Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals who fail to share responsibility for not doing enough to address the diseases associated with substance use. The purpose of this paper is to (...) explore the interrelatedness between the ethics of a merit-based system of moral responsibility and the lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An interdisciplinary approach to the argument against the lower prioritists is taken with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices of healthcare and transplant committees. Lower priority setting is challenged, and an argument is offered in which substance users are assigned higher priority when relying on "doing enough" in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori nor a posteriori concerning meritorious behavior. (shrink)

Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals who fail to share responsibility for not doing enough to address the diseases associated with substance use. The purpose of this paper is to (...) explore the interrelatedness between the ethics of a merit-based system of moral responsibility and the lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An interdisciplinaryapproach to the argument against the lower prioritists is taken with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices of healthcare and transplant committees. Lower priority setting is challenged, and an argument is offered in which substance users are assigned higher priority when relying on "doing enough" in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori nor a posteriori concerning meritorious behavior. (shrink)

Bioethical discourse on organ donation and transplantation medicine covers a wide range of topics, from informed consent procedures and scarcity issues up to transplant tourism and organ trade. Over the past decades, this discourse evolved into a stream of documents of bewildering proportions, encompassing thousands of books, papers, conferences, blogs, consensus meetings, policy reports, media debates and other outlets. Beneath the manifest level of discourse, however, a more latent dimension can be discerned, revolving around issues of embodiment, the moral status (...) of the human body and the concept of bodily integrity. This publication aims to bring these “deeper” questions to the fore. What is envisioned is a “depth” ethics (the moral equivalent of a depth psychology) focussing on the tensions, conflicts and ambiguities at work in bioethical deliberations on organ transplantation, fuelling the viewpoints articulated on the more manifest levels of discourse. Organ donation reopens the question of the status of the body as something which we have, but at the same time are, and as something which constitutes a whole, while at the same time being a set of replaceable elements or parts. (shrink)

In this paper, I claim that live uterus donors ought to be considered for the possibility of compensation. I support my claim on the basis of comparable arguments which have already been applied to gamete donation, surrogacy, and other kinds of organ donation. However, I acknowledge that there are specificities associated with uterus donation, which make the issue of incentive and reward a harder ethical case relative to gamete donation, surrogacy, and other kinds of organ donation. Ultimately, I contend that (...) while reimbursement for the costs incurred by live uterus donors should be treated as a necessary ethical minimum, how much further we ought to remunerate uterus donations remains an open question. (shrink)

A dissociated area of medical research warrants bioethical consideration: a proposed transplantation of a donor’s entire body, except head, to a patient with a fatal degenerative disease. The seeming improbability of such an operation can only underscore the need for thorough bioethical assessment: Not assessing a case of such potential ethical import, by showing neglect instead of facing the issue, can only compound the ethical predicament, perhaps eroding public trust in ethical medicine. This article discusses the historical background of full-body (...) transplantation, documents the seriousness of its current pursuit, and builds an argument for why prima facie this type of transplant is bioethically distinct. Certainly, this examination can only be preliminary, indicating what should be a wide and vigorous discussion among practitioners and ethicists. It concludes with practical suggestions for how the medical and bioethics community may proceed with ethical assessment. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used to (...) save a greater number of other lives. This argument has not yet been advanced in debates over expanded procurement and could buttress existing concerns about expanded procurement. To support this argument, I review existing empirical data on the cost‐effectiveness of transplantation and compare them to data on interventions for other illnesses. These data should motivate utilitarians and others whose primary goal is maximizing population‐wide health benefits to doubt the merits of expanding organ procurement. I then consider two major objections: one makes the case that transplant candidates have a special claim to medical resources, and the other challenges the use of cost‐effectiveness to set priorities. I argue that there is no reason to conclude that transplant candidates’ medical interests should receive special priority, and that giving some consideration to cost‐effectiveness in priority setting requires neither sweeping changes to overall health priorities nor the adoption of any specific, controversial metric for assessing cost‐effectiveness. Before searching for more organs, we should first ensure the provision of cost‐effective care. (shrink)

Joshua Mezrich is a practicing transplant surgeon who draws on his experiences, and those of his patients, to provide a "here's where we're at" moment in the story of transplant medicine. In so doing, he explains what it is like to practice while telling the stories of his patients, donors, and the pioneering surgeons who persisted in the face of failure to make what Mezrich does a work of healing. Written for a popular audience, When Death Becomes Life is perhaps (...) the most accessible work yet on the modern history of organ transplantation and what the current "standard of care" actually looks like. Indeed, it rounds out a "trinity" of quality books about the transplant experience, this one from the surgeon's... (shrink)

This paper deals with the core version of the Trolley Problem. In one case many people favor an act which will bring about the death of one person but save five other persons. In another case most people would refuse to “sacrifice” one person in order to save five other lives. Since the two cases seem similar in all relevant respects, we have to explain and justify the diverging verdicts. Since I don’t find current proposals of a solution convincing, I (...) propose an alternative one according to which —but not —violates two forms of equality. I also test the underlying egalitarian principle against other cases. I argue that it offers a good explanation and also a normative justification of our intuitive verdicts about the cases. (shrink)

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child’s right to an open future. Individual consent to transplant is (...) in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs. (shrink)

This academic paper on Ethical issues of using umbilical cord blood stem cell therapy of John Stuart Mill perspective aim to investigate the new approaches in the treatment of diseases by using umbilical cord blood stem cells. And also to study ethical issues from the use of umbilical cord blood stem cells in the treatment of diseases considered by Mill’s utilitarianism. 21st century, the medical industry was interested in organ transplantation from stem cells especially stem cells from the umbilical cord (...) to treat chronic and degenerative organ diseases, blood cancer and organ transplantation which successful and widespread throughout the world. Thailand has about 900 new children with Leukemia every year. About 50 percent are leukemia which needs to be treated correctly and urgently. In general Standardized chemotherapy but if the cancer patient has a bad prognosis Or have recurrent cancer Patients need to be treated with bone marrow transplants or stem cells to have a chance to heal. According to Mill’s Utilitarianism, the ethical concepts that determine what is the basic criterion used to determine whether it should or should not concern with the popular benefit that the criterion used is the amount of happiness that results from actions. Treating the disease using stem cells will make the patient recover from the disease, healthier and happier in life. As Mill said "The correctness of an action depends on the tendency that the action will lead to happiness. (shrink)

Janet Radcliffe Richards’ The Ethics of Transplants outlines a novel framework for moral inquiry in practical contexts and applies it to the topic of paid living kidney donation. In doing so, Radcliffe Richards makes two key claims: that opponents of organ markets bear the burden of proof, and that this burden has not yet been satisfied. This paper raises four related objections to Radcliffe Richards’ methodological framework, focusing largely on how Radcliffe Richards uses this framework in her discussion (...) of kidney sales. We conclude that Radcliffe Richards’ method of inquiry hinders our ability to answer the very question that it ought to help us resolve: What is there best reason to do, all things considered? (shrink)

Formal clinical trials of pig-to-human organ transplant—known as xenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there (...) have been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time. (shrink)

An analysis of the identity issues involved in facial allograft transplantation is provided in this paper. The identity issues involved in organ transplantation in general, under both theoretical accounts of personal identity and subjective accounts provided by organ recipients, are examined. It is argued that the identity issues involved in facial allograft transplantation are similar to those involved in organ transplantation in general, but much stronger because the face is so closely linked with personal identity. Recipients of facial allograft transplantation (...) have the potential to feel that their identity is a mix between their own and the donor’s, and the donor’s family is potentially likely to feel that their loved one ‘‘lives on’’. It is also argued that facial allograft transplantation allows the recipients to regain an identity, because they can now be seen in the social world. Moreover, they may regain expressivity, allowing for them to be seen even more by others, and to regain an identity to an even greater extent. Informing both recipients and donors about the role that identity plays in facial allograft transplantation could enhance the consent process for facial allograft transplantation and donation. (shrink)

We explore the ethics of using motivational interviewing, an evidence-based, client-centred and directional counselling method, in conversations with next of kin about deceased solid organ donation. After briefly introducing MI and providing some context around organ transplantation and next of kin consent, we describe how MI might be implemented in this setting, with the hypothesis that MI has the potential to bring about a modest yet significant increase in next of kin consent rates. We subsequently consider the objection that (...) using MI in this context would be manipulative. Although we cannot guarantee that MI would never be used in a problematically manipulative fashion, we conclude that its use would, nevertheless, be permissible as a potential means to increase next of kin consent to deceased solid organ donation. We propose that MI be trialled in consent situations with next of kin in nations where there is widespread public support for organ donation. (shrink)

In Canada, there are currently no guidelines at either the federal or provincial level regarding the provision of kidney transplantation services to foreign nationals (FN). Renal transplant centres have, in the past, agreed to put refugee claimants and other FNs on the renal transplant waiting list, in part, because these patients (refugee claimants) had health insurance through the Interim Federal Health Programme to cover the costs of medication and hospital care. However, severe cuts recently made to this programme have forced (...) clinicians to question whether they should continue with transplants for FNs, for financial and ethical reasons. This paper first examines different national policies (eg, in Canada, USA, France and the UK) to map the diversity of approaches regarding transplantation for FNs, and then works through different considerations commonly used to support or oppose the provision of organs to these patients: (1) the organ shortage; (2) the free-rider problem; (3) the risk of becoming a transplant destination; (4) the impact on organ donation rates; (5) physicians’ duties; (6) economic concerns; (7) vulnerability. Using a Canadian case as a focus, and generalising through a review of various national policies, we analyse the arguments for and against transplantation for FNs with a view to bringing clarity to what is a sensitive political and clinical management issue. Our aim is to help transplant centres, clinicians and ethicists reflect on the merits of possible options, and the rationales behind them. (shrink)

The Australian Federal Government has announced a two-year trial scheme to compensate living organ donors. The compensation will be the equivalent of six weeks paid leave at the rate of the national minimum wage. In this article I analyse the ethics of compensating living organ donors taking the Australian scheme as a reference point. Considering the long waiting lists for organ transplantations and the related costs on the healthcare system of treating patients waiting for an organ, the 1.3 million (...) AUD the Australian Government has committed might represent a very worthwhile investment. I argue that a scheme like the Australian one is sufficiently well designed to avoid all the ethical problems traditionally associated with attaching a monetary value to the human body or to parts of it, namely commodification, inducement, exploitation, and equality issues. Therefore, I suggest that the Australian scheme, if cost-effective, should represent a model for other countries to follow. Nonetheless, although I endorse this scheme, I will also argue that this kind of scheme raises issues of justice in regard to the distribution of organs. Thus, I propose that other policies would be needed to supplement the scheme in order to guarantee not only a higher number of organs available, but also a fair distribution. (shrink)

Bioethical discourse on organ donation covers a wide range of topics, from informed consent procedures and scarcity issues up to ‘transplant tourism’ and ‘organ trade’. This paper presents a ‘depth ethics’ approach, notably focussing on the tensions, conflicts and ambiguities concerning the status of the human body. These will be addressed from a psychoanalytical angle. First, I will outline Lacan’s view on embodiment as such. Subsequently, I will argue that, for organ recipients, the donor organ becomes what Lacan refers (...) to as an object a, the ‘partial object’ of desire, the elusive thing we are deprived of, apparently beyond our grasp. Within the recipient’s body an empty space emerges, a kind of ‘vacuole’, once occupied by a faltering organ. This space can only be filled by a ‘gift’ from the other, by an object a. Once implanted, however, this implant becomes an ‘extimate’ object: something both ‘external’ and ‘intimate’, both ‘embedded’ and ‘foreign’, and which is bound to remain an object of concern for quite some time, if not for life. A Lacanian analysis allows us, first of all, to address the question what organ transplantation has in common with other bodily practices involving bodily parts procured from others, such as cannibalism. But it also reveals the basic difference between the two, as well as the distance between the ‘fragmented body’ of Frankenstein’s ‘monster’—as an aggregate of replaceable parts—and the multiple organ recipients of today. (shrink)

Although much has been written on the dead-donor rule in the last twenty-five years, scant attention has been paid to how it should be formulated, what its rationale is, and why it was accepted. The DDR can be formulated in terms of either a Don’t Kill rule or a Death Requirement, the former being historically rooted in absolutist ethics and the latter in a prudential policy aimed at securing trust in the transplant enterprise. I contend that the moral core (...) of the rule is the Don’t Kill rule, not the Death Requirement. This, I show, is how the DDR was understood by the transplanters of the 1960s, who sought to conform their practices to their ethics—unlike today’s critics of the DDR, who rethink their ethics in a question-begging fashion to accommodate their practices. A better discussion of the ethics of killing is needed to move the debate forward. (shrink)

Abstract Gender and Ethics Committees: Where’s the Different Voice? -/- Prominent international and national ethics commissions such as the UNESCO Bioethics Commission rarely achieve anything remotely resembling gender equality, although local research and clinical ethics committees are somewhat more egalitarian. Under-representation of women is particularly troubling when the subject matter of modern bioethics so disproportionately concerns women’s bodies, and when such committees claim to derive ‘universal’ standards. Are women missing from many ethics committees because of relatively (...) straightforward, if discriminatory, demographic factors? Or are the methods of analysis and styles of ethics to which these bodies are committed somehow ‘anti-female’? It has been argued, for example, that there is a ‘different voice’ in ethical reasoning, not confined to women but more representative of female experience. Similarly, some feminist writers, such as Evelyn Fox Keller and Donna Haraway, have asked difficult epistemological questions about the dominant ‘masculine paradigm’ in science. Perhaps the dominant paradigm in ethics committee deliberation is similarly gendered? This article provides a preliminary survey of women’s representation on ethics committees in Eastern and Western Europe, a critical analysis of the supposed ‘masculinism’ of the principlist approach, and a case example in which a ‘different voice’ did indeed make a difference. (shrink)

This descriptive study explores the views of resident physicians working in intensive care units (ICUs) concerning deceased organ donation and examines the various ethical issues surrounding organ donation encountered by residents. This was a qualitative, descriptive study utilizing solo interviews with participants together with focus group discussions. The participants' experiences and views were elicited via interviews and focus group discussions covering the following topics: ethical thoughts about deceased organ donation, barriers that impede or prevent organ donation, its effect on the (...) next of kin, and its relationship with futile treatment. The discussions were reviewed using qualitative content analysis. The residents commented that deceased organ donation is a complex and stressful process for the family of the potential donor as well as the transplant team, and still lacks wide acceptance in Turkish society. The opt-in system requires informed consent, thus creating a major barrier for both the patient’s family and the ICU team to overcome. The participants stated that new legal, ethical, and medical arrangements are needed to increase organ donation rates in Turkey. In order to increase rates of deceased organ donation and reduce cases of futile treatment, improved communication between the ICU, transplant team, and patient relatives is critical to ensure that ethical issues are properly managed. On a societal level, the subject of deceased organ donation needs to receive greater attention from public health authorities to increase public awareness. Residents can make valuable contributions to the deceased organ donation process as physicians and as psychosocial support for patients and their families. (shrink)

This descriptive study explores the views of resident physicians working in intensive care units (ICUs) concerning deceased organ donation and examines the various ethical issues surrounding organ donation encountered by residents. This was a qualitative, descriptive study utilizing solo interviews with participants together with focus group discussions. The participants' experiences and views were elicited via interviews and focus group discussions covering the following topics: ethical thoughts about deceased organ donation, barriers that impede or prevent organ donation, its effect on the (...) next of kin, and its relationship with futile treatment. The discussions were reviewed using qualitative content analysis. The residents commented that deceased organ donation is a complex and stressful process for the family of the potential donor as well as the transplant team, and still lacks wide acceptance in Turkish society. The opt-in system requires informed consent, thus creating a major barrier for both the patient’s family and the ICU team to overcome. The participants stated that new legal, ethical, and medical arrangements are needed to increase organ donation rates in Turkey. In order to increase rates of deceased organ donation and reduce cases of futile treatment, improved communication between the ICU, transplant team, and patient relatives is critical to ensure that ethical issues are properly managed. On a societal level, the subject of deceased organ donation needs to receive greater attention from public health authorities to increase public awareness. Residents can make valuable contributions to the deceased organ donation process as physicians and as psychosocial support for patients and their families. (shrink)

This chapter asks two questions about the ethics of expectations: one about the nature of expectations, and one about the wrongs of expectations. On the first question, expectations involve a rich constellation of attitudes ranging from beliefs to also include imaginings, hopes, fears, and dreams. As a result, sometimes expectations act like predictions, like your expectation of rain tomorrow, sometimes prescriptions, like the expectation that your students will do the reading, sometimes like proleptic reasons like the hope that your (...) mentee will flourish, and sometimes expectations are peremptory in that they carry the force of moral law. Turning to the second question, given the multiple roles played by expectations it shouldn’t be surprising that there are also multiple ways expectations can be wrong to hold. Sometimes they wrong as beliefs do, e.g., doxastic wronging, and sometimes they result in alienation because of who holds that expectation of us. The upshot of this chapter is that getting clear on these potential ways expectations can wrong not only delivers an ethics of expectations that mirrors familiar discussions of the ethics of belief, but an ethics of expectations further opens the door for taking seriously an ethics of mental attitudes more generally. (shrink)

Assume we could someday create artificial creatures with intelligence comparable to our own. Could it be ethical use them as unpaid labor? There is very little philosophical literature on this topic, but the consensus so far has been that such robot servitude would merely be a new form of slavery. Against this consensus I defend the permissibility of robot servitude, and in particular the controversial case of designing robots so that they want to serve human ends. A typical objection to (...) this case draws an analogy to the genetic engineering of humans: if designing eager robot servants is permissible, it should also be permissible to design eager human servants. Few ethical views can easily explain even the wrongness of such human engineering, however, and those few explanations that are available break the analogy with engineering robots. The case turns out to be illustrative of profound problems in the field of population ethics. (shrink)

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of (...) xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research. (shrink)

Over the past decade, police departments in many countries have experimented with and increasingly adopted the use of police body-worn cameras. This article aims to examine the moral issues raised by the use of PBWCs, and to provide an overall assessment of the conditions under which the use of PBWCs is morally permissible. It first reviews the current evidence for the effects of using PBWCs. On the basis of this review the article sets out a teleological argument for the use (...) of PBWCs. The final two sections of the article review two deontological objections to the use of PBWCs: the idea that use of PBWCs is based on or expresses disrespectful mistrust, and the idea that the use of PBWCs violates a right to privacy. The article argues that neither of these objections is persuasive, and concludes that we should conditionally accept and support the use of PBWCs. (shrink)

Arlie Hochschild glosses the practice of women migrants in poor nations who leave their families behind for extended periods of time to do carework in other wealthier countries as a “global heart transplant” from poor to wealthy nations. Thus she signals the idea of an injustice between nations and a moral harm for the individuals in the practice. Yet the nature of the harm needs a clear articulation. When we posit a sufficiently nuanced “right to care,” we locate the harm (...) to central relationships of the migrant women. The “right to (give and receive) care” we develop uses a concept of a relational self drawn from an ethics of care. The harm is situated in the broken relationships, which in turn have a serious impact on a person’s sense of equal dignity and self-respect, particularly since the sacrifice of central relationships of the migrant woman allows others (mostly women) to maintain these same relationships. The paper ends with a brief discussion of some of the solutions we need to consider. (shrink)

This chapter is a survey of the ethics of belief. It begins with the debate as it first emerges in the foundational dispute between W. K. Clifford and William James. Then it surveys how the disagreements between Clifford and James have shaped the work of contemporary theorists, touching on topics such as pragmatism, whether we should believe against the evidence, pragmatic and moral encroachment, doxastic partiality, and doxastic wronging.

Artificial intelligence (AI) is a digital technology that will be of major importance for the development of humanity in the near future. AI has raised fundamental questions about what we should do with such systems, what the systems themselves should do, what risks they involve and how we can control these. - After the background to the field (1), this article introduces the main debates (2), first on ethical issues that arise with AI systems as objects, i.e. tools made and (...) used by humans; here, the main sections are privacy (2.1), manipulation (2.2), opacity (2.3), bias (2.4), autonomy & responsibility (2.6) and the singularity (2.7). Then we look at AI systems as subjects, i.e. when ethics is for the AI systems themselves in machine ethics (2.8.) and artificial moral agency (2.9). Finally we look at future developments and the concept of AI (3). For each section within these themes, we provide a general explanation of the ethical issues, we outline existing positions and arguments, then we analyse how this plays out with current technologies and finally what policy conse-quences may be drawn. (shrink)

The wishes of registered organ donors are regularly set aside when family members object to donation. This genuine overruling of the wishes of the deceased raises difficult ethical questions. A successful argument for providing the family with a veto must (a) provide reason to disregard the wishes of the dead, and (b) establish why the family should be allowed to decide. One branch of justification seeks to reconcile the family veto with important ideas about respecting property rights, preserving autonomy, and (...) preventing harm. These arguments are ultimately unsuccessful. Another branch of arguments is consequentialist, pointing out the negative consequences of removing the veto. Whether construed as concerning family distress or as a potential drop in the organs available, these arguments are unsuccessful; the first fails to recognize the tremendous distress associated with waiting for an organ, while the second has little supporting evidence. A final section considers and rejects whether combining some of the arguments just examined could justify the family veto. We should thus remove the family veto in organ donation. (shrink)

According to proponents of the extended mind, bio-external resources, such as a notebook or a smartphone, are candidate parts of the cognitive and mental machinery that realises cognitive states and processes. The present chapter discusses three areas of ethical concern associated with the extended mind, namely mental privacy, mental manipulation, and agency. We also examine the ethics of the extended mind from the standpoint of three general normative frameworks, namely, consequentialism, deontology, and virtue ethics.

In this paper, I explore the possibility of developing a Kantian account of the ethics of belief by deploying the tools provided by Kant's ethics. To do so, I reconstruct epistemic concepts and arguments on the model of their ethical counterparts, focusing on the notions of epistemic principle, epistemic maxim and epistemic universalizability test. On this basis, I suggest that there is an analogy between our position as moral agents and as cognizers: our actions and our thoughts are (...) subject to the same rational norm. (shrink)

We explore the ethics of deliberately exposing consenting adults to SARS-CoV-2 to induce immunity to the virus (“DEI” for short). We explain what a responsible DEI program might look like. We explore a consequentialist argument for DEI according to which DEI is a viable harm-reduction strategy. Then we consider a non-consequentialist argument for DEI that draws on the moral significance of consent. Additionally, we consider arguments for the view that DEI is unethical on the grounds that, given that large-scale (...) DEI would be highly likely to result in some severe illnesses and deaths, DEI amounts to a form of killing. Our thesis is that incorporating a DEI program alongside the status-quo “calibrate-the-curve” responses could have significant advantages at the early stages of pandemics. These potential advantages mean that, at a minimum, research into DEI would have been justified early in the COVID-19 pandemic, and that DEI programs should be explored as potential additions to our overall approach to emerging pandemics in the future. (shrink)

In information societies, operations, decisions and choices previously left to humans are increasingly delegated to algorithms, which may advise, if not decide, about how data should be interpreted and what actions should be taken as a result. More and more often, algorithms mediate social processes, business transactions, governmental decisions, and how we perceive, understand, and interact among ourselves and with the environment. Gaps between the design and operation of algorithms and our understanding of their ethical implications can have severe consequences (...) affecting individuals as well as groups and whole societies. This paper makes three contributions to clarify the ethical importance of algorithmic mediation. It provides a prescriptive map to organise the debate. It reviews the current discussion of ethical aspects of algorithms. And it assesses the available literature in order to identify areas requiring further work to develop the ethics of algorithms. (shrink)

In this chapter we analyse the nature and ethical implications of parasocial relationships. While this type of relationship has received significant attention in other interdisciplinary fields such as celebrity studies and fan studies, philosophers have so far had very little to say about them. Parasocial relationships are usually defined as asymmetrical, in which a media-user closely relates to a media-personality as if they were a friend or family member, and where this connection is mostly unreciprocated. We focus on the most (...) typical form of this kind of relationship, between fans and celebrities. We argue that a parasocial relationship between fan and celebrity is a distinct kind of personal relationship, constituted by three basic structural asymmetries: attention, communication, and epistemic. These asymmetries give rise to a more substantial asymmetry concerning the way in which celebrities and fans have ‘directive’ or ‘interpretative’ influence over each other’s identity. This can lead to a failure of recognition respect, and generates ethical responsibilities for both fans and celebrities. We conclude by noting that the structural asymmetries we find in parasocial relationships are present in many other types of relationship, especially those in which one person holds a position of power. As such, it is valuable to pay attention to the way in which asymmetries point to forms of parasociality in these other relationships, and the extent to which they give rise to distinct ethical responsibilities. (shrink)

Philosophy strives to give us a firmer hold on our concepts. But what about their hold on us? Why place ourselves under the sway of a concept and grant it the authority to shape our thought and conduct? Another conceptualization would carry different implications. What makes one way of thinking better than another? This book develops a framework for concept appraisal. Its guiding idea is that to question the authority of concepts is to ask for reasons of a special kind: (...) reasons for concept use, which tell us which concepts to adopt, adhere to, or abandon, thereby shoring up—or undercutting—the reasons for action and belief that guide our deliberations. Traditionally, reasons for concept use have been sought either in timeless rational foundations or in concepts’ inherent virtues, such as precision and consistency. Against this, the book advances two main claims: that we find reasons for concept use in the conceptual needs we discover when we critically distance ourselves from a concept by viewing it from the autoethnographic stance; and that sometimes, concepts that conflict, or exhibit other vices such as vagueness or superficiality, are just what we need. By considering not what concepts are absolutely best, but what concepts we now need, we can reconcile ourselves to the contingency of our concepts, determine the proper place of efforts to tidy up thought, and adjudicate between competing conceptions of things,—even things as contested as liberty or free will. A needs-based approach separates helpful clarification from hobbling tidy-mindedness, and authoritative definition from conceptual gerrymandering. (shrink)

Recently, philosophers have appealed to empirical studies to argue that whenever we think that p, we automatically believe that p (Millikan 2004; Mandelbaum 2014; Levy and Mandelbaum 2014). Levy and Mandelbaum (2014) have gone further and claimed that the automaticity of believing has implications for the ethics of belief in that it creates epistemic obligations for those who know about their automatic belief acquisition. I use theoretical considerations and psychological findings to raise doubts about the empirical case for the (...) view that we automatically believe what we think. Furthermore, I contend that even if we set these doubts aside, Levy and Mandelbaum’s argument to the effect that the automaticity of believing creates epistemic obligations is not fully convincing. (shrink)

Methodological nationalism is the assumption that nation-states are the relevant units for analyzing social phenomena. Most of the social sciences recognized it as a source of bias, but not the ethics of immigration. Is this field biased by methodological nationalism—and if so, to what extent? This article takes nationalism as an implicit bias and provides a method to assess its depth. The method consists in comparing principles that ethicists commonly discuss when immigration is not at stake with principles advocated (...) in the ethics of immigration. To interpret the results, a distinction between mild and heavy bias is established. When a basic principle in ethics is underdiscussed or absent from the ethics of immigration, the field is ‘mildly biased’. When its negation is commonly advocated, the field is ‘heavily biased’. Here, the method is illustrated with two principles: equal opportunity and reparation. They are common in theories of distributive justice and of corrective justice, respectively. But in the ethics of immigration, scholars often argue for the opposite. Instead of equal opportunity, they implicitly support discrimination based on national origin; instead of sanctions or amnesty for the offenders, scholars plead amnesty for those who they otherwise regard as victims. These preliminary results suggest that the field is heavily biased: methodological nationalism seems to turn ethics into its opposite. (shrink)

Methodological nationalism is the assumption that nation-states are the relevant units for analyzing social phenomena. Most of the social sciences recognized it as a source of bias, but not the ethics of immigration. Is this field biased by methodological nationalism—and if so, to what extent? This article takes nationalism as an implicit bias and provides a method to assess its depth. The method consists in comparing principles that ethicists commonly discuss when immigration is not at stake with principles advocated (...) in the ethics of immigration. To interpret the results, a distinction between mild and heavy bias is established. When a basic principle in ethics is underdiscussed or absent from the ethics of immigration, the field is ‘mildly biased’. When its negation is commonly advocated, the field is ‘heavily biased’. Here, the method is illustrated with two principles: equal opportunity and reparation. They are common in theories of distributive justice and of corrective justice, respectively. But in the ethics of immigration, scholars often argue for the opposite. Instead of equal opportunity, they implicitly support discrimination based on national origin; instead of sanctions or amnesty for the offenders, scholars plead amnesty for those who they otherwise regard as victims. These preliminary results suggest that the field is heavily biased: methodological nationalism seems to turn ethics into its opposite. (shrink)

The most plausible line of anti-doping argumentation starts with the fact that performance enhancing substances are harmful and put at considerable risk the health and the life of those who indulge in the overwhelming promises these substances hold. From a liberal point of view, however, this is not a strong reason neither to morally reject doping altogether, nor to put a blanket ban on it; on the contrary, allowing adult, competent and informed athletes to have access to performance enhancement drugs (...) is often showcased as a liberty-related right of noninterference. In this article I will first discuss doping from the liberal point of view, especially in the light of the harm principle as it was introduced by Mill and elaborated by his successors, most notably by Joel Feinberg. Then I will examine whether – and to what degree – one’s decision to receive performance enhancement drugs would mean to use humanity in one’s own person only as a means, which would be self-defeating in the light of Kantian ethics. From this I will move one step backwards to what I consider as the core question concerning the ethics of doping, the one that is logically prior to any other in my view, and concerns the consistency of the thesis that doping may be compatible with sport. I will argue that there is an inherent logical antinomy between doing sport and using performance enhancement drugs, one that presents any argumentation in favor of doping as essentially self-contradictory. (shrink)

The recent #metoo movement has turned public attention to the problem of sex under conditions of power inequality. Is consent impaired, when you have plenty to lose (e.g. a great professional opportunity) from saying “no” to a sexual advance? And even if consent is valid, is this a morally acceptable situation, especially if one party is aware that their position of relative power will influence the other’s decision to have sex? Such situations bring to the fore not only the issues (...) of coerced sex and quid pro quo harassment (asking for sex in exchange for benefits), but the much more controversial question of whether sex between unequal but otherwise competent consenting adult partners is in principle OK—and whether institutions such as companies, universities, or the state itself should be in the business of regulating such relations. In what follows, I will outline the central concept of power asymmetry and its ethical relevance (section 2). I will then distinguish two main views about the ethics of sexual interaction under conditions of power asymmetry: a Kantian view, which categorically condemns such interactions, and a Millian view, which justifies at least some such interactions (section 3). I then briefly consider three contexts, which raise difficult questions about sex between unequals: the workplace, the university (section 4), and voluntary prostitution (section 5). Section 6 provides a short conclusion. (shrink)

Current advances in research, development and application of artificial intelligence systems have yielded a far-reaching discourse on AI ethics. In consequence, a number of ethics guidelines have been released in recent years. These guidelines comprise normative principles and recommendations aimed to harness the “disruptive” potentials of new AI technologies. Designed as a semi-systematic evaluation, this paper analyzes and compares 22 guidelines, highlighting overlaps but also omissions. As a result, I give a detailed overview of the field of AI (...) ethics. Finally, I also examine to what extent the respective ethical principles and values are implemented in the practice of research, development and application of AI systems—and how the effectiveness in the demands of AI ethics can be improved. (shrink)

Artificial Intelligence (AI) is increasingly adopted in society, creating numerous opportunities but at the same time posing ethical challenges. Many of these are familiar, such as issues of fairness, responsibility and privacy, but are presented in a new and challenging guise due to our limited ability to steer and predict the outputs of AI systems. This chapter first introduces these ethical challenges, stressing that overviews of values are a good starting point but frequently fail to suffice due to the context (...) sensitivity of ethical challenges. Frequently, additional (ethical) values emerge for specific applications, as e.g. challenges with fraud detection are very different from those around language technologies. Second, methods to tackle these challenges are discussed. Main ethical theories (virtue ethics, consequentialism, and deontology) are shown to provide a starting point, but often lack the details needed for actionable AI Ethics. Instead, mid-level philosophical theories coupled to design-approaches such as Design for Values, together with interdisciplinary working methods, offer the best way forwards. The chapter aims to show how these approaches can lead to an ethics of AI that is actionable and that can be proactively integrated in the design of AI systems. (shrink)

In this paper we address the ethics of adopting delusional beliefs and we apply consequentialist and deontological considerations to the epistemic evaluation of delusions. Delusions are characterised by their epistemic shortcomings and they are often defined as false and irrational beliefs. Despite this, when agents are overwhelmed by negative emotions due to the effects of trauma or previous adversities, or when they are subject to anxiety and stress as a result of hypersalient experience, the adoption of a delusional belief (...) can prevent a serious epistemic harm from occurring. For instance, delusions can allow agents to remain in touch with their environment overcoming the disruptive effect of negative emotions and anxiety. Moreover, agents are not blameworthy for adopting their delusions if their ability to believe otherwise is compromised. There is evidence suggesting that no evidence-related action that would counterfactually lead them to believe otherwise is typically available to them. The lack of ability to believe otherwise, together with some other conditions, implies that the agents are not blameworthy for their delusions. The examination of the epistemic status of delusions prompts us to acknowledge the complexity and contextual nature of epistemic evaluation, establish connections between consequentialist and deontological frameworks in epistemology, and introduce the notion of epistemic innocence into the vocabulary of epistemic evaluation. (shrink)

In their recently published book Nudge (2008) Richard H. Thaler and Cass R. Sunstein (T&S) defend a position labelled as ‘libertarian paternalism’. Their thinking appeals to both the right and the left of the political spectrum, as evidenced by the bedfellows they keep on either side of the Atlantic. In the US, they have advised Barack Obama, while, in the UK, they were welcomed with open arms by the David Cameron's camp (Chakrabortty 2008). I will consider the following questions. What (...) is Nudge? How is it different from social advertisement? Does Nudge induce genuine preference change? Does Nudge build moral character? Is there a moral difference between the use of Nudge as opposed to subliminal images to reach policy objectives? And what are the moral constraints on Nudge? (shrink)

The paper investigates the ethics of information transparency (henceforth transparency). It argues that transparency is not an ethical principle in itself but a pro-ethical condition for enabling or impairing other ethical practices or principles. A new definition of transparency is offered in order to take into account the dynamics of information production and the differences between data and information. It is then argued that the proposed definition provides a better understanding of what sort of information should be disclosed and (...) what sort of information should be used in order to implement and make effective the ethical practices and principles to which an organisation is committed. The concepts of “heterogeneous organisation” and “autonomous computational artefact” are further defined in order to clarify the ethical implications of the technology used in implementing information transparency. It is argued that explicit ethical designs, which describe how ethical principles are embedded into the practice of software design, would represent valuable information that could be disclosed by organisations in order to support their ethical standing. (shrink)

In this chapter we focus on the debate over publicly-maintained racist monuments as it manifests in the mid-2010s Anglosphere, primarily in the US (chiefly regarding the over 700 monuments devoted to the Confederacy), but to some degree also in Britain and Commonwealth countries, especially South Africa (chiefly regarding monuments devoted to figures and events associated with colonialism and apartheid). After pointing to some representative examples of racist monuments, we discuss ways a monument can be thought racist, and neutrally categorize removalist (...) and preservationist arguments heard in the monument debate. We suggest that both extremist and moderate removalist goals are likely to be self-defeating, and that when concerns of civic sustainability are put on moral par with those of fairness and justice, something like a Mandela-era preservationist policy is best: one which removes the most offensive of the minor racist monuments, but which focuses on closing the monumentary gap between peoples and reframing existing racist monuments. (shrink)