The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do (...) so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways. (shrink)

This article revisits long-standing questions about consent, membership and emigration in Locke’s thought. Commentators such as A John Simmons have argued that Locke opens political membership to both express consenters and some kind of tacit consenters, and not just to the former, as some have suggested. Simmons’s reading seems to render Locke more sensible in that it does not exclude large numbers of people from membership or burden the few members with all the civic duties, and also in that it (...) allows at least tacit-consenting members the right to relocate, while this right is denied to express-consenting members. Against this reading, the article shows, by resolving seemingly conflicting claims in the text, that people become members only by express consent. It also responds to the criticism that the express-consent-only reading would limit membership to a few and so would render Locke’s account implausible from a practical point of view. The article then addresses the purported restriction Locke imposes on express consenters’ right to emigrate, arguing that the restriction concerns the change of membership and not the right to relocate. (shrink)

The advent of personal genomics companies offering direct translation of scientific data into personal health information, calls into question traditional policies to refuse disclosure of such scientific data to research participants. This seems especially true for population biobanks, as they collect not only genotype information but also associated phenotype information, and thus may be in a unique position to translate their scientific findings into personal health information for their participants. Disclosure of such information seems mandated by the expectations raised by (...) biobanks and their participants' rights to know health information, to know clinical research results, to life and health and particularly their right to benefit. Refusals to disclose such information can be grounded in the lack of analytical validity and/or clinical utility of most findings, the need to avoid the therapeutic misconception, the complexity and costs involved in translation and disclosure and the disproportionate burden resulting from the obligation to respect participants' right not to know before any disclosure can be made. Currently, any demands by participants in population biobanks for full disclosure of all pertinent personal health information potentially resulting from the biobank's scientific findings are unlikely to be granted by a Dutch court under Dutch and international law. As the law stands now, a population biobank is neither a doctor nor a personal genomics company. However, in view of the rapid scientific, medical, technological, commercial and social developments, population biobanks must prepare to take more care of their participants' legitimate interest in receiving as much validated personal health information as reasonably possible, in a timely fashion, by developing appropriate translation and disclosure mechanisms. This paper examines whether population biobank participants have the right, under Dutch civil law and international law, to full disclosure, i.e. to all information generated by the biobank that is pertinent to their present and future health. It pioneers the format of a hypothetical court case to elucidate the legal and policy arguments" for and against full disclosure. (shrink)

This chapter contains sections titled: “I'm shocked, I tell you, shocked!” The Preacher and the Porn Star Picnic Sex and the Prudes “Don't look, Ethel!” Tease Me, Whip Me, Persuade Me Biting the Bullet Hard Cases If Porn Isn't Free Speech, What Is It? Notes.

Background: The American Medical Association, the British Medical Association and the Canadian Medical Association have guidelines that specifically discourage physicians from self-prescribing or prescribing to family members, but only the BMA addresses informal prescription requests between colleagues. Objective: To examine the practices of paediatric providers regarding self-prescribing, curbsiding colleagues, and prescribing and refusing to prescribe to friends and family. Methods: 1086 paediatricians listed from the American Academy of Paediatrics 2007 web-based directory were surveyed. Results: 44% of eligible survey respondents returned (...) usable surveys. Almost half of respondents had prescribed for themselves. An equal number had informally requested a prescription from a colleague. Three-quarters stated they had been asked to prescribe a prescription drug for a first-degree or second-degree relative, and 51% had been asked by their spouse. Eighty-six per cent stated that they had refused to write a prescription on at least one occasion for a friend or family member. The following reasons “strongly influenced” their decision to refuse a prescription request: outside of provider’s expertise ; patient’s need for his or her own physician ; not medically indicated ; need for a physical examination. Conclusion: These data confirm that most physicians have engaged in self-prescribing or curbside requests for prescriptions. It can be argued that curbsiding is more morally problematic than self-prescribing because it implicates a third party, and should be discouraged regardless of whether the requester is a colleague, family member or friend. (shrink)

The private sector has implemented many cost containment measures in efforts to control rising health care costs. However, these measures have not controlled costs in the long run, and can be expected not to succeed as long as business cannot control factors within the health care system which affect costs. Controlling private sector health care costs requires constraints on cost shifting which necessitates a unified financing system with expenditure limits. A unified financing system will involve a partnership between the public (...) and private sectors. (shrink)

I take this opportunity of correcting a particularly reprehensible error of my own on p. 140 of my edition of these poems. At A.A. 1. 730 read ‘…hoc multri †non ualuisse† putant’; and at 11. 3-4 of the critical apparatus read ‘equidem multi utique’ eqs. In other words, the manuscripts are unanimous in offering multi. I hope that Dr. Lenz will be glad to have this evidence of our common humanity.

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)

This volume offers an analysis of ethical concepts based on positive legal principles and court decisions, describing what actually happens in practice, or where there are no precedents available, what is most likely to happen. Broadly, it deals with the wide range of potentially difficult situations in which the community, as represented by the law, may come into conflict with the medical profession.

Robert F. is an eighty-five-year-old who suffered a heart attack at home in a rural location some thirty minutes from any major hospital. By the time the paramedics arrived, he was unconscious and nonresponsive. After spontaneous return of circulation, they began their standard procedure of therapeutic hypothermia. Robert's core temperature was lowered using ice packs, and cold intravenous fluids were initiated. Soon afterward, Robert started to shiver when his body temperature reached 35.6° Celsius. He was then given a bolus of (...) vecuronium as a neuromuscular blockade, sedated, and intubated. He was also given a low-dose vasopressin for blood-pressure control. Shortly after Robert arrived in the emergency room, his daughter, his medical decision-maker, produced an advance directive documenting that her father has a do-not-resuscitate order, and she demanded that the breathing tube and any other life-sustaining treatments be withdrawn immediately. The medical staff is very reluctant to comply with this demand for immediate action. Until the neuromuscular blockade wears off, removing the ventilator will prevent Robert from breathing. Furthermore, it may take some time to reverse the therapeutic hypothermia procedure to the point that the patient is at normal temperature. In addition, therapeutic hypothermia itself often causes arrest, so the patient may need to be resuscitated again. Should the staff wait until the patient is warm or honor the decision of his daughter, who holds his medical power of attorney? (shrink)

The current UN policy regarding free speech presents a philosophical dilemma between accepting the free speech provisions in the Universal Declaration of Human Rights and exceptions carved out for hatred, hostility, and religious defamation. The Declaration should be understood to imply viewpoint neutrality and the exceptions for defamation are not viewpoint neutral. If the UN were to adopt J. S. Mill’s crucial distinctions between expression and performative speech, content and context, and mental states and the acts motivated by them, it (...) would be clear that hatred, hostility, and defamation cannot be exceptions to viewpoint neutral free speech. If the heart of free speech is freedom especially for the thought we hate, then the UN should abandon its exceptions or abandon appeals to free speech. However, I will offer a strong reason that it should not do the latter. (shrink)

This article aims to show that Locke’s discussion of tacit consent and the right to punish aliens in the Second Treatise of Government has important bearings on the moral status of undocumented immigrants. It argues that Locke conceptualized both friendly and hostile aliens, counting the former as tacit consenters to whom host states owed rights and protection. Moreover, it highlights how his approach, unlike theorists before and after him, was one that saw individuals as capable of shaping their own relationship (...) with the host. The article also examines Locke’s discussion of the federative power of the state, which includes the power to vet aliens within the country. Seen through this Lockean lens, the article argues that the vast majority of undocumented immigrants can be understood as tacit consenters or potential citizens who should be judged by how they choose to relate to the host, and not by their country of origin. While noting that the Lockean approach is not incompatible with border control, the article also shows how it puts the onus on the host to justify the power it exercises and to engage in dialogue with undocumented immigrants about what their status should be in the country. (shrink)

Recent scholarship on technology-induced ‘conceptual disruption’ has spotlighted the notion of a conceptual gap. Conceptual gaps have also been discussed in scholarship on epistemic injustice, yet up until now these bodies of work have remained disconnected. This article shows that ‘gaps’ of interest to both bodies of literature are closely related, and argues that a joint examination of conceptual disruption and epistemic injustice is fruitful for both fields. I argue that hermeneutical marginalization—a skewed division of hermeneutical resources, which serves to (...) diminish the experiences of marginalized folk—does not only transpire because of conceptual gaps, but also because of two other kinds of conceptual disruption: conceptual overlaps and conceptual misalignments. Hence, there are multiple kinds of conceptual disruption that can be usefully studied through the normative lens of epistemic injustice. Technology can play different roles vis-a-vis epistemic injustices, both as a causal trigger of conceptual disruption, but also as a mediator of hermeneutical resources. Its role is normatively significant, in particular because socially disruptive technologies can have different epistemic implications for different groups: they may amplify the epistemic resources of some groups, while diminishing those of others. (shrink)

In two important articles, Thomas Hurka applies his recursive account of value to virtue. Hurka’s contention is that being virtuous is merely a matter of having the proper pro-attitude toward what is objectively good. Hurka argues that the recursive framework honors much of our traditional conception of virtue, and even if it does not capture everything involved in virtue, it “describes at least part of what virtue involves.” I argue that the recursive account of virtue is not a partial description (...) of traditional virtue, however, but a reconception of virtue. Accepting the recursive account would require abandoning the most distinctive elements of traditional virtue ethics. (shrink)