Equipoise is advocated as a means of achieving high scientific and ethical standards in randomised trials. As used in the context of research the word describes a state of uncertainty characterised by the belief that in a trial no arm is known to offer greater harm or benefit than any other arm. Clinicians who lack personal equipoise are advised to accept clinical or communal equipoise, based on current unresolved disagreement among the medical profession. Equipoise is mainly discussed in the (...) literature as an issue for senior doctors and research directors. Limitations of professional equipoise are reviewed, and data on the neglected topic of patients' equipoise are reported using the example of breast cancer trials. In theory, a patient who gives informed and voluntary consent to enter a randomised trial has achieved the equilibrium of equipoise. In practice, equipoise among patients ranges from personal to proxy acceptance. (shrink)

Limited attention has been paid to the potential of tort law to address the harm of sexual violence. Based on interviews with 35 victim-survivors of sexual violence in Iceland, this study asks: How do victim-survivors understand monetary compensation? How can tort law meet victim-survivors’ justice interests? The findings suggest that in addition to the financial risk involved, most participants had ambivalent views towards pursuing and receiving monetary compensation. Many thought that, given their often extensive pecuniary and non-pecuniary losses, it was (...) only fair to receive compensation; but at the same time, they did not want to accept ‘dirty money’ they considered that pursuing monetary compensation could undermine their credibility, and monetary compensation only partially aligned with their ideas about justice. The findings are interpreted in the context of tort law theory, taboo trade-offs and survivor-centred justice. It is suggested that state intervention is needed to better meet victim-survivors’ justice interests. (shrink)

A person drives her well‐maintained car cautiously and alertly to the movies. Freak circumstances send the car out of control. It veers in the direction of a pedestrian whom it will kill unless she, or a third party, blows it up with a grenade. Whether the driver is liable to be thusly killed polarizes debates about the ethics of self‐defense. But debaters frequently conflate the questions of whether and by what means the driver is liable to be killed. The (...) paper separates these questions: it argues the driver's liability to lethal harm need not entail her liability to the grenade. (shrink)

Many popular artificial intelligence (AI) ethics frameworks center the principle of autonomy as necessary in order to mitigate the harms that might result from the use of AI within society. These harms often disproportionately affect the most marginalized within society. In this paper, we argue that the principle of autonomy, as currently formalized in AI ethics, is itself flawed, as it expresses only a mainstream mainly liberal notion of autonomy as rational self-determination, derived from Western traditional philosophy. In particular, we (...) claim that the adherence to such principle, as currently formalized, does not only fail to address many ways in which people’s autonomy can be violated, but also to grasp a broader range of AI-empowered harms profoundly tied to the legacy of colonization, and which particularly affect the already marginalized and most vulnerable on a global scale. To counter such a phenomenon, we advocate for the need of a relational turn in AI ethics, starting from a relational rethinking of the AI ethics principle of autonomy that we propose by drawing on theories on relational autonomy developed both in moral philosophy and Ubuntu ethics. (shrink)

Lately there has been increased attention to the philosophical issues that death raises, but the focus remains individualistic. Death is philosophically puzzling. Death is thought to be bad for the individual who dies, but there is no one there to experience death as a harm. In this paper I argue that the harm of death is a social harm. Of course, social relationships are fundamentally changed when any member of a social group dies. Death is harmful for those left behind. (...) The problem is not just that social relations are harmed by the loss of a loved one. The very meaning and value of our lives and projects are shaped by social relations. By recognizing death as a social harm that many animals, human and nonhuman, experience, we may be better prepared for the work of mourning. (shrink)

Dementia has rapidly become a major global health crisis. As the aging population continues to increase, the burden increases commensurately on both individual and societal levels. The behavioral and psychological symptoms of dementia are a prominent clinical feature of Alzheimer’s disease and related dementias. BPSD represent a myriad of manifestations that can create significant challenges for persons living with dementia and their care providers. As such, BPSD can result in detriments to social interaction with others, resulting in harm to the (...) psychosocial health of the person with dementia. While brain deterioration can contribute to BPSD as the disease progresses, it may be confounded by language and communication difficulties associated with ADRD. Indeed, when a person with dementia cannot effectively communicate their needs, including basic needs such as hunger or toileting, nor symptoms of pain or discomfort, it may manifest as BPSD. In this way, a person with dementia may be attempting to communicate with what little resources are available to them in the form of emotional expression. Failing to recognize unmet needs compromises care and can reduce quality of life. Moreover, failing to fulfill said needs can also deteriorate communication and social bonds with loved ones and caregivers. The aim of this review is to bring the differential of unmet needs to the forefront of BPSD interpretation for both formal and informal caregivers. The overarching goal is to provide evidence to reframe the approach with which caregivers view the manifestations of BPSD to ensure quality of care for persons with dementia. Understanding that BPSD may, in fact, be attempts to communicate unmet needs in persons with dementia may facilitate clinical care decisions, promote quality of life, reduce stigma, and foster positive communications. (shrink)

Ten years ago, researchers using event-related brain potentials to study language comprehension were puzzled by what looked like a Semantic Illusion: Semantically anomalous, but structurally well-formed sentences did not affect the N400 component—traditionally taken to reflect semantic integration—but instead produced a P600 effect, which is generally linked to syntactic processing. This finding led to a considerable amount of debate, and a number of complex processing models have been proposed as an explanation. What these models have in common is that they (...) postulate two or more separate processing streams, in order to reconcile the Semantic Illusion and other semantically induced P600 effects with the traditional interpretations of the N400 and the P600. Recently, however, these multi-stream models have been called into question, and a simpler single-stream model has been proposed. According to this alternative model, the N400 component reflects the retrieval of word meaning from semantic memory, and the P600 component indexes the integration of this meaning into the unfolding utterance interpretation. In the present paper, we provide support for this “Retrieval–Integration ” account by instantiating it as a neurocomputational model. This neurocomputational model is the first to successfully simulate the N400 and P600 amplitude in language comprehension, and simulations with this model provide a proof of concept of the single-stream RI account of semantically induced patterns of N400 and P600 modulations. (shrink)

IntroductionMeaning is an important psychological resource both in situations of accomplishment and in situations of ongoing adversity and psychological crisis. Meaning in life underlies the reasons for staying alive both in everyday and in critical circumstances, fulfilling a buffering function with respect to life adversities.AimThe aim of the present study was to reveal the role of both meaningfulness, including specific sources of meaning and reasons for living, and meaninglessness (alienation) in patients suffering from profound crisis situations with or without suicidal (...) intentions and behavior.MethodsThe sample included 148 patients (all Caucasian) who were referred to a crisis center in Moscow, Russia. Seventy-seven patients (54 females, mean age 32.00 ± 11.98 years) reported a current crisis situation in their life but denied suicidal thoughts or behavior. Twenty-nine patients (21 females, mean age 31.55 ± 13.76 years) reported suicidal ideations but denied suicidal attempts or self-harming behavior. Forty-two patients (31 females, mean age 30.64 ± 11.38 years) had episodes of suicidal attempts or self-harming behavior accompanied by suicidal intentions. There were no significant gender or age differences between groups.Participants completed a number of measures of different aspects of meaning and meaninglessness, well-being, ill-being and psychological resources. For some patients (N = 74), a clinical checklist was completed by their doctors assessing 28 various characteristics associated with the patient’s clinical status.Results and discussionMeaningfulness and reasons for living were more helpful in distinguishing between reactions to profound crisis situations (suicidal intentions versus non-suicidal behavior) than were measures of well-being, ill-being, meaning crisis or personality resources. In both suicidal and non-suicidal crisis patients meaningfulness predicted more positive reasons for living. The relationship between meaningfulness and most reasons for living remained significant after controlling for clinically appraised suicidal “readiness,” acute stress and lack of social support. Self-transcendence was the major specific source of meaning predicting higher reasons for living after adjusting for general meaningfulness.ConclusionThe data cast some light on the psychological meaning of suicide. It follows that prevention efforts are to be focused not on eliminating the factors “pushing” one to suicidal behavior, but rather on supporting inner strengths conducive of a positive decision,to be, through enhancing meaningfulness and reasons for living. (shrink)

Effective infectious disease control may require states to restrict the liberty of individuals. Since preventing harm to others is almost universally accepted as a legitimate (prima facie) reason for restricting the liberty of individuals, it seems plausible to employ a mid‐level harm principle in infectious disease control. Moral practices like infectious disease control support – or even require – a certain level of theory‐modesty. However, employing a mid‐level harm principle in infectious disease control faces at least three problems. First, it (...) is unclear what we gain by attaining convergence on a specific formulation of the harm principle. Likely candidates for convergence, a harm principle aimed at preventing harmful conduct, supplemented by considerations of effectiveness and always choosing the least intrusive means still leave ample room for normative disagreement. Second, while mid‐level principles are sometimes put forward in response to the problem of normative theories attaching different weight to moral principles, employing a mid‐level harm principle completely leaves open how to determine what weight to attach to it in application. Third, there appears to be a trade‐off between attaining convergence and finding a formulation of the harm principle that can justify liberty‐restrictions in all situations of contagion, including interventions that are commonly allowed. These are not reasons to abandon mid‐level theorizing altogether. But there is no reason to be too theory‐modest in applied ethics. Morally justifying e.g. if a liberty‐restriction in infectious disease control is proportional to the aim of harm‐prevention, promptly requires moving beyond the mid‐level harm principle. (shrink)

I argue that university supervisors should not use student evaluations of teachers (SETs) as a measure of teaching effectiveness in personnel assessments because the evidence suggests SETs likely violate several duties university supervisors have toward their instructional employees. I focus on the duty to not knowingly impose a wrongful risk of harm on nonconsenting and innocent others. Many university employers impose a wrongful risk of harm on instructors by not using relevant, merit-based performance indicators that have adequate construct validity, by (...) using uncorrected indicators that likely perpetuate discrimination, and by incentivizing instructors to do wrong. The use of SETs imposes unjust risk of harm on all instructors, but the risk is higher for women, minorities, and those in precarious, teaching-focused roles. In conclusion, I tentatively suggest some other means of evaluating student learning and assessing instructors. (shrink)

Philosophers spend a lot of time worrying about rules. We worry about how one ought to live, about the rules of justification for beliefs and actions, about what it would be like if the rules of reason were rigorously followed, about what the rules are for scientific enquiry, about which rules govern the meaning of signs and the intentions of agents, and so on. Sometimes, we argue that there are no such rules as most of us want to believe there (...) are, rules which apply to all of us collectively and to each of us individually, which are beyond our ability to change, and whose violation is in some simple sense wrong. To this we often respond that without such rules we are all made somehow less, that our normative deliberations are a sham, or even that the whole business of living becomes somehow pointless. (shrink)

In this paper I explore a new approach to the ethics of animal experimentation by conceiving of it as a form of rescue. The notion of rescue, I suggest, involves some moral agent performing an action or series of actions, whose end is to prevent or alleviate serious harm to another party, harm that otherwise would have occurred or would have continued to occur, had that moral agent not intervened. Animal experiments that are utilized as a means to alleviate (...) human illnesses mirror the structure of rescue cases and this means that we can and should apply principles of rescue to illuminate the moral status of animal experimentation. To do this I consider various principles of rescue that might justify animal experimentation. I’ll argue that all of these rescue principles are either not independently plausible, or else they fail to imply that animal experimentation is morally justified. This suggests that it is quite difficult to morally justify animal experimentation when conceived as a form of rescue. (shrink)

When people suffer they always suffer as a whole human being. The emotional, cognitive and spiritual suffering of human beings cannot be completely separated from all other kinds of suffering, such as from harmful natural, ecological, political, economic and social conditions. In reality they interact with each other and influence each other. Human beings do not only suffer from somatic illnesses, physical pain, and the lack of decent opportunities to satisfy their basic vital, social and emotional needs. They also suffer (...) when they are not able to experience and grasp any meaning of life even if such suffering is not quite as obvious as most forms of physical, social and emotional suffering. Suffering from the lack for the sense of the meaning of life is a special form of emotional, cognitive, and spiritual suffering. Although all human beings share the same basic human need for some meaning of life, the fulfilment of this need is highly individual and personal. Although all forms of human suffering can be a challenge to the meaning of life, the personal conditions of suffering usually are a stronger challenge for the meaning of life. Among the personal conditions of human suffering, the Grenzsituationen cannot be cancelled or raised at all, but only accepted and coped with as existential aspects of the conditio humana. According to Karl Jaspers these are: death, suffering, struggling, guilt, and failing. The challenge for human beings to cope with these Grenzsituationen is a way to move from the mere Being-there to true human Existence. (shrink)

The terms 'transcendence' and 'immanence' are often used casually and as self-evident. The spatial imagery contained in their meaning determines the way they are understood and used: as opposites, like 'there' and 'here'. As a consequence, the two concepts are seen as mutually exclusive when applied to God's being and to his activity and presence in our world and in our history. This view on the relationship between God and world is characteristic not only of deism and pantheism, but also (...) of theism. However, in the view of Thomas Aquinas, such an opposition cannot adequately capture the central tenets of the Christian faith. This book explores Aquinas' thought on transcendence and immanence in his discussions of creation, analogy, the Trinity, grace and Christ, and offers interpretations in which God's transcendence and his immanence do not exclude but imply one another. >br/>The papers contained in this volume were originally presented at the third international conference of the Thomas Instituut at Utrecht in 2005. (shrink)

Climate change presents urgent ethical challenges. It causes us to revisit what it means to ‘do’ professionalism and invites us to enter what Fisher described as the ‘forgotten zone’ of human-nature relationships, posing the troubling question of whether we can continue to valorise a version of being human on the same terms as before.This article begins by considering the relevance of global warming to professional practice, foregrounding the commitment to do no harm. It poses as problematic the manner in (...) which climate change knowledges have been taken up by the ‘psy subject’. It concludes by considering how we might story different versions of being alive in, and to, the natural world. (shrink)

The concept of information tempts us as a theoretical primitive, partly because of the respectability lent to it by highly successful applications of Shannon’s information theory, partly because of its broad range of applicability in various domains, partly because of its neutrality with respect to what basic sorts of things there are. This versatility, however, is the very reason why information cannot be the theoretical primitive we might like it to be. “Information,” as it is variously used, is systematically ambiguous (...) between whether it involves continuous or discrete quantities, causal or noncausal relationships, and intrinsic or relational properties. Many uses can be firmly grounded in existing theory, however. Continuous quantities of information involving probabilities can be related to information theory proper. Information defined relative to systems of rules or conventions can be understood relative to the theory of meaning . A number of causal notions may possibly be located relative to standard notions in physics. Precise specification of these distinct properties involved in the common notion of information can allow us to map the relationships between them. Consequently, while information is not in itself the kind of single thing that can play a significant unifying role, analyzing its ambiguities may facilitate headway toward that goal. (shrink)

The central task of my reflections is to deal with the question what harming a person could mean. In the first part of the reflections, I will be critically concerned with current ways of dealing with the concept of human dignity, and why it is no longer plausible to uphold these regulations, whereby I will particularly focus on the legal dimension. It will come out that the person-object-dichotomy cannot simply be upheld in its traditional manner. Given the plausibility of (...) these reflections, the legal implication that it ought to be legally prohibited to treat another person merely as a means becomes implausible, too, as it rests on the aforementioned distinction between persons and objects. As an alternative, it will be suggested that legally we ought to separate ontological insights clearly from normative ones. In the following part, I will focus on the moral status of personhood, and develop some philosophical reflections which could be upheld on the basis of a posthuman paradigm-shift. Thereby, I will develop a gradual concept of personhood which implies several levels of personhood depending on the corresponding capacity of suffering, which needs to be established empirically. Once, the direction of an alternative concept of personhood becomes clearer, which implies that some animals become person and which provides some reasons for holding that some sufficiently developed embodied AIs could also deserve personhood, the question can be reflected upon further what it could mean to harm a person. The issue of harming, however, is so complex that I merely plan to raise some questions which need to be confronted when clarifying the concept of harming. I do not attempt to propose a definite concept of harming, but stress that the concept is closely related to cultural circumstances, so that there is a permanent need to engage with the concept, redefine it, and adapt it to the current cultural situation. Not proposing a clear concept of harm is not a shortcoming, but rather a necessity. (shrink)

Evolving signaling systems can be said to induce partitions on the space of world states as they approach equilibrium. Formalizing this claim provides a general framework for understanding what it means for language to “cut nature at its seams”. In order to avoid taking our current best science as providing the adaptive target for all evolving systems, the state space of the world must be characterized exclusively in terms of the coincidence of stimuli and payoffs that drives the evolution (...) of cognitive complexity. Cognition exploits the reliable clustering of events in this space. Using this framework to analyze our ordinary concepts of truth and justification, it appears that while justification can be a simple matter of conforming to historically entrenched strategies, truth cannot be fully specified on the basis of the system’s causal history, but requires a robust clustering in the larger world state space. (shrink)

Information theory offers a measure of "mutual information" which provides an appropriate measure of tracking efficiency for the naturalistic epistemologist. The statistical entropy on which it is based is arguably the best way of characterizing the uncertainty associated with the behavior of a system, and it is ontologically neutral. Though not appropriate for the naturalization of meaning, mutual information can serve as a measure of epistemic success independent of semantic maps and payoff structures. While not containing payoffs as terms, mutual (...) information places both upper and lower bounds on payoffs. This constitutes a non-trivial relationship to utility. (shrink)

This essay begins with a brief description of my approach to the study of argumentation and fallacies which is empirical, historical-textual, dialectical, and meta-argumentational. It then focuses on the fallacy of composition and elaborates a number of conceptual definitions and distinctions: argument of composition; fallacy of composition; arguments and fallacies of division; arguments that confuse the distributive and collective meaning of terms; arguments from a property belonging to members of a group to its belonging to the entire group; several nuanced (...) schemes for arguments of composition; and several principles for the evaluation of such arguments. I then call attention to the fact that some scholars have claimed that the basic argument for global warming commits the fallacy of composition, and undertake a critical analysis of this claim. I show that the global-warming argument is not a fallacy of composition, but is rather a deductively valid argument of composition from the temperature of the parts to the temperature of the whole earth; moreover, I criticize the meta-argumentation of these scholars by showing that the global-warming argument is not similar to the one for global pollution, which is indeed fallacious; finally, I argue that these scholars confuse the global-warming argument with the argument claiming that all effects of global warming are harmful, which is indeed incorrect as a hasty generalization. (shrink)

Abstract Democracy is a fundamental right linked to the realization of a person’s worthy life project regarding its corresponding fulfillment of Human Rights. Along with the procedures to form political majorities, it is mandatory to incorporate the substantial part as a means and end for the normative content of Human Dignity to be carried out allowing it to: i) freely choose a project of valued life with purpose and autonomy ii) to have material and intangible means to function (...) in society; and iii) to live free from harm and fear in order to achieve human flourishing. The integral democracy is a means and an end to materialize individual happiness and the common good as long as everyone has concrete opportunities to unfold its inherent human dignity capacities within the trademark of the democratic constitutional State. Assuming this, integral democracy is the fundamental right of Fundamental Rights. (shrink)

This paper reviews the social scientific literature on biometric surveillance, with particular attention to its potential harms. It maps the harms caused by biometric surveillance, traces their theoretical origins, and brings these harms together in one integrative framework to elucidate their cumulative power. Demonstrating these harms with examples from the United States, the European Union, and Israel, I propose that biometric surveillance be addressed, evaluated and reframed as a new form of control rather than simply another means of inspection. (...) I conclude by delineating three features of biometric technologies—complexity, objectivity, and agency—that demonstrate their social power and draw attention to the importance of studying biometric surveillance. (shrink)

The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years. This paper examines the problem of medical mistakes historically. It documents how legal, scientific, and medical trends during (...) the years 1890Ð1934 intersected to effect the reporting of mistakes in the subspecialty of neurosurgery. At the start of this time frame, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone ÒundergroundÓ and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOMÕs suggestions for change and comments on what they mean for the culture of medicine. (shrink)

Irish legislative engagement with abortion law reform has never been framed by recognition of the rights of pregnant women, girls and other people. Rather, where it has taken place at all, it has always been foetocentric and punitive, exceptionalising abortion and conceptualising law as a means of discouraging it. In important ways, the post-repeal landscape has failed to break decisively with this orientation. While in 2018 there was certainly more discussion of women’s entitlement not to be exiled from the (...) country in order to make decisions about reproduction, the framing that dominated legislative and government discourses of abortion law reform was one in which the ‘problem’ being addressed was such that unsafe medication, exclusion from formal medical systems, and the undeserved punishment of people who had received diagnoses of fatal foetal conditions in the course of their ‘much wanted pregnancies’ were the focus. There was little or no engagement in legislative politics with the right to choose, reproductive agency, reproductive justice or the moral standing of pregnant people as ethical decision makers when it came to their pregnancies. As a result, post-repeal abortion law reform was more about managing risk than maximising agency. I will argue that this underpins and partly explains the shortcomings of the new law: the Health (Regulation of Termination of Pregnancy) Act 2018 (‘HRTPA 2018’). Within that new legal regime, I argue, pregnant people continue to lack decisional security when it comes to their reproductive lives and are exposed to significant constitutional and dignitary harms as a result. (shrink)

Some have recently argued that parents are morally obligated, under certain circumstances, to use pre-natal genetic intervention as a means of enhancement. Despite aiming to benefit the child, such intervention may produce serious and irreparable harm. In these cases, parents seem to have an obligation not to intervene, as such efforts make the child worse off. Julian Savulesu has argued that while harm raises doubts about the acceptability of genetic enhancement, genetic selection remains an obligation. This claim, however, rests (...) on an indefensible privileging of personal over impersonal harm. I propose instead that we reframe the debate as stemming from fundamentally different views about parental obligation. The objection from harm rests on an objectivist conception, according to which obligation is determined by all relevant facts, including unpredictable harm. Proponents of genetic enhancement, however, operate within subjectivist assumptions about obligation, according to which moral requirements are determined by reasons that are epistemically accessible to the relevant agents. I will argue here that because subjectivism offers a more reasonable conception of parental obligation, such unforeseeable harm does not remove a parent’s obligation to enhance. (shrink)

Regulatory authorities have advised smokers who would not or could not quit smoking to switch to lower tar cigarettes. Smoking such cigarettes was seen as a means of reducing the harm caused by smoking, but not as offering a ‘safe’ smoking option. Correspondingly manufacturers have been required to place tar and nicotine information on packet labels and/or advertisements. This paper explores the possibility that the conventional format for conveying tar and nicotine information could be responsible for the belief, held (...) by a significant proportion of smokers, that some brands of lower tar cigarettes are absolutely ‘safe’. To deal with this situation it is suggested that changes should be made to health warnings, and tar and nicotine communications. Proposed changes to the latter are evaluated in terms of their ethical and public health implications. The authors conclude that brand specific warnings and a classification of cigarettes as either ‘Very Dangerous’ or ‘Dangerous’, is best suited to reconciling consumer needs for information with the public health objectives of reducing the harm caused by smoking. (shrink)

Essential to the doctrine of double effect is the idea that agents are prohibited from intending evil as a means to a good end. I argue in this paper that some recent accounts of intention from proponents of double effect cannot sustain this prohibition on harmful means. I outline two ways to gerrymander intention that mark these accounts. First, intention is construed in such a way that an agent intends only those states of affairs that she cares about (...) or finds motivating for their own sake. Second, intention is construed in such a way that what counts as intended is determined sufficiently by the agent’s beliefs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comment on Hospice of Washington's PolicyJohn A. Robertson (bio)The recent history of medical ethics may accurately be described as a history of coming to terms with personal autonomy and informed consent across the range of medical practice. Nowhere has this recognition been more important than in decisions to withhold or withdraw life-sustaining medical procedures from terminal and chronically ill patients.Despite the widespread acceptance of autonomy in these decisions, many (...) people—physicians, families, and policymakers—have balked at extending it to the withdrawal of artificially supplied fluids and nutrition. The symbolic connotations of food and water have led some persons to perceive cessation of medically-supplied fluids and nutrition to be a cruel, barbarous act, rather than the merciful respect for the dying patient that such withdrawal usually represents.Two recent events might help resolve the controversy, and ensure that decisions about artificial fluid and nutrition are handled like any other medical intervention—according to patient and family choice and patient welfare. One event is the Supreme Court decision in Cruzan (Cruzan v. Director of Missouri Department of Health, 110 S.Ct. 2841, 1990). Although the Supreme Court upheld Missouri's constitutional power to require artificial nutrition for a patient in a persistent vegetative state, its decision was not based on the symbolic importance of artificial fluids and nutrition. No Supreme Court justice saw a significant difference between medically-supplied nutrition and hydration and other medical interventions, thus allowing them to be discontinued either directly or by advance directive on the same basis as other medical interventions.The second event is the publication of the statement of "Philosophy Regarding Medical Intervention to Supply Fluids and Nutrition" by Hospice of Washington (or similar statements by other organizations). This statement is useful and important because it removes the issue of food and water from its symbolic overlay [End Page 139] and places it in the real context of dying hospice patients. It makes clear that the overriding consideration should be benefit to the patient "in accord with the patient's wishes or those of the appropriate surrogate(s) for the patient." Depending on those wishes and their impact on the patient, this position may or may not involve medically-supplied fluids and nutrition.This statement is also helpful in showing the medical complexity of such decisions in terms of their actual effect on dying patients. Rather than an either/or position, it recognizes that fluids may harm a dying patient by increasing discomfort, and that "persons near death do not ordinarily tolerate substantial volumes of enteral feedings." Thus rather than adhere to a symbolically-based position about the meaning of food and water to a dying patient, the important thing is to look to that patient's needs and give fluids or not, as the patient's wishes and situation demand.Fortunately, the law in most jurisdictions will recognize such a position. In those few jurisdictions that have made a fetish of artificial fluids and nutrition, the law should be changed, for the HOW statement makes clear that such a position may actually end up harming dying patients. Patient welfare should be privileged above all else, and patient welfare may often entail that fluids and nutrition not be medically supplied. Even then, however, caregivers will look to patient comfort and remedy dry mouths and lips with lubricants and ice chips.The HOW statement is, in my view, a very useful guideline not only for hospices but for hospitals, too—for any situation in which a patient is terminally ill and soon to die. A somewhat different set of issues arises, however, when the patient is chronically ill and incompetent, and will survive for long periods with medically-supplied fluids and nutrition. Recognition of patient rights in those situation should also permit cessation of fluids and nutrition on the same basis that respirators, antibiotics, and other life-sustaining measures may be withheld. But the withholding of medically-supplied fluids and nutrition from a patient who no longer has interests in surviving in an extremely debilitated condition raises different issues from withholding fluids that could cause such discomfort and nutrition when the patient is imminently dying. In either case, patient... (shrink)

In The Right to Threaten and the Right to Punish, Warren Quinn justifies punishment on the ground that it can be derived from the rights of persons to protect themselves against crime. Quinn, however, denies that a right of self-protection justifies the punishment of an aggressor solely on the ground that such punishment deters others from harming the victim of that aggression or others. He believes that punishment so justified would constitute a morally objectionable instance of using the punished (...) individual as a means. Contrary to Quinn, I argue that (1) an individual can, on the very ground of a right to self-protection that Quinn ultimately relies upon to justify punishment, justify the punishment of an individual as a means of deterring others from committing crimes; and that (2) an individual or individuals (including state officials) can, on the ground of vindicating the right of protection that others possess, justify the punishment of an individual as a means of deterring others from committing crimes. (shrink)

Institutional investors are increasingly focusing on firms that prioritise Corporate Social Responsibility. In the absence of any objective measure of a firm's CSR Performance, their investment choices are largely guided by independent rating indices that rank firms according to their social performance metrics. As a result, firms looking to increase their attractiveness as targets of social investment focus their CSR efforts on increasing the visibility of activities that are recognised by such indices. However, the validity of these indices as accurate (...) measures of firms' actual social performance has repeatedly been called into question. This means that the ability of these indices to measure and report on firms' actual social impact cannot be ascertained with any degree of accuracy. The result is that firms are incentivised to engage in activities that cannot be said to improve social responsibility, and may even ultimately harm society. Thus, another method of measuring CSP must be found that enables firms to measure their true impact on society. We propose a new approach to measuring CSP that is integrated with stakeholder theory. Such an approach provides managers of firms with an interest in engaging in real social development for the purposes of ensuring firm survival with the ability to understand their social obligations, and the ability to measure the resulting benefit to society. (shrink)

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I argue that the (...) author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

Many activities impose risks of harm on other people. One such class of risks are those that individuals culpably impose on others, such as the risk arising from reckless driving. Do such risks in themselves constitute a harm, over and above any harm that actually eventuates? This paper considers three recent views that each answer in the affirmative. I argue that each fails to overcome what I call the ‘interference objection’. The risk of harm itself, whether taken as a subjective (...) or an objective risk, is unable to interfere with the interests of victims in order to constitute a harm. This does not mean that a risk of harm cannot itself be wrongful, but the conclusion does weaken the moral objectionableness of impositions of risks of harm. (shrink)

Although risk and uncertainty are inevitable aspects of the sustainability problem, they are often neglected in the sustainability discourse, especially in the economic analysis of sustainable development. We argue that this deprives the sustainability discourse of interesting connections to risk management. We show that defining sustainability as the obligation to limit the risk of harming future individuals provides a framework in which tools from risk management, like mean-variance analysis, can be employed to analyze planning decisions and to calculate a (...) risk-minimizing policy mix. Furthermore, we discuss whether such a notion of sustainability can be an ethically tenable sustainability concept and how a positive probability of harming future individuals might be defended. (shrink)

When considering a paradigm shift in higher education, it is imperative to focus on removing obstacles against maintaining integrity in academia. One such obstacle is contract cheating sites that have mushroomed disproportionately during the 18 months of emergency distance learning threatening graduate quality and university reputations. It was sharply brought to focus in 2015 due to a mass-scale scandal involving 16 universities and more than 1000 students leading to a subsequent law making such services illegal in Australia. Contract cheating is (...) a mushrooming industry that is constantly targeting often unsuspecting students under the guise of legitimate help. Moreover, these services in turn began black mailing students after delivering services. It is therefore vital to explore the existence and number of such websites that target students in UAE, sometimes using university logos to show legitimacy to understand the extent of the problem. This is primarily because an accurate measure of the extent does not currently exist. Curtis et al. have reported on self-reported cases from students which can be varied and often under-reported. This study is an attempt at using Boolean search technique to count unique and organic websites that have manifested. Coded analysis was used to collate the websites and count the total number of searches. For a total of 34 unique and organic websites, 29 showed a z score higher than the mean value 2.94, at standard deviation of 1.89, positing that the probability of appearance of these 29 websites across different search engines, different browsers and across separate search keywords was significant. This demonstrates the aggressive nature of these sites and their considerable efforts to offer a service that is harmful and detrimental to the students and education sector. This study is a milestone towards developing a nation-wide understanding of contract cheating in the UAE. It is also positioned as a proposal for higher education sustainability in the nation to look to ban services that offer to write assignments for students with or without a fee as a top-down approach to tackling the issue. (shrink)

In some cases people judge it morally acceptable to sacrifice one person’s life in order to save several other lives, while in other similar cases they make the opposite judgment. Researchers have identified two general factors that may explain this phenomenon at the stimulus level: (1) the agent’s intention (i.e. whether the harmful event is intended as a means or merely foreseen as a side-effect) and (2) whether the agent harms the victim in a manner that is relatively “direct” (...) or “personal”. Here we integrate these two classes of findings. Two experiments examine a novel personalness/directness factor that we call personal force, present when the force that directly impacts the victim is generated by the agent’s muscles (e.g., in pushing). Experiments 1a and b demonstrate the influence of personal force on moral judgment, distinguishing it from physical contact and spatial proximity. Experiments 2a and b demonstrate an interaction between personal force and intention, whereby the effect of personal force depends entirely on intention. These studies also introduce a method for controlling for people’s real-world expectations in decisions involving potentially unrealistic hypothetical dilemmas. (shrink)

The second way to characterize a constraint against harm is as a constraint against intending harm. This presupposes a distinction between harm that is intended as a means or an end, and harm that is merely foreseen as an unintended side effect. We can again provide some intuitive support for this distinction – in terms of either the idea of using someone or the idea of aiming at evil – but here too the distinction ends up sorting cases in (...) ways that are intuitively unattractive. And once again, attempts to defend the relevance of the distinction are ultimately unsuccessful, as are attempts to show that the distinction would support a constraint. (shrink)

The clinical introduction of medical devices often occurs with relatively little oversight, regulation and (long-term) follow-up. Some recent controversies underscore the weaknesses of the current regime, such as the complications surrounding the metal-on-metal hip implants and the scandal surrounding the global breast implant scare of silicone implants made by France's Poly Implant Prothese (PIP) Company. The absence of national registries hampered the collection of reliable information on the risks and harms of the PIP breast implants. To warrant long-term safety, a (...) case can be made for mandatory post-marketing surveillance by means of the establishment of compulsory registries. In this edition of Public Health Ethics, Schofield calls for debate on how such a registry system should be initiated and maintained and how it would relate to the ethical requirement of consent. Here we use breast implant registries as a case to discuss whether and when a so-called ‘thick opt-out’ would be an appropriate method to include people in medical device registries. We conclude that a thick opt-out procedure for medical device registries is only justifiable in cases where inclusion does not involve burdens (or very low), when it does not involve a sensitive subject and when the data are stored anonymously (or at least not directly linked to the medical record). Otherwise, inclusion should be sought by means of an opt-in. (shrink)

The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at all. In this paper, we focus on the (...) harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In this respect, we briefly examine the two components of harm, distress and disability, and then trace a distinction between mental disorder tokens and mental disorder types. Second, we argue that the decision not to regard the harm requirement as a necessary criterion for mental disorder is tenable for a number of practical and theoretical reasons, some pertaining to conceptual issues surrounding the two components of harm and others pertaining to the problem of false negatives and the status of psychiatry vis-à-vis somatic medicine. However, we believe that the harm requirement can be maintained among the specific diagnostic criteria of certain individual mental disorders. More precisely, we argue that insofar as the harm requirement is needed among the specific diagnostic criteria of certain individual mental disorders, it should be unpacked and clarified. (shrink)

The validity of the double effect doctrine is examined in euthanasia and abortion. In these two situations killing is a method of treatment. It is argued that the doctrine cannot apply to the care of the dying. Firstly, doctors are obliged to harm patients in order to do good to them. Secondly, patients should make their own value judgments about being mutilated or killed. Thirdly, there is little intuitive moral difference between direct and indirect killing. Nor can the doctrine apply (...) to abortion. Doctors kill fetuses as a means of treating the mother. They also kill them as an inevitable side effect of other treatment. Drawing a moral distinction between the direct and the indirect killing gives counterintuitive results. It is suggested that pragmatic rules, not ethics, govern practices around euthanasia and cause it to be more restricted than abortion. (shrink)

Many research ethics guidelines now oblige researchers to offer research participants the results of research in which they participated. This practice is intended to uphold respect for persons and ensure that participants are not treated as mere means to an end. Yet some scholars have begun to question a generalised duty to disclose research results, highlighting the potential harms arising from disclosure and questioning the ethical justification for a duty to disclose, especially with respect to individual results. In support (...) of this view, we argue that current rationales for a duty of disclosure do not form an adequate basis for an ethical imperative. We review policy guidance and scholarly commentary regarding the duty to communicate the results of biomedical, epidemiological and genetic research to research participants and show that there is wide variation in opinion regarding what should be disclosed and under what circumstance. Moreover, we argue that there is fundamental confusion about the notion of “research results,” specifically regarding three core concepts: the distinction between aggregate and individual results, amongst different types of research, and across different degrees of result veracity. Even where policy guidance and scholarly commentary have been most forceful in support of an ethical imperative to disclose research results, ambiguity regarding what is to be disclosed confounds ethical action. (shrink)

Philosophy of epidemiology has recently emerged as a distinct branch of philosophy. The field will surely benefit from pluralism, reflected in the broad range of topics and perspectives in this special issue. Here, I argue that a healthy pluralistic field of philosophy of epidemiology has social responsibilities that require the field as a whole to engage actively with research on social determinants of health and health disparities. Practicing epidemiologists and the broader community of public health scientists have gradually acknowledged that (...) much of their attention ought to be paid to these, i.e. inequitable between-population health variations that largely reflect the world’s inequitable distribution of resources and social conditions. The paper illustrates how and why health disparities and social determinants of health, through no ill will, become de facto secondary concerns in Alex Broadbent’s field-defining Philosophy of Epidemiology, showing the ease with which these topics can be incidentally sidelined. As means for philosophy of epidemiology to meet its social responsibility obligations, I suggest philosophy of epidemiology expand its attention to two particular lines research. First, the paper discusses Geoffrey Rose’s concept of “causes of incidence”—causes of disparities between populations—and argues for the importance of engaging with these causes. Second, the paper argues for the value of engaging with Bruce Link and Jo Phelan’s “fundamental causes” model of how flexible social resources serve as buffers from harms, generating a plethora of shifting and locally-contingent health effects. (shrink)

Wakefield’s harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction and a value component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions (...) need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction’s harmfulness is best understood in dispositional terms. (shrink)

The concept of hospitality has seen a strong revival in the literature on migration and among pro-migrant activists. However, its meaning, its scope, and the nature of the obligations it imposes remain contested. Open-border advocates see hospitality as a moral principle of openness that should trump nationalist arguments for closure, while nationalists tap into the home analogy and compare the state to a household welcoming migrants as guests, whose stay should accordingly be temporary and marked by gratitude. Some consider hospitality (...) a virtue that should translate into a personal responsibility to open one’s doors to others, while some politicise the concept to apply it to borders and state duties towards migrants. This paper unpacks the various literal and metaphorical meanings of the age-old concept of hospitality, and the shortcomings of its rhetorical uses. It then argues for a conception of hospitality as a principle of care towards displaced people. Hospitality alleviates ordinary obstacles that prevent a functional life in a new environment and allows for home-making practices. It is triggered by the vulnerability created by displacement, i.e., the material, emotional and political harms resulting from the loss of a home. (shrink)

Frances Kamm's Principle of Secondary Permissibility specifies a class of exceptions to the general rule not to kill as a means. The principle allows us to harm as a means some of those who would have been otherwise harmed as side effects. ‘For example, suppose it is impermissible to paralyze A's legs as a means to a greater good. It would still be permissible to do this as the alternative to permissibly killing A as a mere indirect (...) side effect.’ I argue that, despite of its great appeal, PSP is incorrect; it is simply not true that the victims of substitutive harm are not worse off than they would otherwise permissibly have been. In fact, there is no moral difference between the purportedly substitutive harm licensed by PSP and the standard sort of harming as means repudiated by nonconsequentialists. (shrink)

Harm minimisation has been proposed as a means of supporting people who self-injure. When adopting this approach, rather than trying to stop self-injury immediately the person is allowed to injure safely whilst developing more appropriate ways of dealing with distress. The approach is controversial as the health care professional actively allows harm to occur. This paper will consider a specific objection to harm minimisation. That is, it is a misguided collaboration between the health care professional and the person who (...) self-injures that is morally and clinically questionable. The objection has two components. The first component is moral in nature and asserts that the health care professional is complicit in any harm that occurs and as a result they can be held morally responsible and subject to moral blame. The second component is clinical in nature and suggests that harm minimisation involves the health care professional in colluding in the perpetuation of self-injury. This element of the objection i... (shrink)

This book argues that the risk of harm in armed conflict should be divided equally between combatants and enemy non-combatants. International law requires that combatants in war take 'all feasible precautions' to minimise damage to civilian objects, injury to civilians, and incidental loss of civilian life. However, there is no clear explanation of what 'feasible precautions' means in this context, or what would count as sufficiently minimised incidental harm. As a result, it is difficult to judge whether a particular (...) war or offensive actually satisfies this requirement. Just war theorists often consider it common sense that merely not intending to harm innocent civilians is not sufficient, but there is little clarity in the literature regarding what this means. One crucial question that is almost always overlooked is that of what the appropriate baseline distribution of risk should be. This book defends the Minimal Harm Requirement, which states that combatants should make an effort to reduce merely foreseen harm to enemy non-combatants to the lowest reasonable level. In order to assess which risk impositions are reasonable, and which are not, an egalitarian baseline should be adopted, suggesting that other things being equal risk of harm should be distributed equally between just combatants and unjust non-combatants. This book will be of much interest to students of just war theory, ethics, security studies, and international relations. (shrink)

In her latest book _Spying Through a Glass Darkly: The Ethics of Espionage and Counter-Intelligence_, Cécile Fabre suggests that the deception of third parties during an infiltration operation can be justified as a foreseen but unintended side effect. In this essay, I criticize this view. Such deception, I argue, is better justified paternalistically as a means of preventing third parties from becoming wrongful threats. In the second part of the article, I show that Fabre ignores an important moral complication (...) in deception operations where agents intentionally allow others to be harmed as a means of protecting a secret. I argue that intentionally allowing harm to others as a means is a particularly problematic mode of agency which must be addressed in a normative account of espionage. (shrink)

The meaning of the word philosophy, “love of wisdom,” the dominant interest of Socrates, the developments of Greek philosophy in Epicureanism and Stoicism, Kant's reliance on the practical reason as a clue to reality—all justify the direction of attention in this essay from the abstract theoretical to the concrete practical aspects of thought. Not that the two can or ought to be separated from, or opposed to one another; for human personality is a unity, and theory and practice must act (...) and react the one on the other. The familiar saying: “More harm is wrought for want of thought than even want of heart,” indicates that in moral activity under-standing of consequences is no less necessary than goodness of intention or motive. The preacher who declared that he was an Agnostic in mind, and a Christian in heart, if he really knew himself and was not deceiving himself with a rhetorical phrase, was in a perilous and unsatisfactory state of mental equilibrium. (shrink)