Analyses of dispositional ascriptions in terms of conditional statements famously confront the problems of finks and masks. We argue that conditional analyses of dispositions, even those tailored to avoid finks and masks, face five further problems. These are the problems of: (i) Achilles' heels, (ii) accidental closeness, (iii) comparatives, (iv) explaining context sensitivity, and (v) absent stimulus conditions. We conclude by offering a proposal that avoids all seven of these problems.

While procreation is ubiquitous, attention to the ethical issues involved in creating children is relatively rare. In Debating Procreation, David Benatar and David Wasserman take opposing views on this important question. David Benatar argues for the anti-natalist view that it is always wrong to bring new people into existence. He argues that coming into existence is always a serious harm and that even if it were not always so, the risk of serious harm is sufficiently great (...) to make procreation wrong. In addition to these "philanthropic" arguments, he advances the "misanthropic" one that because humans are so defective and cause vast amounts of harm, it is wrong to create more of them.David Wasserman defends procreation against the anti-natalist challenge. He outlines a variety of moderate pro-natalist positions, which all see procreation as often permissible but never required. After criticizing the main anti-natalist arguments, he reviews those pronatalist positions. He argues that constraints on procreation are best understood in terms of the role morality of prospective parents, considers different views of that role morality, and argues for one that imposes only limited constraints based on the well-being of the future child. He then argues that the expected good of a future child and of the parent-child relationship can provide a strong justification for procreation in the face of expected adversities without giving individuals any moral reason to procreate. (shrink)

Previous theories of the relationship between dispositions and conditionals are unable to account for the fact that dispositions come in degrees. We propose a fix for this problem that has the added benefit of avoiding the classic problems of finks and masks.

We argue against accounting for dispositions (and of the progressive aspect) in terms of a fundamentally teleological metaphysics, and we defend our previous conditional account from some novel objections. -/- In “Teleological Dispositions,” Nick Kroll offers a novel theory of dispositions in terms of primitive directed states. Kroll is clear that his notion of directedness “outstrips talk of goals, purposes, design, and function”, and that it commits him to “primitive teleological facts”. This notion may strike some as outdated and unscientific, (...) but Kroll argues that it has an important theoretical role to play. In particular, he holds that a primitive notion of directedness can provide a theory of dispositions, an explanation of the link between dispositions and conditionals, and an account of the progressive aspect in English. In this paper, we raise some worries for each of these claims. (shrink)

New fetal therapies offer important prospects for improving health. However, having to consider both the fetus and the pregnant woman makes the risk–benefit analysis of fetal therapy trials challenging. Regulatory guidance is limited, and proposed ethical frameworks are overly restrictive or permissive. We propose a new ethical framework for fetal therapy research. First, we argue that considering only biomedical benefits fails to capture all relevant interests. Thus, we endorse expanding the considered benefits to include evidence-based psychosocial effects of fetal therapies. (...) Second, we reject the commonly proposed categorical risk and/or benefit thresholds for assessing fetal therapy research. Instead, we propose that the individual risks for the pregnant woman and the fetus should be justified by the benefits for them and the study’s social value. Studies that meet this overall proportionality criterion but have mildly unfavorable risk–benefit ratios for pregnant women and/or fetuses may be acceptable. (shrink)

This volume concerns the status and ambitions of metaphysics as a discipline.

This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare (...) burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness. (shrink)

How should we respond to individuals with disabilities? What does it mean to be disabled? Over fifty million Americans, from neonates to the fragile elderly, are disabled. Some people say they have the right to full social participation, while others repudiate such claims as delusive or dangerous. In this compelling book, three experts in ethics, medicine, and the law address pressing disability questions in bioethics and public policy. Anita Silvers, David Wasserman, and Mary B. Mahowald test important theories (...) of justice by bringing them to bear on subjects of concern in a wide variety of disciplines dealing with disability. They do so in the light of recent advances in feminist, minority, and cultural studies, and of the groundbreaking Americans with Disabilities Act. (shrink)

This collection of essays investigates the obligations we have in respect of future persons, from our own future offspring to distant future generations.

New fetal therapies offer important prospects for improving health. However, having to consider both the fetus and the pregnant woman makes the risk–benefit analysis of fetal therapy trials challenging. Regulatory guidance is limited, and proposed ethical frameworks are overly restrictive or permissive. We propose a new ethical framework for fetal therapy research. First, we argue that considering only biomedical benefits fails to capture all relevant interests. Thus, we endorse expanding the considered benefits to include evidence-based psychosocial effects of fetal therapies. (...) Second, we reject the commonly proposed categorical risk and/or benefit thresholds for assessing fetal therapy research. Instead, we propose that the individual risks for the pregnant woman and the fetus should be justified by the benefits for them and the study’s social value. Studies that meet this overall proportionality criterion but have mildly unfavorable risk–benefit ratios for pregnant women and/or fetuses may be acceptable. (shrink)

Jon Elster reports that in 1940, and again in 1970, the U.S. draft lottery was challenged for falling short of the legally mandated ‘random selection’. On both occasions, the physical mixing of the lots appeared to be incomplete, since the birth dates were clustered in a way that would have been extremely unlikely if the lots were fully mixed. There appears to have been no suspicion on either occasion that the deficiency in the mixing was intended, known, or believed to (...) favor or disfavor any identifiable group. If the selection was non-random in the way charged, Elster asks, was it unfair? (shrink)

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

In coming decades, fetal medicine may become a routine part of reproductive care. The measures pregnant women now take to protect fetal health are largely generic, like restricting their diets and using supplements. Relatively few interventions are based on specific conditions revealed by ultrasound or genetic testing. A recent finding, though, may herald a dramatic rise in “personalized” fetal medicine: certain drugs already approved by the Food and Drug Administration can apparently boost neural growth in fetuses with Down syndrome, improving (...) cognitive functioning in the future child. Many more condition‐specific findings are likely in the near future. But as commentators have frequently observed about prenatal testing, technologies that appear to increase reproductive options also complicate and constrain them. (shrink)

We are gratified by Nelson's response to our commentary. It shows, for the first time, an appreciation of the distinctive character of our criticism of individual decisions to test and terminate for fetal impairment. Although we still find much to disagree with in Nelson's characterization and critique of our views, he has given us a welcome opportunity to clarify and develop them.

In their comprehensive article, Bayefsky and Berkman outline a framework for limiting access to certain types of fetal genetic information through professional self-regulation. Given the rap...

Although philosophers have explored several connections between neuroscience and moral responsibility, the issue of how real-world neurological modifications, such as Deep Brain Stimulation, impact moral responsibility has received little attention. In this article, we draw on debates about the relevance of history and manipulation to moral responsibility to argue that certain kinds of neurological modification can diminish the responsibility of the agents so modified. We argue for a historicist position - a version of the history-sensitive reflection view - and defend (...) that account against a rival, relational view of responsibility. We conclude that DBS can, under certain conditions, diminish responsibility, and explore the circumstances under which this might be so. We conclude by suggesting that philosophical debates about moral responsibility, manipulation, and history have greater practical relevance than is sometimes thought, and that attention to practical cases can help inform and deepen this body of scholarship. (shrink)

This paper examines the moral import of a distinction between natural and social inequalities. Following Thomas Nagel, it argues for a “denatured” distinction that relies less on the biological vs. social causation of inequalities than on the idea that society is morally responsible for some inequalities but not others. It maintains that securing fair equality of opportunity by eliminating such social inequalities has particularly high priority in distributive justice. Departing from Nagel, it argues that society can be responsible for inequalities (...) not only when they are the unintended result of justifiable projects, but even when their alleviation would be very costly. Sharing Nagel’s general concept of ‘social inequality’, then, this paper proposes a far more expansive conception. We argue that many disadvantages due to disability fall under this conception. Eliminating or alleviating those disadvantages should be regarded as securing fair equality of opportunity, not improving the condition of the worst-off. (shrink)

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

In his thoughtful defence of very modest moral enhancement, David DeGrazia1 makes the following assumption: ‘Behavioural improvement is highly desirable in the interest of making the world a better place and securing better lives for human beings and other sentient beings’. Later in the paper, he gives a list of some psychological characteristics that ‘all reasonable people can agree … represent moral defects’. I think I am a reasonable person, and I agree that most if not all items on (...) the lists do represent moral defects—I certainly would regard them as such in a close family member or friend. But if I were in the business of ‘making the world a better place and securing better lives for human beings and other sentient beings’, I would hesitate to prescribe moral enhancement for everyone with these acknowledged defects. A lot of good work, from removing tumours to negotiating treaties, may be best done by people with serious moral defects.For a simple consequentialist, a moral defect is just a trait that tends to make the world a worse place. Not being a consequentialist, I think that moral defects should be identified independently of their tendency to produce worse outcomes. For this reason, I think it's necessary to qualify DeGrazia's starting assumption—I think behavioural improvement may sometimes be undesirable if our goal is to make the world a better place. My reasons will be familiar to readers of Bernard Williams.As …. (shrink)

This study brings together two important literatures together in the one volume. One concerns the role of quality assessments in social policy, especially health policy. The second concerns ethical and social issues raised by prenatal testing for disability. Hitherto, these two literatures have had little contact with each other: few scholars have written about both, or have compared the two domains in a systematic way, while people with disabilities and disability scholars are underrepresented in recent discussion on health policy and (...) quality of assessment. This book turns the perspectives of disability scholars on issues that have largely been the province of health methodology, policy and philosophy, while angling philosophical policy analysis on problems that have largely been the province of disability scholarship. This volume will be sought after by bioethicists, philosophers, and specialists in disability studies and healthcare economics. (shrink)

This article asks whether personal ventilators should be redistributed to maximize lives saved in emergency condition, like the COVID-19 pandemic. It begins by examining extant claims that items like ventilators are literally parts of their user’s bodies. Arguments in favor of incorporation for ventilators fail to show that they meet valid sufficient conditions to be body parts, but arguments against incorporation also fail to show that they fail to meet clearly valid necessary conditions. Further progress on this issue awaits clarification (...) of difficult normative, conceptual, and metaphysical questions about the possible boundaries of a person’s body. Rather than relying solely on incorporation arguments, we propose an argument against reallocation from widely accepted anti-discrimination principles. Possession of a personal ventilator is an obvious marker of disability identity; thus, reallocating ventilators from those that already possess them discriminates on the basis of a stigmatized trait – a paradigm case of presumptively wrongful discrimination. This discrimination claim, taken together with uncertainty about the bodily status of ventilators, yields a strong presumption against personal ventilator reallocation. (shrink)

Ingmar Persson and Julian Savulescu1 warn of our destruction by the cognitively enhanced beings we create. Now, in a fascinating paper, Nicholas Agar2 warns of an even more disturbing prospect: cognitively enhanced beings may be entitled to sacrifice us for their own ends. These post-humans would likely conclude that they had higher moral status than we mere human beings, and we would have good reason to defer to their vastly superior moral knowledge. We would lack even the consolation of moral (...) complaint.I will question both these claims: that we would have good reason to accept the conclusion of cognitively enhanced beings that they had superior moral status, and that they would be likely to reach such a conclusion . I will also question whether, if they were to have higher moral status, it would be wrong to create them, because it would be wrong to create beings with such costly needs.Agar argues that moral truths, including those about moral status, are like mathematical truths in eventually yielding to expert reasoning. This belief in moral enlightenment is extreme even for a moral realist. Michael Smith,3 whom Agar cites, merely adduces the gradual consensus that has emerged about issues that were once the subject of seemingly intractable disagreement: slavery, workers’ and women's rights and democracy. One may agree with Smith about slow, halting, moral progress, …. (shrink)

Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...) first-served allocation; (iv) the relevance of post-episode survival; (v) the difference between age and other factors that affect life-expectancy; and (vi) the need to avoid quality-of-life judgments. In the second part, we lay out some positions on which reasonable people can and do differ. These include (i) conflicts between maximizing benefits and priority to the worst off; (ii) role-based priority; and (iii) whether patients’ existing lifesaving resources should be subject to redistribution. (shrink)

In this 2001 volume a group of leading philosophers address some of the basic conceptual, methodological and ethical issues raised by genetic research into criminal behavior. The essays explore the complexities of tracing any genetic influence on criminal, violent or antisocial behavior; the varieties of interpretations to which evidence of such influences is subject; and the relevance of such influences to the moral and legal appraisal of criminal conduct. The distinctive features of this collection are: first, that it advances public (...) discussion while clarifying the debate about genetic research and criminal behavior; second, that it explains scientific controversies about behavioral genetics in lucid, non-technical terms; third, that it demonstrates how the possible findings on genetics and crime bear on fundamental issues of moral and criminal responsibility. The volume will be of particular value to philosophers concerned with applied ethics, behavioral geneticists, psychologists, legal theorists, and criminologists. (shrink)

The authors respond to four JME commentaries on their Feature Article, ‘Autonomy-based criticisms of the patient preference predictor’.

abstract In this paper, we examine issues raised by the possibility of regulating emotions through pharmacological means. We argue that emotions induced through these means can be authentic phenomenologically, and that the manner of inducing them need not make them any less our own than emotions arising 'naturally'. We recognize that in taking drugs to induce emotions, one may lose opportunities for self-knowledge; act narcissistically; or treat oneself as a mere means. But we propose that there are circumstances in which (...) none of these concerns arise. Finally, we consider how the possibility of drug-regulation might affect duties to feel emotions. (shrink)

In this article I want to ask what we should do, either collectively or individually, if we could identify by genetic and family profding the 12% of the male population likely to commit almost half the violent crime in our society. What if we could identify some individuals in that 12% not only at birth, but in utero, or before implantation? I will explain the source of these figures later; for now, I will use them only to provide a concrete (...) example of the kind of predictive claims we can expect to be made with some frequency, and some scientific credibility, over the next generation. I will adopt an outlook that one commentator has called “pragmatic optimism,” but which could also be called technological optimism - the belief that a science or technology will achieve many or most of its advertised goals. My optimism will be directed towards human behavioral genetics, the source of predictions like the one I just offered; I will assume that this controversial discipline will achieve a substantial pan of its scientific ambition to identlfy genetic differences among individuals that help predict and possibly explain future behavior, psychological health, and cognitive skill. This optimism is very limited -it concerns the scientific success of behavioral genetics, not the social value of that success. (shrink)

In this article I want to ask what we should do, either collectively or individually, if we could identify by genetic and family profding the 12% of the male population likely to commit almost half the violent crime in our society. What if we could identify some individuals in that 12% not only at birth, but in utero, or before implantation? I will explain the source of these figures later; for now, I will use them only to provide a concrete (...) example of the kind of predictive claims we can expect to be made with some frequency, and some scientific credibility, over the next generation. I will adopt an outlook that one commentator has called “pragmatic optimism,” but which could also be called technological optimism - the belief that a science or technology will achieve many or most of its advertised goals. My optimism will be directed towards human behavioral genetics, the source of predictions like the one I just offered; I will assume that this controversial discipline will achieve a substantial pan of its scientific ambition to identlfy genetic differences among individuals that help predict and possibly explain future behavior, psychological health, and cognitive skill. This optimism is very limited -it concerns the scientific success of behavioral genetics, not the social value of that success. (shrink)

This imaginative guide to decision-making about prenatal genomics is situated in a not-too-distant future in which parents can easily choose among embryos from gametes that have been produced in a laboratory using their own skin cells. Readers are invited into a future vision of conscientious parenting that involves testing to protect, rather than to select, a future child.

Priority setting in healthcare is a highly contentious area of public decision making, in which different values often support incompatible policy options and compromise can be elusive. One promising approach to resolving priority-setting conflicts divides the decision-making process into two steps. In the first, a set of eligible options is identified; in the second, one of those options is chosen by a deliberative process. This paper considers the first step, examining proposals for identifying a set of options eligible for deliberation. (...) It focuses on the approach proposed by Anders Herlitz, which limits deliberation to options that are on a par; neither better or worse than, nor strictly equal to the alternatives. Once these “maximal” options are identified, the choice among them is made though a deliberative process that acknowledges the difficult tradeoffs which must be made. While parity and kindred notions are clearly useful in resolving some priority-setting conflicts, this paper argues that the conflicts that arise in setting priorities make it as difficult to decide which options are on a par as it is to decide among those options. The paper draws on priority-setting debates that occurred during the recent pandemic to illustrate the challenges in identifying eligible options: There may be sharp disagreement about how to understand and individuate relevant values; about whether certain values are relevant in a priority-setting context; about how to establish parity between “consequential” and “deontic” options, and about whether one option remains on a par with others after it is modified in various ways. (shrink)

As imaging technologies help us understand the structure and function of the brain, providing insight into human capabilities as basic as vision and as complex as memory, and human conditions as impairing as depression and as fraught as psychopathy, some have asked whether they can also help us understand human agency. Specifically, could neuroimaging lead us to reassess the socially significant practice of assigning and taking responsibility?While responsibility itself is not a psychological process open to investigation through neuroimaging, decision‐making is. (...) Over the past decade, different researchers and scholars have sought to use neuroimaging (or the results of neuroimaging studies) to investigate what is going on in the brain when we make decisions. The results of this research raise the question whether neuroscience—especially now that it includes neuroimaging—can and should alter our understandings of responsibility and our related practice of holding people responsible. It is this question that we investigate here. (shrink)

The moral limits on how, and how much, parents may attempt to shape their children depend on what the moral project of parenthood is all about. A great deal has been written in the past forty years on the moral functions of parents and families and the acquisition and character of parental duties and rights. There has also been a great deal of philosophical writing on the use of technologies to create, select, and modify children, with such seminal works as (...) Warnock et al., and Robertson. The two literatures have overlapped... (shrink)

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