In cases where the claims of different groups of people compete, the Relevance View occupies a middle ground between aggregation and nonaggregation. It allows weaker claims to aggregate to outweigh a stronger claim just when the competing claims, compared pairwise, are sufficiently close in strength. The view has strong intuitive appeal when applied to simple binary choices, but I argue that attempts to extend it to nonbinary choices have been unsuccessful. I propose a new extension of the Relevance (...) View to nonbinary choices based on a “binary contrastive” account of the moral reasons that obtain in the cases of interest. (shrink)

Summary measures of health, such as the quality-adjusted life year and disability-adjusted life year, have long been known to incorporate a number of value choices. In this paper, though, I show that the value choices in the construction of such measures extend far beyond what is generally recognized. In showing this, I hope both to improve the understanding of those measures by epidemiologists, health economists and policy-makers, and also to contribute to the general debate about the extent to (...) which such measures should be adjusted to reflect ethical values. (shrink)

This book examines some of the deepest questions in philosophy: What is involved in judging a belief, action, or feeling to be rational?

When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating (...) that one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)

This paper presents an argument against the widespread view that ‘hard choices’ are hard because of the incomparability of the alternatives. The argument has two parts. First, I argue that any plausible theory of practical reason must be ‘comparativist’ in form, that is, it must hold that a comparative relation between the alternatives with respect to what matters in the choice determines a justified choice in that situation. If comparativist views of practical reason are correct, however, the incomparabilist view (...) of hard choices should be rejected. Incomparabilism about hard choices leads us to an implausible error theory about the phenomenology of hard choices, threatens an unattractive view of human agency, and leaves us in perplexity about what we are doing when we choose in hard choices. The second part of the argument explores the main competitor to comparativist views of practical reason, noncomparativist view, according tow which a choice is justified so long as it is not worse than any of the alternatives. This view is often assumed by rational choice theorists but has its best philosophical defense in work by Joseph Raz. On Raz’s view, incomparabilism about hard choices avoids the problems faced if comparativism is correct, but it faces different difficulties. I argue that Raz’s noncomparativist view mistakenly assimilates practical reason to more restricted normative domains such as the law. (shrink)

However far we are from either in practice, basic global and intergenerational justice, including climate change mitigation, are taken to be theoretically compatible. If population grows as predicted, this could cease to be the case. This paper asks whether that tragic legacy can now be averted without hard or even tragic choices on population policy. Current generations must navigate between: a high-stakes gamble on undeveloped technology; violating human rights; demanding unbearable sacrifices of the already badly off; institutional unfairness across (...) adults; institutional unfairness across children; failing to protect children’s basic interests; and threatening the autonomy of the family. We are not yet forced to choose between bequeathing a tragic choice and making one, by adopting basically unjust measures. However, even the remaining options present a morally hard choice. The fact we face it is yet another damning indictment on the combined actions and collective failures of the global elite. (shrink)

How computer games can be designed to create ethically relevant experiences for players. Today's blockbuster video games—and their never-ending sequels, sagas, and reboots—provide plenty of excitement in high-resolution but for the most part fail to engage a player's moral imagination. In Beyond Choices, Miguel Sicart calls for a new generation of video and computer games that are ethically relevant by design. In the 1970s, mainstream films—including The Godfather, Apocalypse Now, Raging Bull, and Taxi Driver—filled theaters but also treated their (...) audiences as thinking beings. Why can't mainstream video games have the same moral and aesthetic impact? Sicart argues that it is time for games to claim their place in the cultural landscape as vehicles for ethical reflection. Sicart looks at games in many manifestations: toys, analog games, computer and video games, interactive fictions, commercial entertainments, and independent releases. Drawing on philosophy, design theory, literary studies, aesthetics, and interviews with game developers, Sicart provides a systematic account of how games can be designed to challenge and enrich our moral lives. After discussing such topics as definition of ethical gameplay and the structure of the game as a designed object, Sicart offers a theory of the design of ethical game play. He also analyzes the ethical aspects of game play in a number of current games, including Spec Ops: The Line, Beautiful Escape: Dungeoneer, Fallout New Vegas, and Anna Anthropy's Dys4Ia. Games are designed to evoke specific emotions; games that engage players ethically, Sicart argues, enable us to explore and express our values through play. (shrink)

Animals are usually considered to lack the status of autonomous agents. Nevertheless, they do appear to make ostensible choices. This article considers whether, and how, I should respect animals' choices. I propose a concept of volitionality which can be respected if, and insofar as, doing so is in the best interests of the animal. Applying that concept, I will argue that an animals' choices be respected when the relevant human decision maker's capacities to decide are potentially challenged (...) or compromised. For example, it will be best to respect the animals' choice when the human decision maker: lacks accurate knowledge of the animal's subjective experiences; does not know what will lead to desirable experiences or allow for the avoidance of undesirable ones; is biased; is less aware of the animal's specific situation; cannot appreciate all elements comprehensively, including considering any value to the animal being allowed to make and implement a choice, such as where a lack of control or liberty would be unpleasant or where an animal would usefully learn from the process of choice-making; and when the animal's choice is achievable. This additionally suggests that we may often beneficially choose to set up situations that empower animals to make better choices. (shrink)

It is a commonly held position in the literature on distributive justice that choices individuals make from an equalized background may lead to inequalities of outcome. This raises the question of how to assign consequences to particular types of behaviour. Theories of justice based on the concept of moral responsibility offer considerable guidance as to how society should be structured, but they rarely address the question of what the consequences of making a particular choice should be. To fill this (...) lacuna, these theories must rely on a theory of consequences. I argue that the most plausible theories of consequences are substantive rather than procedural in nature. Such theories of consequences are inherently based on the concept of desert. By evaluating individuals' choices society may determine the appropriate consequences of choices for which they are responsible. (shrink)

The emergence of personal assistants in the form of smart speakers has begun to significantly alter people’s everyday experiences with technology. The rate at which household Intelligent Personal Assistants such as Amazon’s Echo and Google Home emerged in household spaces has been rapid. They have begun to move human–computer interaction from text-based to voice-activated input, offering a multiplicity of features through speech. The supporting infrastructure connects with artificial intelligence and the internet of things, allowing digital interfaces with domestic appliances, lighting (...) systems, thermostats, media devices and more. Yet this also constitutes a significant new production of situated and sensitive data. This study focuses on how users negotiate and make choices about household Intelligent Personal Assistant use in connection with their data. This study is based on empirical research in Europe with early adopters in Germany and potential users in the Netherlands. This examination of users’ early stage technology acceptance considerations highlights particular practices and choices of users to either preserve their privacy or determine what is acceptable use for their data. Drawing on a simplified version of Unified Theory of Acceptance and Use of Technology 2, a quantitative model for technology acceptance, we demonstrate how acceptance of a household Intelligent Personal Assistants does not imply access to all household data, how users see usefulness in relation to a proliferation of devices, and note the recognition by users regarding the efforts needed for full use and acceptance. The study highlights the complexity of data production at a household level and how these devices produce myopic views of users for platforms. (shrink)

Discusses ethical issues in medicine, including informed consent, the right to die, incompetency, parental decisions, resource allocation, and experiments with human subjects.

The Drosophila tracheal system is a branched tubular structure that supplies air to target tissues. The elaborate tracheal morphology is shaped by two linked inductive processes, one involving the choice of cell fates, and the other a guided cell migration. We will describe the molecular basis for these processes, and the allocation of cell fate decisions to four temporal hierarchies. First, tracheal placodes are specified within the embryonic ectoderm. Subsequently, branch fates are allocated within the tracheal placodes, prior to migration. (...) Localized presentation of the FGF ligand, Branchless, to tracheal cells that express the FGF receptor, Breathless, guides migration. Once cell migration is initiated, distinct cell fates are determined within each migrating branch. Finally, inhibitory feedback mechanisms ensure the correct assignment of these fates. Tracheal cell fate choices are determined by signaling cascades triggered by signals emanating from the tracheal cells, as well as by ligands produced by adjacent tissues. BioEssays 22:219–226, 2000. © 2000 John Wiley & Sons, Inc. (shrink)

In this paper, I make three arguments regarding Crisis Standards of Care developed during the COVID-19 pandemic. First, I argue against the consideration of third person quality of life judgments that deprioritize disabled or chronically ill people on a basis other than their survival, even if protocols use the language of health to justify maintaining the supposedly higher well-being of non-disabled people. Second, while it may be unavoidable that some disabled people are deprioritized by triage protocols that must consider the (...) likelihood that someone will survive intensive treatment, Crisis Standards of Care should not consider the amount or duration of treatment someone may need to survive. Finally, I argue that, rather than parsing who should be denied treatment to maximize lives saved, professional bioethicists should have put our energy into reducing the need for such choices at all by resisting the systemic injustices that drive the need for triage. (shrink)

Background: Adolescents’ health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties, and responsibilities, have been disregarded and scale is required to measure these. Objective: To describe the development of a scale that measures adolescents’ rights, duties, and responsibilities in relation to health choices and document the preliminary scale testing. Research design: A multi-phase development method was used to construct the Health Rights Duties and Responsibilities ( HealthRDR) scale. The concepts (...) and content were defined through document analysis, a systematic literature review, and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses, and researchers. We calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15–16 years. Descriptive statistics, Cronbach’s alpha correlation, and statistics for the item-analysis were calculated. Ethical considerations: Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study. Findings: The Health Rights Duties and Responsibilities scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties, and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. Cronbach’s alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were health choices (0.93), rights (0.97), responsibilities (0.99), and duties (0.98). Discussion: The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale. Conclusion: The Health Rights Duties and Responsibilities scale defines and understands adolescents’ rights, duties, and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed. (shrink)

This paper investigates what choices teachers made and what rationales they offered related to the inclusion and exclusion of primary source photographs for a hypothetical unit about the U.S. Civil Rights Movement in order to better understand teachers’ curricular decision-making as it relates to representing the histories of oppressed people. Elementary and secondary social studies/history teachers from three different in-service and pre-service cohorts ( n=62) selected and discarded images from a bank of 25 famous and lesser-known photographs. Their decisions (...) and explanations were coded for emergent themes. Findings reveal that these teachers tended to be guided by criteria both technical (how they might teach using a particular photograph) and philosophical (why they might teach about a particular photograph), with narrow definitions of what they deemed relevant and appropriate for their students. Their choices constructed a sanitized narrative of the Civil Rights Movement that largely avoided a discussion of racism. (shrink)

The changing milieu of research—increasingly global, interdisciplinary and collaborative—prompts greater emphasis on cultural context and upon partnership with international scholars and diverse community groups. Ethics training, however, tends to ignore the cross-cultural challenges of making ethical choices. This paper confronts those challenges by presenting a new curricular model developed by an international team. It examines ethics across a very broad range of situations, using case studies and employing the perspectives of social science, humanities and the sciences. The course has (...) been developed and taught in a highly collaborative way, involving researchers and students at Zhejiang University, the Indian Institute of Technology, Bombay and Brown University. The article presents the curricular modules of the course, learning outcomes, an assessment framework developed for the project, and a discussion of evaluation findings. (shrink)

Papers presented at a conference held at the James A. Baker III Institute for Public Policy at Rice University, in Apr. 2006.

Although autonomy is clearly still the paradigm in bioethics, there is increasing concern over its value and feasibility. In agreeing with those concerns, I argue that autonomy is not just a status, but a skill, one that must be developed and maintained. I also argue that nearly all healthcare interactions do anything but promote such decisional skills, since they rely upon assent, rather than upon genuinely autonomous consent. Thus, throughout most of their medical lives, patients are socialised to be heteronomous, (...) rather than autonomous. Yet, at the worst possible time – critical care decision-making – when life and death consequences are attached to the choices, the paradigm shifts and real consent is sought, even demanded, thereby making an often traumatic situation even harder.I go on, though, to also reject paternalistic models of beneficence as an alternative. Rather, I conclude that the problem is so fundamental in healthcare that a genuine solution would require a radical restructuring. I recommend steps that can be taken in the interim to improve the situation and to move toward such a restructuring. (shrink)

Here is an important new theory of human action, a theory that assumes actions are founded on choices made by agents who face an open future.

Childbearing is an increasingly complicated matter, which has evolved significantly over the past several decades. Treatment options for infertility have expanded. Prenatal testing and treatment have led to an evolution in obstetrical decision-making, wherein the risks and benefits to the fetus and future child are better understood and more strongly considered in medical management of the pregnant woman. Obstetrics appears to be increasingly interventional; one in three babies in the United States is now born by cesarean section. Neonatal intensive care (...) has markedly improved outcomes for premature babies. A pregnant woman may now be presented with many options— obstetrician or midwife, home or hospital delivery, choices among prenatal testing and monitoring, early induction of labor, cesarean delivery. Health care professionals face similar decisions with regard to what they recommend and the boundaries of safe and responsible care they should make available. Preterm Babies, Fetal Patients, and Childbearing Choices, by John D. Lantos and Diane S. Lauderdale, provides an excellent overview of the available information relevant to these questions. (shrink)

Putting in writing what you want -- What may happen if you don't make it "clear and convincing" -- Facts and statistics -- Empathy and the imagination -- Ancient myth and modern medicine: what can we learn from the past? -- Hoping for a miracle -- What could be wrong with hope? -- Medical futility -- Beyond futility to an ethic of care -- Future decisions we may all have to make.

Researchers are working to derive sperm from banked testicular tissue taken from pre-pubertal boys who face therapies or injuries that destroy sperm production. Success in deriving sperm from this tissue will help to preserve the option for these boys to have genetically related children later in life. For the twin moral reasons of preserving access and equity in regard to having such children, clinicians and researchers are justified in offering the option to the parents of all affected boys. However, some (...) parents may wish to decline the option to bank tissue from their boys because the technique may seem too unfamiliar or unusual, but over time people may become more comfortable with the technique as they have done with other novel assisted reproductive treatments. Other parents may wish to decline the option because of moral or religious reasons. A prominent natural law theory holds, for example, that the ARTs that would be involved in using sperm derived from banked tissue to produce a child are morally objectionable. Some parents might not want to bank tissue in order to shield their son from using ARTs they see as objectionable. Clinicians and researchers should respect parents who wish to decline banking tissue, but parents should ordinarily embrace choices that protect the possible interests their sons may have as adult men, including the wish to have genetically related children. (shrink)

The present qualitative study analyzes how cultural capital, gender, class, and family involvement impact Chinese female students’ aspirations of studying in the United Kingdom. We investigated how these factors facilitate or limit female students’ choice of study destination, as well as choices of subject and program. Data were gathered through participant observation and semi-structured interviews in a British university. A total of 25 young Chinese female students from different subject areas took part in the semi-structured interviews. Out of those, (...) five students are undergraduates, 11 are taught master’s students, and the other nine students are doctoral candidates. Most of the undergraduates and postgraduates are from middle-class families, while some of the Ph.D. students are from working-class families. The results of the content analysis were examined in light of gender and cultural capital theory. It was found that although there exist differences within the middle-class families regarding the possession of cultural capital, many female students from middle-class families obtained high levels of cultural capital, and these students usually internalized the idea of pursuing a place in the United Kingdom’s tertiary education system as a way of enhancing women’s competency in future job markets. Furthermore, compared with working-class students, many respondents’ choice of subject and program was highly gendered, as their families expect them to live a feminine life by choosing “appropriate” feminine subjects. Therefore, despite having the privilege to study abroad, female middle-class students’ educational choices are still constrained by gender and class. (shrink)

People with gut issues are often constrained in the foods they are able to eat. The choices they are able to make about food, however, are shaped not merely by specific medical and dietary needs but also by social, relational, and environmental factors such as the presence of trusted and supportive others who take their needs seriously. Drawing on work in disability theory and relational autonomy, as well as interviews undertaken in summer 2019, the paper explores the ways that (...) choices are enabled or undermined, and argues that these should be taken into account in work on the ethics and politics of food. (shrink)