56 found
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  1. Autonomy, Rationality, and Contemporary Bioethics.Jonathan Pugh - 2020 - Oxford, UK: Oxford University Press.
    Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...)
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  2.  56
    The unnaturalistic fallacy: COVID-19 vaccine mandates should not discriminate against natural immunity.Jonathan Pugh, Julian Savulescu, Rebecca C. H. Brown & Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (6):371-377.
    COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the (...)
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  3. The Ethics of Deep Brain Stimulation for the Treatment of Anorexia Nervosa.Hannah Maslen, Jonathan Pugh & Julian Savulescu - 2015 - Neuroethics 8 (3):215-230.
    There is preliminary evidence, from case reports and investigational studies, to suggest that Deep Brain Stimulation could be used to treat some patients with Anorexia Nervosa. Although this research is at an early stage, the invasive nature of the intervention and the vulnerability of the potential patients are such that anticipatory ethical analysis is warranted. In this paper, we first show how different treatment mechanisms raise different philosophical and ethical questions. We distinguish three potential mechanisms alluded to in the neuroscientific (...)
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  4.  54
    Clarifying the Normative Significance of ‘Personality Changes’ Following Deep Brain Stimulation.Jonathan Pugh - 2020 - Science and Engineering Ethics 26 (3):1655-1680.
    There is evidence to suggest that some patients who undergo Deep Brain Stimulation can experience changes to dispositional, emotional and behavioural states that play a central role in conceptions of personality, identity, autonomy, authenticity, agency and/or self. For example, some patients undergoing DBS for Parkinson’s Disease have developed hypersexuality, and some have reported increased apathy. Moreover, experimental psychiatric applications of DBS may intentionally seek to elicit changes to the patient’s dispositional, emotional and behavioural states, in so far as dysfunctions in (...)
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  5. The Moral Imperative to Continue Gene Editing Research on Human Embryos.Julian Savulescu, Jonathan Pugh, Thomas Douglas & Chris Gyngell - 2015 - Protein Cell 6 (7):476–479.
    The publication of the first study to use gene editing techniques in human embryos (Liang et al., 2015) has drawn outrage from many in the scientific community. The prestigious scientific journals Nature and Science have published commentaries which call for this research to be strongly discouraged or halted all together (Lanphier et al., 2015; Baltimore et al., 2015). We believe this should be questioned. There is a moral imperative to continue this research.
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  6.  33
    Green bioethics, patient autonomy and informed consent in healthcare.David B. Resnik & Jonathan Pugh - 2024 - Journal of Medical Ethics 50 (7):489-493.
    Green bioethics is an area of research and scholarship that examines the impact of healthcare practices and policies on the environment and emphasises environmental values, such as ecological sustainability and stewardship. Some green bioethicists have argued that healthcare providers should inform patients about the environmental impacts of treatments and advocate for options that minimise adverse impacts. While disclosure of information pertaining to the environmental impacts of treatments could facilitate autonomous decision-making and strengthen the patient–provider relationship in situations where patients have (...)
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  7.  57
    Evidence-Based Neuroethics, Deep Brain Stimulation and Personality - Deflating, but not Bursting, the Bubble.Jonathan Pugh, Laurie Pycroft, Hannah Maslen, Tipu Aziz & Julian Savulescu - 2018 - Neuroethics 14 (1):27-38.
    Gilbert et al. have raised important questions about the empirical grounding of neuroethical analyses of the apparent phenomenon of Deep Brain Stimulation ‘causing’ personality changes. In this paper, we consider how to make neuroethical claims appropriately calibrated to existing evidence, and the role that philosophical neuroethics has to play in this enterprise of ‘evidence-based neuroethics’. In the first half of the paper, we begin by highlighting the challenges we face in investigating changes to PIAAAS following DBS, explaining how different trial (...)
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  8. Moral Bio-enhancement, Freedom, Value and the Parity Principle.Jonathan Pugh - 2019 - Topoi 38 (1):73-86.
    A prominent objection to non-cognitive moral bio-enhancements is that they would compromise the recipient’s ‘freedom to fall’. I begin by discussing some ambiguities in this objection, before outlining an Aristotelian reading of it. I suggest that this reading may help to forestall Persson and Savulescu’s ‘God-Machine’ criticism; however, I suggest that the objection still faces the problem of explaining why the value of moral conformity is insufficient to outweigh the value of the freedom to fall itself. I also question whether (...)
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  9. Justifications for Non-­Consensual Medical Intervention: From Infectious Disease Control to Criminal Rehabilitation.Jonathan Pugh & Thomas Douglas - 2016 - Criminal Justice Ethics 35 (3):205-229.
    A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of (...)
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  10.  36
    The morally disruptive future of reprogenetic enhancement technologies.Jon Rueda, Jonathan Pugh & Julian Savulescu - 2022 - Trends in Biotechnology.
    Emerging reprogenetic technologies may enable the enhancement of our offspring's genes. Beyond raising ethical questions, these biotechnologies may change some aspects of future morality. In the reproductive field, biotechnological innovations may transform moral views about reproductive choices regarding what we consider to be just or even of equal standing.
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  11.  36
    Genetic information, insurance and a pluralistic approach to justice.Jonathan Pugh - 2021 - Journal of Medical Ethics 47 (7):473-479.
    The use of genetic testing has prompted the question of whether insurance companies should be able to use predictive genetic test results (GTRs) in their risk classification of clients. While some jurisdictions have passed legislation to prohibit this practice, the UK has instead adopted a voluntary code of practice that merely restricts the ways in which insurance companies may use GTRs. Critics have invoked various theories of justice to argue that this approach is unfair. However, as well as sometimes relying (...)
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  12.  53
    The child's right to bodily integrity and autonomy: A conceptual analysis.Jonathan Pugh - forthcoming - Clinical Ethics.
    It is widely accepted that children enjoy some form of a right to bodily integrity. However, there is little agreement about the precise nature and scope of this right. This paper offers a conceptual analysis of the child's right to bodily integrity, in order to further elucidate the relationship between the child's right to bodily integrity and considerations of autonomy. Following a discussion of Leif Wenar's work on the structure and justification of rights, I first explain how the adult's right (...)
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  13.  75
    No going back? Reversibility and why it matters for deep brain stimulation.Jonathan Pugh - 2019 - Journal of Medical Ethics 45 (4):225-230.
    Deep brain stimulation (DBS) is frequently described as a ‘reversible’ medical treatment, and the reversibility of DBS is often cited as an important reason for preferring it to brain lesioning procedures as a last resort treatment modality for patients suffering from treatment-refractory conditions. Despite its widespread acceptance, the claim that DBS is reversible has recently come under attack. Critics have pointed out that data are beginning to suggest that there can be non-stimulation-dependent effects of DBS. Furthermore, we lack long-term data (...)
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  14. Compulsory medical intervention versus external constraint in pandemic control.Thomas Douglas, Lisa Forsberg & Jonathan Pugh - 2020 - Journal of Medical Ethics 47 (12).
    Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...)
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  15. Neuro-interventions as Criminal Rehabilitation: An Ethical Review.Jonathan Pugh & Thomas Douglas - 2016 - In Jonathan Jacobs & Jonathan Jackson (eds.), The Routledge Handbook of Criminal Justice Ethics. Routledge.
    According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...)
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  16. Driven to extinction? The ethics of eradicating mosquitoes with gene-drive technologies.Jonathan Pugh - 2016 - Journal of Medical Ethics 42 (9):578-581.
    Mosquito-borne diseases represent a significant global disease burden, and recent outbreaks of such diseases have led to calls to reduce mosquito populations. Furthermore, advances in ‘gene-drive’ technology have raised the prospect of eradicating certain species of mosquito via genetic modification. This technology has attracted a great deal of media attention, and the idea of using gene-drive technology to eradicate mosquitoes has been met with criticism in the public domain. In this paper, I shall dispel two moral objections that have been (...)
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  17.  37
    Vaccine mandates for healthcare workers beyond COVID-19.Alberto Giubilini, Julian Savulescu, Jonathan Pugh & Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (3):211-220.
    We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members (...)
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  18. Risk assessment tools in criminal justice and forensic psychiatry: The need for better data.Thomas Douglas, Jonathan Pugh, Illina Singh, Julian Savulescu & Seena Fazel - 2017 - European Psychiatry 42:134-137.
    Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.
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  19. Coercion and the Neurocorrective Offer.Jonathan Pugh - 2018 - In David Birks & Thomas Douglas (eds.), Treatment for Crime: Philosophical Essays on Neurointerventions in Criminal Justice. Oxford: Oxford University Press.
    According to what Douglas calls ‘the consent requirement’, neuro-correctives can only permissibly be provided with the valid consent of the offender who will undergo the intervention. Some of those who endorse the consent requirement have claimed that even though the requirement prohibits the imposition of mandatory neurocorrectives on criminal offenders, it may yet be permissible to offer offenders the opportunity to consent to undergoing such an intervention, in return for a reduction to their penal sentence. I call this the neurocorrective (...)
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  20. ‘Drugs That Make You Feel Bad’? Remorse-Based Mitigation and Neurointerventions.Jonathan Pugh & Hannah Maslen - 2017 - Criminal Law and Philosophy 11 (3):499-522.
    In many jurisdictions, an offender’s remorse is considered to be a relevant factor to take into account in mitigation at sentencing. The growing philosophical interest in the use of neurointerventions in criminal justice raises an important question about such remorse-based mitigation: to what extent should technologically facilitated remorse be honoured such that it is permitted the same penal significance as standard instances of remorse? To motivate this question, we begin by sketching a tripartite account of remorse that distinguishes cognitive, affective (...)
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  21. Beyond Individual Triage: Regional Allocation of Life-Saving Resources such as Ventilators in Public Health Emergencies.Jonathan Pugh, Dominic Wilkinson, Cesar Palacios-Gonzalez & Julian Savulescu - 2021 - Health Care Analysis 29 (4):263-282.
    In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...)
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  22.  55
    Brainjacking in deep brain stimulation and autonomy.Jonathan Pugh, Laurie Pycroft, Anders Sandberg, Tipu Aziz & Julian Savulescu - 2018 - Ethics and Information Technology 20 (3):219-232.
    'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...)
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  23.  81
    Neurostimulation, doping, and the spirit of sport.Jonathan Pugh & Christopher Pugh - 2020 - Neuroethics 14 (2):141-158.
    There is increasing interest in using neuro-stimulation devices to achieve an ergogenic effect in elite athletes. Although the World Anti-Doping Authority does not currently prohibit neuro-stimulation techniques, a number of researchers have called on WADA to consider its position on this issue. Focusing on trans-cranial direct current stimulation as a case study of an imminent so-called ‘neuro-doping’ intervention, we argue that the emerging evidence suggests that tDCS may meet WADA’s own criteria for a method’s inclusion on its list of prohibited (...)
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  24. Cohen’s Conservatism and Human Enhancement.Jonathan Pugh, Guy Kahane & Julian Savulescu - 2013 - The Journal of Ethics 17 (4):331-354.
    In an intriguing essay, G. A. Cohen has defended a conservative bias in favour of existing value. In this paper, we consider whether Cohen’s conservatism raises a new challenge to the use of human enhancement technologies. We develop some of Cohen’s suggestive remarks into a new line of argument against human enhancement that, we believe, is in several ways superior to existing objections. However, we shall argue that on closer inspection, Cohen’s conservatism fails to offer grounds for a strong sweeping (...)
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  25. The Moral Obligation to Prioritize Research Into Deep Brain Stimulation Over Brain Lesioning Procedures for Severe Enduring Anorexia Nervosa.Jonathan Pugh, Jacinta Tan, Tipu Aziz & Rebecca J. Park - 2018 - Frontiers in Psychiatry 9:523.
    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, (...)
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  26.  27
    Rethinking techno-moral disruption in bioethics, society, and justice.Jon Rueda, Jonathan Pugh & Julian Savulescu - 2023 - Trends in Biotechnology 41 (6):743-744.
    In response to De Proost and Segers, we provide further reflections on how technologies induce moral change. We discuss moral changes at the societal level as distinguished from changes in bioethical principles or ethical concepts, impacts on theories of justice, and whether the transformations are negative or positive.
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  27. Ravines and Sugar Pills: Defending Deceptive Placebo Use.Jonathan Pugh - 2015 - Journal of Medicine and Philosophy 40 (1):83-101.
    In this paper, I argue that deceptive placebo use can be morally permissible, on the grounds that the deception involved in the prescription of deceptive placebos can differ in kind to the sorts of deception that undermine personal autonomy. In order to argue this, I shall first delineate two accounts of why deception is inimical to autonomy. On these accounts, deception is understood to be inimical to the deceived agent’s autonomy because it either involves subjugating the deceived agent’s will to (...)
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  28.  27
    The Need for Further Fine-Grained Distinctions in Discussions of Authenticity and Deep Brain Stimulation.Jonathan Pugh, Hannah Maslen & Julian Savulescu - 2017 - American Journal of Bioethics Neuroscience 8 (3):W1-W3.
  29.  28
    Lies of Omission and Commission, Providing and Withholding Treatment, Local and Global Autonomy – There Are Reasons for Clinical Ethicists to Attend to All of These Distinctions.Jonathan Pugh - 2021 - American Journal of Bioethics 21 (5):43-45.
    Meyers argues that clinical ethicists should sometimes be active participants in the deception of patients and families, whether that involves lies of omission or commission. I shall...
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  30. Autonomy, Natality and Freedom: A Liberal Re‐examination of Habermas in the Enhancement Debate.Jonathan Pugh - 2015 - Bioethics 29 (3):142-152.
    Jurgen Habermas has argued that carrying out pre-natal germline enhancements would be inimical to the future child's autonomy. In this article, I suggest that many of the objections that have been made against Habermas' arguments by liberals in the enhancement debate misconstrue his claims. To explain why, I begin by explaining how Habermas' view of personal autonomy confers particular importance to the agent's embodiment and social environment. In view of this, I explain that it is possible to draw two arguments (...)
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  31.  80
    Enhancing Autonomy by Reducing Impulsivity: The Case of ADHD.Jonathan Pugh - 2014 - Neuroethics 7 (3):373-375.
    In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in claiming that (...)
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  32.  11
    Genetic exceptionalism, revisionism, pluralism and convergence in the ethics of insurance: response to commentators.Jonathan Pugh - 2022 - Journal of Medical Ethics 48 (11):879-880.
    I would like to begin by thanking all of the commentators for their insightful analyses of ‘Genetic information, insurance and a pluralistic approach to justice’; I learnt a great deal from them all. Naturally, I cannot do justice to all of their criticisms in this brief response; instead, I shall use their remarks to prompt some clarificatory points about my arguments in the hope that this will help readers to draw their own conclusions about the various points of disagreement. My (...)
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  33.  48
    Navigating individual and collective interests in medical ethics.Jonathan Pugh - 2018 - Journal of Medical Ethics 44 (1):1-2.
    In medical ethics, we are often concerned with questions that pertain predominantly to the treatment of a particular individual. However, in a number of cases it is crucial to broaden the scope of our moral inquiry beyond consideration of the individual alone, since the interests of the individual can come into conflict with the interests of the wider community. How should we resolve such conflicts between the interests of the individual and the collective? Most readers of this journal will likely (...)
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  34.  23
    Sense and sensitivity: can an inaccurate test be better than no test at all?Jonathan Pugh, Dominic Wilkinson & Julian Savulescu - 2022 - Journal of Medical Ethics 48 (5).
    The UK government has put lateral flow antigen tests at the forefront of its strategy to scale-up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggested that the test missed over half of the positive cases in the tested population. This raises the question of whether it can be ethical to use an inaccurate test to guide public health measures. We begin by explicating different dimensions of test (...)
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  35.  59
    Authenticity and the Stimulated Self: Neurosurgery for Anorexia Nervosa.Hannah Maslen, Jonathan Pugh & Julian Savulescu - 2015 - American Journal of Bioethics Neuroscience 6 (4):69-71.
    Müller and colleagues (2015) address a range of ethical considerations associated with neurosurgical interventions for the treatment of anorexia nervosa (AN), arguing for several protective measures to safeguard clinical research and practice. This is an important article, which provides a thorough review of current neurosurgical research and presents key insights into challenges associated with compromised decision-making capacities in the context of AN and the early average age of onset. However, it is somewhat striking that they neither use nor examine the (...)
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  36.  76
    Lay attitudes toward deception in medicine: Theoretical considerations and empirical evidence.Jonathan Pugh, Guy Kahane, Hannah Maslen & Julian Savulescu - 2016 - AJOB Empirical Bioethics 7 (1):31-38.
    Background: There is a lack of empirical data on lay attitudes toward different sorts of deception in medicine. However, lay attitudes toward deception should be taken into account when we consider whether deception is ever permissible in a medical context. The objective of this study was to examine lay attitudes of U.S. citizens toward different sorts of deception across different medical contexts. Methods: A one-time online survey was administered to U.S. users of the Amazon “Mechanical Turk” website. Participants were asked (...)
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  37. Unexpected Complications of Novel Deep Brain Stimulation Treatments: Ethical Issues and Clinical Recommendations.Hannah Maslen, Binith Cheeran, Jonathan Pugh, Laurie Pycroft, Sandra Boccard, Simon Prangnell, Alexander Green, James FitzGerald, Julian Savulescu & Tipu Aziz - 2018 - Neuromodulation 21 (2).
    Background -/- Innovative neurosurgical treatments present a number of known risks, the natures and probabilities of which can be adequately communicated to patients via the standard procedures governing obtaining informed consent. However, due to their novelty, these treatments also come with unknown risks, which require an augmented approach to obtaining informed consent. -/- Objective -/- This paper aims to discuss and provide concrete procedural guidance on the ethical issues raised by serious unexpected complications of novel deep brain stimulation treatments. -/- (...)
     
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  38.  63
    Coercive paternalism and back-door perfectionism.Jonathan Pugh - 2014 - Journal of Medical Ethics 40 (5):350-351.
    In this response piece, I argue that the ‘coercive paternalism’ that Sarah Conly endorses in her book Against Autonomy veers towards a back-door perfectionism. Although Conly points out that coercive paternalism does not mandate the imposition of alien values upon us in the same way that perfectionism does, I argue that coercive paternalism might yet impose an alien weighting of our own values; this, I suggest, means that coercive paternalism remains perfectionist in spirit, if not in letter. I go on (...)
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  39. Deep brain stimulation and revising the Mental Health Act: the case for intervention-specific safeguards.Jonathan Pugh, Tipu Aziz, Jonathan Herring & Julian Savulescu - 2018 - British Journal of Psychiatry 214 (3).
    Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.
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  40. Exploring the Ethics of Tuberculosis Human Challenge Models.Abie Rohrig, Josh Morrison, Jonathan Pugh, Julian Savulescu & Helen McShane - manuscript
    TB human challenge studies could accelerate TB vaccine development by reducing uncertainty in early-stage vaccine testing, selecting promising vaccine candidates for large-scale field trials, and identifying an immune correlate of protection. However, ethical concerns regarding the exposure of trial participants and bystanders to significant risk have been a limiting factor for TB human challenge models. We analyze the expected social value and risks of different types of TB human challenge models, and conclude that given the massive public health burden of (...)
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  41.  16
    Exploring the ethics of tuberculosis human challenge models.Abie Rohrig, Josh Morrison, Gavriel Kleinwaks, Jonathan Pugh, Helen McShane & Julian Savulescu - forthcoming - Journal of Medical Ethics.
    We extend recent conversation about the ethics of human challenge trials to tuberculosis (TB). TB challenge studies could accelerate vaccine development, but ethical concerns regarding risks to trial participants and third parties have been a limiting factor. We analyse the expected social value and risks of different challenge models, concluding that if a TB challenge trial has between a 10% and a 50% chance of leading to the authorisation and near-universal delivery of a more effective vaccine 3–5 years earlier, then (...)
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  42.  20
    Deep Brain Stimulation, Authenticity and Value—CORRIGENDUM.Jonathan Pugh, Hannah Maslen & Julian Savulescu - 2018 - Cambridge Quarterly of Healthcare Ethics 27 (1):179-179.
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  43. Ethical heuristics for pandemic allocation of ventilators across hospitals.César Palacios-González, Jonathan Pugh, Dominic Wilkinson & Julian Savulescu - 2022 - Developing World Bioethics 22 (1):34-43.
    In response to the COVID‐19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important (...)
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  44. Exercise Prescription and The Doctor's Duty of Non-Maleficence.Jonathan Pugh, Christopher Pugh & Julian Savulesu - 2017 - British Journal of Sports Medicine 51 (21):1555-1556.
    An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...)
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  45. The Case against Forced Methadone Detox in the US Prisons.Daniel D’Hotman, Jonathan Pugh & Thomas Douglas - 2019 - Public Health Ethics 12 (1):89-93.
    Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies. Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350–359). This novel evidence raises questions as to the justification for current policies of (...)
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  46.  23
    Tackling the COVID elective surgical backlog: Prioritising need, benefit or equality?Jonathan Pugh, Matthew Seah, Andrew Carr & Julian Savulescu - 2023 - Clinical Ethics 18 (4).
    The National Health Service (NHS) in the UK is currently facing a significant waiting list backlog following the disruption of the COVID-19 pandemic, with millions of patients waiting for elective surgical procedures. Effective treatment prioritisation has been identified as a key element of addressing this backlog, with NHS England's delivery plan highlighting the importance of ensuring that those with ‘the clinically most urgent conditions are diagnosed and treated most rapidly’. Indeed, we describe how the current clinical guidance on prioritisation issued (...)
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  47.  47
    Concerns about eroding the ethical barrier to in vitro eugenics: lessons from the hESC debate.Jonathan Pugh - 2014 - Journal of Medical Ethics 40 (11):737-738.
    In his discussion of in vitrogametogenesis, Rob Sparrow claims that an ethical barrier to development of this technology is that many jurisdictions currently prohibit the practice of creating embryos solely for the purpose of research. However, he suggests that this ethical barrier will soon be eroded, in view of the fact that in vitro gametogenesis could serve as a powerful new technology to overcome infertility. In this commentary, I argue that Sparrow is being overly optimistic in his analysis here. I (...)
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  48.  17
    A principle‐based framework for disclosing a psychosis risk diagnosis.Oliver Y. Zhang, Doug McConnell, Adrian Carter & Jonathan Pugh - 2022 - Bioethics 37 (2):171-182.
    In recent decades, researchers have attempted to prospectively identify individuals at high risk of developing psychosis in the hope of delaying or preventing psychosis onset. These psychosis risk individuals are identified as being in an ‘At-Risk Mental State’ (ARMS) through a standardised psychometric interview. However, disclosure of ARMS status has attracted criticism due to concerns about the risk–benefit ratio of disclosure to patients. Only approximately one quarter of ARMS patients develop psychosis after three years, raising concerns about the unnecessary harm (...)
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  49.  83
    Embryos, The Principle of Proportionality, and the Shaky Ground of Moral Respect.Jonathan Pugh - 2013 - Bioethics 28 (8):420-426.
    The debate concerning the moral permissibility of using human embryos in human embryonic stem cell (hESC) research has long centred on the question of the embryo's supposed right to life. However, in focussing only on this question, many opponents to hESC research have escaped rigorous scrutiny by making vague and unfounded appeals to the concept of moral respect in order to justify their opposition to certain hESC practices. In this paper, I offer a critical analysis of the concept of moral (...)
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  50.  21
    Proportionality, wrongs and equipoise for natural immunity exemptions: response to commentators.Jonathan Pugh, Julian Savulescu, Rebecca C. H. Brown & Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (11):881-883.
    We would like to thank each of the commentators on our feature article for their thoughtful engagement with our arguments. All the commentaries raise important questions about our proposed justification for natural immunity exemptions to COVID-19 vaccine mandates. Thankfully, for some of the points raised, we can simply signal our agreement. For instance, Reiss is correct to highlight that our article did not address the important US-centric considerations she helpfully raises and fruitfully discusses. We also agree with Williams about the (...)
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