There is considerable concern that climate change will displace many people in developing countries from their homes. This article examines whether developed countries are morally obligated to assist people displaced by climate change in developing countries. The article argues that there may not be a moral duty to assist climate change migrants as a category. Nonetheless, developed countries may have duties to assist vulnerable people elsewhere and may be obligated to assist climate change migrants along with (...) other vulnerable people. In addition, there likely is a duty to assist a particular subset of climate change migrants, specifically the citizens of small island countries existentially threatened by climate change. The article concludes by assessing the implications of its moral analysis for the focus of law and policy. Instead of developing new treaties to assist climate change migrants as a number of academics and practitioners have recently proposed, law and policy should be concerned with assisting migrants at risk generally, and/or the citizens of small island countries existentially threatened by climate change. (shrink)

This chapter critically explores the extent to which pharmaceutical companies have a moral obligation to assist poor patients in least developed countries who currently have no or inadequate access to lifesaving medications. Focusing on the ongoing HIV/AIDS epidemic in LDCs, the first section of this essay begins with some background information of the disproportionate burden of HIV/AIDS in LDCs. The second section provides a brief overview of some of the salient arguments for holding multinational antiretroviral treatment manufacturers as (...) morally responsible for easing the disproportionate global disease burden. The third section explains that these arguments regarding pharmaceutical companies’ duty to assist are going too far on the one hand by downplaying other non-pharmacological contributors to the slow response, but are also not going far enough on the other hand in upholding reciprocity-based duties. As the international community and researchers battle the reemergence of Ebola in Africa, the fourth section explores how lessons from the HIV/AIDS situation can help to address what pharmaceutical companies may subsequently owe patients in this region and how the international community should respond to ongoing unequal disease burden. (shrink)

What we could call ‘relational non-interventionism’ holds that we have no general obligation to alleviate animal suffering, and that we do not typically have special obligations to alleviate wild animals’ suffering. Therefore, we do not usually have a duty to intervene in nature to alleviate wild animal suffering. However, there are a range of relationships that we may have with wild animals that do generate special obligations to aid—and the consequences of these obligations can be surprising. In this paper, (...) it is argued that we have special obligations to those animals we have historically welcomed or encouraged into our spaces. This includes many wild animals. One of the consequences of this is that we may sometimes possess obligations to actively prevent rewilding—or even to dewild—for the sake of welcomed animals who thrive in human-controlled spaces. (shrink)

The paper considers arguments concerning the obligation to assist strangers. It analyzes the problem of specifying obligations, which the inhabitants of the world have toward one another. The considerations focus on two closely connected questions: what is the obligation to assist and what is its source? what is the scope of the obligation to assist? The author considers the assumptions that are to be made if we take the obligation to assist distant (...) strangers to be a duty of justice. The paper concentrates on the most frequent assumptions, which are of two kinds: institutional and universal; axiological and particular. It is pointed out, given various examples of international dilemmas, how these two types of arguments may justify a hierarchy of mutual obligations. (shrink)

The HIV/AIDS epidemic is increasingly a diseaseof the disadvantaged, a destroyer of nations,and a threat to global security and well-being.But this need not be so: the world has thescientific knowledge, technologicalinnovations, and financial resources tosignificantly reduce the spread and sufferingcaused by the disease. This paper argues thatthe wealthy nations of the world, led by theUnited States, have a moral obligation to offermuch greater assistance to developing countrieswhere the epidemic is most severe. UsingZimbabwe as a case study, this essay examinesthe (...) immediate and underlying factors behind theepidemic in order to make realistic andaffordable policy recommendations that includenew investments in global health care, debtrelief, and long-term economic development. Bydemonstrating our ability to dramaticallyaffect the future course and consequences ofthis unprecedented epidemic, the paperconcludes that greater action is not only inthe interest of public health, but is also amoral imperative. By investing the necessaryresources to improve public health and toreduce global poverty, we promote and extendthe fundamental rights and values that weprofess to hold dear. (shrink)

In response to recent criticisms of traditional theories of political obligation, scholars have advanced moral reasons for complying with the law that focus on natural duties to assist other people who are in need. In discussions of political obligation, these ‘rescue principles’ are presented as alternatives to traditional principles. I argue that theories of political obligation based on rescue principles are not able to fulfill the role theorists assign them. If the underlying assumptions of rescue theories (...) are uncovered, they can be seen also to support more traditional obligations to obey the law. Accordingly, rather than serving as alternatives to traditional principles, rescue principles can only supplement them. Key Words: political obligation • rescue • Copp. (shrink)

Clare Palmer has recently argued that most humans have special obligations to assist domesticated animals, because domestication creates vulnerable, dependent individuals, and most humans benefit from the institution of domestication. I argue that Palmer has given us no grounds for accepting this claim, and that one of the key premises in her argument for this claim is false. Next, I argue that voluntarism, which is the view that one acquires special obligations only by consenting to those obligations in some (...) way, offers a plausible explanation of the sorts of cases that motivate Palmer’s analysis. I conclude that voluntarism allows us to explain the prevalent intuition that special obligations to assist often obtain for domesticated animals, but rarely obtain for wild animals. (shrink)

The Health Protection Agency has recently attempted to create a postmortem tissue archive to determine the prevalence of abnormal prion protein. The success of this archive was prevented because the Health Protection Agency could not convince coroners to support the study’s methodology and participate on that basis. The findings of this paper detail and support the view that the Coroners’ Society of England and Wales’s refusal to participate was misguided and failed to appreciate that coroners have a moral obligation (...) to protect public health. Measures to assist coroners in fulfilling this role are proposed. (shrink)

In Globalization and Global Justice , Nicole Hassoun offers advice on practical ways to fulfill obligations to the poor. Our recommendations must be well informed by empirical evidence, and so important research on poverty that suggests we sometimes focus inadvertently on the wrong objects in our attempted assistance efforts, deserves consideration here. We also need guidelines on how to choose from among plausible policy options on how to help the poor. I offer one and explain why some of Hassoun s (...) policy recommendations do not meet these criteria. (shrink)

Some have challenged Thomson’s case of the famous unconscious violinist (UV) by arguing that in cases of consensual sex a woman is partially morally responsible for the existence of a needy fetus; since she is partially responsible she ought to assist the fetus, and so abortion is morally wrong. Call this the Responsibility Objection (RO) to UV. In this paper, I briefly criticize one of the most widely discussed objections to RO and then suggest a new way to challenge (...) RO. In so doing, I investigate the plausibility of the moral principle that appears to be driving RO: If a woman is partially morally responsible for the existence of a needy fetus, she has a moral obligation to assist the fetus. I argue that this principle is false. I suggest modified versions of this principle but argue that, even on the most plausible version, RO does not persuade. (shrink)

The principle of assistance says that the global rich should help the global poor because they are able to do so, and at little cost. The principle of contribution says that the rich should help the poor because the rich are partly to blame for the plight of the poor. This paper explores the relationship between the two principles and offers support for one version of the principle of assistance. The principle of assistance is most plausible, the paper argues, when (...) formulated so as to identify obligations that arise from the needs of particular identifiable members of the global poor, not from impersonal rules or values. Under that formulation, the principle can explain why knowledge of the circumstances faced by individual members of the global poor can have such a marked effect upon the willingness of the global rich to provide help, and can offer a better grounded motivational basis for helping the global poor. These are real advantages, the paper argues, and ones that cannot be matched by stories that focus upon the ways in which the global rich contribute to global poverty. (shrink)

Our understanding of the philosophers of the past is not always assisted by the attempt to fit them under one or other of the categories that we currently use to map the philosophical landscape. We have grown used to the idea that there are three principal kinds of moral theory—deontological and broadly Kantian, consequentialist and broadly Millian, virtue-theoretic and broadly Aristotelian—and so historical approaches to moral philosophy tend to orientate themselves by assuming that each and every object of study must (...) count as one or other of these kinds of moralist. This is unfortunate. It is particularly unfortunate in respect of the moral philosophy of the seventeenth and eighteenth centuries. Philosophers. (shrink)

In this paper, we take up the question of whether there comes a point at which one is no longer morally obliged to do further good, even at very low cost to oneself. More specifically, they ask: under precisely what conditions is it plausible to say that that “point” has been reached? A crude account might focus only on, say, the amount of good the agent has already done, but a moment’s reflection shows that this is indeed too crude. We (...) develop and defend a nuanced account according to which considerations of three types are all relevant to whether one has satisfied one’s duties to assist: “inputs” (types and quantities of sacrifice made), “characteristics” (the beliefs and intentions that informed the donor’s decisions), and “success” (the extent to which the donations in question succeeded in generating value). (shrink)

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C (...) transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

Moral individualists like Jeff McMahan and Peter Singer argue that our moral obligations to animals, both human and non‐human, are grounded in the morally salient capacities of those animals. By contrast, what might be called moral relationalists argue that our obligations to non‐human animals are grounded in our relationship to them. Moral relationalists are of various kinds, from relationalists regarding assistance to animals, such as Clare Palmer and Elizabeth Anderson, to relationalists grounded in a Wittgensteinian view of human practice, such (...) as Cora Diamond and Alice Crary. This article argues that there are, in fact, two distinct types of moral reasons, those based on salient capacities and those based on relationships. Neither type of reason is reducible to the other, and there is no third type to which to reduce them both. Any attempt at reduction would run counter to deep intuitions about our moral relation to non‐human animals as well as to other humans. Among the implications of this is that certain kinds of arguments, such as the argument from marginal cases, seem to be incomplete precisely because they do not capture the complexity of our moral relations to non‐human animals. (shrink)

The contentious, topical debate about whether faith-based health care organizations should be granted accommodation on the basis of institutional conscientious objection to medical assistance is dying (MAiD) is addressed through a comparative analysis of arguments on both sides of the issue that references such relevant considerations as: claimed ‘moral-authority’, competing rights-based claims, obligations arising from patient welfare principles, formal justice, dissimilarity in consequences, and two illustrative arguments from analogy. The analysis leads to the conclusion that nonconditional accommodation on the basis (...) of institutional conscientious objection to MAiD is not ethically acceptable in Canada. A compromise mechanism, consisting of a suggested set of pragmatic conditions, is proposed that could effectively balance the competing moral responsibilities that arise from this conclusion and a core assumption of the paper, i.e., that some dominant faith-based health institutions can legitimately request, and expect, that provincial/territorial governments pay them a measure of respect in their operational, health-care-delivery decision making because of these institutions’ long history of providing high quality, health care in Canada. It is further suggested that provincial/territorial governments only allow large, publicly funded, faith-based health care organizations to enact a conditional version of accommodation on the basis of institutional conscientious objection to MAiD in circumstances where the organization has entered into a formal agreement with the relevant health department to meet the proposed, compromise conditions (or a relevantly-similar set of conditions). (shrink)

Contemporary arguments concerning the permissibility of physician-assisted suicide [PAS], or suicide in general, often rehearse classical arguments over whether individual persons have a fundamental right based on autonomy to determine their own death, or whether the community has a legitimate interest in individual members’ welfare that would prohibit suicide. I explicate historical arguments pertaining to PAS aligned with these poles. I contend that an ethical indictment of PAS entails moral duties on the part of one’s community to provide effective means (...) of ameliorating physical and existential suffering. I further elucidate how such duties have been affirmed by the Roman Catholic Church. My aim is to provide reasons why the expanding legalization of PAS should not preclude social investment in effective palliative care and providing a communal presence to the dying as they confront their subjectively experienced suffering. (shrink)

Several European and North American states encourage or even require, via good Samaritan and duty to rescue laws, that persons assist others in distress. This paper offers a utilitarian and contractualist defense of this view as applied to corporations. It is argued that just as we should sometimes frown on bad Samaritans who fail to aid persons in distress, we should also frown on bad corporate Samaritans who neglect to use their considerable multinational power to undertake disaster relief or (...) to confront widespread social ills such as those currently befalling public health (obesity) and the environment (climate change). As such, the corporate duty to assist approach provides a novel justification for sustainable business practices in such cases. The paper concludes by arguing that traditional stakeholder approaches have not articulated this duty of assistance obligation, though a new utilitarian stakeholder theory by Thomas Jones and Will Felps may be coextensive. (shrink)

In his classic article, Famine, Affluence, and Morality, pp. 229–243), Peter Singer claimed that affluent people in the developed world are morally obligated to transfer large amounts of resources to poor people in the developing world. For present purposes I will not call Singers argument into question. While people can reasonably disagree about exactly how demanding morality is with respect to duties to the desperate, there is little question in my mind that it is much more demanding than common sense (...) morality or our everyday behavior suggests. Even someone who disagrees with this might still find some interest in seeing what a demanding morality would imply for well-off residents of the rich countries of the world. I proceed in the following way. First, I survey humanitarian aid, development assistance, and intervention to protect human rights as ways of discharging duties to the desperate. I claim that we should be more cautious about such policies than is often thought. I go on to suggest two principles that should guide our actions, based on an appreciation of our roles, relationships, and the social and political context in which we find ourselves. (shrink)

Euthanasia and assisted suicide have proved to be very contentious topics in medical ethics. Some ethicists are particularly concerned that allowing physicians to carry out these procedures will undermine their professional obligations and threaten the very goals of medicine. However, I maintain that the fundamental goals of medicine not only do not preclude the practice of euthanasia and assisted suicide by physicians, but can in fact be seen to support these practices in some instances. I look at two influential views (...) of the goals of medicine, one based on the broad guiding principles of autonomy, beneficence and nonmaleficence, and the other focusing on several more concrete aims, concluding that both approaches can be seen to support euthanasia and assisted suicide. I then turn to the popular concern that allowing physicians to carry out euthanasia and assisted suicide will lead to widespread abuse. I argue that the possibility for abuse can be minimised if we make the patient's autonomous consent an essential requirement of the practice. (shrink)

All things considered, there are many public assistance recipients for whom there are compelling moral reasons to engage in welfare fraud. For many people, failure to defraud the welfare system, should they find themselves in a position to do so with impunity, would constitute a serious moral offense. This conclusion seems to fly in the face of prevailing notions of common sense. But this is misleading, since it is at the same time implied by principles that are widely embraced, assuming (...) a set of circumstances that can be readily shown to obtain in many cases. Under that set of circumstances, and given our affirmation of certain basic moral convictions, we cannot consistently blame the practitioner of welfare fraud, or excuse, without special justifications, the legal conformist. (shrink)

The world is in the early stages of what will be the greatest health crisis since the advent of modern medical technologies. Millions of people—particularly people in many of the world's poor countries—are infected with HIV. The vast majority of these people will go without modern medical intervention or substantial treatment, and will rapidly develop AIDS. The extent of this problem presents profound moral and ethical questions for the world's wealthy people and countries, for it is they who are most (...) able to assist the poor in managing and reversing this human tragedy. (shrink)

In this paper, I consider whether we should offer assistance to both wild and domesticated animals when they are suffering. I argue that we may have different obligations to assist wild and domesticated animals because they have different morally-relevant relationships with us. I explain how different approaches to animal ethics, which, for simplicity, I call capacity-oriented and context-oriented, address questions about animal assistance differently. I then defend a broadly context-oriented approach, on which we have special obligations to assist (...) animals that we have made vulnerable to or dependent on us. This means that we should normally help suffering domesticated animals, but that we lack general obligations to assist wild animals, since we are not responsible for their vulnerability. However, we may have special obligations to help wild animals where we have made them vulnerable to or dependent on us. I consider some obvious difficulties with this context-oriented approach, and I conclude by looking more closely at the question whether we should intervene, if we could do so successfully, to reduce wild animal suffering by reducing predation. (shrink)

Destination therapy is the permanent implantation of a left ventricular assist device in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications. Because of deeply ingrained cultural and religious beliefs regarding death and (...) the sanctity of life, Japanese society may not be ready to make changes needed to enable patients to have LVADs deactivated under certain circumstances to avoid needless suffering. Western ethical views that permit LVAD deactivation based mainly on respect for autonomy and dignity have not been accepted thus far in Japan and are unlikely to be accepted, given the current Japanese culture and traditional values. Some healthcare professionals might regard patients as ineligible for DT unless they have prepared advance directives. If this were to happen, the right to prepare an advance directive would instead become an obligation to do so. Furthermore, patient selection for DT poses another ethical issue. Given the predominant sanctity of life principle and lack of cost-consciousness regarding medical expenses, medically appropriate exclusion criteria would be ignored and DT could be applied to various patients, including very old patients, the demented, or even patients in persistent vegetative states, through on-site judgment. There is an urgent need for Japan to establish and enact a basic act for patient rights. The act should include: respect for a patient’s right to self-determination; the right to refuse unwanted treatment; the right to prepare legally binding advance directives; the right to decline to prepare such directives; and access to nationally insured healthcare. It should enable those concerned with patient care involving DT to seek ethical advice from ethics committees. Furthermore, it should state that healthcare professionals involved in the discontinuation of life support in a proper manner are immune to any legal action and that they have the right to conscientiously object to LVAD deactivation. (shrink)

In The Case for Animal Rights, Tom Regan argues that, in addition to the negative duty not to harm nonhuman animals, moral agents have a positive duty to assist nonhuman animals who are victims of injustice. This claim is not unproblematic because, in many cases, assisting a victim of injustice requires that we harm some other nonhuman animal(s). For instance, in order to feed victims of injustice who are obligate carnivores, we must kill some other animal(s). It seems, then, (...) that sometimes the duty to assist nonhuman animals who are victims of injustice conflicts with the prima facie duty not to harm nonhuman animals. In defense of Regan’s theory against this apparent inconsistency, I introduce an additional principle, the “guardianship principle,” which can be used to illustrate how we can be justified, under certain conditions, in overriding our prima facie duty not to harm nonhuman animals in order to fulfill our duty to assist nonhuman animals who are victims of injustice. (shrink)

Humanitarian assistance in conflicts sometimes undermines local coping strategies, reinforces wartime economies, and strengthens the existing power structures. This article argues that some victims of conflicts are made extremely vulnerable and uniquely dependent on humanitarian agencies. In this case, humanitarian agencies have a distinct obligation to assist them. This article considers one novel account that justifies the continued provision of aid to victims of conflicts and rejects the widespread view that aid should be withdrawn to avoid its negative (...) impact. This article presents the “Distinct Dependence Argument” to address the aid dependency predicament in conflicts. It explores the degree of vulnerability and dependence of victims of conflicts and evaluates humanitarian agencies’ causal responsibility in causing such vulnerability and dependency. (shrink)

BackgroundDealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the (...) inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process.MethodsSeventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically.ResultsOur results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants.ConclusionThe broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately. (shrink)

Many philosophers have defended the view that well‐off people or nations have an obligation to assist people who suffer from famine in less developed areas of the world. However, in contrast to this outlook, some theorists have claimed that it is ethically wrong to provide this kind of assistance. In this article the non‐assistance view is discussed. It is argued that even if a neo‐Malthusian population theory is correct and if we accept a maximizing policy which allows the (...) relevant weighing of evils, there may still be an obligation to assist the victims of starvation in poor countries. (shrink)

This paper examines the links between acting upon a duty to assist, responsibility for these actions, and how such actions link with incremental moral duties that can amass as a consequence of such action. More specifically, this paper is concerned with practices of international aid and assistance, whereby public and privately funded donations enable the actions of parties outside of the territorial and jurisdictional boundaries of a community and state to directly influence the functioning of that community, and the (...) incremental moral duties to which such action can give rise. Using a Senian account of the basis of moral duty, it explains how agents are responsible for the outcomes of their acts of assistance, even when mediated through international institutional actors, and how such acts can give rise to accumulative duties and obligations that are not bound or constrained by territorial boundaries or pre-existing special obligations. (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)

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on legal precedents, (...) there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). (shrink)

Doctors have been treating infectious diseases for hundreds of years, but the risk they and other medical professionals are exposed to in an epidemic has always been high. At the front line of the present war against COVID-19, medical teams are endangering their lives as they continue to treat patients suffering from the disease. What is the degree of danger that a medical team must accept in the face of a pandemic? What are the theoretical justifications for these risks? This (...) article offers answers to these questions by citing opinions based on Jewish ethical thought that has been formulated down through the ages. According to Jewish ethics, the obligation to assist and care for patients is based on many commandments found in the Bible and on rulings in the Responsa literature. The ethical challenge is created when treating the sick represents a real existential danger to the caregivers and their families. This consideration is relevant for all dangerous infectious diseases and particularly for the coronavirus that has struck around the world and for which there is as yet no cure. Many rabbis over the years have offered the religious justifications for healing in a general sense and especially in cases of infectious diseases as they have a bearing on professional and communal obligations. They have compared the ethical expectations of doctors to those of soldiers but have not sanctioned taking risks where there is insufficient protection or where there is a danger to the families of the medical professionals. (shrink)

We live in an era when increasing numbers of babies are conceived through assisted reproduction technologies (ART). Using a comprehensive approach, the present research seeks to contribute to the understanding of gender differences in experiencing and coping with infertility, and in dealing with ART treatment. Our sample consisted of 10 heterosexual couples aged 24 to 43 and the data were collected through semi-structured interviews. In the studied sample, gender differences existed not only in experiences of infertility, but also in understanding (...) it, and in dealing with ART treatment. Responses to stress caused by infertility were stronger in women and they also perceived this stress more intensely than men. For women the central aspect of infertility was the desire for a child, while for men it was perceived more as a socially imposed obligation to fulfill the male role. (shrink)

An aging population is often taken to require a profound reorganization of the prevailing health care system. In particular, a more cost-effective care system is warranted and ICT-based home care is often considered a promising alternative. Modern health care devices admit a transfer of patients with rather complex care needs from institutions to the home care setting. With care recipients set up with health monitoring technologies at home, spouses and children are likely to become involved in the caring process and (...) informal caregivers may have to assist kin-persons with advanced care needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutional care to technology-assisted home care and the subsequent impact on the care recipient and formal- and informal care providers. (shrink)

Using Madison Powers and Ruth Faden's definition of ‘well‐being,’ the authors argue that Israel, the international community and public health practitioners have a justice‐based obligation to assist the Palestinian people in the Occupied Palestinian Territories. Focusing on Palestinians in Gaza, the authors first outline a normative framework of justice, as articulated by Powers and Faden. Following Powers and Faden's assumption that empirical assessments of justice can be made using the six dimensions of well‐being, the authors next present current (...) data on the living conditions in Gaza and describe how these conditions prevent residents from achieving sufficient levels of well‐being. Using these indicators to demonstrate that Palestinians living in Gaza suffer deficiencies in these dimensions of well‐being, the authors present a strong argument from justice to assist the residents of Gaza. The medical, public health, and bioethics community cannot sit idle while injustice continues. (shrink)

Assisted migration (AM) is a translocation of the representatives of species to areas outside their natural habitats as a response to climate change. This article seeks to identify how customary norms and general principles of international environmental law could guide the development of regulation of AM maximizing the benefits of using AM and minimizing AM-related risks. Among the customary norms and principles of international environmental law discussed in the article and relevant to the regulation of AM are the permanent sovereignty (...) over natural resources, the principle of cooperation, the no-harm rule, the precautionary principle, the principles of prevention, due diligence, and obligation to conduct environmental impact assessment (EIA), the principles of integration and intergenerational equity, common but differentiated responsibilities, and the polluter pays principle, the principles of non-regression, progression, resilience, in dubio pro natura, the principle of ecological proportionality, and the principle of access to information, public participation, and access to justice in environmental matters (principle of good governance, environmental democracy). (shrink)

Christians have an obligation to attend to the voices of persons who are crying out that their dignity and very lives are in jeopardy when physician-assisted suicide becomes legalized. The following essay begins with an account of the concept of “disability moral psychology,” which elucidates the unique ways persons with disabilities perceive the world, based on their phenomenological experience. The author then explores the disability critique of PAS and the shared social conditions of persons who are chronically disabled and (...) terminally ill. Finally, the author positions the disability critique within Christian moral deliberations on PAS to unearth its significance for Christian ethics. To bear witness to a compassionate God, theological and ethical judgments concerning PAS must seek perspectives from persons who claim that their dignity and even their lives are in jeopardy by the practice. (shrink)

We citizens of the affluent countries tend to discuss our obligations toward the distant needy mainly in terms of donations and transfers, assistance and redistribution: How much of our wealth, if any, should we give away to the hungry abroad? Using one prominent theorist to exemplify this way of conceiving the problem, I show how it is a serious error — and a very costly one for the global poor.

Several states, including the United Kingdom, the United States, and France, have recently engaged in the high-profile supporting of foreign rebel fighters, providing them with training, weapons, and financial resources. Justifications for providing this assistance usually invoke, at least in part, our obligations to prevent harm to the citizens of oppressive and violent regimes. Providing such assistance is often presented as a morally safe ‘middle ground’ between doing nothing and putting one’s own troops at risk. Yet this assistance typically enables (...) rebels to cause unjust harms, since armed uprisings almost invariably cause harm to innocent people. I argue that enabling these unjust harms can render the provision of assistance unjustified. When a state could prevent at least as much harm by using its resources in other ways, such as preventing disease, without thereby causing comparable unjust harm and without incurring a (significantly greater) supererogatory cost, the state acts unjustifiably if it nonetheless funds the rebellion. When assistors unjustifiably enable unjust harms, they are morally liable to bear costs for the sake of people who suffer those harms. This is true even if the rebels act justifiably in directly inflicting those harms. (shrink)

Political societies are essentially intergenerational—not only because they often last for many generations and because they maintain their existence largely through members having or adopting children, but because the children of members acquire entitlements simply as a result of being born or adopted by members. Even in a liberal political society, members by birth or adoption are supposed to enjoy from birth the irrevocable status of membership and the privileges it entails. They have opportunities and civil rights that outsiders cannot (...) claim. In liberal welfare states they are entitled to assistance in need. But from a liberal point of view birthright entitlements, and the obligations they entail, are problematic. I will discuss three attempts to justify them. (shrink)

That Kant’s moral thought is invoked by both advocates and opponents of a right to assisted dying attests to both the allure and and the elusiveness of Kant’s moral thought. In particular, the theses that individuals have a right to a ‘death with dignity’ and that assisting someone to die contravenes her dignity appear to gesture at one of Kant’s signature moral notions, dignity. The purposes of this article are to outline Kant’s understanding of dignity and its implications for the (...) ethics of assisted dying. According to Kant, that which has dignity must be treated as an end in itself and may not permissibly be exchanged for that which merely has price. Kant’s reasoning thus seems to preclude acts of self-killing, including voluntary assisted dying, that rest on individual self-interest, since a person’s interests merely have price. However, a recognizably Kantian view of dignity can permit assisted dying under two sets of circumstances: First, it can be permissible for agents who anticipate a degradation of their rational agency due to conditions such as dementia to direct others to end their lives once sufficiently demented. In so doing, such agents in effect exercise a right to impose obligations on others regarding how their bodies, which will at some future point no longer be the vessels of their rational agency, are to be disposed of. Second, Kant errs in supposing that our dignity can stem solely from our moral personality, i.e., from our capacity to abide by universalizable moral principles. Rather, complete dignity also requires the capacity for setting discretionary ends and the means to those ends, i.e., the dignity of humanity. Individuals with prolonged and intense depression, in severe pain, or with serious disability may lack humanity while retaining their moral personality. In such cases, I propose that their opting to end their lives, with or without the assistance of others, does not amount to exchanging their dignified selves for something which merely has price and is therefore not objectionable on Kantian grounds. (shrink)

ABSTRACT This paper [1] is a defence of a modified version of Jane English's model of filial obligations based on adult children's friendship with their parents. Unlike the more traditional view that filial obligations are a repayment for parental sacrifices, the friendship model puts filial duties in the appealing context of voluntary, loving relationships. Contrary to English's original statement of this view, which is open to the charge of tolerating filial ingratitude, the friendship model can generate obligations to help our (...) parents even if we are no longer friendly with them. Joseph Kupfer has pointed out several ways in which parent‐child relationships differ from peer friendships; but his arguments do not preclude our enjoying a type of friendship with our parents. In response to Christina Hoff Sommers, who objects that feelings of friendship toward our parents are too flimsy a ground for filial duties, the friendship model can provide a plausible, robust account of filial obligations. As for adult children who have never formed friendships with their loving, caring parents, and refuse to give them much‐needed assistance, they can be criticised by moral considerations independent of but compatible with the friendship model. (shrink)

What are our responsibilities in the face of injustice? How far should we go to fight it? Many would argue that as long as a state is nearly just, citizens have a moral duty to obey the law. Proponents of civil disobedience generally hold that, given this moral duty, a person needs a solid justification to break the law. But activists from Henry David Thoreau and Mohandas Gandhi to the Movement for Black Lives have long recognized that there are times (...) when, rather than having a duty to obey the law, we have a duty to disobey it. -/- Taking seriously the history of this activism, A Duty to Resist wrestles with the problem of political obligation in real world societies that harbor injustice. Candice Delmas argues that the duty of justice, the principle of fairness, the Samaritan duty, and political association impose responsibility to resist under conditions of injustice. We must expand political obligation to include a duty to resist unjust laws and social conditions even in legitimate states. -/- For Delmas, this duty to resist demands principled disobedience, and such disobedience need not always be civil. At times, covert, violent, evasive, or offensive acts of lawbreaking can be justified, even required. Delmas defends the viability and necessity of illegal assistance to undocumented migrants, leaks of classified information, distributed denial-of-service (DDoS) attacks, sabotage, armed self-defense, guerrilla art, and other modes of resistance. There are limits: principle alone does not justify law breaking. But uncivil disobedience can sometimes be not only permissible but required in the effort to resist injustice. (shrink)

Une personne compétente peut-elle refuser des soins afin de rendre son décès naturel raisonnablement prévisible pour être admissible à l’aide médicale à mourir (AMM)? Prenons l’exemple d’un patient compétent atteint d’une paralysie du côté gauche à la suite d’un accident vasculaire cérébral droit qui ne devrait pas mourir avant de nombreuses années ; normalement, la cause de son décès ne serait pas prévisible. Cependant, il refuse de se retourner régulièrement, de sorte que son médecin peut prédire que des plaies de (...) pression se développeront, entraînant une infection pour laquelle il refusera le traitement et mourra par conséquent. Est-il maintenant admissible à l’AMM? Prenons l’exemple d’un patient compétent atteint d’une sténose spinale (affection non mortelle) qui refuse de manger (mais pas de boire pour ne pas perdre sa capacité à cause de la déshydratation). Par conséquent, son médecin peut prédire la mort par famine. Est-elle maintenant admissible à l’AMM? Pour répondre à ces questions, nous devons répondre à trois sous-questions : 1) les patients compétents ont-ils le droit de refuser des soins ; 2) les prestataires de soins de santé ont-ils l’obligation de respecter ces refus ; et 3) les décès résultant de refus de soins sont-ils naturels aux fins de déterminer si un patient est admissible à l’AMM? Si un patient compétent a le droit de refuser certains soins particuliers et que les prestataires de soins de santé ont l’obligation de respecter ce refus, et si le décès qui résulterait du refus de ces soins est naturel, alors ce refus de soins est une voie légale vers le AMM. Toutefois, si le patient compétent n’a pas le droit de refuser certains soins particuliers, ou si les prestataires de soins de santé n’ont pas l’obligation de respecter ce refus, ou si le décès qui résulterait du refus de ces soins n’est pas naturel, alors ce refus de soins ne constitue pas une voie légale vers le AMM. Dans cet article, nous explorons ce terrain juridique complexe avec les implications éthiques les plus profondes : l’accès à l’AMM. (shrink)

This paper aims to refute a common line of argument that it is immoral for physicians to engage in medical assistance in death (MAiD), i.e., the practices of euthanasia and physician-assisted suicide. The argument in question is based on the notion that participating in MAiD is contrary to the professional-role obligations of physicians, due to MAiD’s putative inconsistency with the ends of medicine. The paper describes several major flaws from which that argument suffers.

This paper considers whether states have a duty to accept those who cross borders to escape environmental disasters associated with climate change. It then examines how such a responsibility might be distributed, focusing on the predicament of the citizens of small island states expected to be inundated by rising sea levels. In assessing states' responsibility to admit these individuals, I draw on Walzer's theory of mutual aid, demonstrating that even under this narrow conception of states' obligations, a duty to accept (...) displaced islanders can be established. However, the proximity principle is ill-suited to determining which states should shoulder responsibility in this situation. Drawing on Miller's account of remedial responsibility and his ‘connection theory,’ I suggest that the obligation to accept ‘environmental refugees’ should be shouldered principally by affluent states that share significant degrees of causal and moral responsibility for climate change, and also have particularly strong capacities to assist the displaced. (shrink)

In recent discussions, it has been argued that a theory of animal rights is at odds with a liberal abortion policy. In response, Francione (1995) argues that the principles used in the animal rights discourse do not have implications for the abortion debate. I challenge Francione’s conclusion by illustrating that his own framework of animal rights, supplemented by a relational account of moral obligation, can address the moral issue of abortion. I first demonstrate that Francione’s animal rights position, which (...) grounds moral consideration in sentience, is committed to the claim that a sentient fetus has a right to life. I then illustrate that a fully developed account of animal rights that recognizes the special obligations humans have to assist animals when we cause them to be dependent and vulnerable through our voluntary actions or omissions is committed to the following: a woman also has a special obligation to assist a sentient fetus when she causes it to be dependent and vulnerable through her voluntary actions or omissions. From these considerations, it will become evident that a fully developed and consistent animal rights ethic does in fact have implications for the abortion discussion. (shrink)