A child’s objection, refusal and dissent regarding participation in non-beneficial biomedical research must be respected, even when the parents or legal representatives have given their permission. There is, however, no consensus on the definition and criteria of a meaningful and valid child’s objection. The aim of this article is to clarify this issue. In the first part we describe the problems of a child’s assent in research. In the second part we distinguish and analyze two models of a child’s objection (...) to research: the capacity-based model and the distress-based model. In the last part we present arguments for a broader and unified understanding of a child’s objection within regulations and practices. This will strengthen children’s rights and facilitate the entire process of assessment of research protocols. (shrink)

Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: “bunkering”—physicians act as though societal cost issues are not their problem; “bailing”—physicians assume that they are merely agents of society (...) and deliver care typically based on a strongly consequentialist public health ethic; or “balancing”—a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously—all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession. (shrink)

The World Health Organisation encourages that blood donation becomes voluntary and unremunerated, a system already operated in the UK. Drawing on public documents and videos, this paper argues that blood donation is regarded and presented as altruistic and supererogatory. In advertisements, donation is presented as something undertaken for the benefit of others, a matter attracting considerable gratitude from recipients and the collecting organisation. It is argued that regarding blood donation as an act of supererogation is wrongheaded, and an alternative account (...) of blood donation as moral obligation is presented. Two arguments are offered in support of this position. First, the principle of beneficence, understood in a broad consequentialist framework obliges donation where the benefit to the recipient is large and the cost to the donor relatively small. This argument can be applied, with differing levels of normativity, to various acts of donation. Second, the wrongness of free riding requires individuals to contribute to collective systems from which they benefit. Alone and in combination these arguments present moral reasons for donation, recognised in communication strategies elsewhere. Research is required to evaluate the potential effects on donation of a campaign which presents blood donation as moral obligation, but of wider importance is the recognition that other-regarding considerations in relation to our own as well as others’ health result in a range not only of choices but also of obligations. (shrink)

According to many, to have epistemic justification to believe P is just for it to be epistemically permissible to believe P. Others think it is for believing P to be epistemically good. Yet others think it has to do with being epistemically blameless in believing P. All such views of justification encounter problems. Here, a new view of justification is proposed according to which justification is a kind of composite normative status. The result is a view of justification that offers (...) hope of solving some longstanding epistemological problems. (shrink)

Abstract:It is argued that virtuous peers in work organizations have two elements of character no matter what the nature of the goods the organization produces: loyalty to common projects for their own sake and trustworthiness. Each of these is shown to be a uniquely human attribute, an element of character that contributes to a life well lived, and a trait that leads to the flourishing of an entire work community.

Many maintain that if a beneficiary has a right to a benefit provided by his benefactor, then the former cannot owe the latter gratitude for that benefit. In this paper I argue against that view. I provide examples in which benefactors provide others with benefits to which they have a right even though most others are denying them that right. These benefactors are moral standouts; they do what is right when most similarly situated agents fail to do so. I then (...) spell out some of the features of these benefactors’ actions that make them worthy of gratitude. (shrink)

If we were required to sacrifice our own interests whenever doing so was best overall, or prohibited from doing so unless it was optimal, then we would be mere sites for the realisation of value. Our interests, not ourselves, would wholly determine what we ought to do. We are not mere sites for the realisation of value — instead we, ourselves, matter unconditionally. So we have options to act suboptimally. These options have limits, grounded in the very same considerations. Though (...) not merely such sites, you and I are also sites for the realisation of value, and our interests (and ourselves) must therefore sometimes determine what others ought to do, in particular requiring them to bear reasonable costs for our sake. Likewise, just as my moral status grounds a requirement that others show me appropriate respect, so must I do to myself. (shrink)

The purpose of this paper is to consider the question of whether we have a duty to forgive those who repent and apologize for the wrong they have done. I shall argue that we have a pro tanto duty to forgive repentant wrongdoers, and I shall propose and consider the norm of forgiveness. This norm states that if a wrongdoer repents and apologizes to a victim, then the victim has a duty to forgive the wrongdoer, other things being equal. That (...) someone has a pro tanto duty to forgive a repentant wrongdoer means that he or she ought to forgive unless other considerations outweigh the norm of forgiveness. Furthermore, a distinction is made between what are termed 'general considerations' and 'case-relative considerations', and it is argued that only after all the relevant considerations have been examined can it be determined whether there is a duty to forgive, all things considered. (shrink)

This paper takes the philosophical notion of suberogatory acts or morally permissible moral mistakes and, via a reinterpretation of a thought experiment from the medical ethics literature, offers an initial demonstration of their relevance to the field of medical ethics. That is, at least in regards to this case, we demonstrate that the concept of morally permissible moral mistakes has a bearing on medical decision-making. We therefore suggest that these concepts may have broader importance for the discourse on medical ethics (...) and should receive fuller consideration by those working the field. The focus of the discussion we present is on a particular thought experiment originally presented by Sulmasy and Sugarman. Their case formed the basis of an exchange about the moral equivalence of withdrawing and withholding life-saving treatment. The analysis Sulmasy and Sugarman set out is significant because, contrary to common bioethical opinion, it implies that the difference between withdrawing and withholding life-saving treatment holds, rather than lacks, moral significance. Following a brief discussion of rejoinders to Sulmasy and Sugarman’s article, we present a constructive reinterpretation of the thought experiment, one that draws on the idea of suberogatory acts or “morally permissible moral mistakes.” Our analysis, or so we suggest, accounts for the differing moral intuitions that the case prompts. However, it also calls into question the degree to which this thought experiment can be thought of as illustrating the moral equivalence of withdrawing and withholding life-saving treatment. Rather, we conclude that it primarily illuminates something about the ethical parameters of healthcare when family members, particularly parents, are involved in decision-making. (shrink)

We present a new “reason-based” approach to the formal representation of moral theories, drawing on recent decision-theoretic work. We show that any moral theory within a very large class can be represented in terms of two parameters: a specification of which properties of the objects of moral choice matter in any given context, and a specification of how these properties matter. Reason-based representations provide a very general taxonomy of moral theories, as differences among theories can be attributed to differences in (...) their two key parameters. We can thus formalize several distinctions, such as between consequentialist and non-consequentialist theories, between universalist and relativist theories, between agent-neutral and agent-relative theories, between monistic and pluralistic theories, between atomistic and holistic theories, and between theories with a teleological structure and those without. Reason-based representations also shed light on an important but under-appreciated phenomenon: the “underdetermination of moral theory by deontic content”. (shrink)

I confess to finding the term ‘supererogation’ ugly and unpronounceable. I am also generally suspicious of technical terms in moral philosophy, since they are vulnerable to self-serving definition and counter-definition, to the point of obscuring whether there is a single phenomenon about which to disagree. It was surely not accidental that J.O. Urmson, in his classic 1958 article that launched the contemporary Anglophone debate, eschewed the technical term in favour of the more familiar concepts of saints and heroes. Since then, (...) however, the term Supererogation has bedded down to encompass a number of more or less clear-cut philosophical debates, one of which concerns precisely the extent to which saintliness and heroism exhaust the supererogatory. And it has to be admitted that the word ‘saint’ has certain theological connotations that might be misleading in a secular philosophical discussion, while the word ‘hero’ has potentially limiting associations with knights and soldiers and other forms of testosterone-driven accomplishment. (shrink)

‘Supererogation’ is the notion of going beyond the call of duty. The concept of supererogation has received scrutiny in ethical theory, as well as clinical bioethics. Yet, there has been little attention paid to supererogation in research ethics. Supererogation is examined in this paper from three perspectives: (1) a summary of two analyses of ‘supererogation’ in moral theory, as well as an examination as to whether acts of supererogation exist; (2) a discussion of supererogation in clinical practice, including arguments that (...) both physicians and patients can practice acts of supererogation; (3) a discussion as to why researchers, qua researchers, are not routinely recognized to perform acts of supererogation, while at the same time the very nature of research subject participation involves supererogation. The article concludes by considering three examples of supererogation on the part of researchers, with a plea that researchers’ supererogatory actions be recognized as such. (shrink)

This thesis engages with three topics and the relationships between them: (i) the phenomenon of disagreement (paradigmatically, where one person makes a claim and another denies it); (ii) the normative character of disagreements (the issue of whether, and in what sense, one of the parties is “at fault” for believing something that’s untrue); (iii) the issue of which theory of what truth is can best accommodate the norms relating belief and truth. People disagree about all sorts of things: about whether (...) climate is changing, death penalty is wrong, sushi is delicious, or Louis C.K. is funny. However, even focusing on disagreements in the evaluative domain (e.g., taste, moral and comedic), where people have the intuition that there is ‘no fact of the matter’ about who is right, there are significant differences that require explanation. For instance, disagreement about taste is generally perceived as shallow. People accept to disagree and live comfortably with that fact. By contrast, moral disagreement is perceived as deep and sometimes hard to tolerate. Comedic disagreement is similar to taste. However, it may involve an element of ‘intellectual snobbery’ that is absent in taste disagreement. The immediate questions are whether these contrasts allow of precise characterization and what is responsible for them. I argue that, once a case is made for the truth-aptness of judgments in these areas, the contrast can be explained in terms of variable normative function of truth – as exerting a lightweight normative constraint in the domain of taste and a stricter constraint in the moral domain. In particular I claim that while truth in the moral domain exerts a sui generis deontic control, this normative feature of truth is silent in both the taste and the comedic domains. This leads me to investigate how to conceive of truth in the light of normative variability. I argue that an amended version of deflationism – minimally inflated deflationism – can account for the normative variability of truth. (shrink)