The concept of responsibility for health is a significant feature of health discourse and public health policy, but application of the concept is poorly understood. This paper offers an analysis of the concept in two ways. Following an examination of the use of the word ‘responsibility’ in the nursing and wider health literature using three examples, the concept of ‘responsibility for health’ as fulfilling a social function is discussed with reference to policy documents from the UK. The philosophical literature on (...) moral responsibility is introduced, and in considering two versions, reactive attitudes and accountability, it is argued that in application both can be regarded, though with different emphasis, as being constituted in three parts: a responsible agent; having obligations ; and being susceptible to being held responsible if he fails to meet them. The three‐stage model is consistent with the examples of the word responsibility in use, but application to the social function model causes a number of problems for healthcare practice, especially for the reactive attitudes account. Apart from considerable problems in stating what exactly the obligations are and how they can be justified; and how blame might justly be apportioned and by whom, the very ideas of obligation and blame are in conflict within healthcare systems and professional nursing practice which have foundations deeply embedded in the notion of the supremacy of personal autonomy. It is concluded that current application of the concept of responsibility for health is conceptually incoherent, and if it is to retain its place in health policy and discourse, urgent remedy is required. (shrink)

This paper examines some of the issues related to the distinction between acts and omissions. It discusses the difficulties involved in deciding whether there is any moral significance in this distinction, particularly when it is applied to cases which involve killing or allowing to die. The paper shows how this problem relates to some of the current issues in medical ethics. It examines the issues raised by the widely publicised cases of selective treatment of handicapped children and argues that such (...) decisions are taken and have to be taken in the context of wider ethical theories. (shrink)

ABSTRACT Not all crimes require mens rea, but all serious ones do. Crudely the requirement is that the defendant be able to take responsibility for the actus reus of which he is accused. What must be implied by this is essentially that the agent retain control of his actions. It is unjust to punish actions which are outside of the agent's control since such punishment cannot deter and is, arguably, pointless. Duress does not remove an agent's control of his actions. (...) This does not mean that actions performed under duress should be viewed as fully intentional. For though the agent foresees and wishes for the result of his action performed under duress, it is wished for as the best option out of a range of alternatives manipulated by the one who makes the threats which constitute the duress. The agent is responsible for his choice, but not for what is available for him to choose. He has an obligation to do what is best in the circumstances and should not be blamed if that would, in other circumstances, be accounted criminal. (shrink)

Over the past years, various accounts of ethical consumption have been produced which identify certain concepts as central to mediating the ethical relationship between the consumer and the consumed. Scholars across disciplinary fields have explored how individuals construe their ethical consumption responsibilities and commitments through the notions of identity, taking care and doing good, proximity and distance, suggesting the centrality of these themes to consumer engagement in ethical practices. This paper contributes to the body of research concerned with unravelling consumers’ (...) conceptually mediated relationship to moral and ethical issues in the sphere of consumption by revealing a new set of ideas through which people interpret and relate to consumption ethics. Drawing upon findings from an empirical study on self-perceived ethical food consumers, I demonstrate that people’s perceptions and views of ethical problems around consumption are bound up with notions of vulnerability, suffering, and harm, and that these notions permeate and impact all aspects of ethical consumer behaviour. The paper concludes by arguing that we need to further explore the conceptual underpinnings of ethical consumer commitments and practices, and expand the conceptual toolkit of research on ethical consumption to account for a wider range of ideas and notions that shape individual as well as collective motivations, intentions, and actions throughout the process of becoming and being an ethical consumer. Finally, the paper suggests a specific analytical framework to facilitate such research. (shrink)

Moral and political philosophers no longer condemn harm inflicted on nonhuman animals as self-evidently as they did when animal welfare and animal rights advocacy was at the forefront in the 1980s, and sentience, suffering, species-typical behavior, and personhood were the basic concepts of the discussion. The article shows this by comparing the determination with which societies seek responsibility for human harm to the relative indifference with which law and morality react to nonhuman harm. When harm is inflicted on humans, policies (...) concerning negligence and duty of care and principles such as the ‘but for’ rule and the doctrine of double effect are easily introduced. When harm is inflicted on nonhumans, this does not happen, at least not any more. As an explanation for the changed situation, the article offers a shift in discussion and its basic terminology. Simple ethical considerations supported the case for nonhuman animals, but many philosophers moved on to debate different views on political justice instead. This allowed the creation of many conflicting views that are justifiable on their own presuppositions. In the absence of a shared foundation, this fragments the discussion, focuses it on humans, and ignores or marginalizes nonhuman animals. (shrink)

A well-known thought experiment has us ponder a lottery system that selects one person as the source of transplantable organs for two others. The organs are forcibly harvested and the “donor” dies, whereas the other two patients live. The Survival Lottery is supposed to get at the distinction between killing and letting die, but it is also a challenge to beliefs about moral duties: what are my obligations if my life could be used to save yours and another person's as (...) well? A less extreme version of this thought experiment might have us imagining that officials of the public healthcare system would devise a similar lottery in the aftermath of a large-scale medical emergency. We could imagine that a natural disaster or an attack using biological weapons, for example, has so diminished the ability to provide public health care that in some communities, officials might consider implementing a lottery. To avoid the concerns about outright killing of selectees, officials might offer a wide range of participation in medical practice and research, not just organ allocation. Officials could ensure that no significant risks are involved, and selectees could in various ways be compensated. Would it be possible to ethically justify this “Healthcare Lottery” on the grounds that it was a temporary, yet necessary, infringement on autonomy? (shrink)

This paper identifies human enhancement as one of the most significant areas of bioethical interest in the last twenty years. It discusses in more detail one area, namely moral enhancement, which is generating significant contemporary interest. The author argues that so far from being susceptible to new forms of high tech manipulation, either genetic, chemical, surgical or neurological, the only reliable methods of moral enhancement, either now or for the foreseeable future, are either those that have been in human and (...) animal use for millennia, namely socialization, education and parental supervision or those high tech methods that are general in their application. By that is meant those forms of cognitive enhancement that operate across a wide range of cognitive abilities and do not target specifically ‘ethical’ capacities. The paper analyses the work of some of the leading contemporary advocates of moral enhancement and finds that in so far as they identify moral qualities or moral emotions for enhancement they have little prospect of success. (shrink)

Vaccines, when available, will prove to be crucial in the fight against Covid-19. All societies will face acute dilemmas in allocating scarce lifesaving resources in the form of vaccines for Covid-19. The author proposes The Value of Lives Principle as a just and workable plan for equitable and efficient access. After describing what the principle entails, the author contrasts the advantage of this approach with other current proposals such as the Fair Priority Model.

This article explores the consequences of interventions to secure moral enhancement that are at once compulsory and inescapable and of which the subject will be totally unaware. These are encapsulated in an arresting example used by Ingmar Perrson and Julian Savulescu concerning a “God machine” capable of achieving at least three of these four objectives. This article demonstrates that the first objective—namely, moral enhancement—is impossible to achieve by these means and that the remaining three are neither moral nor enhancements nor (...) remotely desirable. Along the way the nature of morality properly so called is further explored. (shrink)

Recent debate on the relationship between cyber threats, on the one hand, and both strategy and ethics on the other focus on the extent to which ‘cyber war’ is possible, both as a conceptual question and an empirical one. Whether it can is an important question for just war theorists. From this perspective, it is necessary to evaluate cyber measures both as a means of responding to threats and as a possible just cause for using armed kinetic force. In this (...) paper, I shift the focus away from ‘war’ as such in order to ask whether some cyber threats might justifiably be characterized as a form of ‘violence.’ Some theorists argue that the term violence ought to be defined so as to encompass things like ‘structural’ harm or harm by neglect and thereby question implicitly the focus of just war theorists on armed force. This paper draws on a theory of violence I developed elsewhere as a defence of just war theory’s narrow understanding of violence. According to the ‘Double-Intent’ theory, a distinctive form of ‘Violent Agency’ is the factor uniting the category of violence while partly accounting for the peculiar moral connotations of the term. Here, I argue that the resulting definition of violence reshapes the category in a way that includes some forms of cyber-attack. This may help us to see where cyber might fit in relation to just war theory and the ethics of kinetic attack. (shrink)

Recent debate on the relationship between cyber threats, on the one hand, and both strategy and ethics on the other focus on the extent to which ‘cyber war’ is possible, both as a conceptual question and an empirical one. Whether it can is an important question for just war theorists. From this perspective, it is necessary to evaluate cyber measures both as a means of responding to threats and as a possible just cause for using armed kinetic force. In this (...) paper, I shift the focus away from ‘war’ as such in order to ask whether some cyber threats might justifiably be characterized as a form of ‘violence.’ Some theorists argue that the term violence ought to be defined so as to encompass things like ‘structural’ harm or harm by neglect and thereby question implicitly the focus of just war theorists on armed force. This paper draws on a theory of violence I developed elsewhere as a defence of just war theory’s narrow understanding of violence. According to the ‘Double-Intent’ theory, a distinctive form of ‘Violent Agency’ is the factor uniting the category of violence while partly accounting for the peculiar moral connotations of the term. Here, I argue that the resulting definition of violence reshapes the category in a way that includes some forms of cyber-attack. This may help us to see where cyber might fit in relation to just war theory and the ethics of kinetic attack. (shrink)

John Harris has previously proposed that there is a moral duty to participate in scientific research. This concept has recently been challenged by Iain Brassington, who asserts that the principles cited by Harris in support of the duty to research fail to establish its existence. In this paper we address these criticisms and provide new arguments for the existence of a moral obligation to research participation. This obligation, we argue, arises from two separate but related principles. The principle of fairness (...) obliges us to support the social institutions which sustain us, of which research is one; while the principle of beneficence, or the duty of rescue, imposes upon us a duty to prevent harm to others, including by supporting potentially beneficial, even life-saving research. We argue that both these lines of argument support the duty to research, and explore further aspects of this duty, such as to whom it is owed and how it might be discharged. (shrink)

ABSTRACT Principles of justice and equality demand that HIV seropositive individuals and those with AIDS should not be discriminated against in any area of social provision. If social policy on AIDS is constructed in terms of reciprocal obligations, that is if obligations to the HIV seropositive individual and obligations of the HIV seropositive individual are given equal weight, the civil rights of HIV seropositive individuals may be secured and this may create a climate in which HIV seropositive individuals will more (...) readily notify partners, and others at risk of infection, of their HIV status. It is conceivable that such a climate could facilitate greater control of the spread of HIV/aids. (shrink)

The principle of non-maleficence, primum non nocere, has deep roots in the history of moral philosophy, being endorsed by John Stuart Mill, W. D. Ross, H. L. A. Hart, Karl Popper and Bernard Gert. And yet, this principle is virtually absent from current debates on social justice. This article suggests that non-maleficence is more than a moral principle; it is also a principle of social justice. Part I looks at the origins of non-maleficence as a principle of ethics, and medical (...) ethics in particular. Part II introduces the idea of non-maleficence as a principle of social justice. Parts III and IV define the principle of justice as non-maleficence in terms of its scope and coherence, while Part V argues that the motivation of not doing harm makes this principle an alternative to two well-established paradigms in the literature on social justice: justice as mutual advantage (David Gauthier) and justice as impartiality (Brian Barry). (shrink)

John Harris is one of the prominent philosophers and bioethicists of our time. He has published tens of books and hundreds of papers throughout his professional life. This paper aims to take a ‘deep-look’ at Harris' works to argue that it is possible to find some principles of Islamic ethics in Harrisian philosophy, namely in his major works, as well as in his personal life. This may be surprising, or thought of as a ‘big’ and ‘groundless’ claim, since John Harris (...) has nothing to do with any religion in his intellectual works. The major features of Harrisian philosophy could be defined as consequentialism or utilitarianism with liberal overtones. Despite some significant and fundamental differences in the application of principles (ie, abortion, euthanasia), the similarities between the major principles in Harrisian philosophy and Islamic ethics are greater at some points than the similarities between Islamic ethics and some other religious ethics (ie, Christian, Judaism). In this study I compare Harrisian teachings with major Islamic principles on ‘Responsibility’, ‘Side-effects and Double-effects’, ‘Equality’, ‘Vicious choice, guilt and innocence’, ‘Organ transplantation and property rights’ and ‘Advance directives’. (shrink)

On the ethics of extending human life: healthy people have a right to carry on livingHumanity has long demonstrated a paradoxical ambivalence concerning the extension of a healthy human lifespan. Modest health extension has been universally sought, whereas extreme health extension has been regarded as a snare and delusion—a dream beyond all others at first blush, but actually something we are better off without. The prevailing pace of biotechnological progress is bringing ever closer the day when humanity will be able (...) to act on the latter view by rejecting a clear and present opportunity for much longer healthy lives. Indeed, some biogerontologists contend that that day has already arrived, to the extent that our hesitation in embarking on a vigorous “war on ageing” is already delaying the point at which a cure for ageing will be developed. Here I consider whether our present caution concerning the wisdom of truly curing ageing is likely to survive the increased scrutiny that it will receive in coming years as a result of these technical advances. I conclude that it will not, because of its irreconcilability with values that are more deeply held by the large majority of humanity than any values that argue against the quest for a cure. I further conclude that all the major current reasons given for not curing ageing are mere crutches to help us cope with the immutability of ageing that we have been brought up to accept. Our failure to set aside such irrationality is already shortening potential longevity—quite probably of those already alive today—to a staggering degree. Once we realise this, our determination to consign human ageing to history will be second …. (shrink)

Intuitively we feel that we ought (to attempt) to save the lives, or ameliorate the suffering, of identifiable individuals where we can. But this comes at a price. It means that there may not be any resources to save the lives of others in similar situations in the future. Or worse, there may not be enough resources left to prevent others from ending up in similar situations in the future. This chapter asks whether this is justifiable or whether we would (...) be better served focusing on public health in the form of preventative medicine. It looks briefly at the supposed difference between benefiting individuals and benefiting populations by considering the difference between interventions aimed at ‘rescue’ and those which are preventative. It then considers the rule of rescue in the health care setting, and looks at some of the reasons stemming from this that we might have for allocating resources to rescue interventions. If these reasons do not provide adequate justification for preferring these types of interventions, then the implication is that our current mode of resource allocation may need to be revised in favour of a more public health-oriented model. (shrink)