Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. We (...) also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)

The question of what makes someone the same person through time and change has long been a preoccupation of philosophers. In recent years, the question of what makes ordinary or lay people judge that someone is—or isn’t—the same person has caught the interest of experimental psychologists. These latter, empirically oriented researchers have sought to understand the cognitive processes and eliciting factors that shape ordinary people’s judgments about personal identity and the self. Still more recently, practitioners within an emerging discipline, experimental (...) philosophical bioethics or “bioxphi”—the focus of this chapter—have adopted a similar aim and employed similar methodologies, but with two distinctive features: (a) a special concern for enhanced ecological validity in the examples and populations studied; and (b) an interest in contributing to substantive normative debates within the wider field of bioethics. Our aim in this chapter is to sample illustrative work on personal identity in bioxphi, explore how it relates to studies in psychology covering similar terrain, and draw out the implications of this work for matters of bioethical concern. In pursuing these issues, we highlight recent work in bioxphi that includes the perceived validity of advance directives following neurodegeneration, the right of psychologically altered study participants to withdraw from research, how drug addiction may cause one to be regarded by others as “a completely different person,” the effect of deep-brain stimulation on perceptions of the self, and the potential influence of moral enhancement interventions on intuitive impressions of a person’s character. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the _diminishment_ of a capacity or function, under the right set of circumstances, could plausibly contribute (...) to an individual's overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a _welfarist_ conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing. (shrink)

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals (...) to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices. (shrink)

“Love hurts”—as the saying goes—and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could “cure” an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses—and misuses—of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

Much of modern ethics is built around the idea that we should respect one another’s autonomy. Here, “we” are typically imagined to be adult human beings of sound mind, where the soundness of our mind is measured against what we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack (...) of consent makes sex wrong.1 Consent, in turn, is analysed in terms of autonomous decision-making: a “yes” or “no” that reflects the free and informed will of our idealised, sound-minded adult. Whether such models provide adequate normative guidance for ethical, much less good, sex between neurotypical human adults is an open question.2 3 When it comes to the ethics of sexual activity between humans and non-humans—robots, say—or between humans who don’t fit the rational stereotype, we hardly know where to begin.4–7 It is therefore heartening to see a number of papers in this issue tackling the difficult question how to respectfully facilitate or respond to the needs, desires, and decisions of people with different kinds or degrees of autonomy.8 For example, Sumytra Menon and colleagues9 explicitly discuss the notion of “borderline capacity” and argue, in the medical domain, for shared and supportive decision-making practices to “foster the autonomy of patients with compromised mental capacity while being mindful of the need to safeguard their well-being.” Touching on a similar theme, Zahra Ladan 10 asks how we should conceive of liberty in the case of persons with certain inborn physical or mental limitations. Might it sometimes be necessary to …. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either good (...) or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

Our understanding of the neurochemical bases of human love and attachment, as well as of the genetic, epigenetic, hormonal, and experiential factors that conspire to shape an individual's sexual orientation, is increasing exponentially. This research raises the vexing possibility that we may one day be equipped to modify such variables directly, allowing for the creation of “high-tech” conversion therapies or other suspect interventions. In this article, we discuss the ethics surrounding such a possibility, and call for the development of legal (...) and procedural safeguards for protecting vulnerable children from the application of such technology. We also consider the more difficult case of voluntary, adult “conversion” and argue that in rare cases, such attempts might be permissible under strict conditions. (shrink)

The WHO, American Academy of Pediatrics and other Western medical bodies currently maintain that all medically unnecessary female genital cutting of minors is categorically a human rights violation, while either tolerating or actively endorsing medically unnecessary male genital cutting of minors, especially in the form of penile circumcision. Given that some forms of female genital cutting, such as ritual pricking or nicking of the clitoral hood, are less severe than penile circumcision, yet are often performed within the same families for (...) similar reasons, it may seem that there is an unjust double standard. Against this view, it is sometimes claimed that while female genital cutting has ‘no health benefits’, male genital cutting has at least some. Is that really the case? And if it is the case, can it justify the disparate treatment of children with different sex characteristics when it comes to protecting their genital integrity? I argue that, even if one accepts the health claims that are sometimes raised in this context, they cannot justify such disparate treatment. Rather, children of all sexes and genders have an equal right to bodily autonomy. This includes the right to decide whether their own ‘private’ anatomy should be exposed to surgical risk, much less permanently altered, for reasons they themselves endorse when they are sufficiently mature. (shrink)

Male circumcision—partial or total removal of the penile prepuce—has been proposed as a public health measure in Sub-Saharan Africa, based on the results of three randomized control trials showing a relative risk reduction of approximately 60 per cent for voluntary, adult male circumcision against female-to-male human immunodeficiency virus transmission in that context. More recently, long-time advocates of infant male circumcision have argued that these findings justify involuntary circumcision of babies and children in dissimilar public health environments, such as the USA, (...) Australasia and Europe. In this article, we take a close look at the necessary ethical and empirical steps that would be needed to bridge the gap between the African RCTs and responsible public health policy in developed countries. In the course of doing so, we discuss some of the main disagreements about the moral permissibility of performing a nontherapeutic surgery on a child to benefit potential future sexual partners of his. In this context, we raise concerns not only about weaknesses in the available evidence concerning such claims of benefit, but also about a child’s moral interest in future autonomy and the preservation of his bodily integrity. We conclude that circumcision of minors in developed countries on public health grounds is much harder to justify than proponents of the surgery suggest. (shrink)

Psychedelics require cross-cultural, interdisciplinary study, and we were happy to see a contribution from the field of medical anthropology. Such a study holds the promise of characterizing the ways in which psychedelics are situated in contemporary societies, both within and beyond research and clinical contexts. Here, we offer some friendly criticism of the target article by Noorani while also highlighting various points of agreement and looking ahead to future research in this field.Noorani’s article is structured around an organizing theme of (...) “containment.” The term is not formally defined, but functions more as a poetic metaphor, allowing the author to explore various ways in which psychedelics... (shrink)

This Handbook covers the most urgent, controversial, and important topics in the philosophy of sex. It is both philosophically rigorous and yet accessible to specialists and non-specialists, covering ethics, political philosophy, metaphysics, the philosophy of science, and the philosophy of language, and featuring interactions with neighboring disciplines such as psychology, bioethics, sociology, and anthropology. The volume's 40 chapters, written by an international team of both respected senior researchers and essential emerging scholars, are divided into eight parts: I. What is Sex? (...) Is Sex Good? II. Sexual Orientations III. Sexual Autonomy and Consent IV. Regulating Sexual Relationships V. Pathologizing Sex and Sexuality VI. Contested Desires VII. Commercialized Sex VIII. Technology and the Future of Sex The broad scope of coverage, depth in insight and research, and accessibility in language make The Routledge Handbook of Philosophy of Sex and Sexuality a comprehensive introduction for newcomers to the subject as well as an invaluable reference work for those advanced students and researchers in the field. (shrink)

The moral enhancement (or bioenhancement) debate seems stuck in a dilemma. On the one hand, the more radical proposals, while certainly novel and interesting, seem unlikely to be feasible in practice, or if technically feasible then most likely imprudent. But on the other hand, the more sensible proposals – sensible in the sense of being both practically achievable and more plausibly ethically justifiable – can be rather hard to distinguish from both traditional forms of moral enhancement, such as non-drug-mediated social (...) or moral education, and non-moral forms of bioenhancement, such as smart-drug style cognitive enhancement. In this essay, I argue that bioethicists have paid insufficient attention to an alternative form of moral bioenhancement – or at least a likely candidate – that falls somewhere between these two extremes, namely the (appropriately qualified) use of certain psychedelic drugs. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after (...) becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

Volume 20, Issue 8, August 2020, Page 72-75.

Historically, empirical research in bioethics has drawn on methods developed within the social sciences, including qualitative interviews, focus groups, ethnographic studies, and opinion surveys, t...

In this chapter, we introduce the notion of “moral neuroenhancement,” offering a novel definition as well as spelling out three conditions under which we expect that such neuroenhancement would be most likely to be permissible (or even desirable). Furthermore, we draw a distinction between first-order moral capacities, which we suggest are less promising targets for neurointervention, and second-order moral capacities, which we suggest are more promising. We conclude by discussing concerns that moral neuroenhancement might restrict freedom or otherwise “misfire,” and (...) argue that these concerns are not as damning as they may seem at first. (shrink)

The ‘born this way’ movement for sexual orientation minority rights is premised on the view that sexual orientation is something that can neither be chosen nor changed. Indeed, current sexual orientation change efforts appear to be both harmful and ineffective. But what if ‘high-tech conversion therapies’ are invented in the future that are effective at changing sexual orientation? The conceptual basis for the movement would collapse. In this chapter, we argue that the threat of HCT should be taken seriously, motivating (...) a change in tactics for proponents of sexual orientation minority rights. We also discuss some of the practical-ethical and public-policy issues surrounding HCT, in case the technology is one day developed. (shrink)

Efforts aimed at broadening participation in science, technology, engineering, and mathematics (STEM) require a holistic presentation of the state of racial and gender participation. Statistics currently used to describe participation often include raw counts of degrees and the percentages of demographic groups receiving STEM degrees. While these data provide insights into demographic trends, they do not present the complete picture because these “traditional” statistics do not capture how well a field of study reflects—or is proportionally similar to—a larger body, such (...) as the college population. If the goal of broadening participation in STEM education is to ensure that all racial and gender groups are proportionally represented, analysts require direct measures of representation. In this article, we present a novel metric that assesses the degree to which groups are overrepresented or underrepresented in a given field. This metric calculates field-specific representation by comparing the proportion of degrees awarded to members of a demographic group in a specific field of study with the proportion of all degrees awarded to that group. Using data from the National Science Foundation and the Department of Education, we demonstrate the efficacy of this representation metric and show that it provides new insights into STEM participation levels for women and other groups considered to be underrepresented. While traditional measurements show the increasing number of degrees awarded to and the increasing share of underrepresented minority students in STEM, our metric revealed that underrepresented minorities remain underrepresented in STEM fields, especially in engineering and the natural sciences. (shrink)

In this paper I ask how Timaeus explains change within the trianglebased part of his cosmos. Two common views are that change among physical items is somehow caused or enabled by either the forms or the demiurge. I argue for a competing view, on which the physical items are capable of bringing about change by themselves, prior to the intervention of the demiurge, and prior to their being turned into imitations of the forms. I outline three problems for the view (...) that physical things depend on the forms for their causal powers, and show how the view I propose solves each. I then add further arguments for my view, based on (a) statements by Timaeus that seem to favor my view directly, (b) implications of Timaeus’ positions that favor the view, and (c) Timaeus’ explanatory practice in the second half of his speech. (shrink)

In English, as in many other languages, male-gendered pronouns are sometimes used to refer not only to men, but to individuals whose gender is unknown or unspecified, to human beings in general (as in ―mankind‖) and sometimes even to females (as when the casual ―Hey guys‖ is spoken to a group of women). These so-called he/man or masculine generics have come under fire in recent decades for being sexist, even archaic, and positively harmful to women and girls; and advocates of (...) gender-neutral (or nonsexist) language have put forward serious efforts to discourage their use. Have they been successful, and to what extent? In this paper, I review some of the main arguments in favor of abolishing sexist male generics. I then present three studies tracking the use of he/man terminology in academic, popular, and personal discourse over the past several decades. I show that the use of these terms has fallen dramatically in recent years, while nonsexist alternatives have gradually taken their place. We may be paying witness to the early stages of the ultimate extinction of masculine generics. (shrink)

It is sometimes argued that the non-therapeutic, non-consensual alteration of children‘s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed 'female genital mutilation' or FGM), and one for boys (in which such alterations should be termed 'male circumcision‘). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children - whether female, male, or indeed intersex - should be free from (...) having parts of their genitals removed unless there is a pressing medical indication. (shrink)

For someone with an outsized influence on a field he helped to create, Dan Callahan was anything but overbearing. Physically compact, thin, and wiry in older age, he spoke at the rapid speed of his mind. Soon after I met him—when I was on the cusp of what would become a year‐long residency at The Hastings Center—I found myself seated in his decidedly quaint living room. Dan told a story that evening, one of many that has stuck in my head. (...) It seemed to encapsulate his moral mindset and, in a way, his broader vision for bioethics. I am sure he has told the story many times to many people, but here it is as I recall it. (shrink)

Over the past few years, we and our colleagues have been exploring the ethical implications of what we call “love drugs” and “anti-love drugs.” We use these terms informally to refer to “current, near-future, and more speculative distant-future technologies that would enhance or diminish, respectively, the romantic bond between couples engaged in a relationship”. In a recent “qualified defense” of our work, Andrew Andrew McGee suggests that, if we would only stop using the word “love” so expansively, our ethical proposals (...) might gain more traction. Specifically, he argues that “many of the putative instances of love” that we discuss in our papers “are not in fact... (shrink)

Near the end of his speech, Timaeus outlines a theory of bodily health and disease which has seemed to many commentators loosely unified or even inconsistent . But this section is better unified than it has appeared, and gives us at least one important insight into the workings of physical causality in the Timaeus. I argue first that the apparent disorder in Timaeus’s theory of disease is likely a deliberate effect planned by the author. Second, the taxonomy of disease in (...) the passage consists of one genus subsuming two species. Third, in Timaeus’s theory, health lies between perfect stability and a chaos of all possible motions; this indicates a conception of health as the activation of the body's powers in the right way. A power is a property directed towards bringing about some change. Fourth, the activation of these powers can change depending on the location of their possessors. This last point shows that causation among the physical items in the Timaeus involves structures as well as pushes. (shrink)

Large language models (LLMs) such as ChatGPT or Google’s Bard have shown significant performance on a variety of text-based tasks, such as summarization, translation, and even the generation of new...

In her excellent essay, Blumenthal-Barby (2024) argues that it is “time for bioethics to end talk of personhood.” She is concerned, more specifically, with “the philosophical concept of personhood,...

Pickering et al. argue that patients who refuse doctor-recommended treatments should in some cases be deemed incompetent to decide about their own medical care—in part because of their decis...

We thank Carrie Jenkins and Neil Levy for their thoughtful comments on our article about love and addiction. Although we do not have room for a comprehensive reply, we will touch on a few main issues.Jenkins points out, correctly in our view, that the word ‘addiction’ can trigger “connotations of reduced autonomy.” It may therefore be used, she argues, to “excuse” violent or otherwise harmful behaviors—disproportionately carried out by men—within the context of romantic relationships. Debates about love addiction, therefore, “are (...) best addressed with an eye to the more general issue of how we as a society apportion responsibility for things like date rape and intimate partner violence” (Jenkins... (shrink)

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of (...) ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making.In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

INTRODUCTIONIs the non-therapeutic circumcision of infant males morally permissible? The most recent major development in this long-simmering debate was the 2012 release of a policy statement and technical report on circumcision by the American Academy of Pediatrics . In these documents, the US paediatricians’ organisation claimed that the potential health benefits of infant circumcision now outweigh the risks and costs. They went on to suggest that their analysis could be taken to justify the decision of parents to choose circumcision for (...) their incompetent children.1Circumcision and ‘health benefits’The AAP's pronouncement unleashed a firestorm of commentary, much of it censorious. In this issue, human rights attorney J Steven Svoboda and Professor of Clinical Paediatrics Robert Van Howe take the AAP to taski for committing numerous significant errors, both in their analysis of relevant evidence and in basic medical-ethical reasoning.3 In addition, an independent international panel—composed of 38 leading paediatricians, paediatric surgeons, urologists, medical ethicists and heads of hospital boards and children's health societies—has likewise condemned the findings of the AAP. Writing in the journal Pediatrics, these authors state: "Only one of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.4"My own analysis of the AAP documents—and of ‘health benefits’ defences of circumcision generally—can be found elsewhere.5 Let me turn my attention in this editorial, then, to …. (shrink)

What makes conscious experience a difficult or confusing subject for science to deal with is its personal or individualistic character (that is to say the fact that a given experience is an experience apparently tied to a particular individual). It is in this respect very different from the other phenomena studied by science, where while the phenomena may be observed by a particular individual they are considered to be in principle independent of that individual. To say that an individual’s experience (...) is merely the functioning ofthat individual’s brain does not fully resolve the problem, since experiences are so very different in nature from brain processes. (shrink)

This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn to (...) the status of the genitals as ‘intimate’ anatomy—a status that is not fully erased by being in a medical context. In this editorial, we draw on the work of Talia Mae Bettcher on ‘intimate agency’ to explore why unconsented interventions into the genitalia may constitute a distinctive sort of personal violation compared to unconsented contact with various other parts of the human body. In their feature article, Marit van der Pijl and colleagues1 argue it is unethical for healthcare providers to perform unconsented episiotomies on persons in labour. In particular, they suggest that, outside of certain rare emergencies in which, for example, the person giving birth is incapacitated1 and the procedure cannot be delayed until consent becomes possible without introducing a significant risk of serious harm (call these ‘medically necessary’2 procedures), ‘presumed consent’ is the incorrect standard to apply. Instead, they stress that, especially when a proposed intervention involves a person’s genital, sexual or reproductive organs, the need to obtain their explicit consent in advance of proceeding must be honoured. As the authors note, the broader social significance of our genitalia—widely regarded as ‘private’ anatomy—is not erased by being in a medical context (see also 2–4). Boundaries must still be observed. Ethically, this ‘leaves a very small margin for error because invasion of these body parts …. (shrink)

What to do with the missing shade of blue (MSB)? Some have argued that Hume's famous thought experiment undermines his central doctrine – the ‘copy principle’ – such that he should have revised his whole theory in light of it. Others contend that the MSB is not a true or actual counterexample to the copy principle, but merely an apparent or conceivable one, so that he had no such obligation to revise. In this essay, I argue that even if the (...) MSB is a true counterexample, Hume would not have been obligated to revise his theory, given methodological resources he makes available to himself elsewhere in his work and his overarching empiricist aims. And I offer a new suggestion for why he might have included and even highlighted the MSB in his writings despite its being so very vexing and peculiar. (shrink)

The current study investigated the relationship of the Dark Triad with peer reporting, which occurs when an employee informs management that another coworker has engaged in counterproductive work behavior (CWB). We hypothesized that low organizational commitment would strengthen the negative relationships between each Dark Triad trait and peer reporting. Data from 281 employees suggested that low organizational commitment indeed strengthened the negative relationships between (a) narcissism and the base rate of peer reporting CWBs and (b) psychopathy and the base rate (...) of peer reporting CWBs. Our findings thus extended Dark Triad research to the topic of peer reporting. (shrink)

This thesis is about toleration as a modality of citizenship for pluralistic societies. Its central argument is that the current dissatisfaction with "mere" toleration which we find so broadly represented in our public and scholarly cultures is based on an underestimation of the capacities and attitudes that toleration entails. The liberal recasting of toleration, sophisticated and indeed invaluable though it is abets this devaluation by focusing too exclusively on public justification and on the Lockean stream of the tradition from which (...) we draw. ;The present thesis begins by tracing some of the difficulties facing the Rawlsian and Habermasian projects if we accept a vivid picture of the pluralisms amidst which we live. It then sketches the central features of a complementary tradition of toleration as it flows to us through the works of Montaigne, William James, Mikhail Bakhtin and others. An attempt is made to show where the resources drawn from this tradition might fit in to a theory of citizenship given reasonable Rawlsian qualms about "thick" public conceptions and given the fissiparous nature of a civil society like ours. The thesis ends with a pair of empirically oriented chapters which show ways in which we could conceive a praxis of toleration which might respond to the issues raised in the earlier sections of the work. (shrink)

How shall we decide for others who cannot decide for themselves? And who—or what, in the case of artificial intelligence — should make the decision? The present issue of the journal tackles several interrelated topics, many of them having to do with surrogate decision making. For example, the feature article by Jardas et al 1 explores the potential use of artificial intelligence to predict incapacitated patients’ likely treatment preferences based on their sociodemographic characteristics, raising questions about the means by which (...) we come to decide for others. And a clinical ethics round table led by Wilkinson and Pillay2 examines the case of a premature baby on life support whose primary surrogate is herself incapacitated. Together, these examples force us to think more deeply about the meaning and significance of taken-for-granted concepts: respect for autonomy, substituted judgement, best interests. We’ll consider the baby first and then turn to AI. “Baby T” is a critically ill newborn delivered prematurely by emergency caesarean section. The mother had entered into a surrogacy arrangement with a same-sex male couple, the intended parents, who were to take over the baby’s care after birth—just as soon as a formal parental order could be obtained through the court. Until then, the birth mother, who had used her own eggs to conceive Baby T along with sperm from an unidentified donor, would have legal and ethical responsibility to decide about the baby’s care. Unfortunately, she too was in critical condition, having fallen unconscious prior to delivery due to a sudden brain haemorrhage. She remained unconscious, and thus incapacitated, during a crucial period in which time-sensitive decisions about Baby T’s care needed to be made, including whether to continue life support. Given the mother’s incapacity, who should …. (shrink)

Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state—something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments (...) from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services. (shrink)

Insight problem solving is hindered by automated verbal–conceptual processes. Because mindfulness meditation training aims at “nonconceptual awareness” which involves a reduced influence of habitual verbal–conceptual processes on the interpretation of ongoing experience, mindfulness may facilitate insight problem solving. This hypothesis was examined across two studies . Participants in both studies completed a measure of trait mindfulness and a series of insight and noninsight problems. Further, participants in Study 2 completed measures of positive affect and a mindfulness or control training. The (...) results indicated that trait mindfulness predicts better insight but not noninsight problem solving , this relation is maintained when controlling for positive affect , mindfulness training improves insight but not noninsight problem solving and this improvement is partially mediated by state mindfulness . These findings are the first to document a direct relation between mindfulness and creativity. (shrink)