In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair or (...) just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice. (shrink)
Perhaps the greatest determinant of individual and societal welfare is who raises children and with what degree of discretion. Philosophers have endeavored in myriad ways to provide normative justification for ascribing a right to be a legal parent and to possess particular legal powers as a parent. This Article shows why they fail and offers an alternative theoretical framework for delimiting parental rights. The prevailing tendency in philosophical writing on the topic is to begin with observations and intuitions specific to (...) parent-child relationships. Against that tendency, this Article demonstrates the need to begin with principles at a high level of generality, covering a broad range of human relationships. This yields a much more limited moral right in connection with parenthood than do accounts that fail to generalize. (shrink)
: When health care workers migrate from poor countries to rich countries, they are exercising an important human right and helping rich countries fulfill obligations of social justice. They are also, however, creating problems of social justice in the countries they leave. Solving these problems requires balancing social needs against individual rights and studying the relationship of social justice to international justice.
Last year, I flew to two bioethics conferences, one in Europe and one in North America. These were good things to do, or so I thought. But I worry that flying and other activities are contributing to climate changes that will affect the health of vulnerable people, the life prospects of future generations, and the balance of the natural world. Thus, in this paper, I consider how I should respond. To begin, I describe briefly how climate change will impact human (...) health. Then I note how climate change raises issues about justice. But I focus on issues about moral responsibility and responsiveness. (shrink)
Many medical students are fearful of voicing their concerns about ethically troubling medical practice. Yet they must speak up if they are to meet their responsibilities to patients, colleagues, and the profession of medicine.
Last year I flew to two bioethics conferences, one in Europe and one in North America. I also flew to Taiwan to teach abroad for a year. These were good things to do, or so I thought. I contributed to educational events, learned more about bioethics, and visited with friends and colleagues. But I worry that flying and other activities in my life are contributing to climate changes that will affect the health of vulnerable people, the life prospects of future (...) generations, and the balance of the natural world.I sometimes imagine a dialogue with a young person, twenty years from now, when the climate crisis is much worse.What were you people in bioethics thinking? You flew to conferences all over the world, emitting .. (shrink)
Climate change and environmental problems will force or induce millions of people to migrate. In this article, I describe environmental migration and articulate some of the ethical issues. To begin, I give an account of these migrants that overcomes misleading dichotomies. Then, I focus attention on two important ethical issues: justice and responsibility. Although we are all at risk of becoming environmental migrants, we are not equally at risk. Our risk depends on our temporal position, geographical location, social position, and (...) the kind of society in which we live. We all contribute to environmental problems, but we do not contribute equally. About 11% of the world population is responsible for 50% of carbon emissions. These inequalities raise issues of justice because many of the people who are at high risk have contributed little to the problems. Since the issues of justice are relatively clear and compelling, I focus more attention on issues of responsibility. I use Iris Marion Young’s account of responsibility for structural injustice to address four key questions about moral responsibility and environmental migration. (shrink)
In Australia, Japan, Sweden, and Switzerland, the average life expectancy is now greater than 80 years. But in Angola, Malawi, Sierra Leone, and Zimbabwe, the average life expectancy is less than 40 years. The situation is even worse than these statistics suggest because average figures tend to mask inequalities within countries. What are we to make of a world with such unequal health prospects? What does justice demand in terms of global health? To address these questions, I characterize justice at (...) the local level, at the domestic or social level, and at the international or global level. Because social conditions, structures, and institutions have such a profound influence on the health of populations, I begin by focusing attention on the relationship between social justice and health prospects. Then I go on to discuss health prospects and the problem of global justice. Here I distinguish two views: a cosmopolitan view and a political view of global justice. In my account of global justice, I modify and use the political view that John Rawls developed in The Law of Peoples. I try to show why an adequate political account must include three duties: a duty not to harm, a duty to reconstruct international arrangements, and a duty to assist. (shrink)
Are children of equal, lesser, or perhaps even greater moral importance than adults? This work of applied moral philosophy develops a comprehensive account of how adults as moral agents ascribe moral status to beings - ourselves and others - and on the basis of that account identifies multiple criteria for having moral status. It argues that proper application of those criteria should lead us to treat children as of greater moral importance than adults. This conclusion presents a basis for critiquing (...) existing social practices, many of which implicitly presuppose that children occupy an inferior status, and for suggesting how government policy, law, and social life might be different if it reflected an assumption that children are actually of superior status. (shrink)
Climate change continues to have profound impacts on people’s health, lives and life prospects. For the most part, people who are at highest risk from the impacts of climate change have contributed very little to the problem. This is the crux of the injustice. After I discuss the risks and contributions associated with the injustice of climate change, I turn to the issue of responsiveness: of why and how people should respond to this injustice. I avoid discussions of legal liability (...) and focus more attention on the need to take political action to change social structures and habits. However, I realize how political engagement can prove to be ineffective, burdensome and dangerous. So in the last section, I say more about the reasons and changes that limit the effectiveness of political engagement. I suggest how we might change both the perception and practice of politics. At the end, I note two issues that I have not addressed in this limited article. (shrink)
ABSTRACT We live in a world with enormous disparities in health. The life expectancy in Japan is 80 years; in Malawi, 40 years. The under‐five mortality in Norway is 4/1000; in Sierra Leone, 316/1000. The situation is actually worse than these figures suggest because average rates tend to mask inequalities within a country. Several presidents of the IAB have urged bioethicists to attend to global disparities and to broaden the scope of bioethics. For the last six years I have tried (...) to do just that. In this paper, I report and reflect on my attempts to teach bioethics in ways that address global health and justice. To begin, I discuss how I structure bioethics courses so as to move naturally from clinical ethics to health policy to global health. I then discuss ways to address key ethical issues in global health: the problem of inequalities; the nature of the duty to assist; the importance of the duty not to harm; the difference between a cosmopolitan and a political view of justice. I also discuss how teaching about global health may help to shift the emphasis in bioethics – from sensational cases to everyday matters, from autonomy to justice, and from access to healthcare to the social determinants of health. At the end of my paper, I reflect on questions that I have not resolved: how to delineate the scope of bioethics, whether my approach over‐politicises bioethics, and how to understand the responsibilities of bioethicists. (shrink)
The COVID-19 pandemic exposed social shortcomings and ethical failures, but it also revealed strengths and successes. In this perspective article, we examine and discuss one strength: the duty to care. We understand this duty in a broad sense, as more than a duty to treat individual patients who could infect health care workers. We understand it as a prima facie duty to work to provide care and promote health in the face of risks, obstacles, and inconveniences. Although at least one (...) survey suggested that health care workers would not respond to a SARS-like outbreak according to a duty to care, we give reasons to show that the response was better than expected. The reasons we discuss lead us to consider normative accounts of the duty to care based on the adoption of social roles. Then, we consider one view of the relationship between empirical claims and normative claims about the duty to care in the COVID-19 pandemic. Here, we draw insight from Mengzi, with an emendation from Dewey. Our perspective leaves many question to research, but one point seems clear: there will be future pandemics and the need for health care workers who respond. (shrink)
I begin this essay with an autobiographical introduction to explain why I studied philosophy and how I came to work in bioethics. I then consider three ethical frameworks and practices that I adopted in my work in bioethics. I begin with the framework that John Rawls makes explicit, where the purpose of ethical theory is to set out aims and objectives to guide our responses to the world. Since this approach did not provide the guidance that I was looking for, (...) I took up writing haiku as an ethical practice. I present here many examples of haiku that I wrote to pay attention to situations in life and bioethics. The hope was that paying attention would lead me to respond in better ways. Since this practice helped me more with attending than responding, I turned to a third framework. Here I explore John Dewey’s ethical framework. After characterizing this framework, I consider features that an associated practice needs to have. In a brief conclusion, I note some affinities between the second and third ethical approaches, and note that the last ethical framework adopted may just be the latest stage in trying out frameworks and practices. (shrink)
When Van Rensselaer Potter coined the English word “bioethics”, he envisioned a field that would bring together biological understanding and ethical values to address global environmental problems. Following Potter’s broad vision of bioethics, I explore ethical ideas that we need to address climate change. However, I develop and emphasize ideas about justice and responsibility in ways that Potter did not. At key points, I contrast the ideas that I develop with those in Potter’s work, but I try to avoid scholarly (...) debates and stay focused on the practical task: developing ideas to help us address climate change. To begin, I describe the problem of climate change. Then I show how it raises deep and serious issues of justice. Since the issues of justice are relatively clear and compelling, I proceed to focus attention on issues of responsibility – on why and how to respond to the structural injustices of climate change. I also note how my emphasis on justice and responsibility raises two new issues. To conclude, I mention the role of ecological citizens in bringing about social change. (shrink)
Do societies have an ethical responsibility to care for and about the health of undocumented migrants? Some people claim that societies have no responsibility to care for undocumented migrants because these migrants have no legal right to be in the country. But this view tends to ignore ethical responsibilities that are independent of legal status. Other people claim that all human beings, in virtue of their dignity and status as human beings, have a right to the highest standard of health. (...) But this view tends to ignore ethical responsibilities that arise out of relationships between a society and the undocumented migrants who are living and working in that society. In this article, I take a different approach. In the case of undocumented workers, I try to show how these workers are used in the economy and why a widely accepted pattern of responsibility should be extended to them. In the case of undocumented young people, I try to show how these people are socialized in a society and why a widely accepted pattern of responsibility should be extended to them. Toward the end of this article, I reflect on the nature and limits of these arguments. (shrink)
On March 11, 2011, one of the most powerful earthquakes ever recorded occurred off the northeast coast of Japan. It destroyed buildings, damaged infrastructure, and killed people in the Tohoku region. The associated tsunami was even more destructive, engulfing coastal areas and obliterating whole towns. The earthquake and the tsunami together occasioned a third disaster: the meltdown at the Fukushima nuclear power plant. Like most people, Dr. Makoto Sato was horrified by the destruction and suffering that he saw. He wanted (...) to help and felt that he should, but doing something appropriate and effective was not easy. He is a general internist and bioethicist at a university medical center in Hokkaido, the large island north of Tohoku. What should Dr. Sato have done then? What should he do now? (shrink)
Pierre Hadot has discussed the deep connections between ancient Western philosophy and spiritual exercises. The author appreciates these connections, but he explains why he explored a different path. He began to write haiku as a form of spiritual practice. He wanted to use these short verses to become more mindful, present, and responsive – in his life and in his work in bioethics. After comparing traditional haiku and modern haiku, the author gives some examples from classical sources. Then he considers (...) how reading and writing haiku might help bioethics to focus less on deliberation and choice, and more on attention and perception. Haiku might help bioethics to attend to the contexts, life conditions, and lifeworlds that shape and situate people’s lives. These short poems might even illuminate some of the backgrounds and existential grounds of ethical life. At the end, the author presents some haiku that he wrote about modern life, young children, older adults, illness, medicine, and death. (shrink)
Many environmental problems are now more serious and urgent than ever. In high‐income countries, health care is part of the problem. In Principles of Green Bioethics: Sustainability in Health Care, Cristina Richie focuses on medical developments, techniques, and procedures, and she proposes four principles for green bioethics: distributive justice, resource conservation, simplicity, and ethical economics. Richie is right to emphasize the need for green bioethics, and I admire her aim to bring environmental concerns back into bioethics, but I was disappointed (...) with this book. Since Plato, much of ethics has focused on the characteristics or principles of the ideally just society. This work in ethics seeks to transcend the culture in which we live in order to provide guidance about what we should do. I think it would be better to start with the messy, problematic, and unjust situations in which we are enmeshed. (shrink)
This short story raises ethical issues about a woman’s request for medical assistance to get pregnant. In this fictional account, a 34-year-old woman has been trying to get pregnant for the last year. Her husband would like to keep trying for one more year, but the woman loses patience. She visits an ob-gyn and requests artificial insemination. She does not intend to tell her husband about this medical assistance. The doctor has helped single women, lesbian couples, and married couples with (...) pregnancies, but he feels conflicted by this request. The doctor and the woman discuss their concerns and plans. Then they decide on a course of action. In a creative way, this story aims to bring to life ethical issues about assisted reproduction, complex relationships, individual choice, non- judgmental attitudes, deception, confidentiality, genetic connections, and social parents. But this story is not a textbook case that illustrates a clearly defined ethical issue. On the contrary, the story shows that some common ethical ideas don’t quite fit the characters’ experiences and the readers’ reactions. (shrink)
When a doctor sees a patient, answers to a few questions can be crucial. So what to do when no one at the hospital speaks the patient's language? Doctors can often devise creative, makeshift ways of communicating with their patients, but the problem calls ultimately for a creative organizational response.