The failure of many patients with chronic conditions to correctly follow medical advice that they hope or intend to follow is a major concern, especially as effective long‐term therapies for chronic conditions materialize. Some US healthcare providers have responded with strategies that involve implementing contracts with their patients, including provisions that may deny future treatments after continued nonadherence. This is among the first articles to explicitly discuss the ethics of patient contracts.

Whole-genome analysis and whole-exome analysis generate many more clinically actionable findings than traditional targeted genetic analysis. These findings may be relevant to research participants themselves as well as for members of their families. Though researchers performing genomic analyses are likely to find medically significant genetic variations for nearly every research participant, what they will find for any given participant is unpredictable. The ubiquity and diversity of these findings complicate questions about disclosing individual genetic test results. We outline an approach for (...) disclosing a select range of genetic results to the relatives of research participants who have died, developed in response to relatives? requests during a pilot study of large-scale medical genetic sequencing. We also argue that studies that disclose individual research results to participants should, at a minimum, passively disclose individual results to deceased participants? relatives. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

The idea of a right not to know emerged in the late 20th century, largely in response to the early incorporation of genetic testing into clinical care. While a few commentators took a more absolute view about the strength of the RNTK, most of the scholarship was openly sceptical of the concept, or at least was willing to acknowledge that the RNTK was defeasible.1 After two decades of relative quiet, it was surprising, then, that the RNTK reappeared with a seemingly (...) widespread consensus that it deserved to be treated as an absolute right. In response to the American College of Medical Genetics and Genomics recommendation2 to actively search for a limited set of high-value medical variants as a default many bioethics commentators came forward to endorse a strong RNTK.3 While ‘deliberate ignorance’ is a complicated moral and psychological concept,4 I was and remain sceptical of a strong RNTK in all cases, and largely support the novel arguments put forth by Ben Davies. But he makes two moves that deserve additional discussion and analysis. Specifically, I have concerns about conflating the provision of medical information with the separate decision about whether or not to act on …. (shrink)

Background: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines.Method: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998–99 policies of 38 organisations—18 medical associations , nine physician group practices , and 12 health plans —selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics taxonomy; a reconciled (...) abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society.Results: A majority in all three groups mention “fiduciary obligations” of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians’ obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations.Conclusions: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery. (shrink)

Drawing on diverse first-person documents, philosophical writings, and historical scholarship, this bio-historical introduction to Edith Stein examines her crucial life choices and philosophical creativity within the framework of her formative personal and historical circumstances. Drawn deeply to unravel the mysteries of life that she prized as a fertile hidden darkness, Stein deliberately disclosed and concealed her inner tumult and reflections. This essay argues that the axis of herlife was her agonizing struggle—rife with ambiguity, confusion, contradiction, and luminous clarity—to redefine and (...) re-constellate her various selves as a highlyeducated woman, Jew, German, Catholic convert, philosopher, mystic, educator, nun, citizen, friend, and family member. At the heart of her striving for psychological coherence was her unquenchable curiosity, her search for complex truth, her sustained optimistic belief in human agency and empathic potential, her longing to help create a better world, and, after World War I, her invincible faith in God. (shrink)

The recent Common Rule revision process took almost a decade and the resulting changes are fairly modest, particularly when compared to the ambitious ideas proposed in the advance notice of proposed rulemaking and notice of proposed rulemaking. Furthermore, the revision process did not even attempt to tackle any of the Common Rule subparts pertaining to vulnerable populations where commentators think the rules unduly restrict important research. We believe that this was a missed opportunity to make desirable changes, and that given (...) the usual process the next opportunity to revisit the Common Rule is unacceptably remote. In this article, we argue that the Common Rule should be regularly reassessed, with a mechanism for making substantive changes. Drawing on lessons learned from the recent revision process, we make recommendations about ways to structure future attempts to maximize the ability to make timely and necessary changes. (shrink)

Well-Being and Death addresses philosophical questions about death and the good life: what makes a life go well? Is death bad for the one who dies? How is this possible if we go out of existence when we die? Is it worse to die as an infant or as a young adult? Is it bad for animals and fetuses to die? Can the dead be harmed? Is there any way to make death less bad for us? Ben Bradley defends the (...) following views: pleasure, rather than achievement or the satisfaction of desire, is what makes life go well; death is generally bad for its victim, in virtue of depriving the victim of more of a good life; death is bad for its victim at times after death, in particular at all those times at which the victim would have been living well; death is worse the earlier it occurs, and hence it is worse to die as an infant than as an adult; death is usually bad for animals and fetuses, in just the same way it is bad for adult humans; things that happen after someone has died cannot harm that person; the only sensible way to make death less bad is to live so long that no more good life is possible. (shrink)

This paper defends the view, put roughly, that to think that p is to guess that p is the answer to the question at hand, and that to think that p rationally is for one’s guess to that question to be in a certain sense non-arbitrary. Some theses that will be argued for along the way include: that thinking is question-sensitive and, correspondingly, that ‘thinks’ is context-sensitive; that it can be rational to think that p while having arbitrarily low credence (...) that p; that, nonetheless, rational thinking is closed under entailment; that thinking does not supervene on credence; and that in many cases what one thinks on certain matters is, in a very literal sense, a choice. Finally, since there are strong reasons to believe that thinking just is believing, there are strong reasons to think that all this goes for belief as well. (shrink)

This article argues that standard causal and functionalist definitions of realization fail to account for the realization of entities that cannot be individuated in causal or functional terms. By modifying such definitions to require that realizers also logically suffice for any historical properties of the entities they realize, one can provide for the realization of entities whose resistance to causal/functional individuation stems from their possession of individuative historical properties. But if qualia cannot be causally or functionally individuated, then qualia can (...) be physically realized only if the thesis that all things are physical or physically realized is insufficient for physicalism. (shrink)

Shavelson et al. (2023) identify an important problem in their Target article: a significant number of terminally ill patients with impaired motor function are wrongfully excluded from receiving ai...

The risk and crisis communication process in public health emergencies (PHERCC, public health emergency risk and crisis communication) matrix, as proposed by Spitale, Germani, and Biller-Andorno (2...

In this article, I attempt to resuscitate the perennially unfashionable distinctive feeling theory of pleasure (and pain), according to which for an experience to be pleasant (or unpleasant) is just for it to involve or contain a distinctive kind of feeling. I do this in two ways. First, by offering powerful new arguments against its two chief rivals: attitude theories, on the one hand, and the phenomenological theories of Roger Crisp, Shelly Kagan, and Aaron Smuts, on the other. Second, by (...) showing how it can answer two important objections that have been made to it. First, the famous worry that there is no felt similarity to all pleasant (or unpleasant) experiences (sometimes called ‘the heterogeneity objection’). Second, what I call ‘Findlay’s objection’, the claim that it cannot explain the nature of our attraction to pleasure and aversion to pain. (shrink)

Motivated by weaknesses with traditional accounts of logical epistemology, considerable attention has been paid recently to the view, known as anti-exceptionalism about logic, that the subject matter and epistemology of logic may not be so different from that of the recognised sciences. One of the most prevalent claims made by advocates of AEL is that theory choice within logic is significantly similar to that within the sciences. This connection with scientific methodology highlights a considerable challenge for the anti-exceptionalist, as two (...) uncontentious claims about scientific theories are that they attempt to explain a target phenomenon and prove their worth through successful predictions. Thus, if this methodological AEL is to be viable, the anti-exceptionalist will need a reasonable account of what phenomena logics are attempting to explain, how they can explain, and in what sense they can be said to issue predictions. This paper makes sense of the anti-exceptionalist proposal with a new account of logical theory choice, logical predictivism, according to which logics are engaged in both a process of prediction and explanation. (shrink)

According to hedonism about well-being, lives can go well or poorly for us just in virtue of our ability to feel pleasure and pain. Hedonism has had many advocates historically, but has relatively few nowadays. This is mainly due to three highly influential objections to it: The Philosophy of Swine, The Experience Machine, and The Resonance Constraint. In this paper, I attempt to revive hedonism. I begin by giving a precise new definition of it. I then argue that the right (...) motivation for it is the ‘experience requirement’ (i.e., that something can benefit or harm a being only if it affects the phenomenology of her experiences in some way). Next, I argue that hedonists should accept a felt-quality theory of pleasure, rather than an attitude-based theory. Finally, I offer new responses to the three objections. Central to my responses are (i) a distinction between experiencing a pleasure (i.e., having some pleasurable phenomenology) and being aware of that pleasure, and (ii) an emphasis on diversity in one’s pleasures. (shrink)

The rapid growth of next-generation genetic sequencing has prompted debate about the responsibilities of researchers toward genetic incidental findings. Assuming there is a duty to disclose significant incidental findings, might there be an obligation for researchers to actively look for these findings? We present an ethical framework for analyzing whether there is a positive duty to look for genetic incidental findings. Using the ancillary care framework as a guide, we identify three main criteria that must be present to give rise (...) to an obligation to look: high benefit to participants, lack of alternative access for participants, and reasonable burden on researchers. Our analysis indicates that there is no obligation to look for incidental findings today, but during the ongoing translation of genomic analysis from research to clinical care, this obligation may arise. (shrink)

Much new global genetic research employs whole genome sequencing, which provides researchers with large amounts of data. The quantity of data has led to the generation and discovery of more incidental or secondary findings and to vigorous theoretical discussions about the ethical obligations that follow from these incidental findings. After a decade of debate in the genetic research community, there is a growing consensus that researchers should, at the very least, offer to return incidental findings that provide high‐impact, medically relevant (...) information, when it is not unduly burdensome to the research enterprise to do so. Much as genetic research has been limited to U.S. and European settings, the incidental findings debate has primarily focused on research conducted in high‐income countries. In a 2015 paper, Alberto Ortiz‐Osorno, Linda Ehler, and Judith Brooks note salient differences between the circumstances of research participants in low‐ and high‐resource settings that alter the analysis of when and why incidental findings should be offered to research participants. In this article, we expand on their analysis and present a framework for thinking about how investigators’ obligations to return genomic data might change in low‐resource settings, particularly in settings where participants do not have access to the medical care needed to treat, assess, or monitor incidental findings that are actionable in settings with plentiful resources. (shrink)

What is it for a life to be meaningful? In this article, I defend what I call Consequentialism about Meaning in Life, the view that one's life is meaningful at time t just in case one's surviving at t would be good in some way, and one's life was meaningful considered as a whole just in case the world was made better in some way for one's having existed.

Philosophers of logic are particularly interested in understanding the aims, epistemology, and methodology of logic. This raises the question of how the philosophy of logic should go about these enquires. According to the practice-based approach, the most reliable method we have to investigate the methodology and epistemology of a research field is by considering in detail the activities of its practitioners. This holds just as true for logic as it does for the recognised empirical and abstract sciences. If we wish (...) to systematically understand the aims and epistemology of logic, we are best placed achieving this by looking at what logicians do, rather than reflecting upon the nature of logic itself. In this entry, we outline the motivations for a practice-based approach towards the philosophy of logic and highlight its advantages over more “top-down” approaches, which attempt to infer conclusions about the nature of logic and its methodology on the basis of traditional assumptions about knowledge, metaphysics, or logic itself. We end by addressing several prominent concerns raised against the practice-based approach. (shrink)

I argue that extant accounts of harm all fail to account for important desiderata, and that we should therefore jettison the concept when doing moral philosophy.

Bioethics, Volume 36, Issue 3, Page 298-304, March 2022.

One prominent argument in international law and religious thought for abolishing capital punishment is that it violates individuals’ right to life. Notably, this _right-to-life argument_ emerged from normative and legal frameworks that recognize deadly force against aggressors as justified when necessary to stop their unjust threat of grave harm. Can capital punishment be necessary in this sense—and thus justified defensive killing? If so, the right-to-life argument would have to admit certain exceptions where executions are justified. Drawing on work by Hugo (...) Bedau, I identify a thought experiment where executions are justified defensive killing but explain why they cannot be in our world. A state’s obligations to its prisoners include the _obligation to use nonlethal incapacitation_ (ONI), which applies as long as prisoners pose no imminent threat. ONI precludes executions for reasons of future dangerousness. By subjecting the right-to-life argument to closer scrutiny, this article ultimately places it on firmer ground. (shrink)

In this volume twenty-three major scholars comment on and critically evaluate In Search of a Universal Ethic, the 2009 document written by the International Theological Commission (ITC) of the Catholic Church. That historic document represents an official Church contribution both to a more adequate understanding of a universal ethic and to Catholicism s own tradition of reflection on natural law. The essays in this book reflect the ITC document s complementary emphases of dialogue across traditions (universal ethic) and reflection on (...) broadly applicable ethical guidance within the Christian tradition (natural law). Among other things, the document situates the natural law ethical tradition within the larger search for a universal ethic. Along with its insightful essays, Searching for a Universal Ethic offers — for the first time in published form — the Vatican s official English translation of In Search of a Universal Ethic. Contributors: John Berkman Serge-Thomas Bonino, O.P. David Burrell, C.S.C. Lisa Sowle Cahill Joseph E. Capizzi David Cloutier Anver M. Emon Robert P. George Sherif Girgis Jennifer A. Herdt Russell Hittinger M. Cathleen Kaveny Anthony J. Kelly, C.Ss.R. Fergus Kerr, O.P. Steven A. Long William C. Mattison III Gilbert Meilaender Livio Melina Michael S. Northcott David Novak Jean Porter Martin Rhonheimer Tracey Rowland. (shrink)

In this paper, I reconstruct Robert Nozick's experience machine objection to hedonism about well-being. I then explain and briefly discuss the most important recent criticisms that have been made of it. Finally, I question the conventional wisdom that the experience machine, while it neatly disposes of hedonism, poses no problem for desire-based theories of well-being.

Given the plethora of competing logical theories of validity available, it’s understandable that there has been a marked increase in interest in logical epistemology within the literature. If we are to choose between these logical theories, we require a good understanding of the suitable criteria we ought to judge according to. However, so far there’s been a lack of appreciation of how logical practice could support an epistemology of logic. This paper aims to correct that error, by arguing for a (...) practice-based approach to logical epistemology. By looking at the types of evidence logicians actually appeal to in attempting to support their theories, we can provide a more detailed and realistic picture of logical epistemology. To demonstrate the fruitfulness of a practice-based approach, we look to a particular case of logical argumentation—the dialetheist’s arguments based upon the self-referential paradoxes—and show that the evidence appealed to support a particular theory of logical epistemology, logical abductivism. (shrink)

The article argues the thesis that institutions have a prima facie obligation to fund the feedback of individual findings in genomic research conducted on the African continent by drawing arguments from an underexplored Afro-communitarian view of distributive justice and rights of researchers to be aided. Whilst some studies have explored how institutions have a duty to support return as a form of ancillary care or additional foreseeable service in research by mostly appealing to dominant principles and theories in the Global (...) North, this mostly normative study explores this question by appealing to underexplored African philosophy. This is a new way of thinking about institutional responsibility to fund feedback and responds to the call to decolonise health research in Africa. Further studies are required to study how this prima facie obligation will interact with social contexts and an institution’s extant relationships to find an actual duty. The research community should also work out procedures, policies and governance structures to facilitate feedback. In our opinion, though the impacts of feeding back can inform how institutions think about their actual duty, these do not obliterate the binding duty to fund feedback. (shrink)

L’enjeu de ce recueil est de contribuer à repenser la notion de limite, en l’envisageant sous les différentes figures, philosophiques, écologiques, politiques, que lui confère notre présent. Comme le montrent, sous des modalités diverses, les contributions de ce collectif, la limite peut et doit être conçue en dehors des valeurs négatives – borne, restriction ou frontière –, qui en affaiblissent la portée. Elle peut alors être pensée sur le fond de cet illimité où s’ouvre la question même du dehors. Si (...) la finitude demeure la condition de l’existence, de l’art et de la pensée, assumer notre condition finie ne consiste donc pas à se murer dans le connu, mais bien à en transgresser les bornes, et ce faisant, à s’illimiter. Au plus loin de la fermeture des frontières que prônent certaines politiques, ou de la certitude dogmatique dans laquelle certains cherchent à réassurer leur pensée, la limite ne vit que de son rapport fécond à l’illimité. Interrogeant l’existence, la politique, l’art – autant dire, la pensée même –, les textes de ce recueil mettent au jour un certain don de l’illimité. (shrink)

The move to satisficing has been thought to help consequentialists avoid the problem of demandingness. But this is a mistake. In this article I formulate several versions of satisficing consequentialism. I show that every version is unacceptable, because every version permits agents to bring about a submaximal outcome in order to prevent a better outcome from obtaining. Some satisficers try to avoid this problem by incorporating a notion of personal sacrifice into the view. I show that these attempts are unsuccessful. (...) I conclude that, if satisficing consequentialism is to remain a position worth considering, satisficers must show (i) that the move to satisficing is necessary to solve some problem, whether it be the demandingness problem or some other problem, and (ii) that there is a version of the view that does not permit the gratuitous prevention of goodness. (shrink)

The philosophical study of well-being concerns what makes lives good for their subjects. It is now standard among philosophers to distinguish between two kinds of well-being: - lifetime well-being, i.e., how good a person's life was for him or her considered as a whole, and - temporal well-being, i.e., how well off someone was, or how they fared, at a particular moment in time or over a period of time longer than a moment but shorter than a whole life, say, (...) a day, month, year, or chapter of a life. Many theories have been offered of each of these kinds of well-being. A common view is that lifetime well-being is in some way constructed out of temporal well-being. This book argues that much of this literature is premised on a mistake. Lifetime well-being cannot be constructed out of temporal well-being, because there is no such thing as temporal well-being. The only genuine kind of well-being is lifetime well-being. The Passing of Temporal Well-Being will prove essential reading for professional philosophers, especially in moral and political philosophy. It will also be of interest to welfare economists and policy-makers who appeal to well-being. (shrink)

Respect for patient autonomy has served as the dominant ethical principle of genetic counselling, but as we move into a genomic era, it is time to actively re-examine the role that this principle plays in genetic counselling practice. In this paper, we argue that the field of genetic counselling should move away from its emphasis on patient autonomy and toward the incorporation of a more balanced set of principles that allows counsellors to offer clear guidance about how best to obtain (...) or use genetic information. We begin with a brief history of how respect for patient autonomy gained such emphasis in the field and how it has taken on various manifestations over time, including the problematic concept of nondirectiveness. After acknowledging the field's preliminary move away from nondirectiveness, we turn to a series of arguments about why the continued dominance of patient autonomy has become untenable given the arrival of the genomic era. To conclude, we describe how a more complete set of bioethical principles can be adapted and used by genetic counsellors to strengthen their practice without undermining patient autonomy. (shrink)

Among the areas of knowledge that the method of reflective equilibrium (RE) has been applied to is that of logical validity. According to RE in logic, we come to be justified in believing a (deductive) logical theory in virtue of establishing some state of equilibrium between our initial judgements over the validity of specific (natural language) arguments and the logical principles which constitute our logical theory. Unfortunately, however, while relatively popular, RE with regards to logical theorizing is underspecified. In particular, (...) it’s unclear what constitute: (1) the relevant logical “data”, (2) logical theories, so that they can be suitably tested, and (3) the mechanisms under which such theories are tested. Considering the various options for how to interpret the position, we argue that in order to be workable the advocate of RE about logic must embrace what we call an _operationalised_, _wide_ and _communal_ version of RE with a _rich_ understanding of logical theories. Fortunately for the advocate of RE, there is an available account of logic’s epistemology which possesses just these properties, _logical predictivism_. However, equally unfortunately, logical predictivism commits the advocate of RE to certain further claims that they have historically been weary of holding. Consequently, it is unclear whether RE about logic itself is a viable proposal, or rather a similar but distinct epistemology of logic. (shrink)

New Blackfriars, Volume 102, Issue 1101, Page 706-727, September 2021.

One's conception of the conditions and applicability of the principle of double effect derive from one's broader convictions about moral methodology. Developed in a Catholic context which presumed the existence of moral absolutes, the principle of double effect was originally a conceptual tool to aid priests in being skilled confessors. In recent decades, as the practice of moral theology has become less connected with its earlier ecclesial and sacramental context, the principle of double effect has fallen into an epistemological crisis. (...) Contemporary moral theological discussion of the principle of double effect usually operates in one of the following four contexts: interpretation of Aquinas; in relation to manualist casuistry; as understood within proportionalist methodology; as defended within the new natural law methodology. The essay argues that juridically-oriented methodologies do not adequately sustain the principle of double effect. To be sustained, it must be viewed as a theological achievement based upon the meaning of our redemption in Christ and the concomitant possibilities regarding our actions in pursuit of our true good and true end. (shrink)

Research studies increasingly use genomic sequencing to draw inferences based on comparisons between the genetic data of a set of purportedly related individuals. As use of this method progresses, it will become much more common to discover that the assumed biological relationships between the individuals are mistaken. Consequently, researchers will have to grapple with decisions about whether to return incidental findings of misattributed parentage on a much larger scale than ever before. In this paper we provide an extended argument for (...) the view that the default position for researchers ought to be the non-disclosure of misattributed parentage. (shrink)

Recent literature on intrinsic value contains a number of disputes about the nature of the concept. On the one hand, there are those who think states of affairs, such as states of pleasure or desire satisfaction, are the bearers of intrinsic value (“Mooreans”); on the other hand, there are those who think concrete objects, like people, are intrinsically valuable (“Kantians”). The contention of this paper is that there is not a single concept of intrinsic value about which Mooreans and Kantians (...) have disagreed, but rather two distinct concepts. I state a number of principles about intrinsic value that have typically (though not universally) been held by Mooreans, all of which are typically denied by Kantians. I show that there are distinct theoretical roles for a concept of intrinsic value to play in a moral framework. When we notice these distinct theoretical roles, we should realize that there is room for two distinct concepts of intrinsic value within a single moral framework: one that accords with some or all of the Moorean principles, and one that does not. (shrink)

Thanks to David Kaplan (1989a, 1989b), we all know how to handle indexicals like ‘I’. ‘I’ doesn’t refer to an object simpliciter; rather, it refers to an object only relative to a context. In particular, relative to a context C, ‘I’ refers to the agent of C. Since different contexts can have different agents, ‘I’ can refer to different objects relative to different contexts. For example, relative to a context cwhose agent is Gottlob Frege, ‘I’ refers to Frege; relative to (...) a context 0* whose agent is Alexius.. (shrink)

The distinction between perception and cognition has always had a firm footing in both cognitive science and folk psychology. However, there is little agreement as to how the distinction should be drawn. In fact, a number of theorists have recently argued that, given the ubiquity of top-down influences, we should jettison the distinction altogether. I reject this approach, and defend a pluralist account of the distinction. At the heart of my account is the claim that each legitimate way of marking (...) a border between perception and cognition deploys a notion I call ‘stimulus-control.’ Thus, rather than being a grab bag of unrelated kinds, the various categories of the perceptual are unified into a superordinate natural kind. (shrink)