Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is (...) morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free—they are coercive, after all—voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making. (shrink)

This paper imagines what the liberatory possibilities of (full) ectogenesis are, insofar as it separates woman from female reproductive function. Even before use with human infants, ectogenesis productively disrupts the biological paradigm underlying current gender categories and divisions of labour. I begin by presenting a theory of women’s oppression drawn from the radical feminisms of the 1960s, which sees oppression as deeply rooted in biology. On this view, oppressive social meanings are overlaid upon biology and body, as artefacts of culture (...) and history. I then argue that ectogenesis should be pursued to replace two modes of assisted gestation that can be seen as outgrowths of oppressive assumptions about women's function, ectogenesis should be pursued to replace two modes of assisted gestation. These are gestational surrogacy and uterine transplant, which arise partly from gendered, pronatalist, and geneticist norms. These practices are supported by assumptions about women’s identity and value. Pursuing technologies such as ectogenesis, which weaken the presumed link between biology and gender, is beneficial to (trans-inclusionary radical) feminist aims, as part of a broad project of challenging dominant power relations resting on and maintaining gender categories. By allowing the conceptual separation of female reproductive function from ‘woman’, ectogenesis raises questions about how we determine who counts in this gender identity, and also how we value those who claim the identity ‘woman’. I conclude that ectogenesis has the potential to challenge traditional patriarchal family structures, and thence all other male-dominated structures (of work, education, cultural production), allowing a reimagining of the family and society in more radical ways than we have yet achieved. (shrink)

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a (...) policy RCT, policy experts must either reasonably disagree about whether the trial arms are more effective than this policy, or know that they are. (shrink)

Government agencies and nonprofit organizations have increasingly turned to randomized controlled trials (RCTs) to evaluate public policy interventions. Random assignment is widely understood to be fair when there is equipoise; however, some scholars and practitioners argue that random assignment is also permissible when an intervention is reasonably expected to be superior to other trial arms. For example, some argue that random assignment to such an intervention is fair when the intervention is scarce, for it is sometimes fair to use a (...) lottery to allocate scarce goods. We investigate the permissibility of randomization in public policy RCTs when there is no equipoise, identifying two sets of conditions under which it is fair to allocate access to a superior intervention via random assignment. We also reject oft-made claims that alternative study designs, including stepped-wedge designs and uneven randomization, offer fair ways to allocate beneficial interventions. (shrink)

Governments are increasingly using randomized controlled trials (RCTs) to evaluate policy interventions. RCTs are often understood to provide the highest quality evidence regarding the causal efficacy of an intervention. While randomization plays an essential epistemic role in the context of policy RCTs however, it also plays an important distributive role. By randomly assigning participants to either the intervention or control arm of an RCT, people are subject to different policies and so, often, to different types and levels of benefits. In (...) this paper, I identify one necessary condition as well as a set of sufficient conditions for the permissible use of random assignment by government agencies. I argue first that random assignment is permissible only if it is consistent with governments’ duty to realize morally important outcomes. I argue second that random assignment is permissible in cases where investigators are in a state of genuine equipoise regarding all arms of the experiment and the policy to which people have a claim of justice. Finally, I defend a set of conditions under which random assignment is permissible in cases where one or more arms of a policy RCT are reasonably expected to be either superior or inferior to this policy. (shrink)

Australia, Canada, and New Zealand currently apply health requirements to prospective immigrants, denying residency to those with health conditions that are likely to impose an “excessive demand” on their publicly funded health and social service programs. In this paper, I investigate the charge that such policies are wrongfully discriminatory against persons with disabilities. I first provide a freedom-based account of the wrongness of discrimination according to which discrimination is wrong when and because it involves disadvantaging people in the exercise of (...) their freedom on the basis of morally arbitrary features of their identity. Discrimination is permissible, I suggest, when it is necessary to advance a valuable exercise of the discriminating agent’s freedom. I then apply this account to the case of social cost health requirements. Against critics of these requirements, I argue that it is sometimes permissible for states to discriminate against prospective immigrants with disabilities. States may do so, I suggest, when such discriminatory treatment is necessary to prevent an increase in rates of mortality and/or morbidity amongst citizens. Alongside critics of social cost health requirements however, I argue that existing policies are likely a form of wrongful discrimination insofar as they are too broad to satisfy this standard. (shrink)

The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to whom (...) they might possess a duty to rescue. Investigators may often ask themselves, what can I do, what should I do, to help? Such investigators often help people in the future by carrying out their... (shrink)

Many high-income countries have skill-selective immigration policies, favoring prospective immigrants who are highly skilled. I investigate whether it is permissible for high-income countries to adopt such policies. Adopting what Joseph Carens calls a " realistic approach " to the ethics of immigration, I argue first that it is in principle permissible for high-income countries to take skill as a consideration in favor of selecting one prospective immigrant rather than another. I argue second that high-income countries must ensure that their skill-selective (...) immigration policies do not contribute to the non-fulfillment of their duty to aid residents of low-and middle-income countries. (shrink)

In this paper, I explore the ethics of subject selection in the context of biomedical research. I reject a key principle of what I shall refer to as the standard view. According to this principle, investigators should select participants so as to minimise aggregate risk to participants and maximise aggregate benefits to participants and society. On this view, investigators should exclude prospective participants who are more susceptible to risk than other prospective participants. I argue instead that investigators should select subjects (...) in accordance with an alternative principle: formal equality of opportunity. According to this principle, investigators must treat all prospective participants the same unless differential treatment is warranted by the scientific goals of the study or the need to promote participants' medically related interests. All prospective participants (1) who meet the scientifically defined eligibility criteria and (2) for whom participation is consistent with their medically related interests should have an equal, formal opportunity to participate in the study. Prospective participants should not be excluded simply because they are more susceptible to risk than others. (shrink)

I argue that ‘actually’ does not have a reading according to which it is synonymous with the actuality operator of modal logic, and propose an alternative account of ‘actually’. The cases that have been thought to show that ‘actually’ is synonymous with the actuality operator are modal and counterfactual sentences in which an embedded clause's evaluation is held fixed at the world of the context. In these cases, though, this embedded clause's evaluation is not due to the presence of ‘actually’. (...) As an alternative, I propose that ‘actually’ is a presupposition trigger along the lines of ‘even’ or ‘too’, and it signals that presupposed information states in the discourse are evolving in a non-standard way. (shrink)

Governments are increasingly making use of field experiments to evaluate policy interventions in the spheres of education, public health and welfare. However, the research ethics literature is largely focused on the clinical context, leaving investigators, institutional review boards and government agencies with few resources to draw on to address the ethical questions they face regarding such experiments. In this article, we aim to help address this problem, investigating the conditions under which informed consent is required for ethical policy research conducted (...) or authorized by government. We argue that investigators need not secure participants' informed consent when conducting government policy experiments if: the government institution conducting or authorizing the experiment possesses a right to rule over the spheres of policy targeted by the research; and data collection does not involve the violation of participants' autonomy rights. (shrink)

In their Target Article, “Promoting Ethical Payment in Human Infection Challenge Studies,” Lynch et al. propose a framework for ethical payment to research participants and apply it to the c...

The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...) appealing to controversial conceptions of the good life, liberals committed to this principle face a significant puzzle. (shrink)

According to the norm of policy equipoise, it is permissible to randomly assign participants to two or more interventions in a public policy randomized controlled trial (RCT) when there is meaningful uncertainty among the relevant expert community regarding which intervention is superior. While this norm is gaining traction in the research ethics literature, the idea of interventional superiority remains unclear. Is one intervention superior to another if it is reasonably expected to realize one outcome of interest more effectively, even though (...) there is uncertainty regarding other outcomes of interest? Or must an intervention be reasonably expected to realize all outcomes of interest more effectively? I address this question in this paper. My aim is to develop and defend an account of interventional superiority for policy RCTs that are authorized, funded, or conducted by government institutions. I defend the greatest value view, according to which one intervention is superior to another if and only if it is reasonably expected to more effectively realize a set of outcomes with greater value. (shrink)

How has feminism changed in the UK since the 1960s? This was the question I set out to explore in my research on the British Women’s Liberation Movement, published as Radical Feminism: Feminist Activism in Movement (2015). I found that the motivations and aspirations of activists today were similar to those reported by feminists of the Second Wave; but the methods and tactics were more professionalized and there was less of a focus on women-only space.

A chief objection to opt-out organ donor registration policies is that they do not secure people's actual consent to donation, and so fail to respect their autonomy rights to decide what happens to their organs after they die. However, scholars have recently offered two powerful responses to this objection. First, Michael B Gill argues that opt-out policies do not fail to respect people's autonomy simply because they do not secure people's actual consent to donation. Second, Ben Saunders argues that opt-out (...) policies do secure people's actual—if not explicit—consent, provided that certain conditions are satisfied. I argue that Gill and Saunders’ arguments are not successful. My conclusion does not imply that jurisdictions should not implement opt-out policies—their failure to secure people's actual consent may be outweighed by other considerations. But, my conclusion does imply that Gill and Saunders are mistaken to claim that opt-out policies are respectful of people's autonomy. (shrink)

Reasons for the limited uptake of the clinician–scientist role within nursing are examined, specifically: the lack of consensus about the nature of nursing science; the varying approaches to epistemology; and the influence of post-modern thought on knowledge development in nursing. It is suggested that under-development of this role may be remedied by achieving agreement that science is a necessary, worthy pursuit for nursing, and that rigorous science conducted from a clinical perspective serves nursing well. Straddling practice and research is a (...) powerful strategy for ensuring relevant research while forging strong links with practice. The clinician–scientist role, typically requiring a 75:25 ratio between research and clinical activities, is well established in medicine. Nursing, however, has been slow to institute the role; it is rare within North America, Australia, and western European countries, and almost non-existent outside those areas. Beyond structural obstacles, philosophical issues may explain nursing's reluctance to implement the role. Following a survey of clinician–scientist roles throughout the world, the nature of nursing science and epistemology, and the influence of post-modern thought on nursing attitudes to research are examined with respect to their influence on this role. The nurse clinician–scientist role holds promise for making strides in clinically relevant research, and for accelerating the knowledge cycle from clinical problem to research question to change in clinical practice. (shrink)

Political philosophers often formulate the problem of distributive justice as the problem of how the government ought to distribute different types of goods—for example, income or health care—to its citizens. They therefore presuppose that the government is a unitary agent that governs its citizens directly. However, although a number of governments are unitary in this way, many are federations, exhibiting a division of sovereignty between two or more levels of government having independent grounds of authority. In contrast to unitary states, (...) therefore, within a federation, two or more levels of government directly govern their citizens and are directly accountable to them. Because of the way in which different levels of government in a federation can separately affect the distribution of goods in society, federations face resource allocation problems that are far more complex than those of unitary states. In addition to determining what a just distribution of goods is, federations must also determine (1) whether distributive justice is a shared responsibility amongst different levels of government, and, if so, (2) how this shared responsibility should be allocated between them. (shrink)

Governments often aim to improve children’s wellbeing by targeting the decision-making of their parents. In this paper, I explore this phenomenon, providing an ethical evaluation of the ways in which governments target parental decision-making in the context of anti-poverty policies. I first introduce and motivate the concept of parent-targeted paternalism to categorize such policies. I then investigate whether parent-targeted paternalism is ever pro tanto wrong, arguing that it is when directed at parents who meet a threshold of parental competency. I (...) next explore the factors that affect the degree of pro tanto wrongness of paternalistic anti-poverty policies targeting parents, and provide an account of the conditions under which such policies are on balance permissible, and when they are not. Finally, I illustrate the plausibility and usefulness of my framework by considering a case. (shrink)

There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology have gained prominence on the political agenda. The relationship between the social determinants of health and behavioural science in health policy has not hitherto been explored. Given the (...) on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures. (shrink)

The Popperian epistemology underlying Levelt's commentary and other aspects of contemporary psychology has limited application and, in particular, does not apply to the creation or development of theory, the main goal of MacKay . This is relevant to Levelt's questions, “What has changed?” and “What is the harvest?”: From a non-Popperian perspective, both changes and harvest are greater than Levelt's commentary would suggest and carry implications for the field at large.

Emotions can be understood as a coherent, integrated system of general-purpose coping strategies, guided by appraisal, for responding to situations of crisis and opportunity (when specific-purpose motivational systems may be less effective). This perspective offers functional explanations for the presence of particular emotions in the emotion repertoire, and their elicitation by particular appraisal combinations. Implications of the Emotion System model for debated issues, such as the dimensional vs. discrete nature of appraisals and emotions, are also discussed.

In this article, I focus on two problematic aspects of British health-promotion campaigns regarding feeding children, particularly regarding breastfeeding and obesity. The first of these is that health-promotion campaigns around “lifestyle” issues dehumanize mothers with their imagery or text, stemming from the ongoing undervaluing and objectification of mothers and women. Public health-promotion instrumentalizes mothers as necessary components in achieving its aims, while at the same time undermining their agency as persons and interlocutors by tying “mother” to particular images. This has (...) a double effect: first, it excludes mothers who do not fit the campaign picture of a mother; second, it encloses those who do fit the picture into an objectified image of motherhood that is defined by and subject to the dominant white, heteropatriarchal gaze. The second problem is that campaigns place unjustified demands on mothers, which stem from a misinterpretation of the maternal duty to benefit. I argue that nutrition-related health concerns regarding children are improperly framed as individual failures of maternal duty, rather than as failures of a system to function correctly. These arguments ultimately support shifting the focus of responsibility for issues around childhood nutrition away from mothers and back toward policymakers. (shrink)

The field of public policy is dominated by the social sciences. Schools and departments of public policy and public administration are largely populated by economists, political scientists, and sociologists, and the vast majority of work in prestigious public policy journals employs empirical methods. This is unsurprising, in one respect, for collecting data, predicting and identifying the causal impacts of policies, and understanding political institutions and processes are massive, important tasks that require the tools of the social sciences. It is surprising, (...) in another respect however, since much policy scholarship and analysis aspires to offer recommendations to policymakers, and recommendations necessarily involve evaluative judgments, for example, that the status quo is deficient and that a certain course of action will make things better. To defend such judgments, policy scholars and analysts cannot appeal to the social sciences alone for these judgments concern the realm of values, not facts. Instead, careful ethical reflection and analysis is required. This need for ethical reflection in public policy is particularly evident in the practice of policy analysis, a principal analytic tool of the field. Policy analyses involve the identification of policy problems, the specification of criteria for evaluating possible solutions, and the recommendation that a policy option offers the best balance of trade offs. This identification of bads, the specification of goods policies should realize, and the weighing of these goods with the judgment that policymakers should or ought to pursue this course of action or that, are all deeply ethical activities. Ethical reflection and analysis is thus a constituent feature of policy analysis, and like the amassing of evidence and projection of outcomes, this reflection and analysis may be performed well or badly. The overall aim of this book is to provide students, scholars, and practitioners of public policy with guidance regarding the ethical dimensions of policy analysis. My aim in this chapter is to set the stage, providing an overview of these dimensions. After providing a brief overview of the practice of policy analysis, I identify the steps of an analysis where analysts must make ethical judgments in order to move forward, and fully articulate the ethical questions they must confront and take a position on. (shrink)

A person of average height would assert a truth by the conditional ‘if I were seven feet tall, I would be taller than I am,’ in which an indicative clause ‘I am’ is embedded in a subjunctive conditional. By contrast, no one would assert a truth by ‘if I were seven feet tall, I would be taller than I would be’ or ‘if I am seven feet tall, I am taller than I am’. These examples exemplify the fact that whether (...) a sentence's evaluation remains at the actual world in the scope of a modal or conditional depends on the combination of mood in the embedded and matrix clauses rather than, as is commonly thought, just on the presence of an operator ‘actually’. This essay argues that this phenomenon provides evidence that mood admits of bound and free readings along the lines of tenses and pronouns. It therefore favors the hypothesis that natural language contains variables and quantifiers for possible worlds in the object language. This, in turn, requires that the truth of a semantic value of a sentence (or whatever structure is embedded in a modal) be relativized to a sequence of worlds rather than to an individual world, and thus be distinguished from a proposition in the traditional sense. The essay also compares the framework defended with an alternative account of similar phenomena by Kai Wehmeier. (shrink)

The federal system for allocating donated livers in the United States is often criticized for allowing geographic disparities in access to livers. Critics argue that such disparities are unfair on the grounds that where one lives is morally arbitrary and so should not influence one's access to donated livers. They argue instead that livers should be allocated in accordance with the equal opportunity principle, according to which US residents who are equally sick should have the same opportunity to receive a (...) liver, regardless of where they live. In this paper, we examine a central premise of the argument for the equal opportunity principle, namely, that geographic location is a morally arbitrary basis for allocating livers. We raise some serious doubts regarding the truth of this premise, arguing that under certain conditions, factors closely associated with geographic location are relevant to the allocation of livers, and so that candidates' geographic location is sometimes a morally non-arbitrary basis for allocating livers. Geographic location is morally non-arbitrary, we suggest, since by taking it into account, the UNOS may better fulfill its central goals of facilitating the effective and efficient placement of organs for transplantation and increasing organ donation. (shrink)

Researchers have found undeniable variability and irrefutable evidence of consistencies in emotional responses across situations, individuals, and cultures. Both must be acknowledged in constructing adequate, enduring models of emotional phenomena. In this article I outline an empirically-grounded model of the structure of the emotion system, in which relatively variable actions may be used to pursue relatively consistent goals within discrete emotion syndromes; the syndromes form a stable, coherent set of strategies for coping with crises and opportunities. I also discuss a (...) framework that can integrate dimensional and discrete perspectives on emotions. (shrink)

Lewisian Genuine Realism about possible worlds is often deemed unable to accommodate impossible worlds and reap the benefits that these bestow to rival theories. This thesis explores two alternative extensions of GR into the terrain of impossible worlds. It is divided in six chapters. Chapter I outlines Lewis’ theory, the motivations for impossible worlds, and the central problem that such worlds present for GR: How can GR even understand the notion of an impossible world, given Lewis’ reductive theoretical framework? Since (...) the desideratum is to incorporate impossible worlds into GR without compromising Lewis’ reductive analysis of modality, Chapter II defends that analysis against objections. The rest of the thesis is devoted to incorporating impossible worlds into GR. Chapter III explores GR-friendly impossible worlds in the form of set-theoretic constructions out of genuine possibilia. Then, Chapters IV-VI venture into concrete impossible worlds. Chapter IV addresses Lewis’ objection against such worlds, to the effect that contradictions true at impossible worlds amount to true contradictions tout court. I argue that even if so, the relevant contradictions are only ever about the non-actual, and that Lewis’ argument relies on a premise that cannot be nonquestion- beggingly upheld in the face of genuine impossible worlds in any case. Chapter V proposes that Lewis’ reductive analysis can be preserved, even in the face of genuine impossibilia, if we differentiate the impossible from the possible by means of accessibility relations, understood non-modally in terms of similarity. Finally, Chapter VI counters objections to the effect that there are certain impossibilities, formulated in Lewis’ theoretical language, which genuine impossibilia should, but cannot, represent. I conclude that Genuine Realism is still very much in the running when the discussion turns to impossible worlds. (shrink)

Philippe Schlenker gives a method of deriving local contexts from an expression’s classical semantics. In this paper I show that this method, when applied to the traditional variably strict semantics for subjunctive conditionals of Robert Stalnaker, David Lewis, and Angelika Kratzer, delivers an empirically incorrect prediction. The prediction is that the antecedent of a conditional should have the whole domain of possible worlds as its local context and therefore should be allowed to have only necessary presuppositions. In the later part (...) of the paper, I suggest the outlines of a solution to the problem. The solution involves adding a shifting contextual restriction on the domain of possible worlds. (shrink)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine (...) two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private‐for‐profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private‐for‐profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice‐based account of standard of care. (shrink)

Social scientists and research ethicists have begun, somewhat belatedly, to confront and address the ethical challenges raised by public policy experiments. In doing so however, they have not fully availed themselves of the large and sophisticated literature on the ethics of clinical research which has developed over the past 40 years. While clinical and public policy research are different, I argue that the clinical research ethics literature yields valuable insights for discussions of the ethics of policy experiments. Focusing on seven (...) ethical issues which have received a good deal of attention in public and scholarly discussions of the ethics of policy experiments, I make use of the history of reflection on the ethics of clinical research to provide guidance to researchers planning and conducting policy experiments. (shrink)

In this chapter, we provide an overview of the ethical considerations relevant to the use of nudges in organ donation policy. We do not defend a position on the permissibility of nudging in this context, but instead aim to clearly outline the strongest arguments on the different sides of this issue that have been presented in the English-language scholarly bioethics literature. We also highlight the questions that are in need of further investigation. In part 1, we briefly discuss nudging before (...) considering proposals to use nudges to increase the number of registered organ donors, including opt-out donor registration systems and the use of “nudge statements.” In part 2, we discuss the use of nudges to influence the decision-making of family members in circumstances where they have a veto over the donation of their loved one’s organs. (shrink)

Policy analyses begin with a systematic overview of the policy problem they address. This includes a comprehensive discussion of the nature and context of the problem, and the institutional and behavioral factors responsible for its emergence. Problem statements must also explain why the status quo is bad or undesirable, why it is something that governments, rather than private actors, should address, and establish that the relevant government institutions have the legitimacy to intervene. In this chapter, I provide an overview of (...) the principal types of policy problems that it is morally appropriate for governments to address. Each type denotes a class of states of affairs that (1) are bad, undesirable, or unjust, (2) the government is particularly well-suited to address, and (3) arise from spheres of action over which the relevant government institutions have the right to intervene. I begin with a discussion of collective action problems, that is, states of affairs in which action by rational and self-interested private actors is collectively self-defeating. I then argue for two additional types of policy problems. First, since the goal of government action is the construction of a just legal order, not merely an efficient one, states of affairs which are unjust constitute an additional type of policy problem. Relatedly, second, whereas analyses of collective action problems typically presuppose the existence of effective government institutions which can address them, such institutions may be deficient and/or unjust. A third type of policy problem is therefore deficient government institutions. -/- . (shrink)

Khoo (2022) defends a principle called Weak Sufficiency, which is that coming to accept an indicative conditional involves nothing more than coming to accept the corresponding indicative conditional. Khoo argues both that Weak Sufficiency is true and that the selection function theorist lacks an explanation of why it seems plausible. In this paper, I contest both claims, examining how various versions of the selection function theory interact with cases that might seem to support Weak Sufficiency.

In the ethics of public health, questions of virtue, that is, of what it means for public health to act excellently, have received little attention. This omission needs remedy first because achieving improvements in population-wide health can be in tension with goals like respect for the liberty, self-determination, or non-oppression of various individuals or groups. A virtue-ethics approach is flexible and well-suited for the kind of deliberation required to resolve or mitigate such tension. Public health requires practically wise and careful (...) thinking, which virtue ethics brings with it. Furthermore, too tight a focus on delivering outcomes in determining how public health should act has, in some cases, actually undermined its ability to achieve those consequences. However, the main concern about incorporating virtue into public health in a pluralistic society is likely to be that virtue is generally teleological, and we would surely need some widely agreed upon idea of something like flourishing or the common good for this to work. In this paper, I propose that for public health to express virtue in its work, it must express a commitment to justice as it goes about its business promoting and protecting the health of the population. Justice is both a contributor toward better health for groups in society, and a worthwhile goal in its own right. I will sketch an argument that justice as non-oppression – not merely health equity – is the right telos toward which excellent public health should aim in a pluralist society. (shrink)

In her (1996) Kadri Vihvelin argues that autoinfanticide is nomologically impossible and so that there is no sense in which time travelers are able to commit it. In response, Theodore Sider (2002) defends the original Lewisian verdict (Lewis 1976) whereby, on a common understanding of ability, time travelers are able to kill their earlier selves and their failure to do so is merely coincidental. This paper constitutes a critical note on arguments put forward by both Sider and Vihvelin. I argue (...) that although Sider’s criticism starts out promisingly he doesn’t succeed in establishing that Vihvelin’s analysis fails, because (a) he neglects to rule out a class of counterfactuals to which Vihvelin’s sample-case may belong; and (b) (together with Lewis) he is wrong to suggest that future facts are irrelevant in the evaluation of time travelers’ abilities. I show instead that Vihvelin’s argument is viciously circular, indicating that even if there are nomological constraints on autoinfanticide these cannot be established a priori. (shrink)

In two‐dimensional semantics in the tradition of Davies and Humberstone, whether a singular term receives an epistemically shifted reading in the scope of a modal operator depends on whether the world considered as actual is shifted. This means that epistemically shifted readings should be available only in environments where an explicit contrast between the actual world and some counterfactual worlds cannot be made. In this paper, I argue that this is incorrect. Whether a singular term receives an epistemically shifted reading (...) is independent of whether the world treated as actual is shifted. This, I argue, undermines the two‐dimensionalist account of epistemic shift. I then turn to the question how a positive view should handle these two phenomena separately. I argue for treating singular terms with a version of counterpart theory in which the difference between epistemically shifted and other readings is determined in the context of utterance. (shrink)

A principal rationale for public policy is to address market failures. Pareto efficiency is therefore a highly common and relatively non-controversial evaluative criterion for many policy analyses and is discussed at length in policy analysis texts. This makes sense, for Pareto improvements involve making at least one person better off without making anyone worse off. Who could object to that? But does efficiency deserve the prominence it enjoys in public policy? Is one policy option better than another, at least in (...) one respect, simply because it is more Pareto efficient? Or, is efficiency valuable for some other reason? In this chapter, I discuss Pareto efficiency as an evaluative criterion and argue that it is a stand-in for a more foundational criterion: wellbeing. I begin with an overview of Pareto efficiency, discuss the various ways in which it is operationalized to evaluate policy options, and argue that it is valuable insofar as more efficient states of affairs promise more wellbeing than less efficient states of affairs. I then raise questions regarding whether the conception of wellbeing presupposed by Pareto efficiency – preference satisfaction – is a defensible conception of wellbeing. I go on to introduce three alternative conceptions of wellbeing which have been proposed and defended by both philosophers and policy scholars, namely, hedonism, objective goods views, and the capability approach, and suggest ways in which each can be operationalized as an evaluative criterion. I close by discussing four ‘theory-free’ approaches to thinking about the impact of policies on the quality of people’s lives. Such approaches reject the idea that there is one single theory of wellbeing that should be used to evaluate policy options, and instead develop ways to evaluate the impact of policies on people’s lives that are not grounded in a specific theory. (shrink)

In the never-ending debate about the scope and limits of science, the hottest argument now centres on the scientific study of man himself. Can there be a science of man at all, in any comprehensive sense? Or is the idea in some way ultimately self-defeating, like that of pulling oneself up by one's own shoelaces? My purpose in this paper is not to venture a direct answer to this ticklish question, but rather to highlight one or two desirable characteristics of (...) a science which I think must inevitably be lacking in any attempt to turn the scientific spotlight upon ourselves. Whether we call the attainable residue by the name of ‘science’ is less important than that we see clearly what not to expect of it. (shrink)

Most characters that distinguish one individual from another, like height or weight, vary continuously in populations. Continuous variation of these ‘quantitative’ traits is due to the simultaneous segregation of multiple quantitative trait loci (QTLs) as well as environmental influences. A major challenge in human medicine, animal and plant breeding and evolutionary genetics is to identify QTLs and determine their genetic properties. Studies of the classic quantitative traits, abdominal and sternopleural bristle numbers of Drosophila, have shown that: (1) many loci have (...) small effects on bristle number, but a few have large effects and cause most of the genetic variation; (2) ‘candidate’ loci involved in bristle development often have large quantitative effects on bristle number; and (3) alleles at QTLs affecting bristle number have variable degrees of dominance, interact with each other, and affect other quantitative traits, including fitness. Lessons learned from this model system will be applicable to studies of the genetic basis of quantitative variation in other species. (shrink)

Twenty psychologists were interviewed about an ethical dilemma that they had found to be particularly difficult to resolve. In just under half of the cases the dilemma involved a perceived conflict of ethical principles (e.g., the welfare of the consumer vs. the right to privacy). In the other cases, the psychologists were prevented from following an ethically prescribed course of action by some nonethical consideration such as contractural obligation, legal requirement, or the demands of an employer. We discuss the implications (...) of these two sorts of dilemmas for psychological practice and make some suggestions for proactive approaches to ethical problem solving. (shrink)

Alternative food networks (AFNs) have become increasingly important in response to growing concerns about industrial animal agriculture’s harmful impacts on animals. Alternative animal agriculture seeks to address problems with industrial animal agriculture given its purported emphases on animal welfare and, more controversially, “happy” meat. Debates in critical food studies and animal studies literature, however, caution against the glorification of “alterity” and how welfare claims provide an ethical façade for violence towards farm animals. These debates, while critically important, leave little room (...) for exploring the complexities of alternative animal agriculture, human-farm animal relations, and care. In this article, I build upon the insights of critical food studies scholarship that takes a reflexive and hybrid approach to studying AFNs and literature that explores the complex dynamics of human-farm animal relations. Drawing on qualitative interviews with grass-fed beef farmers in Ontario, Canada, I present an analysis aimed at unsettling divisive thinking about food practices and relations. First, I reflect on how farmers understand their work as an ethical alternative to industrial beef production, benefiting animals, people, and the environment. I then detail the emotional dynamics that shape cows’ commodification and relations with farmers, adding to scholarship that demands more attention to affective dimensions of care for animals in AFNs. Lastly, I discuss grass-fed beef farming challenges and contradictions, empirically exploring, for example, how grass-fed beef farming operates as a niche market whose accessibility is shaped by socio-economic privilege. Collectively, these insights contribute to discussions about the complexities of grass-fed beef farming as an alternative food network with benefits and problems, impacting the wellbeing of animals, people, and the environment. (shrink)

This paper reviews some recent litigation in the United States which addresses the difficult question of withdrawing food and hydration from both competent and incompetent patients. Whilst the decisions in question have manifested a trend towards favouring patient autonomy, they also indicate an underlying tension between doctors, health care facilities and their dying patients which is not yet close to resolution. The author suggests that the courts in the United States are likely to remain, for the foreseeable future, the final (...) arbiters in that country of disputes relating to the termination of life-sustaining treatment. (shrink)

This chapter provides a critical overview and interpretation of fair subject selection in clinical and social scientific research. It first provides an analytical framework for thinking about the problem of fair subject selection. It then argues that fair subject selection is best understood as a set of four subprinciples, each with normative force and each with distinct and often conflicting implications for the selection of participants: fair inclusion, fair burden sharing, fair opportunity, and fair distribution of third-party risks. It then (...) defends an approach to navigating the conflicting imperatives of these subprinciples, one which privileges the need to include epistemically distinct groups in research, before concluding by considering the most pressing research questions regarding fair subject selection. (shrink)

The COVID-19 pandemic has changed the world. The depth and breadth of changes are still unfolding. What is the place of feminist bioethics in this new world? It's important to point out that COVID-19 is only one of a few major catastrophes we are facing as humans. The ongoing and worsening effects of climate change, along with the paltry efforts of politicians to address it, are an urgent concern. Humanitarian crises caused by climate change, by COVID-19, or crises unrelated to (...) either but surely worsened by both, are also... (shrink)

Online and blended learning (OBL) overemphasize the process of creating artifacts, producing strategies, or otherwise utilizing a “making” orientation in education. As an alternative to this making-orientation, we offer a model for relational course design founded in the philosophies of Emmanuel Levinas and Martin Buber. We examine an OBL course design focused on interfaith leadership and ethics that lends itself to the need for relational pedagogy. The focus on asymmetrical and symmetrical relationships that separate Levinas and Buber’s philosophies enable rich (...) ways of designing relational pedagogies and for resisting the making orientation. By focusing on human relationships, we demonstrate design principles through “philosophies of difference” that can be used in OBL. (shrink)

In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihlén Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: first, about the nature of collectives as moral agents, in response to Nihlén Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher.

The methodological device of or, as sometimes euphemistically labeled, does not enjoy much support among institutional review boards (IRBs) and a large portion of scholars in bioethics. The reasons for this have been documented sufficiently, beginning with the now-paradigmatic attack on the well-known study by Milgram and the unsavory study of Laud Humphries on male homosexual activities in public restrooms. But are the current attitudes interfering with some worthwhile approaches to data gathering that seem to have no other methodology of (...) equal effectiveness? (shrink)