This is the first volume in which an account of personal autonomy is developed that both captures the contours of this concept as it is used in social philosophy and bioethics, and is theoretically grounded in, and a part of, contemporary autonomy theory. James Stacey Taylor’s account is unique as it is explicitly a political one, recognizing that the attribution of autonomy to agents is dependent in part on their relationships with others and not merely upon their own mental states. (...) The volume is distinctive in its examples, which touch on the ethics of using inducements to encourage persons to participate in medical research, the ethical issues associated with the use of antibiotics, and the ethical basis for both patient confidentiality and informed consent. (shrink)

Autonomy has recently become one of the central concepts in contemporary moral philosophy and has generated much debate over its nature and value. This 2005 volume brings together essays that address the theoretical foundations of the concept of autonomy, as well as essays that investigate the relationship between autonomy and moral responsibility, freedom, political philosophy, and medical ethics. Written by some of the most prominent philosophers working in these areas, this book represents research on the nature and value of autonomy (...) that will be essential reading for a broad swathe of philosophers as well as many psychologists. (shrink)

Normativism holds that there is a close conceptual link between disease and disvalue. We challenge normativism by advancing an argument against a popular normativist theory, Jerome Wakefield’s harmful dysfunction account. Wakefield maintains that medical disorders are breakdowns in evolved mechanisms that cause significant harm to the organism. We argue that Wakefield’s account is not a promising way to distinguish between disease and health because being harmful is neither necessary nor sufficient for a dysfunction to be a disorder. Counterexamples to the (...) harmful dysfunction account are considered, such as mild infections, perceptual deficits, and beneficial illnesses. Then we consider two ways of amending the harmful dysfunction account to address these cases and argue that the proposed amendments raise even more serious problems for this account. These problems apply generally to any normativist theory and raise doubts about the entire normative approach to the philosophy of health and disease. (shrink)

_Death, Posthumous Harm, and Bioethics_ offers a highly distinctive and original approach to the metaphysics of death and applies this approach to contemporary debates in bioethics that address end-of-life and post-mortem issues. Taylor defends the controversial Epicurean view that death is not a harm to the person who dies and the neo-Epicurean thesis that persons cannot be affected by events that occur after their deaths, and hence that posthumous harms are impossible. He then extends this argument by asserting that the (...) dead cannot be wronged, finally presenting a defence of revisionary views concerning posthumous organ procurement. (shrink)

If pressed to identify the philosophical foundations of contemporary bioethics, most bioethicists would cite the four-principles approach developed by Tom L Beauchamp and James F Childress,1 or perhaps the ethical theories of JS Mill2 or Immanuel Kant.3 Few would cite Aristotle's metaphysical views surrounding death and posthumous harm.4 Nevertheless, many contemporary bioethical discussions are implicitly grounded in the Aristotelian views that death is a harm to the one who dies, and that persons can be harmed, or wronged, by events that (...) occur after their deaths. The view that death is a harm to the one who dies infuses, for example, the debates over abortion and euthanasia, while the view that persons could be harmed or wronged after their deaths informs much of the debate over, for example, policies for the posthumous procurement of transplant and the ethics of research on the dead.In Death, Posthumous Harm, and Bioethics, I argue that we should reject this cluster of influential Aristotelian thanatological claims, and instead endorse a trio of views that together constitute what I term full-blooded epicureanism: That death is not a harm to the person who dies, and that persons can neither be harmed nor wronged by events that occur after their deaths. …. (shrink)

Death, Posthumous Harm, and Bioethics offers a highly distinctive and original approach to the metaphysics of death and applies this approach to contemporary debates in bioethics that address end-of-life and post-mortem issues. Taylor defends the controversial Epicurean view that death is not a harm to the person who dies and the neo-Epicurean thesis that persons cannot be affected by events that occur after their deaths, and hence that posthumous harms are impossible. He then extends this argument by asserting that the (...) dead cannot be wronged, finally presenting a defence of revisionary views concerning posthumous organ procurement. (shrink)

The Metaphysics and Ethics of Death brings together original essays that both address the fundamental questions of the metaphysics of death and explore the relationship between those questions and some of the areas of applied ethics in which they play a central role.

A common criticism of plurality voting is that it fails to reflect the degree of intensity with which voters prefer the candidate or policy that they vote for. To rectify this, many critics of plurality voting have argued that vote buying should be allowed. Persons with more intense preferences for a candidate could buy votes from persons with less intense preferences for the opposing candidate and then cast them for the candidate that they intensely support. This paper argues that instead (...) of better reflecting voters’ weighted preferences, vote buying will lead to electoral outcomes that reflect them less accurately. (shrink)

In recent years, there has been a considerable increase in the degree of philosophical attention devoted to the question of the morality of offering financial compensation in an attempt to increase the medical supply of human body parts and products, such as plasma. This paper will argue not only that donor compensation is ethically acceptable, but that plasma donors should not be prohibited from being offered compensation if they are to give their informed consent to donate. Regulatory regimes that prohibit (...) donor compensation thus unethically prevent the typical donor from being able to give her informed consent to donate. (shrink)

In Markets Without Limits Brennan and Jaworski defend the view that there are “no legitimate worries about what we buy, trade, and sell.” But rather than being a unified defense of this position Brennan and Jaworski unwittingly offer three distinct pro-commodification views—two of which are subject to counterexamples. This Commentary will clarify what should be the thesis of their volume and identify the conditions that any counterexample to this must meet.

For the past three decades philosophical discussions of both personal autonomy and what it is for a person to “identify” with her desires have been dominated by the “hierarchical” analyses of these concepts developed by Gerald Dworkin and Harry Frankfurt. The longevity of these analyses is owed, in part, to the intuitive appeal of their shared claim that the concepts of autonomy and identification are to be analyzed in terms of hierarchies of desires, such that it is a necessary condition (...) for a person to be autonomous with respect to a desire that moves her to act, that she desires that this desire so move her. Despite the intuitive appeal of these analyses, however, Irving Thalberg has argued that they should be rejected. This is because, he argues, a person who is forced to perform an action by being subjected to duress of a certain degree of harshness will desire to be moved by her desire to submit. Thus, he continues, the proponents of hierarchical analyses of autonomy and identification will be forced to hold that such a person acted willingly, and did not suffer from any impairment in her autonomy. This, Thalberg concludes, is so counterintuitive as to justify rejecting hierarchical analyses. (shrink)

Many still oppose legalizing markets in human organs on the grounds that they are morally repugnant. I will argue in this paper that the repugnance felt by some persons towards sales of human organs is insufficient to justify their prohibition. Yet this rejection of the view that markets in human organs should be prohibited because some persons find them to be morally repugnant does not imply that persons’ feelings of distress at the possibility of organ sales are irrational. Eduardo Rivera-Lopez (...) argues that such instinctive distress is an appropriate response to the perception that certain kinds of arguments that are offered in favor of legalizing organ sales are “in an important sense, illegitimate.” Having argued that repugnance should not ground the prohibition of markets in human organs, I will also argue that the moral distress that some feel towards certain arguments that favor such markets is not rationally defensible, either. (shrink)

Legal prohibitions on the financial compensation of donors are frequently justified by appealing either to concerns about patient safety or to concerns about the putatively unethical nature of such compensation. But jurisdictions that legally prohibit the financial compensation of donors routinely import plasma that has been collected from financially compensated donors—and they do so knowing its origins. I outline some possible ways in which this puzzle could be resolved and find them all wanting. Focusing on Canada I draw upon public (...) documents to explain how many provinces came to have its apparently puzzling approach to plasma procurement. I then argue that the actions of those who support this approach to plasma procurement are immoral. (shrink)

A common argument used to defend markets in ‘contested commodities’ is based on the value of personal autonomy. Autonomy is of great moral value; removing options from a person's choice set would compromise her ability to exercise her autonomy; hence, there should be a prima facie presumption against removing options from persons’ choice sets; thus, the burden of proof lies with those who wish to prohibit markets in certain goods. Christopher Freiman has developed a version of this argument to defend (...) markets in votes. I argue that Freiman's argument fails, and that its failure illustrates the falsity of the widespread claim that the more options a person has available to her the better able she will be to exercise her autonomy. In Part 1, I outline Freiman's argument from ‘the presumption of voter liberty’ for legalising markets in votes. In Part 2, I argue that the option to sell one's vote in a legal market for them would be a ‘constraining option’ – an option which, if chosen, would be likely to lead to a diminution in a person's future ability to exercise her autonomy. In Part 3, I respond to objections to my arguments. (shrink)

Jacob Sparks has developed a semiotic critique of markets that is based on the fact that “market exchanges express preferences.” He argues that some market transactions will reveal that the purchaser of a market good inappropriately prefers it to a similar non-market good. This avoids Brennan and Jaworski’s criticism that semiotic objections to markets fail as the meaning of market transactions are contingent social facts. I argue that Sparks’ argument is both incomplete and doomed to fail. It can only show (...) that some preferences are morally problematic, not that the transactions that they lead to are immoral. (shrink)

The Western focus on personal autonomy as the normative basis for securing persons’ consent to their treatment renders this autonomy-based approach to informed consent vulnerable to the charge that it is based on an overly atomistic understanding of the person. This leads to a puzzle: how does this generally-accepted atomistic understanding of the person fits with the emphasis on familial consent that occurs when family members are provided with the opportunity to veto a prospective donor’s wish to donate after she (...) has died and her organs are being considered for harvesting? It is argued in this paper that this charge can be met and this puzzle dissolved once it is recognized that autonomy is an inherently social concept. (shrink)

The UCLA Medical Center has initiated a “voucher program” under which a person who donated a kidney would receive a voucher that she could provide to someone of her choosing who could then use it to move to the top of the renal transplantation waiting list. If the use of such vouchers as incentives for donors is morally permissible, then cash payments for kidneys are also morally permissible. But, that argument faces five objections. First, there are some goods whose nature (...) allows them to be exchanged for similar goods but renders them monetarily inalienable. Hence, kidneys might be exchanged for kidneys but not sold for cash. Second, voucher programs respect donor autonomy, whereas the offer of cash payments does not. Third, the burden of proof lies with the advocates of cash payments for kidneys to show that their benefits would outweigh the costs of their legalization. Fourth, allowing cash payments for kidneys would stifle medical innovation. Fifth, allowing cash payments for kidneys would result in these organs being used as collateral to secure loans—and that this would disadvantage potential borrowers who did not want to risk their kidneys in this way. This paper will rebut all these objections. (shrink)

We should try to alleviate it through allowing a current market in them continues to be morally condemned, usually on the grounds tha.

It is widely accepted that a person can be harmed by events that occur after her death. The most influential account of how persons can suffer such posthumous harm has been provided by George Pitcher and Joel Feinberg. Yet, despite its influence the Feinberg-Pitcher account of posthumous harm has been subject to several well-known criticisms. Surprisingly, there has been no attempt to defend this account of posthumous harm against these criticisms, either by philosophers who work on the metaphysics of death (...) or by those who draw upon this account of posthumous harm in their work in other philosophical fields. This paper will rectify this omission, by defending this view against the criticisms it has been subject to—a defense that will both be of intrinsic interest to those who work on the metaphysics of death and that will remedy the lacunae in the wide-ranging philosophical literature that draws upon this account of how posthumous harm is possible. (shrink)

Christopher Freiman, Jason Brennan, and Peter M. Jaworski have recently defended markets in votes. While their views differ in several respects they all believe that the primary justificatory burden lies not with those who defend markets in votes but with those who oppose them. Yet while the burden of proof should typically rest with those who wish to prohibit markets in certain goods this does not hold for the debate over markets in votes. Votes are crucially different from other goods (...) in that for a market in them to exist, it is not enough that it be legalized; it must also be provided with institutional support so that the buyer of a vote would know that it has been cast as she wished. Defenders of markets in votes must thus provide positive arguments for the view that markets in votes should be institutionally facilitated—they cannot simply try to shift the burden of proof onto those who oppose them. This is bad news for those who defend the legalization of vote-buying, for none of the positive arguments that Freiman has offered in favor of the legalization of this type of vote-buying are sound. (shrink)

It is widely accepted that a person can be harmed by events that occur after her death. The most influential account of how persons can suffer such posthumous harm has been provided by George Pitcher and Joel Feinberg. Yet, despite its influence (or perhaps because of it) the Feinberg-Pitcher account of posthumous harm has been subject to several well-known criticisms. Surprisingly, there has been no attempt to defend this account of posthumous harm against these criticisms, either by philosophers who work (...) on the metaphysics of death or by those who draw upon this account of posthumous harm in their work in other philosophical fields. This paper will rectify this omission, by defending this view against the criticisms it has been subject to—a defense that will both be of intrinsic interest to those who work on the metaphysics of death and that will remedy the lacunae in the wide-ranging philosophical literature that draws upon this account of how posthumous harm is possible. (shrink)

One of the most widespread objections to legalizing a market in human organs is that such legalization would stimulate the black market in human organs. Unfortunately, the proponents of this argument fail to explain how such stimulation will occur. To remedy thus, two accounts of how legalizing markets in human organs could stimulate the black market in them are developed in this paper. Yet although these accounts remedy the lacuna in the anti-market argument from the black market neither of them (...) provide reason to believe that legalizing an organ markets would stimulate the black market in organs. Despite its prevalence, then, the argument from the black market should be rejected. (shrink)

In a recent series or books and articles Jason Brennan and Peter M. Jaworski have developed criticisms of what they term “semiotic” arguments. They hold that these arguments are widely used both to criticize markets in certain goods, to defend democracy, and criticize epistocracy. Their work on semiotics is now widely cited. In this paper I argue that there is no reason to believe that any defenders of democracy or critics of epistocracy have offered semiotic arguments for their positions. I (...) then explain how the operation of academic incentives has led to this being overlooked by both Brennan and Jaworski and their critics. I conclude with suggestions for how to revise peer review so that such errors are less likely to be made in the future. (shrink)

In this paper I argue that the free-market provision of health care is both practical and morally sound, and is superior in both respects to its provision by the State. The State provision of health care will be inefficient compared to its free-market alternative. It will thus provide less health care to persons for the same amount of expenditure, and so save fewer lives and alleviate less suffering for two reasons: state actors have no incentive to husband their resources effectively, (...) and that in a non-market setting, special interest groups can capture resources through lobbying, perverting them away from their efficient allocation. Given these considerations of efficiency a utilitarian should morally prefer the free-market provision of health care to its State-based rival. Furthermore, even if one is not a utilitarian, the free-market provision of health care will be more morally sound than its State-based alternative because it will likely better respect the autonomy of persons, and will better refrain from imposing values upon persons. With these points in hand, I address two prominent objections to a free market system of health care. (shrink)

In 'Stakes and Kidneys' the author discusses various ethical issues surrounding the international trade in human organs.

Markets have long had a whiff of sulphur about them. Plato condemned innkeepers, whose pursuit of profit he believed led them to take advantage of their customers, Aristotle believed that the pursuit of profit was indicative of moral debasement, and Cicero held that retailers are typically dishonest as this was the only path to gain. And even those who are more favorably disposed towards markets in general are frequently inclined to be suspicious of markets in medical goods and services. For (...) example, Margaret Thatcher supported the legal prohibition of markets in kidneys despite being arguably the most pro-market Prime Minister the United Kingdom saw in the 20th century. (shrink)

In 2013 the World Health Organization published a Report in which it was argued that countries should become self-sufficient in safe blood and blood products, and that these should be secured through voluntary non-remunerated donation. These two claims were putatively supported by a wealth of citations to peer-reviewed academic papers, the results of Royal Commissions and Public Inquiries in both Canada and the United Kingdom, and data collected from Non-Government Organizations. Yet not only do many of the sources cited by (...) the authors of this WHO Report fail to support their conclusions, many support conclusions that are the opposite of those that they draw. The aim of this paper is not, however, to argue against the conclusions of this Report. Instead, it is to argue that its authors were culpably negligent in its writing, in that they failed to take reasonable care to ensure that their conclusions were supported by the evidence, and in so doing exposed third parties to risks of harm to which they had not consented. (shrink)

Many people attempt to give meaning to their lives by pursuing projects that they believe will bear fruit after they have died. Knowing that their death will preclude them from protecting or promoting such projects people who draw meaning from them will often attempt to secure their continuance by securing promises from others to serve as their caretakers after they die. But those who rely on such are faced with a problem: None of the four major accounts that have been (...) developed to explain directed promissory obligation support the view that we are obligated to keep our promises to persons who are now dead. But I will provide hope for those who wish to use such promises to protect the meaning with which they have endowed their lives. I will argue that while we cannot wrong a person who is now dead by breaking a promise made to her during her life, we could wrong the living by so doing. We thus have reason to keep the promises that we made to those who are now dead. (shrink)

Schweda and Schicktanz argue that the debate over the ethics of using financial incentives to procure human transplant organs rests on socioempirical premises that need to be critically assessed. They contend that once this is achieved a completely new perspective on the debate should be adopted, with organ donation being viewed primarily as a reciprocal social interaction between donor and recipient. This paper challenges this conclusion, arguing that rather than supporting a new perspective on the debate over the commercial procurement (...) of organs, the observations of Schweda and Schicktanz support the view that human organs should be commercialized. (shrink)

In ‘Three Arguments Against Prescription Requirements’, Jessica Flanigan argues that ‘prescription drug laws violate patients' rights to self-medication’ and that patients ‘have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent , claiming that the strongest of these reasons is grounded on the value of autonomy. However, close examination of the moral value of autonomy shows that rather than being the strongest justification for the DIC, respect for the (...) value of autonomy is actually the weakest, and it is dependent upon the first two well-being-based justifications for the DIC. Recognising this has important implications for Flanigan's argument against prescription requirements. (shrink)

Teck Chuan Voo and Soren Holm argue that “organs should be inheritable if they were to be socially and legally recognised as tradable property.”1 To support this view they first observe that “…legal recognition of objects as property… opens up the possibility of the legal recognition of the survival of the property rights and their inheritability after the death of the source/owner, even if those rights are intimately bound with the person.”1 They also note that if organs are tradable property (...) then they could be sold by their current owners for removal by the buyer after the original owner dies. Having established that a person's property rights in her organs should be respected in this way if organs are tradable property, Voo and Holm hold that “[p]rima facie, organs should be disposable by testation”.1 They believe that this claim is supported by the same consequentialist reasons that support organs being recognised as tradable property: that this increases persons’ freedom and control over their organs, and increases transfers of transplantable organs to persons who need them. But while these reasons support recognising organs as tradable property, they do not support their being …. (shrink)

It is widely believed that the nature of love and friendship precludes them from being bought or sold. It will be argued in this paper that this view is false: There is no conceptual bar to the commodification of love and friendship. The arguments offered for this view will lead to another surprising conclusion: That these goods are asymmetrically alienable goods, goods whose nature is such that separate arguments must be provided for the views that they can be bought and (...) sold. The possibility of asymmetric alienability has not yet been recognized in the literature on commodification. (shrink)

In a recent paper entitled “The Case for Colonialism” Bruce Gilley argued that Western colonialism was “as a general rule” both beneficial to those subject to it and considered by them to be legitimate. He then advocated for a return to the Western colonization of the Third World. Gilley’s article provoked a furious response, with calls for its retraction being followed by the resignation of much of the publishing journal’s editorial board. In this paper I note that Gilley’s article meets (...) none of the criteria required to justify its retraction, and that instead of retracting it it should be rebutted. I then argue that his arguments against those who oppose colonialism are all fatally flawed, and that he has provided no justification for his claims that colonialism was either beneficial to those who lived under it, or considered by them to be legitimate. (shrink)

Jason Brennan and Peter M. Jaworski have recently developed an argument against semiotic objections to markets. They argue that all such semiotic arguments are unsound because they fail to recognize that the meaning of market transactions is a contingent socially-constructed fact. They attribute this type of argument to Debra Satz. This paper argues both that Brennan and Jaworski are mistaken to attribute this particular semiotic objection to Satz and that they are mistaken to attribute to her a semiotic objection of (...) this type. It then argues that Brennan and Jaworski have fundamentally misunderstood the nature of Satz’s project. It concludes by defending Satz against Brennan and Jaworski’s charge that one of her criticisms of markets is based on an equivocation. (shrink)

Petersen and Lippert-Rasmussen argue that persons who decide to be organ donors should receive a tax break, and then defend their view against eight possible objections. However, they misunderstand the Titmuss-style concerns that might be raised against their proposal. This does not mean that it should be rejected, but, instead, that when it is reconfigured to meet the Titmuss-style charges against it, they should support legalizing markets in human organs rather than merely offering tax breaks to encourage their donation.

In 1998, The Lancet published a research paper by Andrew Wakefield that provided support to the formerly-discredited theory that the Measles, Mumps, Rubella (MMR) vaccine could cause colitis and autism spectrum disorders (Wakefield et al. 1998). Although this paper was fully retracted in 2010 after being exposed as fraudulent, it served as a catalyst for concerns about the safety of vaccination, both the MMR vaccine in particular and vaccination in general. While the scientific consensus concerning both the MMR vaccine and (...) others that are routinely provided to persons in developed Western countries is that the benefits of receiving them far outweigh the risks, there is still serious concern on the part of some parents about the safety of vaccinating their children. Moreover, in addition to concerns about the safety of vaccination some parents are concerned about the effects that receiving certain vaccinations will have upon their childrens’ volitional actions. For example, the possibil. (shrink)