Under federal law, an individual religious exemption from vaccines is valid when it is based on subjective, sincere beliefs rooted in religion but not dependent on the existence, veracity, or accurate understanding or application of denominational tenets or doctrines. Despite the subjective nature of the individual religious exemption, Catholic institutions may recognize or deny individual religious exemptions on the basis of the institution’s own religious exemptions. For example, under the doctrine of the common good, the (...) significant risk to the community presented by non-vaccinated individuals could be grounds for an institution to deny an individual’s otherwise valid religious exemption. This paper attempts to clarify the decision-making framework used by law to balance individual religious exemptions and compelling state interests, then proposes a similar decision-making framework, consistent with Catholic moral principles, for religious institutions to use when balancing individual conscience objections and compelling duties to society. (shrink)

Of the many questions Cécile Laborde addresses in her magisterial Liberalism’s Religion, several relate to what she describes as ‘the puzzle of exemptions’. I examine some of the issues raised by her efforts to solve that puzzle: whether her ideal of moral integrity squares with the nature of religious belief; whether we should find the case for collective religious exemptions in freedom of association and the ‘coherence interests’ of associations; how much significance we should give to the ‘competence (...) interests’ of organised religions; and by which criteria we should assess individual claims to religious exemption. (shrink)

The Moral Conscience principle claims that a conflict between the demands of a law and the demands of an individual’s sincere moral conscience provides her with a defeasible moral entitlement to an exemption. This chapter argues that this principle is vulnerable to an unfairness objection. There is nothing special about moral conscience that would justify granting an exemption, it claims, that is not shared by a variety of non-moral projects. Thus, there is no principled moral reason for a defeasible (...) entitlement to moral conscience-based exemptions that is not an equally good reason for a defeasible entitlement to non-moral project-based exemptions. Since the chapter assumes that people are not defeasibly entitled to such project-based exemptions, it advocates scepticism about the Moral Conscience principle. (shrink)

Exemptions from laws of general application are sometimes granted on the basis of an individual’s unwillingness to comply with the law. Most such volitional exemptions involve a conflict between the law and the demands of an individual’s religious or secular moral convictions. I argue here that a limited number of volitional exemptions can be justified on the basis of a futility principle. When otherwise morally permissible penalties for violating the law cannot be expected to induce (...) the compliance of an intransigent minority, the penalties are futile, and the state has some principled reason to exempt the minority from the law’s requirements. Since the futility principle only applies to some cases of conscientious objection, it differs in important ways from justifications grounded in a general entitlement to religious or moral exemptions. (shrink)

Granting differential treatment is often considered a way of placing some groups in a better position in order to maintain or improve their cultural, economic, health-related or other conditions, and to address persistent inequalities. Critics of multiculturalism have pointed out the tension between protection for groups and protection for group members. The ‘rule-and-exemption’ approach has generally been conceived as more resistant to such criticism insofar as exemptions are not conceded to minorities or ethical and religious groups as such, but (...) to individuals who are part of those groups. However, I show that when a government grants an exemption, it inevitably provides a definition of the relevant group in question, and the tendency is to take cultural membership as ‘given’ or as defined by group spokespersons. I discuss some problems related to these definitions and defend instead a definition based on shared group interests. (shrink)

In this article, I defend the view that conscience exemption clauses for medical practitioners (doctors, nurses, technicians, pharmacists) should be limited by patient protection clauses. This view was also defended by Mark Wicclair, in his book on conscience exemptions in medicine (Cambridge UP, 2011). In this article, I defend Wicclair’s view by supplementing it with Hegelian ethical theory and feminist critical theory. Conscience exemptions are important to support as a matter of human rights. They support an individual’s (...) right to protect their deepest value-commitments. A true understanding of conscience is dialectical, however, and it requires patient protection clauses because they, too, protect individuals in their deepest value-commitments. In this article, I show that the defense of patient protection clauses is historically supported by the theory of “conscience [Gewissen]” developed by G.W.F. Hegel in the nineteenth century (mostly in the Phenomenology of Spirit (1807)). (shrink)

The U.S. 2010 Patient Protection and Affordable Care Act exempts members of health care sharing ministries from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption’s less than clear legislative justification, their potential influence on the ACA’s policy and ethical success, and their salience to current religious liberty (...) debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States’ three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: the charity versus insurance status of these ministries; the conflation of two ACA religious exemptions; the tension between the values of religious liberty and of justice; the potential undermining of ACA policy goals; and the questionable compliance of health care sharing ministries with ACA exemption requirements. An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here. (shrink)

While supporters argue that exemptions are needed to equalize opportunities, critics claim they are unwarranted in principle and discriminatory in practice: equal treatment requires only facial neutrality whereas exemptions treat citizens unequally insofar as individuals with idiosyncratic commitments similarly burdened by general rules are rarely given an exemption.The upshot of this critique is that the burdens of cultural and religious commitments ought to be treated as expensive tastes. I argue that religious and cultural commitments cannot be reduced to (...) expensive tastes that can be revised in the face of resource expectations and that, for this reason, opportunities are not equal when minorities must choose between adherence to such commitments and availing of valuable opportunities, when members of more dominant communities need not. I also explain why treating religious and cultural commitments in this way does not entail the adoption of a primordial view of culture that puts these commitments beyond revision and choice. (shrink)

When generally applicable rules clash with one’s cultural, religious or moral commitments, should exemptions be granted? The debate on exemptions raises the question both of what it means to treat people equally and of what it means to protect diversity adequately. The objective of this paper is to defend the no-exemption argument and to make it a more attractive position for liberals. I first argue that exemptions violate the principle of equal treatment because they rely on distinctions (...) that cannot be neutrally justified. I then argue that diversity can be adequately accommodated if we use a more demanding interpretation of the justification of generally applicable rules. There should be no exemption to fully justified rules, but rules are only fully justified when the particular demands that they impose on individuals are justified, i.e. when they are either neutral or pass both a Necessity Test and a Sufficiency Test. When rules are not fully justified, they should be repealed or modified. Based on this focus on the demands of rules, equality can be reconciled with an adequate accommodation of diversity. (shrink)

In the last chapter of her book Liberalism's Religion [2017], Cécile Laborde argues that it is the practices and beliefs aimed at protecting individual integrity that can be candidates for exemptions. It therefore proposes two tests (sincerity and acceptability) in order to assess the link between these beliefs and practices and the individual’s integrity and considers the setting up of a deliberative process. We argue in this article that these two tests and the establishment of a deliberative (...) process are not feasible because they do not take into account, or they even participate in the invisibilization of the voices of women of Muslim faith in the public sphere within Western liberal societies. Our criticism is thus formulated in three points. First, we question the thick sincerity test and the assessment of the coherence between the beliefs/practices of an individual and his integrity, while different public spaces of Western liberal democracies invisibilize Muslim women and make their voice inaudible. We then examine the thin acceptability test, in a context of securitization of Islam and Muslims, allowing the reproduction of discourses racializing Islam and culturalizing gender oppression. Finally, we argue that thinking about the process of democratic deliberation involves reporting on the forms of epistemic injustice and moral injury that occur against minority groups – especially Muslim women. This criticism will be illustrated by excerpts from Swiss parliamentary debates as part of the parliamentary initiative against face concealment. (shrink)

Religious exemptions present an anomaly in American law. Under the power of religious exemptions, individuals and organizations whose actions violate civil and criminal laws are exempt from those l...

Many philosophers and jurists believe that individuals should sometimes be granted religiouslygrounded exemptions from laws or rules. To determine whether an exemption is merited in a particular case, the religious claim must be weighed against the countervailing values that favour the uniform application of the law or rule. This paper develops and applies a framework for assessing the weight of religious claims to exemption, across two dimensions. First, the importance of the burdened religious practice, which is determined by its (...) level of obligatoriness and centrality, according to the beliefs of the individual claimant. Second, the extent of the burden on the practice, which depends on the cost the individual bears if she both undertakes the religious practice and obeys the law or rule, where costs are assessed using an impartial account of individual interests. Exemptions should be granted when claims are weighty on either of these dimensions and the countervailing value is relatively weak. The final section of the paper responds to an important objection to this approach, which concerns administrability. (shrink)

In what ways might we best, and justly, allow for cohabitation between individuals and groups with plural conceptions of the good? Confronting this question, students of political philosophy in the past two decades have encountered a routine contrast between liberal universalism, with a focus on equal individual rights and uniform application of the law, and on the other hand various versions of a 'politics of difference'(...).

Religious beliefs are often singled out for special treatment in secular liberal societies. Yet if a legal exemption is granted for a belief with a religious foundation, the question arises whether a similar, non‐religious moral belief must also be granted an exemption. I argue that common reasons for favoring religious over non‐religious beliefs fail to provide a convincing moral case for drawing a distinction of this nature. I focus on arguments concerning the role of religious beliefs in constituting an (...) class='Hi'>individual's identity and the transcendental nature of religion, which lead me to consider in the final section the role of choice in religious belief. (shrink)

It is a paradox that medical experimentation on individuals, whether patients or healthy volunteers, is now controlled by strict ethical guidelines, while no such protection exists for whole populations which are subjected to medical interventions in the name of preventive medicine or health promotion. As many such interventions are either of dubious benefit or of uncertain harm-benefit balance, such as mass screening for cancers or for risk factors associated with coronary heart disease, there is no justification for maintaining the ethical (...) vacuum in which preventive medicine finds itself at present. (shrink)

Exemption claims remain a tangled and divisive moral and legal issue both in academia and in the public sphere. In his book Exemptions: Necessary, Justified, or Misguided?, the constitutional scholar Kent Greenawalt zeros in on the vexed question of whether exemptions from rules of general applicability based on the conscientious convictions of individuals or groups are sometimes justified or prudent by discussing a wide range of cases drawn from the American jurisprudence. Although he does not engage in a (...) significant way with political and legal philosophy and comparative law, his contextualist and pragmatic approach is a powerful antidote against oversimplification and dogmatism with regard to exemption claims. Unsurprisingly, Greenawalt’s approach comes at times dangerously close to casuistry, and some of his analyses and normative recommendations would benefit from a firmer footing in moral principles and rational argumentation. In this review, I flesh out some of the strengths and limits of Greenawalt’s valuable book. (shrink)

Exemption claims remain a tangled and divisive moral and legal issue both in academia and in the public sphere. In his book Exemptions: Necessary, Justified, or Misguided?, the constitutional scholar Kent Greenawalt zeros in on the vexed question of whether exemptions from rules of general applicability based on the conscientious convictions of individuals or groups are sometimes justified or prudent by discussing a wide range of cases drawn from the American jurisprudence. Although he does not engage in a (...) significant way with political and legal philosophy and comparative law, his contextualist and pragmatic approach is a powerful antidote against oversimplification and dogmatism with regard to exemption claims. Unsurprisingly, Greenawalt’s approach comes at times dangerously close to casuistry, and some of his analyses and normative recommendations would benefit from a firmer footing in moral principles and rational argumentation. In this review, I flesh out some of the strengths and limits of Greenawalt’s valuable book. (shrink)

There is a regulatory option for conscientious objection in health care that has yet to be systematically examined by ethicists and policymakers: granting a liberty to request exemption from prescribed work tasks without a companion guarantee that the request is accommodated. For the right-holder, the liberty’s value lies in the ability to seek exemption without duty-violation and a tangible prospect of reassignment. Arguing that such a liberty is too unreliable to qualify as a right to conscientious objection leads to the (...) problem of consistently distinguishing its effects from those of a right to conscientious objection that is made conditional on an individual assessment of the objector’s motivation. These properties require that we distinguish the liberty to request exemption from more restrictive policy choices, and that we subject it to greater scrutiny in the wider moral discourse as a possible variant of a right to conscientious objection. (shrink)

Theorists of democratic multiculturalism have long-defended individuals’ religious exemptions from generally-applicable laws. Examples include Sikhs being exempt from motorcycle helmet laws, or Jews and Muslims being exempt from humane animal slaughter laws. This paper investigates religious exemptions for organisations. Should organisations ever be granted exemptions from generally-applicable laws in democratic societies, where those exemptions are justified by the organisation’s religion? The paper considers four arguments for this, which respectively rely on: the ‘transferring up’ to organisations of (...) individuals’ claims to autonomy or recognition; organisations’ own claims to autonomy or recognition; organisations’ status in the accountability-community; and organisations’ procedural constraints. The paper concludes that only the last argument works—and then, only with caveats. (shrink)

Recently a number of liberal political theorists, including Rawls and Walzer, have argued for a 'supreme emergency exemption' from the traditional just war principle of discrimination which absolutely prohibits direct attacks against innocent civilians, claiming that a political community threatened with destruction may deliberately target innocents in order to save itself. I argue that this 'supreme emergency exemption' implies that individuals too may kill innocents in supreme emergencies. This is a significant theoretical cost. While it will not constitute a decisive (...) refutation of all arguments for a supreme emergency exemption, my hope is that many will see this cost of endorsing the exemption as unacceptable. (shrink)

Objective Having failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why. Methods Content analysis of applications for religious exemptions from influenza vaccination at a free-standing children’s hospital in Cincinnati, Ohio, USA during the 2014–2015 influenza season. Results Twelve of 15 260 employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical (...) employees. All requestors voluntarily identified their religious affiliation, and most were Christian. Content analysis identified six categories of reasons used to justify an exemption: risks/benefits, ethical/political, lack of direct patient contact, providence, purity and sanctity of life. Individuals articulated reasons in 1–5 categories. The most frequently cited category was purity; the vaccine and/or its mode of administration were impure, or receiving the vaccine would make the individual impure. Two individuals asserted that the vaccine contained cells derived from aborted human fetuses. Individuals also volunteered information supporting the sincerity of their beliefs including distress over previous vaccination and examples of behaviour consistent with their specific objection or their general religious commitment. All requests were approved. Conclusions Less than 0.1% of employees requested religious exemptions. Partnering with religious leaders and carefully correcting erroneous information may help address requestors’ concerns. (shrink)

No provision of the Patient Protection and Affordable Care Act has proven to be more contentious than the so-called “individual mandate.” Starting in 2014, the mandate will impose a penalty on non-exempt individuals who lack health insurance. According to Congress, the mandate is essential to ensuring near universal coverage. Without it, PPACA’s insurance reforms will lead healthy individuals to delay purchasing health insurance until they require medical care, resulting in risk pools with a disproportionate share of high-risk people. The (...) price of insurance will then climb, causing more and more not-so-sick people to forego health insurance. The resulting “death spiral” will make insurance unaffordable to many more Americans. (shrink)

In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case‐by‐case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, (...) harm mitigation, exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case‐by‐case exemptions for individual patients. We propose a process for ethical decision‐making that provides a shared language and structure to decrease the risks and burdens of decision‐making when clinicians or managers are considering requests for exemptions. (shrink)

I investigate the normative and conceptual account of the relationship between public recognition and dignitarian, or egalitarian, commitments. I do so through addressing the normative dispute, sparked by legal cases such as Masterpiece Cakeshop, Ltd. v. Colorado Civil Rights Commission and Fulton v. City of Philadelphia, as to whether there are dignitarian grounds for rejecting religious exemptions to antidiscrimination laws. I argue that there are such grounds. Specifically, I argue that, if granted, such exemptions would inflict dignitary harms (...) against LGBTQ individuals by denying them the public recognition necessary for reliably sustaining civic self-respect. Such exemptions would deny this recognition in two distinct ways. First, such exemptions would institutionalize humiliation of LGBTQ individuals as market actors. Second, such exemptions would condition market access for LGBTQ individuals on unequal terms. Through making this argument, I hope to make three primary, and related, contributions: I introduce a concept of civic self-respect; I argue that the normative import of public recognition is grounded in the good of civic self-respect; and I rely on this normative framework to show how religious exemptions to public accommodations laws inflict dignitary harms. My argument is relevant to both political philosophers and legal scholars grappling with questions of why public recognition matters and what it demands. (shrink)

The emergence of a global industry of digital health platforms operated by Big Tech corporations, and its growing entanglements with academic and pharmaceutical research networks, raise pressing questions on the capacity of current data governance models, regulatory and legal frameworks to safeguard the sustainability of the health research ecosystem. In this article, we direct our attention toward the challenges faced by the European General Data Protection Regulation in regulating the potentially disruptive engagement of Big Tech platforms in health research. The (...) General Data Protection Regulation upholds a rather flexible regime for scientific research through a number of derogations to otherwise stricter data protection requirements, while providing a very broad interpretation of the notion of “scientific research”. Precisely the breadth of these exemptions combined with the ample scope of this notion could provide unintended leeway to the health data processing activities of Big Tech platforms, which have not been immune from carrying out privacy-infringing and socially disruptive practices in the health domain. We thus discuss further finer-grained demarcations to be traced within the broadly construed notion of scientific research, geared to implementing use-based data governance frameworks that distinguish health research activities that should benefit from a facilitated data protection regime from those that should not. We conclude that a “re-purposing” of big data governance approaches in health research is needed if European nations are to promote research activities within a framework of high safeguards for both individual citizens and society. (shrink)

In this paper I will argue, following Moody-Adams’s paper “Culture, responsibility and affected ignorance,” that inability does not excuse in general, but against Moody-Adams I will argue that this is not because of “affected ignorance” but simply because of responsibilities individual agents have by virtue of belonging to and participating in the collective actions of a certain kind of collective. Excusability has been misdiagnosed as depending on whether the ignorance of wrongdoing involved is culpable or non-culpable.

The rapid development and roll-out of COVID-19 vaccines has been a surprising success of the pandemic and has likely saved hundreds of thousands of lives. Although most people were eager to receive a vaccine, many jurisdictions introduced mandates to ensure rapid uptake in the population, especially among key workers including healthcare workers. In some instances, individuals who can prove they have recovered from COVID-19 have been exempt from vaccine mandates, but in other cases such exemptions have not been made. (...) Pugh et al argue that such exemptions for those already immune ought to be included in COVID-19 vaccine mandates.1 They review the evidence on infection-induced and vaccine-induced immunity and show that that there is not evidence that vaccines offer better protection against severe COVID-19 or of SARS-CoV-2 infection. They argue that to treat people differently based on the source of their COVID-19 immunity is wrongful discrimination, with this discrimination bringing harms in the form of unjust restriction of liberty and negative consequences such as lost employment. I agree with Pugh et al ’s view that, given the available evidence, infection-induced immunity to SARS-CoV-2 ought to be treated as equivalent to vaccine-induced immunity for the purposes of most COVID-19 vaccine mandates. However, their article highlights the need for clarity in the rationale for mandates. This clarity is necessary to be able to identify when exemptions are appropriate. It may be the case that in some instances infection-induced immunity ought not to be grounds for exemption. Pugh et al ’s argument also suggests that collection of data on infection-induced immunity may be a requirement for ethical vaccine mandates. To be confident in such exemptions, we need evidence that infection-induced immunity is comparable to vaccine-induced immunity in the …. (shrink)

Lockdowns and quarantines have been implemented widely in response to the COVID-19 pandemic. This has been accompanied by a rise in interest in the ethics of ‘passport’ systems that allow low-risk individuals greater freedoms during lockdowns and exemptions to quarantines. Immunity and vaccination passports have been suggested to facilitate the greater movement of those with acquired immunity and who have been vaccinated. Another group of individuals who pose a low risk to others during pandemics are those with genetically mediated (...) resistances to pathogens. In this paper, we introduce the concept of genomic passports, which so far have not been explored in the bioethics literature. Using COVID-19 as an illustrative example, we explore the ethical issues raised by genomic passports and highlight differences and similarities to immunity passports. We conclude that, although there remain significant practical and ethical challenges to the implementation of genomic passports, there will be ways to ethically use them in the future. (shrink)

This paper defends the view that the primary necessary ontological conditions for any existents and for their knowledge are individual pure possibilities. As being such conditions, pure possibilities exist absolutely independently of actualities, possible worlds, or minds. Pure possibilities are exempt from spatiotemporal and causal restrictions or conditions, whereas any actuality is inescapably subject to them. Each actuality is an actualization of an individual pure possibility, which also serves as its identity. The existence of individual pure possibilities (...) is necessary because it is ontologically indispensable for the existence of anything, possible or actual, and because there are some existents instead of nothing. Ignoring or not acknowledging relevant pure possibilities may result in overlooking their actualities without recognizing or identifying them and, thus, this has hindered the progress of science and knowledge. Hence, the knowledge of actual possibilities, too, depends on their pure possibilities. (shrink)

Courses on bioethics and the law traditionally have focused their coverage on ethical issues arising from individual patients’ encounters with the medical care system, but the course also provides an excellent opportunity to expose students to ethical issues arising at the intersection of medical care and public health. The following materials were assembled for use near the end of a semester-long law school course in Bioethics & Law. I taught the course relying heavily on problems contained in Barry R. (...) Furrow et al., Bioethics: Health Care Law and Ethics, 7th ed., which was the primary text for the course. (shrink)

While all states in the United States require certain vaccinations for school attendance, all but three allow for religious exemptions to receiving such vaccinations, and 18 allow for exemptions on the basis of other deeply held personal beliefs. The rights of parents to raise children as they see fit may conflict with the duty of the government and society to protect the welfare of children. In the U.S., these conflicts have not been settled in a uniform and consistent (...) manner. We apply a test that provides a concrete and formal rubric to evaluate such conflicts. For some vaccinations, based on the individual medical characteristics of the disease and the risks of being unvaccinated, the test would suggest that permitting conscientious exemptions is ethical. However, for vaccinations protecting against other diseases that are more severe or easily transmitted, the test would suggest that the federal government may ethically impose laws that deny such exemptions. (shrink)

This chapter contains sections titled: Introduction Liberalism and Communitarianism: An Abstract Debate Multiculturalism/Identity Politics: Non‐Neutrality and Structural Injustice Liberal Individuals and Their Identities Liberal Rules and Structural Injustices: Rules‐and‐Exemptions Liberal Toleration and Structural Injustice: Equality as Recognition Structural Injustice and Jurisdictional Authority Conclusion Notes.

Collective moral agents can cause their own moral incapacity. If an agent is morally incapacitated, then the agent is exempted from responsibility. Due to self-induced moral incapacity, corporate responsibility gaps resurface. To solve this problem, I first set out and defend a minimalist account of moral competence for group agents. After setting out how a collective agent can cause its own moral incapacity, I argue that self-induced temporary exempting conditions do not free an agent from diachronic responsibility once the agent (...) regains its moral faculties. For collective agents, any exempting condition is potentially temporary due to the ‘malleability’ of their constitution. Therefore, in cases of self-induced moral incapacity and subsequent wrongdoing, unlike individuals, every collective agent can be (made) morally responsible for its actions even though it did not qualify as a moral agent at the time of wrongdoing. Hence, this is no reason for skepticism concerning corporate responsibility. (shrink)

Vaccine mandates can take many forms, and different kinds of mandates can implicate an array of values in diverse ways. It follows that good ethics arguments about particular vaccine mandates will attend to the details of individual policies. Furthermore, attention to particular mandate policies—and to attributes of the communities they aim to govern—can also illuminate which ethics arguments may be more salient in particular contexts. If ethicists want their arguments to make a difference in policy, they should attend to (...) these kinds of empirical considerations. This paper focuses on the most common and contentious vaccine mandate reform in the contemporary United States: the elimination of nonmedical exemptions (NMEs) to school and daycare vaccine mandates. It highlights, in particular, debates about California's Senate Bill 277 (SB277), which was the first successful recent effort to eliminate NMEs in that country. We use media, secondary sources, and original interviews with policymakers and activists to identify and evaluate three ethics arguments offered by critics of SB277: parental freedom, informed consent, and children's rights to care and education. We then turn to one ethics argument often offered by advocates of SB277: harm prevention. We note, however, that three arguments for mandates that are common in the immunization ethics literature—fairness/free-riding, children's rights to vaccination, and utilitarianism—did not play a role in debates about SB277. (shrink)

The individual right of access to one’s own data is a crucial privacy protection long recognized in U.S. federal privacy laws. Mobile health devices and research software used in citizen science often fall outside the HIPAA Privacy Rule, leaving participants without HIPAA’s right of access to one’s own data. Absent state laws requiring access, the law of contract, as reflected in end-user agreements and terms of service, governs individuals’ ability to find out how much data is being stored and (...) how it might be shared with third parties. Efforts to address this problem by establishing norms of individual access to data from mobile health research unfortunately can run afoul of the FDA’s investigational device exemption requirements. (shrink)

To date, both the United States federal government and twenty-one individual states have passed Religious Freedom Restoration Acts that aim to protect religious persons from having their sincere beliefs substantially burdened by governmental interests. RFRAs accomplish this by offering a three-pronged exemption test for religious objectors that is satisfied only when (1) an objector has a sincere belief that is being substantially burdened; (2) the government has a very good reason (e.g., health or safety) to interfere; and (3) there (...) is a reasonable alternative to serve the compelling interest. Legal balancing tests like those found in RFRA are content neutral insofar as they sideline the belief-content of conscientious objections as irrelevant when determining the permissibility of granting legal accommodations. However, some theorists worry that this legal picture may be backward: perhaps balancing tests should be content non-neutral given the usual features of conscientious objections. For example, Yossi Nehushtan contends that, contrary to their typical codification, religious conscience beliefs seem undeserving of special legal accommodations because they possess uniquely strong empirical and theoretical ties to intolerance. Thus, the illiberally intolerant content of these conscientious objections might actually give the state a reason to refuse to grant legal exemptions. In this paper, I offer a cursory defense of content neutrality with respect to balancing tests like those found in RFRA. To begin, I outline Nehushtan’s argument for content non-neutrality. The cornerstone of his argument is that illiberal intolerance is intolerable such that conscientious objections that are based upon illiberally intolerant values provide the state with strong, normally prevailing reason not to grant an exemption. I argue that, even when the illiberally intolerant content of one’s conscience constitutes a weighty and relevant factor in determining the permissibility of granting a legal exemption, there remain significant problems. It is difficult, for example, to determine which views are illiberally intolerant and difficult to say whether illiberally intolerant views can effectively serve as the principled demarcating line in balancing tests. To conclude, I offer several cursory arguments in favor of adopting content-neutral approaches without necessarily making a comprehensive case. By drawing on the work of Amy Sepinwall, Nadia Sawicki, and Nathan Chapman, I show that content-neutral approaches can help to safeguard robust protections for conscience by permitting atypical exercises of conscience, protect minority thoughts and practices from being coercively supplanted by majoritarian understandings of morality, appropriately maintain the skepticism and humility that we owe each other as compatriots in a pluralistic society, and allow the kind of justifiable civil disobedience that has an important place in political history among other things. (shrink)

The troubling ethics and politics of philanthropy Is philanthropy, by its very nature, a threat to today’s democracy? Though we may laud wealthy individuals who give away their money for society’s benefit, Just Giving shows how such generosity not only isn’t the unassailable good we think it to be but might also undermine democratic values and set back aspirations of justice. Big philanthropy is often an exercise of power, the conversion of private assets into public influence. And it is a (...) form of power that is largely unaccountable, often perpetual, and lavishly tax-advantaged. The affluent—and their foundations—reap vast benefits even as they influence policy without accountability. And small philanthropy, or ordinary charitable giving, can be problematic as well. Charity, it turns out, does surprisingly little to provide for those in need and sometimes worsens inequality. These outcomes are shaped by the policies that define and structure philanthropy. When, how much, and to whom people give is influenced by laws governing everything from the creation of foundations and nonprofits to generous tax exemptions for donations of money and property. Rob Reich asks: What attitude and what policies should democracies have concerning individuals who give money away for public purposes? Philanthropy currently fails democracy in many ways, but Reich argues that it can be redeemed. Differentiating between individual philanthropy and private foundations, the aims of mass giving should be the decentralization of power in the production of public goods, such as the arts, education, and science. For foundations, the goal should be what Reich terms “discovery,” or long-time-horizon innovations that enhance democratic experimentalism. Philanthropy, when properly structured, can play a crucial role in supporting a strong liberal democracy. Just Giving investigates the ethical and political dimensions of philanthropy and considers how giving might better support democratic values and promote justice. (shrink)

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in (...) the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. (shrink)

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared assumption (...) in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers (...) on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

Freedom of Conscience and Freedom of Religion should be taken to protect two distinct sets of moral considerations. The former protects the ability of the agent to reflect critically upon the moral and political issues that arise in her society generally, and in her professional life more specifically. The latter protects the individual's ability to achieve secure membership in a set of practices and rituals that have as a moral function to inscribe her life in a temporally extended narrative. (...) Once these grounds are distinguished, it becomes more difficult to grant healthcare professionals' claims to religious exemptions on the basis of the latter than it is on the basis of the former. While both sets of considerations generate ‘internal reasons’ for rights to accommodation, the relevant ‘external’ reasons present in the case of claims of moral conscience do not possess analogues in the case of claims of religious conscience. However, the argument applies only to ‘irreducibly religious’ claims, that is to claims that cannot be translated into moral vocabulary. What's more, there may be reasons to grant the claims of religious persons to exemptions that have to do not with the nature of the claims, but with the beneficial effects that the presence of religious persons may have in the context of the healthcare institutions of multi-faith societies. (shrink)

The HIPAA Privacy Rule is notoriously weak because of its incomplete coverage, numerous exclusions and exemptions, and limited rights for individuals. The three areas in which it provides the most protection are fundraising, marketing, and research. Provisions of the 21st Century Cures Act, pending in Congress, and the Notice of Proposed Rulemaking to amend the federal research regulations, awaiting final regulatory action, would weaken the privacy protections for research. If these measures are adopted, the HIPAA Privacy Rule would have (...) so little value that it might not be worth the aggravation and burden. (shrink)

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions (...) are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified. (shrink)

This essay presents a point of view for looking at `free will', with the purpose of interpreting where exactly the freedom lies. For, freedom is what we mean by it. It compares the exercise of free will with the making of inferences, which usually is predominantly inductive in nature. The making of inference and the exercise of free will, both draw upon psychological resources that define our ‘selves’. I examine the constitution of the self of an individual, especially the (...) involvement of personal beliefs, personal memories, affects, emotions, and the hugely important psychological value-system, all of which distinguish the self of one individual from that of another. The foundational position that adopted in this essay is that all psychological processes are correlated with corresponding ones involving large scale neural aggregates in the brain, communicating with one another through wavelike modes of excitation and de-excitation. Of central relevance is the value-network around which the affect system is organized, the latter, in turn, being the axis around which is assembled the self, with all its emotional correlates. The self is a complex system. I include a brief outline of what complexity consists of. In reality all systems are complex, for complexity is ubiquitous, and certain parts of nature appear to us to be ‘simple’ only in certain specific contexts. It is in this background that the issue of determinism is viewed in this essay. Instead of looking at determinism as a grand principle entrenched in nature independent of our interpretation of it, I look at our ability to explain and to predict events and phenomena around us, which is made possible by the existence of causal links running in a complex course that set up correlations between diverse parts of nature, in this way putting the stamp of necessity on these events. However, the complexity of systems limits our ability to explain and to predict to within certain horizons defined by contexts. Our ability to explain and predict in matters relating to acts of free will is similarly limited by the operations of the self that remain hidden from our own awareness. The aspects of necessity and determinism appear to us in the form of reason and rationality that explain and predict only within a limited horizon, while the rest depends on the complex operation of self-linked psychological resources, where the latter appear as contingent in the context of the exercise of free will. The hallmark of complex systems is the existence of amplifying factors that operate as destabilizing ones, along with inhibiting or stabilizing factors as well that generally limit the destabilizing influences to local occurrences, while preserving the global integrity of a system. This complex interplay of destabilizing and stabilizing influences lead to the possibility of an enormous number of distinct modes of behavior that appear as emergent phenomena in complex systems. Looking at the particular case of the self of an individual that guide her actions and thoughts, it is the operation of our emotions, built around the psychological value-system, that provide for the amplifying and inhibiting factors mentioned above. The operation of these self-linked factors stamps our actions and thoughts as contingent ones that do not fit with our concepts of reason and rationality. And this is what provides the basis of our idea of free will. Free will is not ‘free’ in virtue of exemption from causal links running through all our self-based processes - ones that remain hidden from our awareness, but is free of what is perceived to be ‘reason and rationality’ based on knowledge and the common pool of beliefs and principles associated with a shared world-view. When we speak of the choice involved in an act of exercise of free will what we actually refer to is the commonly observed fact that various different individuals of a similar disposition respond differently when placed under similar circumstances. In other words, free will is ‘free’ precisely because it is not subject to constraints of a commonly accepted and shared set of principles, beliefs, and values. While it is possible that, in an exercise of free will, the self-linked psychological resources are brought into action when a number of alternatives are presented to the self by the operation of the ingredients of a commonly shared world-view, it seems likely that, that set of alternatives is not of primary relevance in the final response that the mind produces, since the latter is primarily a product of the operation of the self-based psychological resources. What is of greater relevance here is the operation of emotion-driven processes, guided by the psychological value-system based on the activity of the so-called reward-punishment network in the brain. These processes lead the individual to a response that appears to be free from the shackles of determinism precisely because their mechanisms, which are hidden from us, do not conform to commonly accepted and shared rules and principles. In contrast, inductive inference is a process that is based on the ‘cognitive face’ of self, where the self-based psychological resources play a supportive role to the commonly shared world-view of an individual. There is never any freedom from the all-pervading causal links representing correlations among all objects, entities, and events in nature. In the midst of all this, the closest thing to freedom that we can have in our life comes with self-examination and self-improvement. The possibility of self-examination appears in the form of specific conjunctions between our complex self-processes and the ceaseless changes of scenario in our external world. This actually makes the emergent phenomenon of self-examination a matter of chance, but one that keeps on appearing again and again in our life. Once realized, self examination creates possibilities that would not be there in the absence of it, and these possibilities include the enhancement of further self-enrichment and further diversity in the exercise of our free will. (shrink)

In 2019, several US states passed “heartbeat” bills. Should such bills go into effect, they would outlaw abortion once an embryonic heartbeat can be detected, thereby severely limiting an individual’s access to abortion. Many states allow health care professionals to refuse to provide an abortion for reasons of conscience. Yet heartbeat bills do not include a positive conscience clause that would allow health care professionals to provide an abortion for reasons of conscience. I argue that this asymmetry is unjustified. (...) The same criteria that justify protecting conscientious refusals to provide abortion also justify protecting positive conscientious appeals regarding abortion. Thus, if the law provides legal exemptions for health care professionals who, as a matter of conscience, refuse to provide abortions where it is legal, it should also provide exemptions for health care professionals who, as a matter of conscience, feel obligated to provide abortions where it is illegal. (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers (...) on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the (...) comparison between naturally acquired immunity and vaccine-induced immunity. While we clearly cannot settle the scientific debates on this point, we suggest that we lack clear and convincing scientific evidence that vaccine-induced immunity has a significantly higher protective effect than natural immunity. Since vaccine requirements represent a substantial infringement of individual liberty, as well as imposing other significant costs, they can only be justified if they are necessary for achieving a proportionate public health benefit. Without compelling evidence for the superiority of vaccine-induced immunity, it cannot be deemed necessary to require vaccination for those with natural immunity. Subjecting them to vaccine mandates is therefore not justified. We conclude by defending the standard of proof that this argument from necessity invokes, and address other pragmatic and practical considerations that may speak against natural immunity exemptions. There are no data in this work. (shrink)

In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue (...) in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others. (shrink)