a narrow set of cases. ‘Pure’ social relationship deprivation—that is, deprivation that is not (...) caused, or accompanied, by deficits in liberties and material resources— mostly generates demands of private beneficence. I suggest that social relationship deprivation is unjust, hence a rights violation, only when it is due to factors—such as one’s race—that are irrelevant to one’s being a good participant in social relationships. I thus conclude that access to meaningful social relationships is not a fundamental concern for theories of justice. (shrink)

I contend that there are important moral reasons for individuals, organisations and states to aid others that have gone largely unrecognised in the literature. Most of the acknowledged reasons for acting beneficently in the absence of a promise to do so are either impartial and intrinsic, on the one hand, being grounded in properties internal to and universal among individuals, such as their pleasure or autonomy, or partial and extrinsic, on the other, being grounded in non-universal properties regarding an actual (...) relation to the agent, such as common membership in a family or culture. In contrast, I articulate and defend the existence of two unrecognised reasons for beneficence that can take the form of being impartial and extrinsic. One is that a being’s capacity to be part of a sharing relationship with us can provide some reason to help it, and another is that a sharing relationship qua relationship is an end-in-itself that can provide some reason to help another. I differentiate these considerations from one another and from the more standard reasons for beneficence, provide arguments for thinking that they are central to beneficence, and rebut objections that are likely to be offered by friends of the more standard reasons. (shrink)

Volume 20, Issue 3, March 2020, Page 71-73.

Philosophers who defend a person’s right, under certain circumstances, to end his own life or to have a physician end it for him typically appeal both to respect for patient autonomy and to considerations of beneficence. Neither autonomy alone nor beneficence alone can ground a persuasive case for euthanasia. I argue, however, that the standard argument for euthanasia is unsound. It is not possible to combine the principles of autonomy and beneficence in such a way as to (...) justify euthanasia for those who request it and are either incurably ill, in irremediable pain, or fearful of future incapacity, while excluding both involuntary euthanasia and assisted death for those who request it despite being neither incurably ill, in irremediable pain nor fearful of future incapacity. (shrink)

There is a familiar problem in moral theories that recognize positive obligations to help others related to the practical room these obligations leave for ordinary life, and the risk that open-ended obligations to help others will consume our lives and resources. Responding to this problem, Kantians have tended to emphasize the idea of limits on positive obligations but are typically unsatisfactorily vague about the nature and extent of these limits. I argue here that aspects of Kant’s discussion of duties of (...) virtue owed to ourselves suggest a useful metric we can use in discussing these limits and that generalizing this account and combining it with elements of Barbara Herman’s view, offers us an attractive model of moral deliberation with the resources we need to engage the critic’s challenge properly. (shrink)

Respect for autonomy and beneficence are frequently regarded as the two essential principles of medical ethics, and the potential for these two principles to come into conflict is often emphasised as a fundamental problem. On the one hand, we have the value of beneficence, the driving force of medicine, which demands that medical professionals act to protect or promote the wellbeing of patients or research subjects. On the other, we have a principle of respect for autonomy, which demands (...) that we respect the self-regarding decisions of individuals. As well as routinely coming into opposition with the demands of beneficence in medicine, the principle of respect for autonomy in medical ethics is often seen as providing protection against beneficial coercion (i.e. paternalism) in medicine. However, these two values are not as straightforwardly opposed as they may appear on the surface. In fact, the way that we understand autonomy can lead us to implicitly sanction a great deal of paternalistic action, or can smuggle in paternalistic elements under the guise of respect for autonomy. -/- This paper is dedicated to outlining three ways in which the principle of respect for autonomy, depending on how we understand the concept of autonomy, can sanction or smuggle in paternalistic elements. As the specific relationship between respect for autonomy and beneficence will depend on how we conceive of autonomy, I begin by outlining two dominant conceptions of autonomy, both of which have great influence in medical ethics. I then turn to the three ways in which how we understand or employ autonomy can increase or support paternalism: firstly, when we equate respect for autonomy with respect for persons; secondly, when our judgements about what qualifies as an autonomous action contain intersubjective elements; and thirdly, when we expect autonomy to play an instrumental role, that is, when we expect people, when they are acting autonomously, to act in a way that promotes or protects their own wellbeing. I then provide a proposal for how we might work to avoid this. I will suggest that it may be impossible to fully separate paternalistic elements out from judgements about autonomy. Instead, we are better off looking at why we are motivated to use judgements about autonomy as a means of restricting the actions of patients or research subjects. I will argue that this is a result of discomfort about speaking directly about our beneficent motivations in medical ethics. Perhaps we can reduce the incentive to smuggle in these beneficent motivations under the guise of autonomy by talking directly about beneficent motivations in medicine. This will also force us to recognise paternalistic motivations in medicine when they appear, and to justify paternalism where it occurs. (shrink)

The view that it is better for life to be created free of disability is pervasive in both common sense and philosophy. We cast doubt on this view by focusing on an influential line of thinking that manifests it. That thinking begins with a widely-discussed principle, Procreative Beneficence, and draws conclusions about parental choice and disability. After reconstructing two versions of this argument, we critique the first by exploring the relationship between different understandings of well-being and disability, and the (...) second by more briefly focusing on the idea of a significant reason. By placing these results against the broader historical and ongoing contexts in which the lives of those with disabilities have been deemed of inferior quality, we conclude with a call for greater humility about disability and well-being in thought and practice. (shrink)

Can robots have significant moral status? This is an emerging topic of debate among roboticists and ethicists. This paper makes three contributions to this debate. First, it presents a theory – ‘ethical behaviourism’ – which holds that robots can have significant moral status if they are roughly performatively equivalent to other entities that have significant moral status. This theory is then defended from seven objections. Second, taking this theoretical position onboard, it is argued that the performative threshold that robots need (...) to cross in order to be afforded significant moral status may not be that high and that they may soon cross it (if they haven’t done so already). Finally, the implications of this for our procreative duties to robots are considered, and it is argued that we may need to take seriously a duty of ‘procreative beneficence’ towards robots. (shrink)

Artificial Intelligence (AI) is already having a major impact on society. As a result, many organizations have launched a wide range of initiatives to establish ethical principles for the adoption of socially beneficial AI. Unfortunately, the sheer volume of proposed principles threatens to overwhelm and confuse. How might this problem of ‘principle proliferation’ be solved? In this paper, we report the results of a fine-grained analysis of several of the highest-profile sets of ethical principles for AI. We assess whether these (...) principles converge upon a set of agreed-upon principles, or diverge, with significant disagreement over what constitutes ‘ethical AI.’ Our analysis finds a high degree of overlap among the sets of principles we analyze. We then identify an overarching framework consisting of five core principles for ethical AI. Four of them are core principles commonly used in bioethics: beneficence, non-maleficence, autonomy, and justice. On the basis of our comparative analysis, we argue that a new principle is needed in addition: explicability, understood as incorporating both the epistemological sense of intelligibility (as an answer to the question ‘how does it work?’) and in the ethical sense of accountability (as an answer to the question: ‘who is responsible for the way it works?’). In the ensuing discussion, we note the limitations and assess the implications of this ethical framework for future efforts to create laws, rules, technical standards, and best practices for ethical AI in a wide range of contexts. (shrink)

In this paper, I argue that within Kantianism, widespread indifference of the global rich to the suffering of the global poor should be understood as resulting at least partly from vice. Kant had much more to say about vice than is often recognized, and it forms a crucial part of his moral anthropology. Kantians should thus attend to the ways in which vice functions as a practical obstacle to fulfilling duties of beneficence. In vice-fueled indifference, inclinations associated with self-love (...) and self-conceit work their way into our wills, interfering with our moral commitments by impeding our ability to recognize moral requirements and our motivation to act on them. Vice distorts our reasoning in ways that promote self-deception and rationalization about the extent to which we are fulfilling moral demands. Kantian vice also has social dimensions. I argue that widespread indifference exacerbates our individual vices through social norms and practices that legitimize ignoring the needs of others. I conclude by offering some potential remedies to indifference within the Kantian framework. (shrink)

This article explores the Nuffield Council on Bioethics’ recent report about non-invasive prenatal testing. Given that such testing is likely to become the norm, it is important to question whether there should be some ethical parameters regarding its use. The article engages with the viewpoints of Jeff McMahan, Julian Savulescu, Stephen Wilkinson and other commentators on prenatal ethics. The authors argue that there are a variety of moral considerations that legitimately play a significant role with regard to (prospective) parental decision-making (...) in the context of NIPT, for example, views on the morality of abortion and understandings of the impact of disability on quality of life. The variable nature of such considerations, both singularly and combined, suggests that any approach to NIPT should be sensitive to and understanding of similarly variable parental assessments and decisions. The implications of the approach developed for current and future policies in this area are explored, along with the impact of such arguments on ideas about procreative beneficence. (shrink)

“Violence” and “nonviolence” are, increasingly, misleading translations for the Sanskrit words hiṃsā and ahiṃsā—used by Gandhi as the basis for his philosophy of satyāgraha. I argue for rereading hiṃsā as “maleficence” and ahiṃsā as “beneficence.” These two more mind-referring English words capture the primacy of intention implied by Gandhi’s core principles. Reflecting a political turn in moral accountability detectable through linguistic data, both the scope and the usage of the word “violence” have expanded dramatically, making it harder to convincingly (...) characterize people and actions as “nonviolent.” New terminology could clarify the distinction between hiṃsā and ahiṃsā, and, thereby, prevent misunderstandings of Gandhi. Training in beneficence would reflect Gandhi’s psychological path to reducing avoidable harm: ego-detachment, universal love, and seeking truth by experiment. -/- NOTE: An extended, unpublished version, with additional arguments and evidence, is also available on PhilPapers as "The Primacy of Intention and the Duty to Truth: A Gandhi-Inspired Argument for Retranslating Hiṃsā and Ahiṃsā, with Connections to History, Ethics, and Civil Resistance". (shrink)

Recent research has relied on trolley-type sacrificial moral dilemmas to study utilitarian versus nonutili- tarian modes of moral decision-making. This research has generated important insights into people’s attitudes toward instrumental harm—that is, the sacrifice of an individual to save a greater number. But this approach also has serious limitations. Most notably, it ignores the positive, altruistic core of utilitarianism, which is characterized by impartial concern for the well-being of everyone, whether near or far. Here, we develop, refine, and validate a (...) new scale—the Oxford Utilitarianism Scale—to dissociate individual differences in the ‘negative’ (permissive attitude toward instrumental harm) and ‘positive’ (impartial concern for the greater good) dimensions of utilitarian thinking as manifested in the general population. We show that these are two independent dimensions of proto-utilitarian tendencies in the lay population, each exhibiting a distinct psychological profile. Empathic concern, identification with the whole of humanity, and concern for future generations were positively associated with impartial beneficence but negatively associated with instrumental harm; and although instrumental harm was associated with subclinical psychopathy, impartial beneficence was associated with higher religiosity. Importantly, although these two dimensions were independent in the lay population, they were closely associated in a sample of moral philosophers. Acknowledging this dissociation between the instrumental harm and impartial beneficence components of utilitarian thinking in ordinary people can clarify existing debates about the nature of moral psychology and its relation to moral philosophy as well as generate fruitful avenues for further research. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

Many advocate practices of ‘local food’ or ‘locavorism’ as a partial solution to the injustices and unsustainability of contemporary food systems. I think that there is much to be said in favor of local food movements, but these virtues are insufficient to immunize locavorism from criticism. In particular, three duties of international ethics—beneficence, repair and fairness—may provide reasons for constraining the developed world’s permissible pursuit of local food. A complete account of why (and how) the fulfillment of these duties (...) constrains locavorism will require extensive empirical evidence about the relationship between agricultural demand-led industrialization, international trade (rules), and local food practices. In this paper I can only gesture at some of this evidence and, for that reason, my policy prescriptions are merely provisional. Instead, the upshot of this paper is that advocates of locavorism ought to be attentive to the empirical-dependence of the moral permissibility of their projects. As local food ‘scales up’—and comes to be embraced as a goal of political communities—these concerns should receive even greater attention. (shrink)

Perioperative staff are frequently exposed to surgical smoke or plume created by using heat-generating devices like diathermy and lasers. This is a concern due to mounting evidence that this exposure can be harmful with no safe level of exposure yet identified. First, I briefly summarise the problem posed by surgical smoke exposure and highlight that many healthcare organisations are not sufficiently satisfying their legal and ethical responsibilities to protect their staff from potential harm. Second, I explore the ethical case for (...) compulsory smoke evacuation systems using the principlist framework and its four ethical principles – autonomy, beneficence, nonmaleficence, and justice. I then consider some objections and argue that surgical smoke evacuation systems – when indicated – should be made compulsory. (shrink)

Euthanasia and assisted suicide have proved to be very contentious topics in medical ethics. Some ethicists are particularly concerned that allowing physicians to carry out these procedures will undermine their professional obligations and threaten the very goals of medicine. However, I maintain that the fundamental goals of medicine not only do not preclude the practice of euthanasia and assisted suicide by physicians, but can in fact be seen to support these practices in some instances. I look at two influential views (...) of the goals of medicine, one based on the broad guiding principles of autonomy, beneficence and nonmaleficence, and the other focusing on several more concrete aims, concluding that both approaches can be seen to support euthanasia and assisted suicide. I then turn to the popular concern that allowing physicians to carry out euthanasia and assisted suicide will lead to widespread abuse. I argue that the possibility for abuse can be minimised if we make the patient's autonomous consent an essential requirement of the practice. (shrink)

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' notion of autonomy that (...) uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously. (shrink)

The words "violence" and "nonviolence" are increasingly misleading translations for the Sanskrit words hiṃsā and ahiṃsā -- which were used by Gandhi as the basis for his philosophy of satyāgraha. I argue for re-reading hiṃsā as “maleficence” and ahiṃsā as “beneficence.” These two more mind-referring English words – associated with religiously contextualized discourse of the past -- capture the primacy of intention implied by Gandhi’s core principles, better than “violence” and “nonviolence” do. Reflecting a political turn in moral accountability (...) detectable through linguistic data, both the scope and the usage of the word “violence” have expanded dramatically. The expanded scope of “violence” reflects greater consciousness of the various forms that serious harm can take, but also makes it harder to convincingly characterize people and actions as “nonviolent.” New translations could clarify the distinction between hiṃsā and ahiṃsā, and thereby prevent some misunderstandings of Gandhi. Training in beneficence would reflect Gandhi’s psychological path to reducing avoidable harm: detachment from the ego, learning to love universally, and seeking truth by experiment. (shrink)

Sidgwick claimed Kant as one of his moral philosophical masters. This did not prevent Sidgwick from registering pointed criticisms of most of Kant’s main claims in ethics. This paper explores the practical ethics of Sidgwick and Kant. In § I, I outline the element of Kant’s theoretical ethics that Sidgwick endorsed. In §§ II and III, I outline and adjudicate some of their sharpest disagreements in practical ethics, on the permissibility of lying and on the demands of beneficence. In (...) § IV, I argue that compared to Kant, Sidgwick has a better strategy for overcoming disagreement in practical ethics. §V sums things up. (shrink)

Duties of beneficence are said to allow for leeway to discharge them. By distinguishing between two different types of leeway, Mejia identified three structurally different duties of beneficence. In this Commentary I deploy those distinctions to clarify the nature of a fourth type of duty of beneficence, one prompted by a global pandemic, a duty with a peculiar, and seldom recognized, conceptual logic. I provide some guidelines that should orient managers when they take themselves to be fulfilling (...) such a duty on behalf of shareholders. (shrink)

Principles of procreative beneficence (PPBs) hold that parents have good reasons to select the child with the best life prospects. Sparrow (2010) claims that PPBs imply that we should select only female children, unlesswe attach normative significance to “normal” human capacities. We argue that this claim fails on both empirical and logical grounds. Empirically, Sparrow’s argument for greater female wellbeing rests on a selective reading of the evidence and the incorrect assumption that an advantage for females would persist even (...) when a serious gender imbalance is obtained. Logically, PPBs cite only pro tanto reasons and allow that the good of an individual child could be outweighed by other morally relevant considerations, such as those which take collectively suboptimal outcomes into account. There is thus no need to attach value to the “normal.”. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report on the (...) difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed (...) consent influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. (shrink)

Biomarker-based predictive tests for subjectively asymptomatic Alzheimer’s disease (AD) are utilized in research today. Novel applications of artificial intelligence (AI) promise to predict the onset of AD several years in advance without determining biomarker thresholds. Until now, little attention has been paid to the new ethical challenges that AI brings to the early diagnosis in asymptomatic individuals, beyond contributing to research purposes, when we still lack adequate treatment. The aim of this paper is to explore the ethical arguments put forward (...) for AI aided AD prediction in subjectively asymptomatic individuals and their ethical implications. The ethical assessment is based on a systematic literature search. Thematic analysis was conducted inductively of 18 included publications. The ethical framework includes the principles of autonomy, beneficence, non-maleficence, and justice. Reasons for offering predictive tests to asymptomatic individuals are the right to know, a positive balance of the risk-benefit assessment, and the opportunity for future planning. Reasons against are the lack of disease modifying treatment, the accuracy and explicability of AI aided prediction, the right not to know, and threats to social rights. We conclude that there are serious ethical concerns in offering early diagnosis to asymptomatic individuals and the issues raised by the application of AI add to the already known issues. Nevertheless, pre-symptomatic testing should only be offered on request to avoid inflicted harm. We recommend developing training for physicians in communicating AI aided prediction. (shrink)

If you focus your charitable giving on global causes where it will do the most good, how should you feel about passing by the local soup kitchen? Would the ideally virtuous agent have their (local) empathy still activated, but simply overridden by the recognition that distant others are in even greater need, leaving the agent feeling torn? Or would their empathetic impulses be wholeheartedly redirected towards the greatest needs? This chapter suggests a way to revise an outdated conception of moral (...) virtue to better meet the demands of a cosmopolitan moral outlook. (shrink)

For decades, student ratings of university faculty have been used by administrators in high stakes faculty employment decisions such as tenure, promotion, contract renewal and reappointment, and merit pay. However, virtually no attention has been paid to the ethical questions of using ratings in employment decisions. Instead, the ratings literature is generally limited to psychometric issues such as whether a given student ratings instrument exhibits the statistical properties of reliability and validity. There is no consensus understanding of teaching effectiveness, the (...) very attribute that students are alleged to “evaluate.” What students are actually doing when they complete a ratings form—whether measuring, evaluating, reporting, judging, opining, etc.—remains unsettled in the ratings literature. If ratings are surveys of student satisfaction, they have no logical or ethical connection with teaching expertise. I argue that the administrative use of student ratings in faculty employment decisions violates basic moral principles including nonmaleficence, beneficence, professional autonomy and clinical independence, and multiple aspects of justice including due care, truthfulness, and equitable treatment. These ethical violations rule against any administrative use of student ratings in faculty employment decisions, including the “use with caution in conjunction with other evaluative methods” deployment of student ratings. My conclusion is that such use should be immediately and universally terminated. Formative use of student questionnaires as part of ordinary instructional communication and feedback between instructor and students is a separate issue and outside of the scope of this paper. (shrink)