When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

When a patient lacks sufficient capacity to make a certain treatment decision, whether because of deficits in their ability to make a judgement that reflects their values or to make a decision that reflects their judgement or both, the decision must be made by a surrogate. Often the best way to respect the patient’s autonomy, in such cases, is for the surrogate to make a ‘substituted’ judgement on behalf of the patient, which is the decision that best reflects the patient’s (...) values and identity-infused beliefs as they were when the patient last possessed capacity. It is by now well-known that there is troubling evidence that surrogates do only slightly better than chance at making accurate substituted judgements. The use of a patient preference predictor, an algorithm that predicts patient preferences based on characteristics like the patient’s age, gender, socioeconomic status and education level, could help. Rid and Wendler have done important work making a moral case for using the PPP.1 If it were shown to enhance accuracy, it is not at all obvious what objections there could be to its use. Yet several subtle criticisms of the PPP have emerged in the literature. In their feature article, Jardas, Wasserman and Wendler select six of the most prominent objections to the PPP in the literature and defend the PPP against them.2 Along the way they make significant contributions to broader issues concerning the proper uses of statistical evidence and limits on the kinds of preferences there can be reasons of autonomy to respect. Since I found the authors’ answers to the final two objections—that the PPP relies on naked statistical evidence and that it uses non-endorsed reasons—to be especially interesting and provocative, I will examine those answers and raise a few questions about …. (shrink)

There is a robust scientific consensus concerning climate change and evolution. But many people reject these expert views, in favour of beliefs that are strongly at variance with the evidence. It is tempting to try to explain these beliefs by reference to ignorance or irrationality, but those who reject the expert view seem often to be no worse informed or any less rational than the majority of those who accept it. It is also tempting to try to explain these beliefs (...) by reference to epistemic overconfidence. However, this kind of overconfidence is apparently ubiquitous, so by itself it cannot explain the difference between those who accept and those who reject expert views. Instead, I will suggest that the difference is in important part explained by differential patterns of epistemic deference, and these patterns, in turn, are explained by the cues that we use to filter testimony. We rely on cues of benevolence and competence to distinguish reliable from unreliable testifiers, but when debates become deeply politicized, asserting a claim may itself constitute signalling lack of reliability. (shrink)

This article draws attention to a pattern of development within science and other intellectual research communities that has received virtually no mention. We propose that subsequent dominance of a research community by a figure responsible for significant innovation often delays progress in the field. During the period in which the revolutionary continues to influence research in a community, far too frequently the effect is to freeze progress within the limited directions which the revolutionary sanctions.

It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions (...) and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted. (shrink)

The aim of this article is to argue, by example, for neuroethics as a new way of doing ethics. Rather than simply giving us a new subject matter—the ethical issues arising from neuroscience—to attend to, neuroethics offers us the opportunity to refine the tools we use. Ethicists often need to appeal to the intuitions provoked by consideration of cases to evaluate the permissibility of types of actions; data from the sciences of the mind give us reason to believe that some (...) of these intuitions are less reliable than others. I focus on the doctrine of double effect to illustrate my case, arguing that experimental results suggest that appeal to it might be question-begging. The doctrine of double effect is supposed to show that there is a moral difference between effects that are brought about intentionally and those that are merely foreseen; I argue that the data suggest that we regard some effects as merely foreseen only because we regard bringing them about as permissible. Appeal to the doctrine of double effect therefore cannot establish that there are such moral differences. (shrink)

In applied ethics, debates about responsibility have been relentlessly individualistic and synchronic, even as recognition has increased in both philosophy and psychology that agency is distributed across time and individuals. I therefore warmly welcome Brown and Savulescu’s analysis of the conditions under which responsibility can be shared and extended. By carefully delineating how diachronic and dyadic responsibility interact with the long-established control and epistemic conditions, they lay the groundwork needed for identifying how responsibility may be inter-individual and intra-individual. Unsurprisingly, I (...) don’t agree with every aspect of their rich account. I strongly suspect that the privileged place the individual continues to occupy in their taxonomy is a residue of the kind of internalist intuitions which dominate WEIRD thinking.1 2 However, I won’t pursue this line of thought here. Instead, I apply Brown and Savulescu’s analysis. Moving beyond the programmatic level at which they develop their account, I will show how it provides a basis for excusing many individuals, focusing not on the dyadic level but the diachronic. Most of the …. (shrink)

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation... (shrink)

On normative order -- On institutional order-- Law and the constitutional state -- A problem : rules or habits? -- On persons -- Wrongs and duties -- Legal positions and relations : rights and obligations -- Legal relations and things : property -- Legal powers and validity -- Powers and public law : law and politics -- Constraints on power : fundamental rights -- Criminal law and civil society : law and morality -- Private law and civil society : law (...) and economy -- Positive law and moral autonomy -- On law and justice -- Law and values : reflections on method. (shrink)

The patient preference predictor is a proposed computer-based algorithm that would predict the treatment preferences of decisionally incapacitated patients. Incorporation of a PPP into the decision-making process has the potential to improve implementation of the substituted judgement standard by providing more accurate predictions of patients’ treatment preferences than reliance on surrogates alone. Yet, critics argue that methods for making treatment decisions for incapacitated patients should be judged on a number of factors beyond simply providing them with the treatments they would (...) have chosen for themselves. These factors include the extent to which the decision-making process recognises patients’ freedom to choose and relies on evidence the patient themselves would take into account when making treatment decisions. These critics conclude that use of a PPP should be rejected on the grounds that it is inconsistent with these factors, especially as they relate to proper respect for patient autonomy. In this paper, we review and evaluate these criticisms. We argue that they do not provide reason to reject use of a PPP, thus supporting efforts to develop a full-scale PPP and to evaluate it in practice. There are no data in this work. (shrink)

There's heated debate around whether people who did terrible things in the past, at a time when there was widespread acceptance of such actions, are appropriately blamed by us, on the grounds they weren't really morally ignorant, or their ignorance was itself culpable. I point to puzzles that arise if we blame them. We need to explain how they could act so badly if they weren't fully ignorant. I argue that plausible answers to that question entail that they're not blameworthy, (...) or that we lack standing to blame them. (shrink)

The self-deceived are usually held to be moral responsible for their state. I argue that this attribution of responsibility makes sense only against the background of the traditional conception of self-deception, a conception that is now widely rejected. In its place, a new conception of self-deception has been articulated, which requires neither intentional action by self-deceived agents, nor that they possess contradictory beliefs. This new conception has neither need nor place for attributions of moral responsibility to the self-deceived in paradigmatic (...) cases. Accordingly, we should take the final step toward abandoning the traditional conception, and drop the automatic attribution of responsibility. Self-deception is simply a kind of mistake, and has no more necessary connection to culpability than have other intellectual errors. (shrink)

Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and (...) voluntary parental involvement in pediatric decision making. This article provides a more expansive account of the value of parental permission. In particular, we suggest that an expansive role for parental permission may reveal facts and values relevant to their child's treatment, encourage resistance to suboptimal default practices, improve adherence to treatment, nurture children's autonomy, and promote the interests of other family members. (shrink)

Several ethicists have argued that research trials and treatment programs that involve the provision of drugs to addicts are prima facie unethical, because addicts can’t refuse the offer of drugs and therefore can’t give informed consent to participation. In response, several people have pointed out that addiction does not cause a compulsion to use drugs. However, since we know that addiction impairs autonomy, this response is inadequate. In this paper, I advance a stronger defense of the capacity of addicts to (...) participate in the programs envisaged. I argue that it is only in certain circumstances that addicts find themselves choosing in ways that conflict with their genuine preferences. Research and treatment programs have none of the features that characterize choices in these autonomy-undermining circumstances, and there is therefore no reason to think that addicts lack the capacity to give informed consent to these programs. (shrink)

Cases in which we find ourselves irrationally worried about whether we have done something we habitually do are familiar to most people, but they have received surprisingly little attention in the philosophical literature. In this paper, I argue that available accounts designed to explain superficially similar mismatches between agents’ behavior and their beliefs fail to explain these cases. In the kinds of cases which have served as paradigms for extant accounts, contents are poised to drive behavior in a belief-like way. (...) But the contents of these irrational worries are not poised in a belief-like way. Nor do they cause behavior due to a deficit of rational scrutiny. Rather, these representations cause behavior deviantly: by generating anxiety, which in turn motivates actions aimed at assuaging it. (shrink)

Most people believe that we have a duty to gather evidence on both sides of central moral and political controversies, in order to fulfil our epistemic responsibilities and come to hold justified cognitive attitudes on these matters. I argue, on the contrary, that to the extent to which these controversies require special expertise, we have no such duty. We are far more likely to worsen than to improve our epistemic situation by becoming better informed on these questions. I suggest we (...) do better to embrace the views of experts who are also morally wise. I argue that this is likely to lead to more accurate beliefs about these political and moral controversies; in any case, it will avoid the incoherence and irrationality which are the likely consequence of open-minded evidence gathering. (shrink)

Food insecurity in the United States is a profound public health challenge that hospitals are uniquely situated to address. Through the enactment of the Hospital Readmission Reduction Program, the Affordable Care Act provides a strong economic incentive for hospitals to actively confront food insecurity within the communities they serve. While there is a spectrum of nutrition interventions that hospitals can look to when engaging in these efforts, healthy food prescriptions and medically tailored meals are two particularly innovative and promising approaches (...) that could help hospitals reduce readmissions by addressing the nutritional needs of vulnerable patients. (shrink)

In a recent paper, Ishtiyaque Haji and Michael McKenna argue that my attack on Frankfurt-style cases fails. I had argued that we cannot be confident that agents in these cases retain their responsibility-underwriting capacities, because what capacities an agent has can depend on features of the world external to her, including merely counterfactual interveners. Haji and McKenna argue that only when an intervention is actual does the agent gain or lose a capacity. Here I demonstrate that this claim is false: (...) capacities are dispositions that can be constituted by features of the environment that are currently inactive. I also reply to two other objections: that my argument begs the question against historical accounts of moral responsibility and that it leaves the very locus of free action, our mental acts, untouched. (shrink)

Disability and enhancement are often treated as opposing concepts. To become disabled in some respect is to move away from those who are enhanced in that same respect; to become enhanced is to move away from the corresponding state of disability. This chapter examines how best to understand the concepts of disability and enhancement in this symmetrical way. After considering various candidates, two types of accounts are identified as the most promising: welfarist accounts and typical-functioning accounts. The authors ultimately defend (...) a complex typical-functioning account as the best way to achieve a symmetrical understanding of disability and enhancement. (shrink)

Introduction -- Cultural theories of people -- Identities in standard English -- Language and social institutions -- The cultural self -- The self's identities -- Theories of identities and selves -- Theories of norms and institutions -- Social reality and human subjectivity.

This paper is a response to Giubilini and Minerva's defence of infanticide. I argue that any account of moral worth or moral rights that depends on the intrinsic properties of individuals alone is committed to agreeing with Giubilini and Minerva that birth cannot by itself make a moral difference to the moral worth of the infant. However, I argue that moral worth need not depend on intrinsic properties alone. It might also depend on relational and social properties. I claim that (...) the in principle availability of neonates to participate in scaffolded interactions with carers might plausibly be seen as contributing to their moral worth. (shrink)

Deception is a useful methodological device for studying attitudes and behavior, but deceptive studies fail to fulfill the informed consent requirements in the U.S. federal regulations. This means that before they can be approved by Institutional Review Boards, they must satisfy the four regulatory conditions for a waiver or alteration of these requirements. To illustrate our interpretation, we apply the conditions to a recent study that used deception to show that subjects judged the same wine as more enjoyable when they (...) believed it had a higher price. (shrink)

Today''s headlines suggest that economic criteria alone is the basis for business decision-making. This paper argues that while profitability is a legitimate end of business, it must be moderated by ethical considerations. But can business be both successfuland ethical? Practical examples highlight individuals who chose profitability over ethical responsibility and those who chose and continue to choose both. The authors propose that there is an ethical person profile. Corporate managers can resolve the profits vs ethics dilemma by modeling ethical behavior.

Moral judgments entail or consist in claims that certain ways of behaving are called for. These actions have expectable consequences. I will argue that these consequences are suspiciously benign: on controversial issues, each side assesses these consequences, measured in dispute-independent goods, as significantly better than the consequences of behaving in the ways their opponents recommend. This remains the case even when we have not formed our moral judgment by assessing consequences. I will suggest that the evidence indicates that our perception (...) of the consequences of acting as recommended by our moral judgments is motivated, such that the warrant of such assessments is lower than we might have thought. The suspicion correlation between our moral judgments and our assessments of the implicated facts provides higher-order evidence that should lead us to reduce our confidence in these assessments. (shrink)

Naïve realism is a theory of perception with great explanatory ambitions. It has been influentially argued that, in order to realize these explanatory ambitions, the naïve realist should say that any perception belongs to just one fundamental kind. I think, however, that adopting this commitment does not particularly help the naïve realist to realize her explanatory ambitions, and so is not warranted. This result is significant because once this commitment about fundamental kinds is relinquished, we see that it is possible (...) to develop some new and surprising forms of naïve realism—most notably, what I call pluralist naïve realism. (shrink)

ABSTRACT We frequently accuse heavy drinkers and drug users of self‐deception if they refuse to admit that they are addicted. However, given the ways in which we usually conceptualize it, acknowledging addiction merely involves swapping one form of self‐deception for another. We ask addicts to see themselves as in the grip of an irresistible desire, and to accept that addiction is an essentially physiological process. To the extent this is so, we, as much as the addicts, suffer from self‐deception, and (...) the responsibility for their state is in part ours. Conversely, since addicts are compelled to accept a self‐deceptive image of themselves, they are at least partially excused from blame for their self‐deception. (shrink)

“Spin” is a pejorative term for a ubiquitous form of communication. Spin is viewed by many as deceptive, and by others as bending or twisting the truth. But spin need not be deceptive and the metaphors are less than clear. The aim here is to clarify what spin is: spin is identified as a form of selective claim-making, where the process of selection is governed by an intention to bring about promotional perlocutionary effects. The process of selection may pertain to (...) aspects of some situation or phenomenon,; or to the lexis used in making the claims. Not all selective promotional communication is spin. Spin involves a distinctive kind of dissociation between the speaker’s first-order interpretation and the constructed interpretation or claim offered to others. With these clarifications in place the discussion turns to the complex connections between spin, truthfulness and deception. Aspect-selective spin can be truthful, and it need not be deceptive in its intentions or effects, but may risk deceiving audiences. Lexical spin is less readily truthful, and both forms of spin prudentially require a distinctive kind of concealment of the speaker’s intentions. The account developed here does not address normative questions about whether, or how, spin might be wrong, but aims to provide a clear and adequate account of spin as a basis for addressing normative questions about spin. (shrink)

Mitochondrial function is achieved through the cooperative interaction of two genomes: one nuclear (nuDNA) and the other mitochondrial (mtDNA). The unusual transmission of mtDNA, predominantly maternal without recombination is predicted to affect the fitness of male offspring. Recent research suggests the strong sexual dimorphism in aging is one such fitness consequence. The uniparental inheritance of mtDNA results in a selection asymmetry; mutations that affect only males will not respond to natural selection, imposing a male‐specific mitochondrial mutation load. Prior work has (...) implicated this male‐specific mutation load in disease and infertility, but new data from fruit flies suggests a prominent role for mtDNA in aging; across many taxa males almost invariably live shorter lives than females. Here we discuss this new work and identify some areas of future research that might now be encouraged to explore what may be the underpinning cause of the strong sexual dimorphism in aging.Editor's suggested further reading in BioEssays: Mitonuclear match: Optimizing fitness and fertility over generations drives ageing within generations AbstractMitochondrial manoeuvres: Latest insights and hypotheses on mitochondrial partitioning during mitosis in Saccharomyces cerevisiae AbstractMitochondria and the culture of the Borg Abstract. (shrink)

“Legalism” is defined as requiring that all matters of legal regulation and controversy ought so far as possible to be conducted in accordance with predetermined rules of considerable generality and clarity. Thus there may be moral limits on governments which ban them from acting on the substantive moral merits of situations with which they have to deal. This is most important in public law, but also applies in private law, e.g., in cases involving property. Hume, Kant, and Hayek are examined (...) in respect of their case for legalism; Alexy and Finnis also reviewed. Autonomy is the foundation for legalism, and justifies “ethical positivism,” in T. Campbell's phrase. Critical legal studies (Unger, Kelman, Kennedy et al.) however challenge legalism's premises. But the “critical” arguments against reification merely raise, they do not settle, the issue about the politics of legalism and the desirability of legal dogmatics. With all faults, legalism is a prerequisite of free government. (shrink)

The historiography of the ‘dark age’ of biochemistry between 1910–1930 is examined. The biochemistry of the period is located within a larger contemporary debate on the interrelationship between structure and function on a submicroscopic level. It is suggested that biocolloid science was an understandable part of the historical development of biochemistry, representing a conceptual bridge between the cell biology of the late nineteenth century, and the era of structural macromolecular studies of proteins that began after 1930.

Many incompatibilists, including most prominently Peter Van Inwagen, have argued that deliberation presupposes a belief in libertarian freedom. They therefore suggest that deliberating determinists must have inconsistent beliefs: the belief they profess in determinism, as well as the belief, manifested in their deliberation, that determinism is false. In response, compatibilists have advanced alternative construals of the belief in freedom presupposed by deliberation, as well as cases designed to show that determinists can deliberate without inconsistency. I argue that the compatibilist case (...) requires a convincing demonstration not merely that belief in determinism is consistent with deliberation, but also that such a belief does not place great psychological strain on agents, and that cases so far advanced have not succeeded in showing this. I then present a case designed to show that agents can accept determinism and deliberate, without inconsistent beliefs and without psychological strain. (shrink)

Our intuitions concerning cultures show that we are committed to thinking that they are intrinsically valuable. I set out the conditions under which we attribute such value to cultures, and show that coming to possess intrinsic value is a matter of having the right kind of causal history.

Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents’ medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential for convergence (...) between intervention principles—or at least an absence of conflict between them—matters for both the theory and practice of pediatric ethics. This article builds on the recent work of a diverse group of pediatric ethicists tasked with identifying consensus guidelines for pediatric decision-making. (shrink)

Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.

In this paper, I introduce the notion of a Frankfurt Enabler, a counterfactual intervener poised, should a signal for intervention be received, to enable an agent to perform a mental or physical action. Frankfurt enablers demonstrate, I claim, that merely counterfactual conditions are sometimes relevant to assessing what capacities agents possess. Since this is the case, we are not entitled to conclude that agents in standard Frankfurt-style cases retain their responsibility-ensuring capacities. There is no principled rationale for bracketing counterfactual interveners (...) in standard Frankfurt-style cases, but admitting their relevance when they are Frankfurt enablers. I argue that the intuition that we ought to bracket counterfactual interveners is, at bottom, an expression of a mistaken internalist view about the mental. (shrink)

In their recent article “A Gentle Ethical Defence of Homeopathy,” Levy, Gadd, Kerridge, and Komesaroff use the claim that “lack of evidence is not equivalent to evidence of lack” as a component of their ethical defence of homeopathy. In response, this article argues that they cannot use this claim to shore up their ethical arguments. This is because it is false.