Many real-world agents recognise that they impose harms by choosing to emit carbon, e.g., by flying. Yet many do so anyway, and then attempt to make things right by offsetting those harms. Such offsetters typically believe that, by offsetting, they change the deontic status of their behaviour, making an otherwise impermissible action permissible. Do they succeed in practice? Some philosophers have argued that they do, since their offsets appear to reverse the adverse effects of their emissions. But we show that (...) they do not. In practice, standard carbon offsetting does not reverse the harms of the original action, nor does it even benefit the same group as was harmed. Standard moral theories hence deny that such offsetting succeeds. Indeed, we show that any moral theory that allows offsetting in this setting faces a dilemma between allowing any wrong to be offset, no matter how grievous, and recognising an implausibly sharp discontinuity between offsettable actions and non-offsettable actions. The most plausible response is to accept that carbon offsetting fails to right our climate wrongs. (shrink)

In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...

BackgroundECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO (...) clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations.MethodsAn online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic.ResultsWhen initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%).ConclusionsWe found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic. (shrink)

A recent article published in Nursing Ethics, written by Professor Bridgit Dimond, highlighted the topic of noncompliance by patients and attention was drawn to a number of issues relevant to health care professionals. In this response, some specific challenges facing nurses are considered in the light of Professor Dimond’s arguments. In doing so, the notion of compliance as an appropriate concept in modern nursing practice is questioned. The recommendations to emerge include strategies to consider patient response to treatment regimens in (...) the form of adherence to health care advice through negotiated therapy. The claimed benefits of health care recommendations are considered and caution about iatrogenesis is advised. (shrink)

The title of Outsider Theory is artfully contrived. By the end of the book, it figures as a near tautology, for Jonathan Eburne here contributes to the study of knowledge production a disclosure of high theory’s intimacy with unrespectable systems of ideas. These systems include the outsider science of Velikovsky’s Worlds in Collision, the amalgam of outsider science and the pick’n’mix theology that is Scientology, and gnostic fictions that tease with a key to all mysteries such as The Da Vinci (...) Code. The book’s first origin story, one out of many, is related in its Preface, with Eburne’s purchase of a large library of popular esoterica, “hundreds upon hundreds of titles” found on Craigslist; this library was... (shrink)

An attempt is made in this paper to analyze the purely formal nature of information-theoretic concepts. The suggestion follows that such concepts, used to supplement the logical and mathematical structure of the language of science, represent an addition to this language of such a sort as to allow the use of a unitary language for the description of phenomena. (The alternative to this approach must be certain multi-linguistic and mutually untranslatable descriptions of related phenomena, as with the various versions of (...) Complementarity). This conception is tested for the specific case of Heisenberg's Uncertainty Principle, in order to show that, with the assumption of a suitable and intuitively satisfactory definition of the quantity of information contained in a measurement, the Heisenberg Principle becomes an informational restriction arising from the formal properties of the symbols of a given language rather than as a "law" of nature. (shrink)

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

Mitochondrial replacement techniques have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer and Maternal Spindle Transfer. It examines how questions of identity impact (...) on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. (shrink)

This book assesses how Vatican II opened up the Catholic Church to encounter, dialogue, and engagement with other world religions. Opening with a contribution from the President of the Pontifical Council for Interreligious Dialogue, Cardinal Jean-Louis Tauran, it next explores the impact, relevance, and promise of the Declaration Nostra Aetate before turning to consider how Vatican II in general has influenced interfaith dialogue and the intellectual and comparative study of world religions in the postconciliar decades, as well as the contribution (...) of particular past and present thinkers to the formation of current interreligious and comparative theological methods. Additionally, chapters consider interreligious dialogue vis-à-vis theological anthropology in conciliar documents; openness to the spiritual practices of other faith traditions as a way of encouraging positive interreligious encounter; the role of lay and new ecclesial movements in interreligious dialogue; and the development of Monastic Interreligious Dialogue. Finally, it includes a range of perspectives on the fruits and future of Vatican’s II’s opening to particular faiths such as Judaism, Islam, Hinduism, and Buddhism. (shrink)

This article analyses the results of a series of interviews conducted among leading firms in agrofood designed to assess the strategic importance of biotechnologies. Earlier analyses have emphasized either the revolutionary character of these technologies or the ability of oligopoly structure to contain the potential within existing market patterns. Our interviews would suggest that biotechnologies must be situated within the shift to a demand oriented food system. This has led on the on hand to a preoccupation with quality rather than (...) cost-cutting applications. It has also highlighted the inter-connectedness of the different phases of the agrofood system, since the incentive and the capacity to introduce innovations at any one point in the system depends on their acceptability to other actors in the agrofood chain.Biotechnologies have now become integrated into the competitive strategies of the leading actors but they remain ambiguously placed within the emerging “biotechnology” paradigm. The peculiarities of the agrofood system and the limitations of its industrialization have opened the way to strong consumer pressure based on the demand for quality and “natural” food and agriculture. It remains to be seen whether advanced biotechnologies can be assimilated within these priorities. (shrink)

The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey (...) findings, both because of the acknowledged limitations of survey methodology, and because survey conclusions cannot, in themselves, yield answers about what the right threshold should be for providing or withholding treatment.2 In this brief response, we are going to address head-on the important ethical question raised within our survey – when life is worth living for an infant. We follow-up on the suggestion of two commentators that the presence or absence of “relational potential” might be ethically important to report in studies of the outcome of severely impaired infants,3 and to whether parental requests for treatment should be supported.4 The notion of “relational potential” was introduced by John Arras in a 1984 commentary.5 Arras was responding to the Baby Doe Regulations and a …. (shrink)

The multistep pathway of eukaryotic gene expression involves a series of highly regulated events in the nucleus and cytoplasm. In the nucleus, genes are transcribed into pre‐messenger RNAs which undergo a series of nuclear processing steps. Mature mRNAs are then transported to the cytoplasm, where they are translated into protein and degraded at a rate dictated by transcript‐ and cell‐type‐specific cues. Until recently, these individual nuclear and cytoplasmic events were thought to be primarily regulated by different RNA‐ and DNA‐binding proteins (...) that are localized either only in the nucleus or only the cytoplasm. Here, we describe multifunctional proteins that control both nuclear and cytoplasmic steps of gene expression. One such class of multifunctional proteins (e.g., Bicoid and Y‐box proteins) regulates both transcription and translation whereas another class (e.g., Sex‐lethal) regulates both nuclear RNA processing and translation. Other events controlled by multifunctional proteins include assembly of spliceosome components, spliceosome recycling, RNA editing, cytoplasmic mRNA localization, and cytoplasmic RNA stability. The existence of multifunctional proteins may explain the paradoxical involvement of the nucleus in an RNA surveillance pathway (nonsense‐mediated decay) that detects cytoplasmic signals (premature termination codons). We speculate that shuttling multifunctional proteins serve to efficiently link RNA metabolism in the cytoplasmic and nuclear compartments. BioEssays 23:775–787, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

This issue of the journal includes papers across both analytical and empirical schools within bioethics.In his feature article, ‘The kindest cut? Surgical castration, sex offenders and coercive offers’, John McMillan asks whether surgical castration can be ethically provided as medical treatment for sex offenders . While surgical castration has previously been available in a number of European countries, in recent years it has only been available in the Czech Republic and in Germany. The European Committee for the Prevention of (...) Torture has attacked the Czech and German governments for engaging in degrading treatments. McMillan focuses on the nature of the relationship between psychiatrist and the detainee. Is the option of surgical castration a non-coercive ‘offer’, or is the option of non-castration a coercive threat? For McMillan, the nature of the intent is important, but he argues that the Czech and German approaches to surgical castration are not necessarily coercive, and can be a component of ethically praiseworthy self-transformation.Responding to McMillan, Alan Wertheimer and Franklin Miller focus on the question of coercion . They argue that the offer of castration is only coercive if psychiatrists or the state threaten to violate sex-offenders’ rights, or forego an obligation to the prisoner if he declines castration. On their view, such offers are not coercive, though they note that this does not settle the key ethical questions.Jesper Ryberg and Thomas Petersen, by contrast, argue both that offers can be coercive and that coercive offers could be morally legitimate - where there is a significant societal benefit . They suggest …. (shrink)

Written with the beginner in mind, Robert Wilkinson carefully introduces the reader to the fundamental components of the philosophy of mind. Each chapter is then helpfully linked to a reading from key thinkers in the field such as Descartes and John R. Searle.

It’s perhaps natural to think that our universe should be more or less the same in all directions, once we average out the lumpiness of stars, galaxies, galactic clusters, superclusters, etc. However, there’s a growing body of evidence suggesting that this presumption is not true. There is now a strong suspicion that our universe may contain a gaping “hole” located in the constellation Eridanus. This all started several years ago with the observation that there was a pronounced “Cold Spot” in (...) the data from the Wilkinson Microwave Anisotropy Probe (WMAP) that produced space-based measurements of the cosmic microwave background (CMB) left behind about 400,000 years after the Big Bang. (shrink)

Persia’s Imperial Power in Late Antiquity: The Great Wall of Gorgān and Frontier Landscapes of Sasanian Iran. By Eberhard W. Sauer; Hamid Omrani Rekavandi; Tony J. Wilkinson; and Jebrael Nokandeh. British Institute of Persian Studies Archaeological Monographs. Oxford: Oxbow Books, 2013. Pp. xvi + 711, illus. $150. [Distributed by the David Brown Book Co., Oakville, CT.].

The first editorial in the Journal of Medical Ethics described an ambition to be a ‘forum for the reasoned discussion of moral issues arising from the provision of medical care’.1 While that statement of intent might seem broad, it is one that has been reaffirmed by successive editors of the journal.2–4 It is an aim that aligns with the mission statement of JME and The Institute of Medical Ethics, to promote ‘ethical reflection and conduct in scientific research and medical conduct.’ (...) It is an end worthy of some reflection because it illuminates how the journal has developed and implies a conception of what good medical ethics is. During his time as editor, Raanan Gillon was a champion for philosophical medical ethics and he wrote an excellent and influential book on that topic.5 In the July issue of JME, Julian Savulescu, Tom Douglas and Dominic Wilkinson affirm the importance of philosophical medical ethics and ably demonstrate why it matters in the Charlie Gard case.6 Does that mean papers published in the JME must be philosophical? In one sense, clearly no and in another yes. Good medical ethics is not philosophy. The degree of scepticism, the narrow focus on a search for truth, the technical nature of some philosophy and it not needing to deliver normative or practical ethical conclusions mean that a narrowly philosophical approach is unlikely to be good medical ethics. JME has never been a narrowly philosophical journal and the perils of this were described well by its first editor: > We therefore intend to put editorial weight behind what we consider to be carefully argued and well informed judgments and not to allow every value …. (shrink)

Dominic Wilkinson suggests that one of Schubert’s songs has relevance for neonatologists today. In the song, Schubert suggests that death sometimes comes as a friend. Wilkinson ponders whether the song has a message for doctors and parents, who sometimes struggle to figure out whether death is an enemy or a friend to a dying baby. Wilkinson reflects on the case of baby ‘Hal’, who was born with serious cardiomyopathy. Hal’s parents and doctors disagree about whether to withdraw (...) life-support. Through his recreations of their discussions, Wilkinson shows how hard it is to confront—and maybe even welcome—death for a child. While adults often frame their own decision to forego life-sustaining treatment with thoughts that they have lived a good life, death in childhood can seem unfair because it robs the child of their opportunity to live a good or completed life. Much as we try, we cannot really imagine what a critically ill neonate experiences or desires. We have very little insight into Hal’s interests or subjective experience. Without direct access to the child’s experience, it is impossible to know whether, like an adult, a child would choose to allow death to occur. We cannot verify the claim that the child’s death was good in the sense that it was good for them. Wilkinson proposes that a prolonged dying process …. (shrink)

This essay revisits the relationship between philosophy and poetry. It argues that a crucial term, ‘verse’, is often missing from discussion of that relationship. The broader term, ‘poetry’, is so difficult to define that it offers insufficient specific resistance to large philosophical schemas. The question is explored here through an analysis of the prosodic microstructures in John Wilkinson's The Speaking Twins. I conclude that Wilkinson's poem is an instance of ‘unfree verse’ and that the poem's verse technique (...) is also the site of its historical truth-content. (shrink)

This paper analyses the personal documents of two early explorers of the Eastern Desert who recorded several monastic monuments in the area: Sir John Gardner Wilkinson and James Burton. We argue that these papers are an important source for the history of early monasticism as they record many of the monuments now destroyed, severely damaged, or forgotten. It is also suggested that Burton preceded Wilkinson in visiting and documenting some of these archaeological sites, even though Wilkinson (...) was the first to publish them. (shrink)

Paternalism has attracted new defenders in recent years. Such defenders typically either downplay the normative significance of autonomy or deny that we are sufficiently rational for paternalistic interventions to be objectionable.1 Both of these argumentative strategies constitute challenges to John Stuart Mill’s influential anti-paternalistic ‘harm principle’, which states that coercive interference with the liberty of competent adults is justifiable only if such interference prevents harm to non-consenting third parties (Mill, p. 23).2 In this journal, Wilkinson has provided a (...) novel, provocative defence of paternalism in the medical context—one that (provisionally) accepts rather than challenges Mill’s harm principle.3 Wilkinson’s argument is complex. But he begins with Parfit’s influential account of personal identity.4 According to Parfit, Alice at T1 can be the same person as Alice at T2, but the extent to which Alice at T1 and Alice at T2 are similar depends on the extent to which there are ‘chains’ of strong psychological connections between Alice at T1 and Alice at T2. Strong psychological connections, in turn, are mental states such as intentions or beliefs, or psychological traits. For example, if Alice at T2 remembers very little about herself the day before, and the day before that, all the way to Alice at T1, Alice at T2 has completely different psychological traits than Alice at T1—for example, Alice at T1 was courageous, whereas Alice at T2 is cowardly—then Alice at T1 and Alice at T2 are distinct persons. If the harm principle is correct and Alice is autonomous, it is permissible to interfere with Alice’s liberty only if it prevents harm to some non-consenting third party. But if we accept Parfit’s view on personal identity, then a novel defence of paternalistic intervention emerges: Alice at T2 may well be a distinct person from Alice at T1. So, …. (shrink)