The purpose of this paper is to unveil the incompleteness of John Harris' view that parents have a moral obligation to genetically enhance their unborn children. Specifically, here two main conclusions are proposed: (1) at present there exist insufficient empirical data for determining whether prenatal genetic enhancement (PGE) is a moral obligation on prospective parents. Although the purpose of PGE research would be to determine the extent to which PGE is safe and effective, the task of determining (...) the veracity of Harris' premises is impossible to achieve without begging the question; we would be forced to assume the moral permissibility of PGE in order to generate the data that are required for determining its moral standing. So, given this empirical blindness, consequence-based normative frameworks like that of Harris cannot determine the moral standing of PGE, but merely push the question of the moral standing of PGE back a step, without offering any plausible and morally endorsable recourse for how to answer it; (2) even if PGE research were legal, which it is not, parents nevertheless have good reason not to consent to it for their children, especially as participants in the first wave(s) of such research. (shrink)

This chapter contains sections titled: Abortion and Mother‐Fetus Conflict Moral Obligations to the Unborn The Obstetrical Cases: Forced Cesareans Fetal Surgery Conclusion References Further reading.

We argue that individuals who have access to vaccines and for whom vaccination is not medically contraindicated have a moral obligation to contribute to the realisation of herd immunity by being vaccinated. Contrary to what some have claimed, we argue that this individual moral obligation exists in spite of the fact that each individual vaccination does not significantly affect vaccination coverage rates and therefore does not significantly contribute to herd immunity. Establishing the existence of a moral obligation (...) to be vaccinated despite the negligible contribution each vaccination can make to the realisation of herd immunity is important because such moral obligation would strengthen the justification for coercive vaccination policies. We show that two types of arguments—namely a utilitarian argument based on Parfit’s Principle of Group Beneficence and a contractualist argument—can ground an individual moral obligation to be vaccinated, in spite of the imperceptible contribution that any single vaccination makes to vaccine coverage rates. We add a further argument for a moral obligation to be vaccinated that does not require embracing problematic comprehensive moral theories such as utilitarianism or contractualism. The argument is based on a “duty of easy rescue” applied to collectives, which grounds a collective moral obligation to realise herd immunity, and on a principle of fairness in the distribution of the burdens that must be borne to realise herd immunity. (shrink)

Central to Watts and Newson’s argument in their seminal paper ‘ Is there a duty to routinely reinterpret genomic variant classifications? ’ is that diagnostic laboratories are not morally obligated to actively reinterpret variants of uncertain significance (VUS) due to the superior outcomes offered by next-generation sequencing (NGS) compared with traditional methods.1 NGS technologies can identify, analyse and interpret millions of genetic variations at once. For example, ‘the use of conventional molecular assays in clinical contexts could require doing a lot (...) of assays for various mutations. Using these different assays, more tissue may be required. These targets can accurately be questioned using NGS technology in a single test.’2 If NGS-based genomic sequencing is reliable and its output outweighs the potential harm of uncertainties, then, it is plausible to say that those test providers cannot incur a moral duty to actively reinterpret VUS because there won’t be any need to do so.1 Despite its seeming reliability, diagnostic laboratories face enormous challenges in implementing NGS-based …. (shrink)

The moral obligation to support space exploration follows from our obligations to protect the environment and to survive as a species. It can be justified through three related arguments: one supporting space exploration as necessary for acquiring resources, and two illustrating the need for space technology in order to combat extraterrestrial threats such as meteorite impacts. Three sorts of objections have been raised against this obligation. The first are objections alleging that supporting space exploration is impractical. The second (...) is the widely held notion that space exploration and environmentalism are at odds with one another. Finally, there are two objections to using space resources that Robert Sparrow has raised on the topic of terraforming. The obligation to support space exploration can be defended in at least three ways: (1) the "argument from resources," that space exploration is useful for amplifying our available resources; (2) the "argument from asteroids," that space exploration is necessary for protecting the environment and its inhabitants from extraterrestrial threats such as meteorite impacts; and (3) the "argument from solar burnout," that we are obligated to pursue interstellar colonization in order to ensure long-term human survival. (shrink)

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)

According to what we call the Principle of Procreative Beneficence, couples who decide to have a child have a significant moral reason to select the child who, given his or her genetic endowment, can be expected to enjoy the most well-being. In the first part of this paper, we introduce PB, explain its content, grounds, and implications, and defend it against various objections. In the second part, we argue that PB is superior to competing principles of procreative selection such (...) as that of procreative autonomy. In the third part of the paper, we consider the relation between PB and disability. We develop a revisionary account of disability, in which disability is a species of instrumental badness that is context- and person-relative. Although PB instructs us to aim to reduce disability in future children whenever possible, it does not privilege the normal. What matters is not whether future children meet certain biological or statistical norms, but what level of well-being they can be expected to have. (shrink)

Is it always morally wrong to violate a law and in doing so does one necessarily act badly? I argue that whether in breaking a law one acts badly depends on considerations unique to the particular act of lawbreaking. The moral judgment in question is deeply contextual and cannot be settled by appeal to blanket moral rules such as that it is wrong to break (any) law. The argument is made by focusing on the example of a runner (...) having to decide whether to disobey the law against trespass. If in trespassing one acts badly it is not because there is a prima facie moral obligation to obey law. Theories of political obligation which ground an obligation to obey law in the principles of fairness or gratitude or in consent all fail to provide a persuasive reason not to trespass given a particular fact situation. I argue that when it is morally wrong to trespass it is morally wrong not because one has broken the law, but because and insofar as one has violated reasonable expectations of privacy. Whether there is a reasonable expectation of privacy in one's property depends in part on the character of the property in question. (shrink)

Donor conceived persons are likely to have a lower quality of life than persons who are genetically related to both parents. Empirical evidence is presented to corroborate this point. The evidence is subdivided into three sections: (1) negative experience of the donor conception itself, (2) negative effects of secrecy and openness and (3) negative effects of donor anonymity and donor identifiability. The principle of procreative beneficence requires parents to select the child with the best possible life. Given the difference in (...) quality of life, intended parents should try to have a genetically related child. This finding is also a strong reason for society to invest public resources in the development of techniques that enable people to create genetically related children. (shrink)

Without doubt, the global challenges we are currently facing—above all world poverty and climate change—require collective solutions: states, national and international organizations, firms and business corporations as well as individuals must work together in order to remedy these problems. In this chapter, I discuss climate change mitigation as a collective action problem from the perspective of moral philosophy. In particular, I address and refute three arguments suggesting that business firms and corporations have no moral duty to reduce greenhouse (...) gas emissions: (i) that business corporations are not appropriate addressees of moral demands because they are not moral agents, and (ii) that to the extent that they are moral agents their primary moral obligation is to their owners or shareholders, and (iii) the appeal to the difference principle: that individual business corporations cannot really make a significant difference to successful climate change mitigation. (shrink)

The widespread availability of effective vaccines against life-threatening infections has been one of the greatest public health achievements. Unfounded but widely circulated safety concerns about some vaccines and ethical concerns about the derivation of others have caused a decline in the number of immunized individuals in the United States. Exploring distinctions between formal and material cooperation in evil provides reassurance that, in the absence of alternatives, Catholics may, in good conscience, receive vaccines originally derived from fetal tissue obtained from abortions. (...) Examining Catholic teaching on the individual’s responsibility to the common good shows that, in the absence of medical contraindications, each person has a duty to receive currently recommended vaccinations. (shrink)

In their article published in Nanoethics, “Ethical, Legal and Social Aspects of Brain-Implants Using Nano-Scale Materials and Techniques”, Berger et al. suggest that there may be a prima facie moral obligation to improve neuro implants with nanotechnology given their possible therapeutic advantages for patients [Nanoethics, 2:241–249]. Although we agree with Berger et al. that developments in nanomedicine hold the potential to render brain implant technologies less invasive and to better target neural stimulation to respond to brain impairments in the (...) near future, we argue against presenting the development of nanobionic clinical devices in terms of a moral obligation to conduct this research. In the first part of the paper, we consider what a duty to pursue new technologies might mean, and in the second we explore some of the negative consequences of defending such development as a moral obligation based on potential benefit. We argue that promoting the advances available to brain implants through developments in nanotechnology and bionics could contribute to medical rhetoric that indirectly increases the risk of exposing patients to harm when participating in clinical trials. We argue that rather than there being a moral obligation to improve nanobionics implants because of their potential benefit, the pursuit of improved neuro implants must be balanced against the prima facie obligations to protect patients against harm and to promote and protect patient autonomy. (shrink)

Dave Chappelle took an extended leave from comedy for moral reasons. I argue that, while he had every right to leave comedy because of his moral concerns, he was not obliged to do so. To make this case, I present Chappelle’s argument that the potential negative consequences of his racial humor obliged him to leave. Next, I argue against Chappelle’s argument about avoidable harms as the harms are not his responsibility, he was not being negligent, and the benefits (...) of his humor outweigh the harms. I also argue in support of the intuition that another’s failure of comprehension or moral character, even if that failure will predictably result in harms to others, should not convert moral acts into immoral ones. (shrink)

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of (...) female genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it. There are no data in this work. (shrink)

Synthetic biology can be understood as expanding the abilities and aspirations of genetic engineering. Nonetheless, whereas genetic engineering has been subject to criticism due to its endangering biodiversity, synthetic biology may actually appear to prove advantageous for biodiversity. After all, one might claim, synthesizing novel forms of life increases the numbers of species present in nature and thus ought to be ethically recommended. Two perspectives on how to spell out the conception of intrinsic value of biodiversity are examined in order (...) to assess this line of thought. At the cost of introducing two separate capacities of human knowledge acquisition, the ‘admiration stance’ turns out to reject outright the assumption of a synthetic species' intrinsic value and of an imperative to create novel species. The ‘kinship stance’ by contrast does ascribe value to both synthetic and natural species and organisms. Nonetheless, while from this perspective creating novel species may become an ethical demand under certain conditions, it favours changing organisms by getting in contact with them rather than synthesizing them. It is concluded that neither the admiration nor the kinship stance warrants a supposed general moral obligation to create novel species to increase biodiversity. (shrink)

ABSTRACT I argue, counter‐intuitively, that under certain conditions many people are under some moral requirement to attempt to bring children into being . There is only rarely a strict obligation to have children, but more moderate, inclining moral considerations in favour of having children, have a place in our moral world. I begin by considering a large number of arguments in favour and against the possibility of an obligation to have children. Then I examine when the weight (...) of one set of arguments is greater. And I conclude by pointing out some general lessons from the discussion. (shrink)

Kathryn Paxton George has recently argued that vegetarianism cannot be a moral obligation for most human beings, even if Tom Regan is correct in arguing that humans and certain nonhuman animals are equally inherently valuable. She holds that Regan's liberty principle permits humans to kill and eat innocent others who have a right to life, provided that doing so prevents humans from being made worse off. George maintains that obstaining from meat and dairy products would in fact make most (...) humans worse off. I argue that Regan's liberty principle either contradicts his equal rights view or does not permit the slaughter of another for food. I show that a different view recognizing the moral rights of nonhumans but according them less value than normal adult humans, the unequal rights view, would permit such action if human survival or health depended upon it. However, it would also permit the slaughter of innocent humans in the same circumstances. Finally, I argue that current nutritional research does not support George's contention that most humans would suffer if they ceased eating other animals and their products. (shrink)

Some people oppose abortion on the grounds that fetuses have full moral status and thus a right to not be killed. We argue that special obligations that hold between mother and fetus also hold between parents and their children. We argue that if these special obligations necessitate the sacrifice of bodily autonomy in the case of abortion, then they also necessitate the sacrifice of bodily autonomy in the case of organ donation. If we accept the argument that (...) it is obligatory to override a woman’s bodily autonomy for the sake of an unborn child’s survival, we must continue to override the bodily autonomy of parents to ensure the survival of their living children, until the parent no longer has a special obligation to their child to the same degree as their special obligation to the fetus. And if the life of a child is truly more important than the bodily autonomy of its parents, as must be the case to force women to carry unwanted pregnancies to term, this should remain true until such a time that their children are no longer considered their responsibility. Thus, parity of reasoning suggests that policies compelling the gestation of a fetus should be accompanied by policies compelling organ donation. (shrink)

In this issue of The Journal of Clinical Ethics, Professor Ruth Tallman argues that pediatricians ought to support adolescent football players in their athletic goals. She does not deny that doing so means “helping children hurt themselves”; rather she argues that this would be consistent with a shared decision-making model in which both the physician and the patient seek to promote the patient’s well-being in light of the patient’s own goals. I argue that this ignores the role of the parents, (...) meaning that Tallman is suggesting “helping parents allow their children to hurt themselves.” As a general pediatrician, I would classify this as child neglect, if not downright child abuse. I argue that pediatricians should counsel directively against youth tackle football, employ a deliberative approach to shared decision making within the triadic doctorpatient- parent relationship, and support youth sport policies that seek to reduce traumatic brain injury by advocating for flag football, by prohibiting checking in boys’ ice hockey, and by minimizing heading the ball in soccer below a certain age. (shrink)

According to second‐personal approaches to moral obligation, the distinctive normative features of moral obligation can only be explained in terms of second‐personal relations, i.e. the distinctive way persons relate to each other as persons. But there are important disagreements between different groups of second‐personal approaches. Most notably, they disagree about the nature of second‐personal relations, which has consequences for the nature of the obligations that they purport to explain. This article aims to distinguish these groups from each (...) other, highlight their respective advantages and disadvantages, and thereby indicate avenues for future research. (shrink)

A particularly strong reason to vaccinate against transmittable diseases, based on considerations of harm, is to contribute to the realization of population-level herd immunity. We argue, however, that herd immunity alone is insufficient for deriving a strong harm-based moral obligation to vaccinate in all circumstances, since the obligation significantly weakens well above and well below the herd immunity threshold. The paper offers two additional harm-based arguments that, together with the herd immunity argument, consolidates our moral obligation. First, we (...) argue that individuals should themselves aim not to expose others to risk of harm, and that this consideration becomes stronger the more non-vaccinated people there are, i.e., the further we are below herd immunity. Second, we elaborate on two pragmatic reasons to vaccinate beyond the realization of herd immunity, pertaining to instability of vaccination rates and population heterogeneity, and argue that vaccinating above the threshold should serve as a precautionary measure for buttressing herd immunity. We also show that considerations of harm have normative primacy in establishing this obligation over considerations of fairness. Although perfectly sound, considerations of fairness are, at worst secondary, or at best complementary to considerations of harm. (shrink)

This article surveys four approaches to moral obligation to non-Muslims found in Islamic legal thought. The first three approaches I refer to in this article as the "revelatory-deontological," the "contractualist-constructivist" and the "consequentialist-utilitarian." The main argument of this article is that present in many of the contemporary works on the "jurisprudence of Muslim minorities" (fiqh al-aqalliyyat) is an attempt to provide an Islamic foundation for a relatively thick and rich relationship of moral obligation and solidarity with non-Muslims. This (...) attempt takes the form of a fourth "comprehensive-qualitative" approach to political ethics in that it appeals not to juridical reasoning of the type "is x permissible and in which conditions?" but rather to Islamic ideals of what it means to live a good life, of what believing, normatively-committed Muslims want to pursue in this world, not only what they may pursue without fear of punishment. This meta-ethical approach builds on and goes beyond the first three. The force of this argument is that this fourth "comprehensive-qualitative" approach to moral obligation to non-Muslims is novel, emergent and not found not in the writings of outright reformers but in those of conservative, "neo-classical," shari'a-minded - even Muslim Brotherhood-affiliated - Islamic scholars. What also adds to the force of this argument is that the other meta-ethical discourses, particularly of contract and utility (maslaha), already get these scholars quite far towards a doctrine of "loyal resident alienage" in non-Muslim societies. That even orthodox Islamic scholars go further shows that they have some interest in giving a theological or principled foundation to a much thicker and richer form of moral obligation to non-Muslims, a relationship which involves recognizing non-Muslims qua non-Muslims and contributing to their well-being. (shrink)

A widespread view among theists is that there is a moral obligation to obey God’s commands. In this paper, four arguments for this view are considered: the argument from beneficence; the argument from property rights; the argument from justice; and the argument from omnipotence and moral perfection. It is argued that none of these arguments succeeds in showing that there is a moral obligation to obey God’s commands. The paper concludes with the suggestion that there might be, (...) nevertheless, weighty and specifically religious (as distinct from moral) reasons to obey God. (shrink)

The HIV/AIDS epidemic is increasingly a diseaseof the disadvantaged, a destroyer of nations,and a threat to global security and well-being.But this need not be so: the world has thescientific knowledge, technologicalinnovations, and financial resources tosignificantly reduce the spread and sufferingcaused by the disease. This paper argues thatthe wealthy nations of the world, led by theUnited States, have a moral obligation to offermuch greater assistance to developing countrieswhere the epidemic is most severe. UsingZimbabwe as a case study, this essay examinesthe (...) immediate and underlying factors behind theepidemic in order to make realistic andaffordable policy recommendations that includenew investments in global health care, debtrelief, and long-term economic development. Bydemonstrating our ability to dramaticallyaffect the future course and consequences ofthis unprecedented epidemic, the paperconcludes that greater action is not only inthe interest of public health, but is also amoral imperative. By investing the necessaryresources to improve public health and toreduce global poverty, we promote and extendthe fundamental rights and values that weprofess to hold dear. (shrink)

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit‐sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity‐building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit because (...) it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity‐building, nurture respectful and trusting partnerships that benefit all stakeholders in international research. (shrink)

There is considerable concern that climate change will displace many people in developing countries from their homes. This article examines whether developed countries are morally obligated to assist people displaced by climate change in developing countries. The article argues that there may not be a moral duty to assist climate change migrants as a category. Nonetheless, developed countries may have duties to assist vulnerable people elsewhere and may be obligated to assist climate change migrants along with other vulnerable people. (...) In addition, there likely is a duty to assist a particular subset of climate change migrants, specifically the citizens of small island countries existentially threatened by climate change. The article concludes by assessing the implications of its moral analysis for the focus of law and policy. Instead of developing new treaties to assist climate change migrants as a number of academics and practitioners have recently proposed, law and policy should be concerned with assisting migrants at risk generally, and/or the citizens of small island countries existentially threatened by climate change. (shrink)

Seasonal influenza poses a significant public health risk in many countries worldwide. Lower immunity and less influenza virus circulating during the pandemic has resulted in a significant increase in cases since the lifting of COVID-19 restrictions in 2022. The seasonal influenza vaccine offers effective protection and is safe for use in large numbers of the population. This article asserts that a moral obligation to vaccinate against influenza can be understood as an Institutional Duty of Rescue. The traditional understanding of (...) the Duty of Rescue encounters issues with force and scope, making it difficult to apply to rescue cases in general, as well as being overdemanding for the individual agent. An Institutional view of the Duty of Rescue addresses these difficulties, looks at the wider context of rescue and leaves room for discussion on collective, preventative rescue measures. This makes the concept well suited to supporting a moral obligation to vaccinate against influenza as part of a collective effort on the part of institutional organisations. (shrink)

The damaging effects of the activities of corporations on the natural environment have given rise to the need to evaluate corporate policies, decisions, and actions affecting the natural environment on moral grounds. There are two important questions that need to be addressed in this regard. The first is whether corporations have a moral obligation to protect the natural environment, which is over and above their economic duty to maximize profits for their stockholders and their legal duty to obey (...) environmental laws. And the second is, given that they do have this moral obligation, what sort of environmental ethical theory (homocentrism, biocentrism, utilitarianism) ought to guide the exercise of such an obligation? This paper argues that corporations do have such moral obligations, for they are moral agents in virtue of their nonmetaphorical possession of rational capacities. This, however, implies that the corporations’ exercise of this obligation can only be properly guided by a rationalist type of ethics. (shrink)

Our understanding of the philosophers of the past is not always assisted by the attempt to fit them under one or other of the categories that we currently use to map the philosophical landscape. We have grown used to the idea that there are three principal kinds of moral theory—deontological and broadly Kantian, consequentialist and broadly Millian, virtue-theoretic and broadly Aristotelian—and so historical approaches to moral philosophy tend to orientate themselves by assuming that each and every object of (...) study must count as one or other of these kinds of moralist. This is unfortunate. It is particularly unfortunate in respect of the moral philosophy of the seventeenth and eighteenth centuries. Philosophers. (shrink)

Although we have an important obligation to protect the environment, people are not morally required to choose to have smaller families for environmental reasons.

Essays cover U.S. farm policy, the current plight of the small farmer, the history of the family farm, and the ethical, and financial issues.

Together we can achieve things that we could never do on our own. In fact, there are sheer endless opportunities for producing morally desirable outcomes together with others. Unsurprisingly, scholars have been finding the idea of collective moral obligations intriguing. Yet, there is little agreement among scholars on the nature of such obligations and on the extent to which their existence might force us to adjust existing theories of moral obligation. What interests me in this paper (...) is the perspective of the moral deliberating agent who faces a collective action problem, i.e. the type of reasoning she employs when deciding how to act. I hope to show that agents have collective obligations precisely when they are required to employ ‘we-reasoning’, a type of reasoning that differs from I-mode, best response reasoning, as I shall explain below. More precisely, two (or more) individual agents have a collective moral obligation to do x if x is an option for action that is only collectively available (more on that later) and each has sufficient reason to rank x highest out of the options available to them. (shrink)

The preventative paradigm of preconception care is receiving increasing attention, yet its boundaries remain vague in three respects: temporally; agentially; and instrumentally. Crucially, it remains unclear just who is to be considered a ‘potential parent’, how soon they should take up preconception responsibilities, and how weighty their responsibilities should be.

In this essay, I consider the question of whether women have an obligation to confront men who sexually harass them. A reluctance to be guilty of blaming the victims of harassment, coupled with other normative considerations that tell in favor of the unfairness of this sort of obligation, might make us think that women never have an obligation to confront their harassers. But 1 argue that women do have this obligation, and it is not overridden by many of the considerations (...) that can override other obligations to confront wrongdoers. (shrink)

Do facts about what an agent would freely do in certain circumstances at least partly determine any of her moral obligations? Actualists answer ‘yes’, while possibilists answer ‘no’. We defend two novel hybrid accounts that are alternatives to actualism and possibilism: Dual Obligations Hybridism and Single Obligation Hybridism. By positing two moral ‘oughts’, each account retains the benefits of actualism and possibilism, yet is immune from the prima facie problems that face actualism and possibilism. We conclude (...) by highlighting one substantive difference between our two hybrid accounts. (shrink)

As a conscientious moral agent, a judge in a court of law often finds herself in a difficult position. She is confident that the law requires a certain result in the case before her, but she is at least as confident that this legally required result is unjust or otherwise morally objectionable. Consider some examples of cases in which a reasonable judge might consider herself to be in this position: ▪ The law of landlord and tenant can require a (...) judge to evict an impoverished, elderly widow from her apartment for missing rent payments.1 ▪ A student in a poor school district sues his state for providing a much lower caliber of education than students receive in wealthier districts. Binding legal precedent requires the judge to dismiss the student’s lawsuit. ▪ Binding precedents construing the Fourth Amendment require judges to exclude evidence obtained without a search warrant. As a result, a child molester is acquitted, and, predictably, strikes again. (shrink)

Existing state surrogate decision-maker laws are fragmented and inconsistent and fail to ensure that all eligible decision makers of the same surrogate priority class are included in the healthcare decisions made for an incapacitated loved one. In this article, we explore three categories of harm that result from failing to include all surrogates of equal priority in a patient’s healthcare decision, namely harms to the patient, harms to the excluded surrogate, and harms to the family. Given these harms, we argue (...) that clinical ethicists have a moral obligation to take reasonable steps to include all surrogate decision makers of equal priority in the healthcare decision-making process for patients without a designated healthcare proxy. (shrink)