ABSTRACT A major moral problem in relation to the deCODE genetics database project in Iceland is that the heavy emphasis placed on technical security of healthcare information has precluded discussion about the issue of consent for participation in the database. On the other hand, critics who have emphasised the issue of consent have most often demanded that informed consent for participation in research be obtained. While I think that individual consent is of major significance, I argue that this demand for (...) informed consent is neither suitable nor desirable in this case. I distinguish between three aspects of the database and show that different types of consent are appropriate for each. In particular, I describe the idea of a written authorisation based on general information about the database as an alternative to informed consent and presumed consent in database research. (shrink)

Abstract:This article deals with the question as to what makes bioethics a critical discipline. It considers different senses of criticism and evaluates their strengths and weaknesses. A primary method in bioethics as a philosophical discipline is critical thinking, which implies critical evaluation of concepts, positions, and arguments. It is argued that the type of analytical criticism that restricts its critical role to critical thinking of this type often suffers from other intellectual flaws. Three examples are taken to demonstrate this: premature (...) criticism, uncritical self-understanding of theoretical assumptions, and narrow framing of bioethical issues. Such flaws can lead both to unfair treatment of authors and to uncritical discussion of topics. In this context, the article makes use of Häyry’s analysis of different rationalities in bioethical approaches and argues for the need to recognize the importance of communicative rationality for critical bioethics. A radically different critical approach in bioethics, rooted in social theory, focuses on analyses of power relations neglected in mainstream critical thinking. It is argued that, although this kind of criticism provides an important alternative in bioethics, it suffers from other shortcomings that are rooted in a lack of normative dimensions. In order to complement these approaches and counter their shortcomings, there is a need for a bioethics enlightened by critical hermeneutics. Such hermeneutic bioethics is aware of its own assumptions, places the issues in a wide context, and reflects critically on the power relations that stand in the way of understanding them. Moreover, such an approach is dialogical, which provides both a critical exercise of speech and a normative dimension implied in the free exchange of reasons and arguments. This discussion is framed by Hedgecoe’s argument that critical bioethics needs four elements: to be empirically rooted, theory challenging, reflexive, and politely skeptical. (shrink)

It is argued that the ethical questions and challenges raised by the project of personalizing medicine are not sufficiently addressed without considering the possible effects thereof on our system of healthcare. I argue that the framing of ethical issues in light of the main principles of bioethics, such as autonomy, welfare and even justice, tends to be too narrow and the larger social implications thus tend to be neglected. Among the possible unintended consequences of the project to increase personal responsibility (...) for health is a reduced emphasis on it’s social determinants, for which we are jointly responsible.This presents important challenges for bioethics, and calls in turn for closer attention to be paid to biopolitics and the social context of bioethical discourse. The conclusion is that the benefits or damage that might result from personalizing medicine will depend no less upon political and policy decisions than on pharmacogenomic developments. (shrink)

This paper defends human dignity in two ways. First, by confronting the criticism that human dignity does not serve an important function in contemporary moral discourse and that its function can be sufficiently performed by other moral terms. It is argued that this criticism invites a danger of moral reductionism, which impoverishes moral discourse. The authority of moral philosophy to correct widely shared moral intuitions, rooted in experiences of grave injustices and wrongs, is questioned. Secondly, dignity is defended by showing (...) what is needed to uphold it, both in theory and practice. It is argued, and demonstrated through examples, that human dignity as a universal value ascribed to human beings and the virtue of dignified action are intimately related. This is fleshed out in terms of Kant’s analysis of respect in the practical sense and of virtue as a commitment to the value of dignity as a constitutive end of our moral order. It is furthermore argued that theoretical attempts to ground respect for dignity in human capacities lead to a moral impasse. It is necessary to act as if every human being is worthy of respect. This practical approach requires institutions and specified moral obligations that are integral to the democratic ethos and the rule of law, which guarantees the equal status of human beings. This practical task requires that we consistently tease out and act on the implications of these principles rather than seek deeper justification for the equal worth of humans, articulated in the term human dignity. (shrink)

The purpose of this paper is to evaluate the significance of the existential notion of authenticity for medical ethics. This is done by analyzing authenticity and examining its implications for the patient-professional relationship and for ethical decision-making in medical situations. It is argued that while authenticity implies important demand for individual responsibility, which has therapeutic significance, it perpetuates ideas which are antithetical both to authentic interaction between patients and professionals and to fruitful deliberation of moral dilemmas. In order to counteract (...) these consequences, an alternative idea of authenticity is introduced. According to this idea, authenticity is not regarded primarily as individual sovereignty, but as an ability to participate in a dialogue in which the subjectivity of both partners is respected. Such practice, based on mutual trust and responsibility, would enhance common decision-making and overcome the alienation between patients and professionals. (shrink)

Three arguments of Habermas against “liberal eugenics”—the arguments from consent, responsibility, and instrumentalization—are critically evaluated and explicated in the light of his discourse ethics and social theory. It is argued that these arguments move partly at a too deep level and are in part too individualistic and psychological to sufficiently counter the liberal position that he sets out to criticize. This is also due to limitations that prevent discourse ethics from connecting effectively to the moral and political domains, e.g., through (...) a discussion of justice. In spite of these weaknesses, Habermas’s thesis is of major relevance and brings up neglected issues in the discussion about eugenic reproductive practices. This relevance has not been duly recognized in bioethics, largely because of the depth of his speculations of philosophical anthropology. It is argued that Habermas’s notion of the colonization of the lifeworld could provide the analytical tool needed to build that bridge to the moral and political domain. (shrink)

According to the orthodox treatment of risk preferences in decision theory, they are to be explained in terms of the agent's desires about concrete outcomes. The orthodoxy has been criticised both for conflating two types of attitudes and for committing agents to attitudes that do not seem rationally required. To avoid these problems, it has been suggested that an agent's attitudes to risk should be captured by a risk function that is independent of her utility and probability functions. The main (...) problem with that approach is that it suggests that attitudes to risk are wholly distinct from people's (non-instrumental) desires. To overcome this problem, we develop a framework where an agent's utility function is defined over chance propositions (i.e., propositions describing objective probability distributions) as well as ordinary (non-chance) ones, and argue that one should explain different risk attitudes in terms of different forms of the utility function over such propositions. (shrink)

ABSTRACT Offsetting is a very ineffective way to do good. Offsetting your lifetime emissions may increase aggregated life expectancy by at most seven years, while giving the amount it costs to offset your lifetime emissions to a malaria charity saves in expectation the life of at least one child. Is there any moral reason to offset rather than giving to some charity that does good so much more effectively? There might be such a reason if your offsetting compensated or somehow (...) benefitted the victims of your emission, since that could mean that you would satisfy the duty not to harm others by emitting and offsetting. But that is typically not true. If your emission harms some person and your offsetting benefits some person, then these are most likely different people. Hence, I conclude, we have a stronger reason to give to effective charities than we have to offset our emissions. (shrink)

Rationality and the Genetic Challenge by Matti Häyry is a well-written and thoughtful book about important issues in the contemporary ethical discussion of genetics. The book is well structured around seven practical themes that the author takes to exemplify “the genetic challenge.” He also refers to them as “seven ways of making people better,” which the subtitle of the book already puts into question form: Making People Better? In the first chapter of the book, Häyry introduces these seven themes and (...) he discusses each of them in Chapters 3–9. In the remaining two chapters, 2 and 10, he describes the main normative positions analyzed in the book and clarifies his own methodology and position. He chooses six authors, or three pairs of authors, whom he takes to “represent the three normative doctrines of Western Moral philosophy” in order to demonstrate six “divergent rationalities” or “methods of genethics.” In this way, Häyry both summarizes the main prescriptive positions in contemporary bioethical debate and contrasts them with his own “nonconfrontational notion of rationality,” which aims to show that there is a variety of divergent, not mutually exclusive normative views, the justification of which “depends ultimately on the choice of worldviews, attitudes, and ideas about the foundation of moral worth”. (shrink)

In his seminal work, Truth and Method, theGerman philosopher Hans-Georg Gadamer distinguishesbetween three types of what he calls the experience ofthe `Thou'. In this paper, Gadamer's analysis of thisexperience is explained in terms of his philosophicalhermeneutics and brought to bear upon thepatient-professional relationship. It is argued thatwhile Gadamer's analysis implies fruitful insights fora dialogical account of the patient-professionalinteraction, it harbours elements which are conduciveto paternalistic practice of medicine. The strongattribution of value to tradition and the respect forauthority emphasized in his (...) theory result in a lack ofsensitivity for individual self-determination which isneeded for a successful account of thepatient-professional relationship. (shrink)

This paper discusses a challenge for Comparativists about belief, who hold that numerical degree of belief (in particular, subjective probability) is a useful fiction, unlike comparative belief, which they regard as real. The challenge is to make sense of claims like ‘I am twice as confident in A as in B’ in terms of comparative belief only. After showing that at least some Comparativists can meet this challenge, I discuss implications for Zynda’s [2000] and Stefánsson’s [2017] defences of Comparativism.

_This article reflects on the central themes of Vilhjálmur Árnason's work, particularly his focus on contextualized morality and dialogical ethics. Vilhjálmur emphasizes the importance of balancing individual freedom and responsibility with an understanding of social and political contexts. By examining relational ethics across healthcare, research, and public health, the article highlights his contributions to bioethics, including concepts like informed consent, scientific citizenship, and authorization in biobank research. Vilhjálmur 1 advocates for communicative reasoning and authentic dialogue as essential tools for ethical (...) analysis, situational decision-making, and fostering trust in research and healthcare practices. The work underscores the importance of trustworthiness, veracity, and participatory engagement in addressing modern ethical challenges, particularly in rapidly advancing biotechnologies. _ _Keywords: _Contextual ethics, dialogical ethics, relational autonomy, informed consent, authorization, bioethics, trustworthiness, communicative reasoning, healthcare ethics, public health ethics, scientific citizenship, biobank research. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated.The themes covered in the section so far include dignity, (...) naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration.All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected]. (shrink)

Many philosophers think that we should use a lottery to decide who gets a good to which two persons have an equal claim but which only one person can get. Some philosophers think that we should save identified persons from harm even at the expense of saving a somewhat greater number of statistical persons from the same harm. I defend a principled way of justifying both judgements, namely, by appealing to the decreasing marginal moral value of survival chances. I identify (...) four desiderata that, I contend, any such justification should satisfy, and explain how my account meets these desiderata, unlike some previous accounts. (shrink)

The veil of ignorance argument was used by John C. Harsanyi to defend Utilitarianism and by John Rawls to defend the absolute priority of the worst off. In a recent paper, Lara Buchak revives the veil of ignorance argument, and uses it to defend an intermediate position between Harsanyi's and Rawls' that she calls Relative Prioritarianism. None of these authors explore the implications of allowing that agent's behind the veil are averse to ambiguity. Allowing for aversion to ambiguity---which is both (...) the most commonly observed and a seemingly reasonable attitude to ambiguity---however supports a version of Egalitarianism, whose logical form is quite different from the theories defended by the aforementioned authors. Moreover, it turns out that the veil of ignorance argument neither supports standard Utilitarianism nor Prioritarianism unless we assume that rational people are insensitive to ambiguity. (shrink)

Recent bioethics discussion and research in Iceland has been greatly affected by the fact that one of the world’s largest genetics research companies is based there and has been in the forefront of creating a population database resource for its research projects. Consequently, a large part of this article is centered around the bioethical discussion engendered by these projects, but other recent bioethical developments related to issues at the beginning and the end of life will also be discussed.

In this paper, I discuss how a Working group on ethics dealt with the question whether the collapse of the Icelandic banks and related financial setbacks can to some extent be explained by morality and work practice. I describe how the Working group delineated its subject matter by evaluating practice in the financial sector, the administration, the political sector and the social or cultural sector. I demonstrate the approach used by the Working group by discussing some important examples which throw (...) light on some aspects of its manifold analyses. The examples show how different aspects of morality are of importance in an analysis of the events that took place. (shrink)

It has recently been argued that indeterminacy and indeterminism make most ordinary counterfactuals false. I argue that a plausible way to avoid such counterfactual skepticism is to postulate the existence of primitive modal facts that serve as truth-makers for counterfactual claims. Moreover, I defend a new theory of ‘might’ counterfactuals, and develop assertability and knowledge criteria to suit such unobservable ‘counterfacts’.

Chance Neutrality is the thesis that, conditional on some proposition being true, its chance of being true should be a matter of practical indifference. The aim of this article is to examine whether Chance Neutrality is a requirement of rationality. We prove that given Chance Neutrality, the Principal Principle entails a thesis called Linearity; the centerpiece of von Neumann and Morgenstern’s expected utility theory. With this in mind, we argue that the Principal Principle is a requirement of practical rationality but (...) that Linearity is not and, hence, that Chance Neutrality is not rationally required. (shrink)

Rowe has recently argued that pure risk of harm cannot itself be a harm. I respond to Rowe and argue that given an appropriate understanding of objective probabilities, pure objective risk of harm can itself be a harm.

Bartha and DesRoches (Synthese 199(3–4):8701–8740, 2021) and Steel and Bartha (Risk Analysis 43(2):260–268, 2023) argue that we should understand the precautionary principle as the injunction to maximise lexical utilities. They show that the lexical utility model has important pragmatic advantages. Moreover, the model has the theoretical advantage of satisfying all axioms of expected utility theory except continuity. In this paper I raise a trilemma for any attempt at modelling the precautionary principle with lexical utilities: it permits choice cycles or leads (...) to paralysis or implies that the smallest value difference that is possible in a context has extreme axiological implications. (shrink)

This paper defends two related claims about belief. First, the claim that unlike numerical degrees of belief, comparative beliefs are primitive and psychologically real. Second, the claim that the fundamental norm of Probabilism is not that numerical degrees of belief should satisfy the probability axioms, but rather that comparative beliefs should satisfy certain constraints.

This paper develops a Multidimensional Decision Theory and argues that it better captures ordinary intuitions about fair distribution of chances than classical decision theory. The theory is an extension of Richard Jeffrey’s decision theory to counterfactual prospects and is a form of Modal Consequentialism, according to which the value of actual outcomes often depends on what could have been. Unlike existing versions of modal consequentialism, the multidimensional decision theory allows us to explicitly model the desirabilistic dependencies between actual and counterfactual (...) outcomes that, I contend, are at the heart of common intuitions about fair distribution of chances. (shrink)

Considerations of dynamic inconsistency have figured prominently in debates over the rationality of preferences that violate the separability conditions characteristic of expected utility theory. These debates have mostly focused on risk- and ambiguity averse preferences, but analogous considerations apply to preferences for fairness. We revisit these debates in the context of a specific hypothesis regarding the violations of separability by such preferences, namely that they are potentially both explained and rationalised by attitudes to the chances of goods that motivate a (...) preference for equality in the distribution of chances across people and possible events. Our main aim is to argue that, first, when these violations of static separability are motivated by such attitudes to chances, then they need not result in dynamically inconsistent behaviour. Second, and more generally, considerations of dynamic consistency do not, we argue, undermine the rationality of such attitudes towards the distribution of chances, despite the fact that such attitudes give rise to violations of the static separability assumptions of expected utility theory. (shrink)

This study attempts to situate ethical discourse within descriptions of a moral context which do justice both to concrete individual moral experiences and to the socio-historical framework within which they are lived. In light of these descriptions it is argued that an adequate theory of morality must focus on the essential continuity between the individual moral life and the communal practices and institutions which constitute our ethical substance. ;In Chapter One it is shown how the existentialist liberation of the moral (...) subject centers ethical concerns around the concrete living individual, who, for the most part, had no place in traditional ethics. ;In Chapter Two it is argued that the existentialist revolt in morals is incomplete and misguided, insofar as the power of individual freedom is overemphasized and the weight of socio-historical reality is neglected. On the basis of hermeneutical analysis of human existence, it is shown how the cultural fabric of interpretations and practices sustains and gives meaning to the moral life. On the basis of Sartre's Marxism, it is shown how the social field of classes and violence alienates and frustrates our individual moral projects. ;In Chapter Three it is asked what implications for ethical theory and conduct emerge from these descriptions of the moral context. It is argued that while Heidegger's thought provides an important criticism of the history of ethics, it escapes all concrete applications to ethical discourse. In this respect Gadamer's hermeneutics is found more fruitful, although his Aristotelian account of the situated moral life underestimates the ideological distortions of the moral context as well as the power of moral consciousness to reject tradition and project its freedom. In order to abet such a critical account of morality, Habermas' analysis of the moral consciousness and its development within the socialization process is introduced. But it is argued that Habermas' emphasis on a theoretical grounding of ethical discourse loses touch with the concrete existential/historical dimension of the moral life. It is proposed that only by moving out from descriptions of individual experiences of injustices and wrongs will it be possible to successfully combine moral and social considerations in a critical theory with practical intent. (shrink)

The Precautionary Principle (PP) is an influential principle of risk management. It has been widely introduced into environmental legislation, and it plays an important role in most international environmental agreements. Yet, there is little consensus on precisely how to understand and formulate the principle. In this paper I prove some impossibility results for two plausible formulations of the PP as a decision-rule. These results illustrate the difficulty in making the PP consistent with the acceptance of any trade-offs between catastrophic risks (...) and more ordinary goods. (shrink)

1. Barry and Cullity (2022b) argue that when morally assessing a person’s climate actions,1 we should ask how these actions affect other people’s prospects.2 For the present purposes, we can unders...

Ocean-based salmon farming, as presently practiced, is thought to pose an existential threat to what we today think of as wild salmon. This raises ethical questions about, first, the value of wild salmon, and, second, the value of wild salmon of the particular type that exists today. This essay uses the debate around ocean-based salmon farming as a case study of ‘irreversible damage’, a concept that figures heavily in environmental laws and regulations, in particular, in the so-called ‘precautionary principle’. It (...) is argued that although ocean-based salmon farming may, on the face of it, seem to be a prime example of a threat of irreversible damage, a wish to avoid irreversible damage does not support banning such farming. In contrast, it is argued that concern for irreplaceable value might support a ban. The findings suggest that it would often be appropriate for environmentalists and conservationists to focus more on irreplaceable value and less on irreversible damage. (shrink)

A moderately risk averse person may turn down a 50/50 gamble that either results in her winning $200 or losing $100. Such behaviour seems rational if, for instance, the pain of losing $100 is felt more strongly than the joy of winning $200. The aim of this paper is to examine an influential argument that some have interpreted as showing that such moderate risk aversion is irrational. After presenting an axiomatic argument that I take to be the strongest case for (...) the claim that moderate risk aversion is irrational, I show that it essentially depends on an assumption that those who think that risk aversion can be rational should be skeptical of. Hence, I conclude that risk aversion need not be irrational. (shrink)

Catastrophic risk raises questions that are not only of practical importance, but also of great philosophical interest, such as how to define catastrophe and what distinguishes catastrophic outcomes from non-catastrophic ones. Catastrophic risk also raises questions about how to rationally respond to such risks. How to rationally respond arguably partly depends on the severity of the uncertainty, for instance, whether quantitative probabilistic information is available, or whether only comparative likelihood information is available, or neither type of information. Finally, catastrophic risk (...) raises important ethical questions about what to do when catastrophe avoidance conflicts with equity promotion. (shrink)

The de minimis principle states that some risks are so trivial that they can be ignored or treated categorically differently from non-trivial risks. Lundgren and Stefánsson criticize the de minimis principle, arguing that it either has to be applied locally or globally and that problems arise whichever application is chosen. Aven and Seif respond to Lundgren and Stefánsson’s argument and defend the de minimis principle as a “meaningful and useful perspective for handling risk in practice.” The response highlights some aspects (...) of the argument in Lundgren and Stefánsson that needs clarification, which is what we do in this note. (shrink)

Neoclassical economists use expected utility theory to explain, predict, and prescribe choices under risk, that is, choices where the decision-maker knows---or at least deems suitable to act as if she knew---the relevant probabilities. Expected utility theory has been subject to both empirical and conceptual criticism. This chapter reviews expected utility theory and the main criticism it has faced. It ends with a brief discussion of subjective expected utility theory, which is the theory neoclassical economists use to explain, predict, and prescribe (...) choices under uncertainty, that is, choices where the decision-maker cannot act on the basis of objective probabilities but must instead consult her own subjective probabilities. (shrink)

Does the desirability of a proposition depend on whether it is true? Not according to the Invariance assumption, held by several notable philosophers. The Invariance assumption plays an important role in David Lewis’ famous arguments against the so-called Desire-as-Belief thesis (DAB), an anti-Humean thesis according to which a rational agent desires a proposition exactly to the degree that she believes the proposition to be desirable. But the assumption is of interest independently of Lewis’ arguments, for instance since both Richard Jeffrey (...) and James Joyce make the assumption (or, strictly speaking, accept a thesis that implies Invariance) in their influential books on decision theory. The main claim to be defended in this paper is that Invariance is incompatible with certain assumptions of decision theory. I show that the assumption fails on the most common interpretations of desirability and/or choice-worthiness found in decision theory. I moreover show that Invariance is inconsistent with Richard Jeffrey’s decision theory, on which Lewis’ arguments against DAB are based. Finally, I show that Invariance contradicts how we in general do and should think about conditional desirability. (shrink)

Orthodox expected utility theory imposes too stringent restrictions on what attitudes to risk one can rationally hold. Focusing on a life-and-death gamble, I identify as the main culprit the theory’s Linearity property, according to which the utility of a particular change in the risk of a bad outcome is independent of the original level of risk. Finally, I argue that a recent non-standard Bayesian decision theory, that does not have this property, handles risky gambles better than the orthodox theory.

What distinguishes indicative conditionals from subjunctive conditionals, according to one popular view, is that the so-called Adams’ thesis holds for the former kind of conditionals but the so-called Skyrms’ thesis for the latter. According to a plausible metaphysical view, both conditionals and chances supervene on non-modal facts. But since chances do not supervene on facts about particular events but facts about event-types, the past as well as the future is chancy. Some philosophers have worried that this metaphysical view is incompatible (...) with the aforementioned view on the probability of conditionals. This paper however shows that there is no need to worry, as these views can all be simultaneously satisfied within the so-called Multidimensional Possible World Semantics for conditionals. (shrink)