In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and (...) make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. (shrink)

Jessica Flanigan defends patients' rights of self-medication on the grounds that same moral reasons against medical paternalism in clinical contexts are also reasons against paternalistic pharmaceutical policies, including prohibitive approval processes and prescription requirements.

Vaccine refusal harms and risks harming innocent bystanders. People are not entitled to harm innocents or to impose deadly risks on others, so in these cases there is nothing to be said for the right to refuse vaccination. Compulsory vaccination is therefore justified because non-vaccination can rightly be prohibited, just as other kinds of harmful and risky conduct are rightly prohibited. I develop an analogy to random gunfire to illustrate this point. Vaccine refusal, I argue, is morally similar to firing (...) a weapon into the air and endangering innocent bystanders. By re-framing vaccine refusal as harmful and reckless conduct my aim is to shift the focus of the vaccine debate from non-vaccinators’ religious and refusal rights to everyone else’s rights against being infected with contagious illnesses. Religious freedom and rights of informed consent do not entitle non-vaccinators to harm innocent bystanders, and so coercive vaccination requirements are permissible for the sake of the potential victims of the anti-vaccine movement. (shrink)

In this essay we argue against preventing people from amassing extreme wealth via increased taxation. The first argument in favor of such a proposal, recently advanced by Ingrid Robeyns (2018), states that billionaires’ resources would be better spent addressing morally important goals such as meeting disadvantaged people’s needs and solving collective action problems. In response to this claim, we argue that billionaires are typically in a better position to benefit the poor and to solve collective action problems than public officials. (...) The second argument in favor of preventing extreme wealth accumulation, advanced by Robeyns and Robert Reich (2018), states that billionaires have an inappropriate amount of influence in public life, which undermines political equality. We argue that corporate leaders tend to be more accountable to their fellow citizens than public officials. We then consider and criticize the objection that billionaires’ success is typically a result of public investment, which entitles public officials to enforce taxes that demand a return on the public investment. (shrink)

_ Source: _Page Count 24 Seat belt mandates seem like a paradigmatic case of justified paternalism. Even those who generally object to paternalism often concede that seat belt laws are justified. Against this near-consensus in favor of mandates, I argue that seat belt laws are unjust and public officials should not enforce them. The most plausible exceptions to a principle of anti-paternalism do not justify seat belt mandates. Some argue that seat belt mandates are not paternalistic because unbelted riders are (...) not fully autonomous. Others claim that the decision to ride unbelted harms other people. Yet these attempts to defend seat belt mandates on non-paternalistic grounds cannot overcome the case against seat belt mandates. I therefore conclude that _even_ seat belt mandates are unjust. With this comprehensive case against seat belt mandates, I demonstrate the more general difficulties in justifying any form of coercive paternalism. (shrink)

I argue that it is permissible for pregnant women to expose their unborn children to risks and injury. I begin with the premise that abortion is permissible. If so, then just as a pregnant woman may permissibly prevent an unborn child from experiencing any future wellbeing, she also may permissibly provide her child relatively poorer prospects for wellbeing. Therefore, it is permissible for pregnant women to take risks and cause prenatal injury. This argument has revisionary implications for policies that prevent (...) medical research and drug use during pregnancy. It also explains why moralistic criticism of pregnant women is unwarranted. (shrink)

Seat belt mandates seem like a paradigmatic case of justified paternalism. Even those who generally object to paternalism often concede that seat belt laws are justified. Against this near-consensus in favor of mandates, I argue that seat belt laws are unjust and public officials should not enforce them. The most plausible exceptions to a principle of anti-paternalism do not justify seat belt mandates. Some argue that seat belt mandates are not paternalistic because unbelted riders are not fully autonomous. Others claim (...) that the decision to ride unbelted harms other people. Yet these attempts to defend seat belt mandates on non-paternalistic grounds cannot overcome the case against seat belt mandates. I therefore conclude that even seat belt mandates are unjust. With this comprehensive case against seat belt mandates, I demonstrate the more general difficulties in justifying any form of coercive paternalism. (shrink)

In this "for and against" book, ethicists Lori Watson and Jessica Flanigan debate the criminalization of sex work. Watson argues for a sex equality approach to prostitution in which buyers are criminalized and sellers are decriminalized, known as the Nordic Model. Flanigan argues that sex work should be fully decriminalized because decriminalization ensures respect for sex workers' and clients' rights, and is more effective than alternative policies.

The choice argument against sweatshop regulations states that public officials should not prohibit workers from accepting jobs that require long hours, low pay, and poor working conditions, because enforcing such regulations would be disrespectful to the workers who choose to work in sweatshops. Critics of the choice argument reply that these regulations can be justified when workers only choose to work in sweatshops because they lack acceptable alternatives and are unable to coordinate to achieve better conditions for all workers. My (...) thesis is that the presence of unacceptable alternatives to sweatshop labor or barriers to coordination cannot justify sweatshop regulations such as minimum wage and maximum hour laws. Although officials should promote alternatives to difficult and dangerous sweatshop labor, they should not do so by limiting workers’ and employers’ options through coercive regulation. And the fact that sweatshop workers may face coordination problems does not undermine the claim that sweatshop workers choose to work in sweatshops, just as other workers face coordination problems but nevertheless make occupational choices. Furthermore, efforts to restrict sweatshop workers’ choices are morally risky and may not promote workers’ wellbeing or wellbeing in general. (shrink)

In this essay, I argue that prescription drug laws violate patients' rights to self-medication. Patients have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent (DIC). Since we should accept the DIC, we ought to reject paternalistic prohibitions of prescription drugs and respect the right of self-medication. In section 1, I frame the puzzle of self-medication; why don't the same considerations that tell in favour of informed consent also (...) justify a right of self-medication? In section 2, I show that the prescription drug system was historically motivated by paternalism. In section 3, I outline the justifications for the DIC in more detail. I show that consequentialist, epistemic, and deontic considerations justify the DIC. In sections 4–6, I argue that these considerations also justify rights of self-medication. I then propose that rights of self-medication require non-prohibitive prescription policies in section 7. I consider two objections in sections 8 and 9: that patients ought not to make medically risky or deadly decisions, and that unrestricted access to prescription-grade pharmaceuticals would result in widespread misuse and abuse. Section 10 concludes. (shrink)

Recent arguments for the basic status of economic liberty can be deployed to show that all liberty is basic. The argument for the basic status of all liberty is as follows. First, John Tomasi’s defense of basic economic liberties is successful. Economic freedom can be further defended against powerful high liberal objections, which libertarians including Tomasi have so far overlooked. Yet arguments for basic economic freedom raise a puzzle about the distinction between basic and non-basic liberties. The same reasons that (...) economic liberties and the traditionally defined list of basic liberties are basic can also be given for all other liberties. Therefore, high liberals and Rawlsian libertarians ought to accept almost all other liberties as basic, even liberties that may strike us as trivial, silly, or unimportant. This claim has revisionary implications for high liberalism. Namely, liberals should endorse strong institutional protections for almost all liberties, even at the expense of other social values. (shrink)

Journal of Political Philosophy, EarlyView.

Public officials should compensate the victims of wrongful conviction and enforcement. The same considerations in favor of compensating people for wrongful conviction and enforcement in other cases support officials’ payment of reparations to the victims of unjust enforcement practices related to the drug war. First, we defend the claim that people who are convicted and incarcerated because of an unjust law are wrongfully convicted. Although their convictions do not currently qualify as wrongful convictions in the legal sense, we argue that (...) the same reasons for legally recognizing other wrongful convictions support conceiving of these cases as wrongful convictions. If so, then people who suffered wrongful convictions associated with unjust laws, like others who were wrongfully convicted, are entitled to compensation and reparation. We then argue that America’s drug laws are unjust laws. Therefore, people who were convicted of nonviolent drug offenses are entitled to compensation. (shrink)

I argue that young patients should be able to access neuroenhancing drugs without a diagnosis of ADHD. The current framework of consent for pediatric patients can be adapted to accommodate neuroenhancement. After a brief overview of pediatric neuroenhancement, I develop three arguments in favor of greater acceptance of neuroenhancement for young patients. First, ADHD is not relevantly different from other disadvantages that could be treated with stimulant medication. Second, establishing a legitimate framework for pediatric neuroenhancement would mitigate the bad effects (...) of diversion and improve research on neuroenhancement and ADHD. Third, some pediatric patients have rights to access neuroenhancements. I then consider several objections to pediatric neuroenhancement. I address concerns about addiction, advertising, authentic development, the parent–child relationship and equal opportunity and conclude that these concerns may inform a framework for prescribing neuroenhancement but they do not justify limits on prescribing. (shrink)

In this essay I argue that the same considerations that justify the strong commitment to anti-paternalism that has been affirmed in bioethics over the past half century, also calls for anti-paternalistic public health policies. First, I frame the puzzle—why are citizens morally entitled to make unhealthy and medically inadvisable decisions as patients but not as consumers? I then briefly sketch the reasons why bioethicists typically reject paternalism. Next, I argue that those same reasons tell against paternalism in public health ethics (...) as well. Patients do not waive their rights to make medically inadvisable decisions when they leave their physician’s care. James Wilson disagrees. After I sketch Wilson’s arguments for paternalism in public health policy, I then argue, contra Wilson, that public health paternalism is wrong for the same reason that medical paternalism is wrong, and that the prevalence of paternalism in public policy does not mean that paternalism is morally permissible. I discuss the state’s authority to enforce paternalistic policies and I sketch an anti-paternalist vision for health policymakers. To close, I consider several objections. (shrink)

Many liberal egalitarians support laws that prevent people from making exploitative and unconscionable contracts. These contracts may include low-wage labor agreements or payday loans, for example. I argue that liberal egalitarians should rethink their support for laws that limit the freedom to make these illiberal contracts, as long as the contracts are voluntary and do not violate people’s other enforceable rights. Paternalistic considerations cannot justify limits on illiberal contracts because they are not only likely to misfire; they also express condescending (...) and inegalitarian judgments of citizens. I then consider Seana Shiffrin’s argument that officials may avoid paternalism while still deterring illiberal contracts if they instead refuse to use public institutions to accommodate contracts that are contrary to the fundamental values on which those institutions are based. This argument encounters a dilemma. Officials may refuse to enforce illiberal contracts and ban private enforcement of illiberal contracts, but this strategy encounters the charges of paternalism it aimed to avoid. Or, officials may refuse to enforce illiberal contracts but tolerate private enforcement, but this approach would make the worst off members of society even more vulnerable and marginalized. Therefore, liberal egalitarians should support public enforcement of illiberal contracts because the alternatives are worse. (shrink)

I argue that public officials and health workers ought to respect and protect women’s rights to make risky choices during childbirth. Women’s rights to make treatment decisions ought to be respected even if their decisions expose their unborn children to unnecessary risks, and even if it is wrong to put unborn children at risk. I first defend a presumption of medical autonomy in the context of childbirth. I then draw on women’s birth stories to show that women’s medical autonomy is (...) often ignored during labor. Medical interventions are performed during childbirth without women’s consent. Childbirth is risky and some coercive medical interventions may be understood as attempts to protect children and to prevent mothers from acting impermissibly. However, even if it is wrong to make risky choices during childbirth, women have rights to do wrong in these cases. Therefore, coercive medical interventions are impermissible during childbirth and institutions should adopt specific protections for obstetric autonomy. (shrink)

:Self-ownership theorists argue that many of our most morally urgent and enforceable rights stem from the fact that we own ourselves. Critics of self-ownership argue that the claim that people own their bodies commits self-ownership theorists to several implausible conclusions because self-ownership theory relies on several vague moral predicates, and any precisification of the required predicates is seemingly too permissive or too restrictive. I argue that this line of criticism does not undermine the case for self-ownership theory because self-ownership theory (...) does not require precisification of each moral concept that it is based on and, even if it did, the theory’s alleged extensional inadequacy does not undermine its justification. (shrink)

Patient-driven drug development is an emerging approach to pharmaceutical research that is forged in rare-disease communities and patient advocacy networks. Patients and their advocates increasingly engage in drug discovery and influence early-stage drug research as clinical trial participants or through compassionate-use programs. Some advocacy groups and patients also influence which therapies are developed by financing promising treatments that otherwise would not secure funding. Though some critics of patient-driven drug development worry about the ethical and scientific implications of this new approach (...) to research, it also has several advantages over the current system. In this essay I argue that patient-driven drug development is morally permissible. (shrink)

University administrators should not enforce speech codes because speech codes are generally counterproductive to a university’s educational mission. In making the case against campus speech codes, we consider and reply to four of the most prominent arguments in favor of restricting student speech. These arguments appeal to the values of harm prevention, inclusive education, relational equality, and the overall promotion of free speech. We show that speech restrictions do not effectively promote these values. We conclude that campus administrators should uphold (...) protections for freedom of expression on college campuses in order to promote a more egalitarian and inclusive learning environment. (shrink)

This book explores our ethical responsibilities regarding health in general and disabilities in particular. Disability studies and human enhancement stand out as two emerging areas of research in medical ethics, prompting debates into ethical questions of identity, embodiment, discrimination, and accommodation, as well as questions concerning distributive justice and limitations on people’s medical rights. Edited by two ethicist philosophers, this book combines their mastery of the theoretical debates surrounding disability and human enhancement with attention to real world questions that health (...) workers and patients may face. By including a wide range of high-quality voices and perspectives, the book provides an invaluable resource for scholars who are working on this important and emerging area of leadership and health care ethics. (shrink)

I argue that asymmetries in taste and talent can explain markets in bodily services, just as they explain other kinds of work. While inequality is a powerful explanation for participation in bodily-service markets, such markets are not unique in their reliance on inequality. Finally, I address another kind of inequality that deserves our attention -- the advantage of the providers of bodily services over those who require them. While those who suffer from infertility or face the terror of organ failure (...) may have a financial advantage over others, they may still be worse off than fertile and organ-rich people who suffer economic or social disadvantage. Egalitarians ought to concern themselves with the whole scope of disadvantage, not just economic disadvantage. (shrink)

Dr Tolga Guven and Dr Gurkan Sert argue the Turkish legal principles do not give clear guidance about the permissibility of medical paternalism. They then argue that the best interpretation of these principles requires respect for patients’ rights. I agree that medical paternalism is wrong, but the truth of this claim does not depend on legal interpretation or medical culture. Further, the antipaternalist thesis of Guven and Sert may command much more extensive reforms than they acknowledge.