Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource (...) allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

Volume 19, Issue 10, October 2019, Page 88-90.

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

The 14 chapters in _Ethics at the End of Life: New Issues and Arguments_, all published here for the first time, focus on recent thinking in this important area, helping initiate issues and lines of argument that have not been explored previously. At the same time, a reader can use this volume to become oriented to the established questions and positions in end of life ethics, both because new questions are set in their context, and because most of the chapters—written (...) by a team of experts—survey the field as well as add to it. Each chapter includes initial summaries, final conclusions, and a Related Topics section. TABLE OF CONTENTS John K. Davis, "Introduction" Geoffrey Scarre, "Is it possible to be better off dead?" Taylor W. Cyr, "How Does Death Harm the Deceased?" Benjamin Mitchell-Yellin, "The Significance of an Afterlife" Jens Johansson, "The Severity of Death" John K. Davis, "Defining Death" James Stacey Taylor, "Autonomy, Competence, and End of Life" Eric Vogelstein, "Deciding for the Incompetent" Paul T. Menzel, "Change of Mind: An Issue for Advance Directives" Nancy S. Jecker, "Medical Futility and Respect for Patient Autonomy" Paul T. Menzel, "Refusing Lifesaving Medical Treatment and Food and Water by Mouth" Thomas S. Huddle, "Suicide, Physician-Assisted Suicide, the Doing-Allowing Distinction and Double Effect" Michael Cholbi, "Grief and End of Life Surrogate Decision-making" Bruce Jennings, "Solidarity near the End of Life: The Promise of Relational Decision-making in the Care of the Dying" Colin Farrelly, "Justice and the Aging of the Human Species". (shrink)

This chapter introduces the edited volume, The Oxford Handbook of Philosophy and Psychiatry. Published in 2013, the centenary of Karl Jaspers' General Psychopathology, the chapter draws lessons from the last hundred years for the coming century. No predictions are made. Instead, five 'conditions for flourishing' are set out: 1) Particular Problems - the importance of focussing on well-defined particular problems rather than general theory building, 2) Product- orientation - remaining always responsibly product oriented in the specific sense that both sides (...) put in the work necessary to 'go deep' with each other's fields, 3) Partnership - working in partnerships of one kind or another, 4) Process - constant reflection on process based on peer review but leaving scope for the occasional rogue voice to cut innovatively against the grain, and 5) Q - a condition of a different kind, Q is an empirically derived measure of the balance between in-group cohesion and out-group openness required to support creativity. Illustrations are given of how these five conditions for flourishing have underpinned the rapid expansion of philosophy and psychiatry in the closing decades of the twentieth century, and, correspondingly, are also reflected in the Handbook as a whole. Overviews and commentaries on individual contributions to the Handbook are given in extended editorial introductions to each of its eight sections. (shrink)

Does respect for autonomy imply respect for precedent autonomy? The principle of respect for autonomy requires us to respect a competent patient’s treatment preference, but not everyone agrees that it requires us to respect preferences formed earlier by a now‐incapacitated patient, such as those expressed in an advance directive. The concept of precedent autonomy, which concerns just such preferences, is problematic because it is not clear that we can still attribute to a now‐incapacitated patient a preference which that patient never (...) disaffirmed but can no longer understand. If we cannot make that attribution, then perhaps we should not respect precedent autonomy – after all, how can you respect patient autonomy by giving patients what they no longer want, even if they never disaffirmed those wants? I argue that whether an earlier preference can still be attributed to a now‐incapacitated patient depends on the reasons behind the preference, for a preference includes (and is not merely supported by) the reasons behind it. When the considerations that served as reasons no longer exist, neither does the preference which included those reasons. In particular, if the considerations that served as reasons for the patient exist only under conditions where the patient retains full mental capacity, then once that capacity is lost, so are those reasons and the preference based upon them. I use this analysis of precedent autonomy to ascertain the merits of various approaches to advance medical decisionmaking, including Nancy Rhoden’s approach, approaches based on a Parfitian personal identity analysis, approaches based on soft paternalism, and approaches based on the stability and longevity of preferences. Despite the apparent absurdity of respecting patient autonomy by giving patients what they no longer prefer but have never disaffirmed, I conclude with some programmatic remarks on when and why respect for (precedent) autonomy nonetheless requires us to respect former preferences. (shrink)

The Dispossessed has been described by political thinker Andre Gorz as 'The most striking description I know of the seductions—and snares—of self-managed communist or, in other words, anarchist society.' To date, however, the radical social, cultural, and political ramifications of Le Guin's multiple award-winning novel remain woefully under explored. Editors Laurence Davis and Peter Stillman right this state of affairs in the first ever collection of original essays devoted to Le Guin's novel. Among the topics covered in this wide-ranging, (...) international and interdisciplinary collection are the anarchist, ecological, post-consumerist, temporal, revolutionary, and open-ended utopian politics of The Dispossessed. The book concludes with an essay by Le Guin written specially for this volume, in which she reassesses the novel in light of the development of her own thinking over the past 30 years. (shrink)

Many studies examine student self-concept during compulsory schooling but few have explored the self-concept of students in higher educational settings. The current study examined self-concept by faculty and gender among higher education students in New Zealand. Participants were 929 undergraduate students from a large New Zealand university. The results showed some differences in verbal and maths self-concept by faculty. Generally, students in faculties teaching subjects more reliant on maths skills had higher maths self-concept than those in faculties where facility in (...) verbal skills was important. The opposite results were found for verbal self-concept. No overall gender differences were found for general, academic, verbal and maths self-concept although a statistically significant difference was found for problem-solving self-concept. This finding suggests students? choice of faculty may be based on perceptions of their skills and capabilities in the various fields, irrespective of gender. (shrink)

Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide objectionable procedures when no (...) other doctor is available, why the moral consensus among doctors seems relevant even though it does not determine whether something is morally acceptable, and whether doctors should stay out of fields whose standard procedures they find morally unacceptable. (shrink)

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her precedent autonomy by giving her what she used to want? There is a similar problem with subsequent consent: How can we justify interfering with someone''s autonomy on the grounds that she will later consent to the interference, if she refuses now?Both problems arise on the assumption that, to respect someone''s autonomy, (...) any preferences we respect must be among that person''s current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone''s wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference. (shrink)

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as “mental health advance directives.” How can health care providers justify enforcing such contracts over an agent’s current, competent refusal? I argue that providers respect an agent’s autonomy not retrospectively—by reference to his or her past wishes—and not merely synchronically—so that the (...) agent gets what he or she wants right now—but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers’ actions over time. Mental health directives accomplish this, so they are a way of respecting the agent’s autonomy even when providers override the agent’s current competent refusal. (shrink)

The worst possible way to resolve this issue is to leave it up to individual choice. There is no known social good coming from the conquest of death (Bailey, 1999). - Daniel Callahan Dramatically extending the human lifespan seems increasingly possible. Many bioethicists object that life-extension will have Malthusian consequences as new Methuselahs accumulate, generation by generation. I argue for a Life-Years Response to the Malthusian Objection. If even a minority of each generation chooses life-extension, denying it to them deprives (...) them of many years of extra life, and their total extra life-years are likely to exceed the total life-years of a majority who do not want life-extension. This is a greater harm to those who want extended life than the Malthusian harms to those who refuse extended life, both because losing an extra year of life is worse than enduring a year of Malthusian conditions, and because the would-be Methuselahs have more life-years at stake. Therefore, even if life-extension seems likely to cause severe overcrowding and resource shortages, that threat is not sufficient to justify society in restricting the development or availability of life-extension. (shrink)

An examination of the ethical issues raised by the possibility of human life extension, including its desirability, unequal access, and the threat of overpopulation. -/- Life extension—slowing or halting human aging—is now being taken seriously by many scientists. Although no techniques to slow human aging yet exist, researchers have successfully slowed aging in yeast, mice, and fruit flies, and have determined that humans share aging-related genes with these species. In New Methuselahs, John Davis offers a philosophical discussion of the (...) ethical issues raised by the possibility of human life extension. Why consider these issues now, before human life extension is a reality? Davis points out that, even today, we are making policy and funding decisions about human life extension research that have ethical implications. With New Methuselahs, he provides a comprehensive guide to these issues, offering policy recommendations and a qualified defense of life extension. -/- After an overview of the ethics and science of life extension, Davis considers such issues as the desirability of extended life; whether refusing extended life is a form of suicide; the Malthusian threat of overpopulation; equal access to life extension; and life extension and the right against harm. In the end, Davis sides neither with those who argue that there are no moral objections to life enhancement nor with those who argue that the moral objections are so strong that we should never develop it. Davis argues that life extension is, on balance, a good thing and that we should fund life extension research aggressively, and he proposes a feasible and just policy for preventing an overpopulation crisis. (shrink)

Relativism and contextualism are the most popular accounts of faultless disagreement, but Crispin Wright once argued for an account I call divergentism. According to divergentism, parties who possess all relevant information and use the same standards of assessment in the same context of utterance can disagree about the same proposition without either party being in epistemic fault, yet only one of them is right. This view is an alternative to relativism, indexical contextualism, and nonindexical contextualism, and has advantages over those (...) views. Wright eventually abandoned this view in favor of relativism for reasons related to a conciliationist view of disagreement between epistemic peers. I argue that he gave up on divergentism too soon. (shrink)

Judith Thomson argues that a fetus may have a right to life yet lack the right to use its mother's body to stay alive. According to Kenneth Einar Himma, Thomson's argument applies only to cases where the parties meet two conditions. First, they must and, second, they must be Himma devises a case involving conjoined twins to show why the mother–fetus case does not meet these conditions.

A growing number of patients make up their minds about some medical issue before they see their provider, either by googling their symptoms or asking a friend. They’ve made up their minds before coming in, and they resist their provider’s recommendations even after receiving information and advice from their provider. This is a new kind of medical autonomy problem; it differs from cases of standard consent, futility, or conscientious refusal. Providers sometimes call this problem “Dr. Google.” I call it premature (...) consent. Providers may wonder whether these patient decisions command the same deference and respect as other patient decisions. The answer is “no,” for these patients are neither fully competent nor properly informed. They typically appear to be competent, but competence includes the ability to deliberate, and they are not deliberating well when they make up their minds before consulting a qualified provider. They seem informed, especially after talking to their provider, but they are misinformed about what sources of medical advice to trust. Moreover, being informed requires believing the information one has received, and these patients sometimes don’t believe the information their provider gives them. (shrink)

Most discussions of medical futility try to answer the Futility Question: when is a medical procedure futile? No answer enjoys universal support. Some futility policies say that the health care provider will answer this question when the provider and patient cannot agree. This raises the Decision Question: who has the moral authority to decide what to do in cases where futility is disputed? I look for a procedural answer to this question, an answer that does not turn on whether a (...) given party happens to answer the Futility Question correctly. I argue that these policies get it right; the provider should decide because providers have a right of conscientious refusal that extends to refusing procedures on grounds of futility. This is a procedural answer because providers have this right even if they are sincerely mistaken about whether a procedure is futile. (shrink)

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or (...) constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition. (shrink)

University human research ethics application procedures can be complicated and daunting, especially for international students unfamiliar with the process and the language. We conducted focus groups and interviews with four research higher degree and 21 Master’s coursework international students at an Australian university to gain their views on the human ethics application process. We found the most important influences on their experience were: the time it took to do an application; support from supervisors, peers and others; their own language skills; (...) and their lack of familiarity with research ethics procedures. To improve the experience of international students undertaking research involving human research ethics applications, we recommend universities provide guidance on institutional ethics review processes, concepts and terminology, with translations in a range of languages, together with guidance on how to conduct research ethically within and outside the students’ own countries. We also recommend curricula be developed to further students’ understanding of the importance of ethical research practice, and that these curricula be embedded in undergraduate and postgraduate degree programs and reflected in course learning outcomes. (shrink)

Background Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to “misuse” and “overuse”, particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice “proper” use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as (...) presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics. Methods This reflection is anchored on Jarrett Zigon’s morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania’s National Action Plans on antimicrobial resistance was conducted. Results Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with “inappropriate” behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery. Conclusion Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur. (shrink)

Moral and legal judgments sometimes depend on personal traits in this sense: the subject offers good reasons for her judgment, but if she had a different social or ideological background, her judgment would be different. If you would judge the constitutionality of restrictions on abortion differently if you were not a secular liberal, is your judgment really based on the arguments you find convincing, or do you find them so only because you are a secular liberal? I argue that a (...) judgment can be based on the considerations the subject claims as justification even when it depends on personal traits. (shrink)

We sometimes decide what to do by applying moral principles to cases, but this is harder than it looks. Principles are more general than cases, and sometimes it is hard to tell whether and how a principle applies to a given case. Sometimes two conflicting principles seem to apply to the same case. To handle these problems, we use a kind of judgment to ascertain whether and how a principle applies to a given case, or which principle to follow when (...) two principles seem to conflict. But what do we discern when we make such judgments—that is, what makes such judgments correct? The obvious answer is that they are made correct by whatever makes other moral judgments correct. However, that cannot be right, for a principle can be inconsistent with morality yet still apply in a particular way to a given case. If the principle is inconsistent with morality, then morality cannot be what we discern when we judge whether and how that principle applies to a given case. I offer an alternative account of what makes such judgments correct. (shrink)

Some moral disagreements are so persistent that we suspect they are deep : we would disagree even when we have all relevant information and no one makes any mistakes. The possibility of deep disagreement is thought to drive cognitivists toward relativism, but most cognitivists reject relativism. There is an alternative. According to divergentism, cognitivists can reject relativism while allowing for deep disagreement. This view has rarely been defended at length, but many philosophers have implicitly endorsed its elements. I will defend (...) it. (shrink)

Although in Drosophila pair‐rule genes play crucial roles in the genetic hierarchy that subdivides the embryo into segments, the extent to which pair‐rule patterning is utilized by different arthropods and other segmented phyla is unknown. Recent data of Dearden et al.1 and Henry et al.,2 however, hint that a pair‐rule mechanism might play a role in the segmentation process of basal arthropods and vertebrates. BioEssays 25:425–429, 2003. © 2003 Wiley Periodicals, Inc.