In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students’ levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects (...) of the “hidden curriculum,” teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors’ right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. (shrink)

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

There are ethical obligations to conduct research that contributes to generalisable knowledge and improves reproductive health, and this should include embryo research in jurisdictions where it is permitted. Often, the controversial nature of embryo research can alarm ethics committee members, which can unnecessarily delay important research that can potentially improve fertility for patients and society. Such delay is ethically unjustified. Moreover, countries such as the UK, Australia and Singapore have legislation which unnecessarily captures low-risk research, such as observational research, in (...) an often cumbersome and protracted review process. Such countries should revise such legislation to better facilitate low-risk embryo research.We introduce a philosophical distinction to help decision-makers more efficiently identify higher risk embryo research from that which presents no more risks to persons than other types of tissue research. That distinction is between future person embryo research and non-future person embryo research. We apply this distinction to four examples of embryo research that might be presented to ethics committees.Embryo research is most controversial and deserving of detailed scrutiny when it potentially affects a future person. Where it does not, it should generally require less ethical scrutiny. We explore a variety of ways in which research can affect a future person, including by deriving information about that person, and manipulating eggs or sperm before an embryo is created. (shrink)

There are ethical obligations to conduct research that contributes to generalisable knowledge and improves reproductive health, and this should include embryo research in jurisdictions where it is permitted. Often, the controversial nature of embryo research can alarm ethics committee members, which can unnecessarily delay important research that can potentially improve fertility for patients and society. Such delay is ethically unjustified. Moreover, countries such as the UK, Australia and Singapore have legislation which unnecessarily captures low-risk research, such as observational research, in (...) an often cumbersome and protracted review process. Such countries should revise such legislation to better facilitate low-risk embryo research. We introduce a philosophical distinction to help decision-makers more efficiently identify higher risk embryo research from that which presents no more risks to persons than other types of tissue research. That distinction is between future person embryo research and non-future person embryo research. We apply this distinction to four examples of embryo research that might be presented to ethics committees. Embryo research is most controversial and deserving of detailed scrutiny when it potentially affects a future person. Where it does not, it should generally require less ethical scrutiny. We explore a variety of ways in which research can affect a future person, including by deriving information about that person, and manipulating eggs or sperm before an embryo is created. (shrink)

Some of my colleagues will sadly not be attending the IAB World Congress in Qatar. Amongst other things, they wish to take a stand against Qatar’s human rights record and the treatment of women and...

Economic environmental valuation remains a much debated and contested issue. Concerns have been voiced that it is unable to capture the manifold immaterial values of ecosystems due to conceptual and methodological issues. Thus, additional value categories (social values) as well as novel valuation approaches like deliberative (monetary) valuation are areas of growing interest, yet the theoretical foundations are rather weak. Against this background, this article aims to develop a consistent conceptual framework for making sense of social values in economic environmental (...) valuation. Based on a holistic view of society and individuals, the role of institutions, the social environment, culture and transcendental values is emphasised. To synthesise diverging concepts of value into an economic concept and to account for the multidimensionality of social values, the framework consists of three spheres: social, natural and contextual. The novel framework demonstrates that social values may be integrated into a preference-based utility framework when denoting a holistic understanding of social preferences and human embeddedness in nature and society. (shrink)

The knowledge norm of assertion is the subject of a lively debate on when someone is in a position to assert something. However, not much has been said about the logic that underlies such debate. In this paper, I propose a formalisation of the knowledge norm in a deontic logic that aims to be explanatory and conceptually sound. Afterwards, I investigate some problems that this formalisation makes visible. This reveals some significant limitations of the underlying logic: it can neither contain (...) Axiom 4 nor Axiom C4. Moreover, sentences of the form p and I have not asserted that p appear to licence a violation of deontic rules. (shrink)

The simulation hypothesis can reinforce a cynical dismissal of human potential. This attitude can allow online platform designers to rationalize employing manipulative neuromarketing techniques to control user decisions. We point to cognitive boosting techniques at both user and designer levels to build critical reflection and mindfulness.

This essay criticizes the current approach to epistemic democracy. Epistemic democrats are preoccupied with the question of how a society can best exploit a given stock of knowledge. This article argues that the problem-solving capability of a society depends on two factors rather than one. The quality of decision-making depends both on how a democracy is able to make use of its stock of knowledge and on the size of the knowledge stock. Society’s problem-solving capability over time is therefore a (...) function of its ability to develop its knowledge exploitation mechanisms and the growth rate of its knowledge stock. Based on this enhanced model of social problem-solving, this essay compares two different political ideal types: experimental democracy, as commonly defended by epistemic democrats; and polycentric democracy, a model defended most commonly by political economists. (shrink)

In 2002, I wrote an editorial in this Journal arguing that it was time to review the structure and function of ethics committees in the USA, Australia and the UK.1 This followed the deaths of Ellen Roche and Jesse Gelsinger, which were at least in significant part due to the poor functioning of research ethics committees in the USA.2 In the case of Ellen Roche, it was the failure to require a systematic review of the existing literature which led to (...) her death. Iain Chalmers and I had previously documented in 1996 the failure of ethics committees to require systematic review.3 In 1998, at the time of revising the previous guidelines and forming the first Australian National Statement on Research Ethics, I made a public submission to the Australian Health Ethics Committee arguing that the new guidelines for RECs should include a person with skills in conducting systematic reviews of the literature and that the requirement to have a religious representative on the committee be replaced with the requirement to have an ethicist. Neither of these changes was made. I argued, ‘It is time to ask whether institutional RECs should be abandoned in favour of expert committees that cover many institutions—suprainstitutional specialist committees. Supraregional specialist ethics committees could specialise—for example, in genetic research, cancer clinical trials, dermatology, respiratory physiology and each of the specialist areas of medical research. An example of such a committee is provided by the Thoracic Society of Australia and New Zealand research ethics committee, which reviews multicentre trials of respiratory drugs’.4 Around that time, I was involved ‘at the coal face’ as Chair of the Department of Human Services Ethics Committee in Victoria. In a public presentation, I arguedThere are two philosophical views of what ethics review is. On the …. (shrink)

(2001). The Fiction of 'Undue Inducement': Why Researchers Should Be Allowed to Pay Participants Any Amount of Money for Any Reasonable Research Project. The American Journal of Bioethics: Vol. 1, No. 2, pp. 1g-3g.

What, if anything, is the import of Hayek to epistemic democracy? Although Hayek is revered by epistemic democrats for his insights into the epistemic aspects of the market sphere, it is generally believed that his theory is moot with respect to democratic reason. This paper aims to challenge this verdict. I argue that a Hayekian analysis of inclusive public deliberation contributes at least three valuable lessons: (1) Hayek makes the case that under certain conditions even unbiased deliberators are permanently unable (...) to converge on the best available policy option. Call this the problem of ‘persistent hidden policy champions’. (2) He demonstrates that to unlock hidden policy champions, reasonable minority factions need the opportunity to act on their own evidential standards. (3) He challenges epistemic democrats to think more carefully about how to design the “epistemic basic structure” (Kurtulmus and Irzik 2017) of society in order to account for persistent hidden policy champions. (shrink)

One objection to embryonic stem (ES) cell research is that it ‘cannibalizes’ human beings, that is, kills some human beings to benefit others. I grant for argument’s sake that the embryo is a person. Nonetheless, killing it may be justified. I show this through the Embryonic Stem Cell Lottery. Whether killing a person is justified depends on: (1) whether innocent people at risk of being killed for ES cell research also stand to benefit from the research and (2) whether their (...) overall chances of living are higher in a world in which killing and ES cell research is conducted. I call this kind of killing ‘risk reductive.‘. (shrink)

Both Jago, in his 2020 article ‘A short argument for truthmaker maximalism’ and his 2021 article ‘Which Fitch?’, and Loss in his 2021 article ‘There are no fundamental facts’, employ arguments similar to that familiar from the Church–Fitch Paradox to infer some substantial metaphysical claims from their mere logical possibility. Trueman in his 2022 article ‘Truthmaking, grounding and Fitch’s paradox’ and Nyseth in his 2022 article ‘Fitch’s paradox and truthmaking’ respond by using exactly the same kind of argument to prove (...) contrary theses. Intended as bad company objections, these counterarguments cast doubt on the original arguments, but do not actually identify their flaw. This paper aims to fill this gap. (shrink)

In this article, the author argues that there are psychological and biological constraints on our moral behaviour, rational decision-making and capacities to love. For example, low oxytocin levels can constrain our willingness to cooperate with others, and our capacity to maintain long-term loving relationships. There is also evidence that increasing iodine intake can improve a person’s general intelligence, while drugs such as Modafinil can enhance cognitive performance. Savulescu argues that we have a moral obligation to remove those constraints, and that (...) we ought to accept these methods of improving our moral behaviour, decision-making, and cognitive functioning. (shrink)

There is asbestos under the eaves of my house, outside my bedroom and bathroom. Imagine I want to remove it. I know there is a danger with asbestos removal causing asbestosis and mesothelioma. I do...

It is often argued that constitution and causation are different kinds of metaphysical relations. Constitution, like other grounding relations, is assumed to be synchronic, while causation is diachronic. It is this synchronic-diachronic division that, more than other difference-makers, is argued to distinguish grounding relations such as constitution from causation. This paper develops an account of a species of constitution that happens over time. We call this type of constitution, diachronic constitution. We show how diachronic constitution is a consequence of a (...) common type of causation, often ignored in metaphysical discussions of causation: continuous reciprocal causation. Hence, constitution is not only sometimes like causation; it can also be a form of causation. We argue that temporalising the constitution relation is neither as remarkable nor as problematic as it might initially seem. It is inevitable, given local interactions between microscale and macroscale states in dynamical systems. (shrink)

Machine‐learning algorithms have the potential to revolutionise diagnostic and prognostic tasks in health care, yet algorithmic performance levels can be materially worse for subgroups that have been underrepresented in algorithmic training data. Given this epistemic deficit, the inclusion of underrepresented groups in algorithmic processes can result in harm. Yet delaying the deployment of algorithmic systems until more equitable results can be achieved would avoidably and foreseeably lead to a significant number of unnecessary deaths in well‐represented populations. Faced with this dilemma (...) between equity and utility, we draw on two case studies involving breast cancer and melanoma to argue for the selective deployment of diagnostic and prognostic tools for some well‐represented groups, even if this results in the temporary exclusion of underrepresented patients from algorithmic approaches. We argue that this approach is justifiable when the inclusion of underrepresented patients would cause them to be harmed. While the context of historic injustice poses a considerable challenge for the ethical acceptability of selective algorithmic deployment strategies, we argue that, at least for the case studies addressed in this article, the issue of historic injustice is better addressed through nonalgorithmic measures, including being transparent with patients about the nature of the current epistemic deficits, providing additional services to algorithmically excluded populations, and through urgent commitments to gather additional algorithmic training data from excluded populations, paving the way for universal algorithmic deployment that is accurate for all patient groups. These commitments should be supported by regulation and, where necessary, government funding to ensure that any delays for excluded groups are kept to the minimum. We offer an ethical algorithm for algorithms—showing when to ethically delay, expedite, or selectively deploy algorithmic systems in healthcare settings. (shrink)

We review recent research to introduce human brain organoids into the brains of infant rats. This research shows these organoids integrate and function to affect behaviour in rats. We argue that this raises issues of moral status that will imminently arise and must be addressed through functional studies of these new life forms. We situate this research in the broader context of the biological revolution, arguing we already have the technological power to create fully human embodied animals. This raises profound, (...) so far unaddressed ethical issues which call for urgent attention. (shrink)

The death of Socrates is often taken as the starting point for reflection on the relationship between the philosopher and established power. In the Apology, Plato gives an account of Socrates’s own...

In the age of neoliberalism, feminists strongly disagree on the ideal legal status of prostitution while the pro-prostitution lobby endeavours to keep their male-dominated business running smoothly. Feminist debates should be concerned with the sex buyers' belief system about women, which is likely to have practical consequences in the way they behave with women (prostituted and non-prostituted) in terms of sexuality and, therefore, for feminist purposes of equality, on a broader scale. A Critical Discourse Analysis of buyer-authored online reviews of (...) prostituted women provides the opportunity to verify whether the relationship they establish with them is based on democratic mutual equality or gendered power relations driven by domination and subordination.En la era del neoliberalismo, no hay consenso entre las feministas acerca del estatus legal que debería tener la prostitución; mientras, el lobby pro-prostitución intenta proteger tan lucrativo negocio. Los debates feministas deben abordar críticamente el sistema de creencias de los sujetos prostituyentes, en tanto que afecta a cómo actúan con las mujeres (prostituidas y no prostituidas) dentro del marco de la sexualidad y, por tanto, al potencial logro de la igualdad fáctica a nivel social. El análisis crítico del discurso online de los sujetos prostituyentes sobre las mujeres prostituidas permite comprobar si las relaciones que establecen con ellas están basadas en términos igualitarios o en la dicotomía dominación-subordinación característica de las relaciones de poder de género. (shrink)

ABSTRACTThis paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life‐supporting (...) treatment. However, his life may be not worth living. If active euthanasia of %on‐terminal’conditions is prohibited, the option of dying will no longer be available. Taking a rational‘wait and see’course may result in being trapped within an unbearable life. On the other hand, sometimes present practice‘lets nature takes its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty. (shrink)

A popular positivistic line of thinking seems to be cropping up again, declaring that the sciences are on the verge of a paradigmatic shift. One that will merge science and philosophy to finally answer all the great big questions once and for all. Questions such as What is life? What is consciousness? What makes individuals who they are? Why does our universe seem fine-tuned for our existence? How did it all begin? While such questions are undoubtedly important, the truth is, (...) they are essentially philosophical. That is to say, they escape the kind of exactness required of the hard sciences. The upshot is that they are at best only answerable to a limited extent, if they are even answerable at all. (shrink)

In ‘Moral Luck,’ Bernard Williams famously argued that “there is a particularly important species of regret, which I shall call ‘agent-regret,’ which a person can feel only towards his past actions.” Much subsequent commentary has focused on Williams’s claim that agent-regret is not necessarily restricted to voluntary actions, and questioned whether such an attitude could be rationally justified. This focus, however, obscures a more fundamental set of questions raised by Williams’s discussion: what is the role in our moral psychology of (...) evaluative attitudes that relate essentially to past exercises of our agency—occurrences which, by their very nature, cannot be repeated? On a standard conception, regret is directed principally towards actions that resulted from suboptimal deliberation. On this view, the main point of regret is to guide us away from similar poor decisions in the future. But Williams’s key insight in ‘Moral Luck,’ I argue, is that there is a mode of evaluation of one’s past actions and decisions that does not track considerations one could and should have been responsive to at the time, and is for this reason essentially retrospective. From this perspective, the full significance of regret cannot be captured in terms of a disposition to deliberate better in the future. Rather, the particular kind of painful of consciousness of the past embodied in regret amounts to a reflective, and essentially backward-looking, insight into the contingency and finitude of our own agency—that I am a particular person leading a particular life, and that the possibility of leading a different life is now gone forever. I end by making some speculative comments about the intractable question whether it is ultimately good or desirable to be disposed to regret one’s past mistakes. (shrink)

The philosophy of Deleuze is as relevant to contemporary thought as it is obscure and complex. Deleuze at the End of the World guides readers through this maze by exploring the raw material that Deleuze took from thinkers in various fields of knowledge to construct his own concepts, some of them well known (such as Hegel, Kant, Husserl, Balibar and Blanchot) and some widely unexplored (Selme, Guillaume, Bakhtine and Dalcq). At the same time, readers will gain access to Latin American (...) perspectives on contemporary philosophy. (shrink)

”Der ökonomische Markt ist nicht moralfrei“, sagt der angesehene Philosoph Julian Nida-Rümelin und präsentiert sein Modell einer humanen Ökonomie. Er glaubt an eine gut funktionierende Wirtschaftsordnung, die menschengerecht und nachhaltig ausgerichtet ist. Dabei sieht er darin keineswegs eine Utopie, sondern vielmehr eine praktikable Form, die unseren Alltag positiv verändern kann. Dieses Buch richtet sich an diejenigen, die über den Tag hinausdenken wollen, die über die Kritik an dem einen oder anderen gravierenden Fehlverhalten ökonomischer Akteure hinaus eine ethische Perspektive gewinnen wollen, (...) die sich Gedanken machen, wie eine auf Kooperation und moralischen Werten basierende Wirtschaftsordnung in der Weltgesellschaft aussehen könnte. (shrink)

Un conocimiento profundo de la historia y la experiencia de una vida bastante larga han llevado al autor a revisar lo que ha sido la obra y a meditar sobre el estado actual de una de las dimensiones decisivas de la vida humana, uno de los núcleos en torno a los cuales se organiza la vida, y precisamente en sus estratos más profundos, donde se encuentran las raíces de casi todos los demás. Las deficiencias en este aspecto contrastan con el (...) nivel de otros aspectos de nuestro tiempo, en el que se ha llegado a matices de una finura e intensidad que nunca habían sido posibles. Al estudiar esta faceta de la vida humana se comprende la historia de una manera inesperada, y a la vez se siente temor por las posibilidades que se pueden perder. El peligro está en que se pueda decir, con Antonio Machado: "tengo en moneda de cobre el oro de ayer cambiado". Pero siempre se puede hacer la operación inversa y trocar el cobre por una resplandeciente moneda de oro. En esto consiste la educación sentimental. (shrink)

Ziel dieses Papiers ist es die Ordnungsethik – einen bereichsethischen Ansatz, der derzeit vor allem für wirtschaftsethische Fragestellungen benutzt wird – als eine universelle Methode zur Analyse von bereichsethischen Fragestellungen vorzustellen. Um das Vorhaben handhabbar zu machen, muss es in zweierlei Hinsicht eingeschränkt werden. Zum einen kann es sich hier natürlich nicht um eine voll ausgearbeitete Methodologie für die Analyse von bereichsethischen Fragestellungen handeln, sondern nur um eine methodische Skizze. Zum anderen soll es in diesem Papier im Wesentlichen um solche (...) bereichsethischen Fragestellungen gehen, deren Lösung die Implementierung von formellen wie informellen Regeln erfordert. (shrink)

… the decision to genome edit will almost certainly be identity affecting, as a couple (or individual) will usually make it before they have created any embryos and the process itself will, at the...

As they are conventionally formulated, Boolean games assume that players make their choices in ignorance of the choices being made by other players – they are games of simultaneous moves. For many settings, this is clearly unrealistic. In this paper, we show how Boolean games can be enriched by dependency graphs which explicitly represent the informational dependencies between variables in a game. More precisely, dependency graphs play two roles. First, when we say that variable x depends on variable y, then (...) we mean that when a strategy assigns a value to variable x, it can be informed by the value that has been assigned to y. Second, and as a consequence of the first property, they capture a richer and more plausible model of concurrency than the simultaneous-action model implicit in conventional Boolean games. Dependency graphs implicitly define a partial ordering of the run-time events in a game: if x is dependent on y, then the assignment of a value to y must precede the assignment of a value to x; if x and y are independent, however, then we can say nothing about the ordering of assignments to these variables—the assignments may occur concurrently. We refer to Boolean games with dependency graphs as partial-order Boolean games. After motivating and presenting the partial-order Boolean games model, we explore its properties. We show that while some problems associated with our new games have the same complexity as in conventional Boolean games, for others the complexity blows up dramatically. We also show that the concurrency in partial-order Boolean games can be modelled using a closure-operator semantics, and conclude by considering the relationship of our model to Independence-Friendly logic. (shrink)