A number of companies including Google and BMW are currently working on the development of autonomous cars. But if fully autonomous cars are going to drive on our roads, it must be decided who is to be held responsible in case of accidents. This involves not only legal questions, but also moral ones. The first question discussed is whether we should try to design the tort liability for car manufacturers in a way that will help along the development and (...) improvement of autonomous vehicles. In particular, Patrick Lin’s concern that any security gain derived from the introduction of autonomous cars would constitute a trade-off in human lives will be addressed. The second question is whether it would be morally permissible to impose liability on the user based on a duty to pay attention to the road and traffic and to intervene when necessary to avoid accidents. Doubts about the moral legitimacy of such a scheme are based on the notion that it is a form of defamation if a person is held to blame for causing the death of another by his inattention if he never had a real chance to intervene. Therefore, the legitimacy of such an approach would depend on the user having an actual chance to do so. The last option discussed in this paper is a system in which a person using an autonomous vehicle has no duty of interfering, but is still held responsible for possible accidents. Two ways of doing so are discussed, but only one is judged morally feasible. (shrink)

Volume 20, Issue 6, June 2020, Page W1-W5.

Since the 1980s, Islamic scholars and medical experts have used the tools of Islamic law to formulate ethico-legal opinions on brain death. These assessments have varied in their determinations and remain controversial. Some juridical councils such as the Organization of Islamic Conferences' Islamic Fiqh Academy (OIC-IFA) equate brain death with cardiopulmonary death, while others such as the Islamic Organization of Medical Sciences (IOMS) analogize brain death to an intermediate state between life and death. Still (...) other councils have repudiated the notion entirely. Similarly, the ethico-legal assessments are not uniform in their acceptance of brain-stem or whole-brain criteria for death, and consequently their conceptualizations of, brain death. Within the medical literature, and in the statements of Muslim medical professional societies, brain death has been viewed as sanctioned by Islamic law with experts citing the aforementioned rulings. Furthermore, health policies around organ transplantation and end-of-life care within the Muslim world have been crafted with consideration of these representative religious determinations made by transnational, legally-inclusive, and multidisciplinary councils. The determinations of these councils also have bearing upon Muslim clinicians and patients who encounter the challenges of brain death at the bedside. For those searching for ‘Islamically-sanctioned’ responses that can inform their practice, both the OIC-IFA and IOMS verdicts have palpable gaps in their assessments and remain clinically ambiguous. In this paper we analyze these verdicts from the perspective of applied Islamic bioethics and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists. (shrink)

In Section One the automatic ratification of existing law as immediately self-validating is shown to undermine the very purpose of law - the surpassing of arbitrariness and of Czar-like ukases. In Sections Two and Three there is an attempt to explore the justification or grounding that can be given for the existing laws and civil disobedience, respectively. In both cases, the justification has been given in terms of fundamental human dignity which should never be violated by empirical laws. Only when (...) such a violation does occur can civil disobedience be justified. Therefore, the rationale for, and motivation of, both a legal system and civil disobedience are the same.However, one does not so easily resolve the opposition between the two. For the law itself is proclaimed apodictically, without the reservation that one may with impunity break the law and commit an act of civil disobedience whenever the law violates one's conscience. Otherwise, we do not have a rule of law but instead anarchy. For, as Jesus has said and Abraham Lincoln paraphrased it: “A kingdom divided against itself will not stand.” The law cannot declare that it is legal to break the law without incapacitating itself. The law must punish its violators to be a valid law; without powers of enforcing sanctions against violators the law is no law.However, we must not consider for this reason that those who are responsible for making, interpreting, and enforcing the law and those who are civilly disobedient are working at cross purposes. Both are concerned with justice. The civilly disobedient individual is concerned with improving the existing legal system. He envisions his role as therapeutic rather than destructive. He believes that the ideal of justice is being violated in some way in the existing laws. He therefore makes of himself a martyr, bearing witness to the truth, and hoping thereby to educate and enlighten and to move men of good will - in short, to effect a change in the law.Before an individual who respects the rule of law should be willing to be civilly disobedient he must be convinced of the violation of basic human rights in the law. He also must consider whether civil disobedience is the most effective means of producing the desired change. But beyond the pragmatic consideration of the most effective means to produce the desired end, there is also the question of what is most meaningful and suitable for him personally in living in conformity with the categorical imperative. Discussions of civil disobedience which limit themselves to questions of practical consequences do a great disservice to such actions. For, must we not admire those who resisted Hitler, even though they realized that their actions were futile in terms of changing the law and might even mean their deaths?In a free society, dedicated to the rule of law, all citizens are concerned with justice. Those entrusted with the responsibility of enforcing the law obviously must do just that, so that violators of the law have to be punished. However, when legislators and judges notice that some of the most perspicacious and conscientious individuals are openly violating existing laws in the name of a higher law, they should also make a serious reappraisal of their positions, looking to see whether they may not have become morally insensitive or careless. Indeed, the real value of a free society is its flexibility and tolerance of dissent, even that of civil disobedience, which can serve to dramatize forcefully, deep-seated convictions concerning the injustice of certain laws on the books. It is true that fanatics from time immemorial have been willing to sacrifice much in the name of their cause. But whenever one finds that there is an individual who is willing to sacrifice much without the hope of personal advantage and who is also willing to provide arguments in defense of his position, society would do well to listen to his words and actions.Without the constant delving scrutiny and criticism of existing laws, there cannot be true legal responsibility. Therefore, the civilly disobedient individual, who is willing to put his head on the block in order to abrogate unjust laws, is in fact the legally responsible individual par excellence. (shrink)

Cyberbullying has been defined as the “process of using the internet, cell phones or other devices to send or post text or images intended to hurt or embarrass another person.” The word “cyberbullying” is often used interchangeably with “cyber stalking” and in fact the Cybercrimes Act 2015 of Nigeria, uses the word “cyber stalking” which it defines as any course of conduct directed at a specific person that would cause a reasonable person to feel fear. By the provisions of the (...) Act, the transmission of any communication through the means of a computer to bully, threaten or harass another person where such communication places another person in fear of death, violence or bodily harm amounts to cyber stalking. Cyberbullying is becoming a common phenomenon in Nigeria as more people engage in it especially on social media platforms. This is carried out in various ways and a common trend is posting indecent imagery of persons online such as naked pictures or videos of persons in order to humiliate them. When posted by a person, the communication is shared by others thereby causing circulation on social media. This act amounts to cyber stalking where the intention consists of those elements stated under the Cybercrimes Act. In other situations where it is shared without the aim of humiliating the victim, such act can still be incriminated under some other laws in Nigeria such as the Criminal Code Act and the Penal Code Act which for instance both criminalise obscene publications. It is worthy of note there have been reported cases where victims of cyberbullying have committed suicide as a result of fear or shame. A major observation is that cyberbullying has gained normalcy and many internet users engaged in it do not seem to be aware of the criminal connotation of their actions. This paper examines the effectiveness of legal responses to cyberbullying in Nigeria. It discusses the forms of cyberbullying commonly perpetrated in Nigeria by citing some real life instances that have happened in the past. The paper notes that most forms of cyberbullying can be prosecuted under the Cybercrimes Act, however, there has not been any notable enforcement of the law in terms of prosecution of cyberbullying cases. It appears that the lack of prosecution of offenders has fostered the act of cyberbullying especially under the present circumstances where there is widespread ignorance among internet users. The paper also notes that the absence of image rights is a precursor in many respects to some forms of cyberbullying especially when photographs and videos of victims are involved. The paper advocates the implementation and enforcement of the Cybercrimes Act as well as other laws relating to cyberbullying in Nigeria. The paper also posits that the protection of image rights will go a long way to assist in curbing the act of cyberbullying in Nigeria. (shrink)

In 1968 the authors of the so-called Harvard Report, proposed the recognition of an irreversible coma as a new criterion for death. The proposal was accepted by the medical, legal, religious and political circles in spite of the lack of any explanation why the irreversible coma combined with the absence of brainstem reflexes, including the respiratory reflex might be equated to death. Such an explanation was formulated in the President’s Commission Report published in 1981. This document stated, (...) that the brain is the central integrator of the body, therefore the destruction of the brain results in the lack of that integration and the death of the organism. Therefore, according to that document, the so-called “brain dead” patients are really, biologically dead; strictly speaking they are not any more biological organisms but collections of organs and tissues. Their death was masked by the use of the medical equipment, but it was a real, biological death. Thus, the explanation given by the President’s Commission Report constituted a biological rationale for the new concept of death, known as “brain death.” However, after the long discussion, this rationale was refuted because of the evidence given by many medical authorities, that the bodies of the “brain dead” and “brainstem dead” patients are alive. In the context of the discussion about the neurological criteria for death, some authors follow the idea of Plato, that human being is the soul or mind, and the body does not belong to the human essence. Therefore, the loss of consciousness, which may be identified with the mind, constitutes the loss of personhood and may be interpreted as human death. The other group stresses the Aristotelian and Thomistic concept that the body belongs to the essence of every living creature, including human. Therefore, as long as the body is alive, the human being is alive and we cannot call the given patient dead even if he is deeply comatose. Moreover, in spite of the opinions dominating in the mass-media, these patients should be considered not only alive but also may be conscious to some degree and their state can be reversible. Their brains are lacking the electrical functions, but the neuronal tissue is alive and that state is reversible for at least first 48 hours since the onset of coma; this phenomenon is called “global ischemic penumbra” and is responsible for the regularly happening events interpreted as miracles, when some of the “brain dead” or “brainstem dead” patients turn to be alive and come back to normal life. Therefore, the neurological criteria of death are still lacking generally accepted scientific basis and should not be used in medicine and in the legal systems as a basis for diagnosing comatose/having no brainstem reflexes/apneic patients dead. (shrink)

Most legal analyses of selective nontreatment of seriously ill children centre on the question of whether it is in a child’s best interests to be kept alive in the face of extreme suffering and/or an intolerable quality of life. Courts have resisted any direct confrontation with the question of whether the child’s death is in his or her best interests. Nevertheless, representations of death may have an important role to play in this field of jurisprudence. The prevailing (...) philosophy is to configure death as a release from a futile or painful existence and/or as a dignified end in an objectively hopeless situation. However, there can be disagreement about the meaning of death in these settings. Some parents object that death would be premature or that it represents a culpable neglect of their child. A closer examination of these discordant interpretations allows for a better comprehension of the cultural understandings that underscore clinical and legal accounts of death following end-of-life decisions. (shrink)

Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all (...) levels, from global to local.Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher. (shrink)

Pandemics challenge the law and often highlight its strengths or expose its limits. The novel strain of influenza A virus that emerged in the spring of 2009 and rapidly spread around the globe was no exception. The H1N1 pandemic prompted the first significant application of a number of international legal and policy mechanisms that have been developed in the last decade to respond to this kind of event. Furthermore, it presented a considerable test for public health systems at all (...) levels, from global to local.Although initial predictions forecasting high morbidity and mortality from this virus overestimated its eventual impact, the human toll of the pandemic was nevertheless significant. The World Health Organization reported approximately 1.5 million people were infected worldwide in 214 countries, resulting in over 25,000 confirmed deaths, but the actual health impact of the outbreak was certainly much higher. (shrink)

In an earlier paper I argued that we do not have an objective conception of best interests and that this is a particular problem because the courts describe that they use an ‘…objective approach or test. That test is the best interests of the patient’ when choosing for children. I further argued that there was no obvious way in which we could hope to develop an objective notion of best interests. As well as this, I argued that a best-interest-based approach (...) was a particular problem around the time of death of some children. A response from a legal perspective argued that, while there is not a clear conception of objective best interests, the courts have a well-described approach to finding a child's objective best interests. In this paper, I argue that without clear agreement on an objective conception of best interests, the courts are unable to locate an objective sense of best interests and that the solutions do not solve the problems that were identified in the initial paper ‘Death and best interests’. (shrink)

In this article I argue that Part II of the Family LawAct 1996 gives expression to a new form ofresponsibility. I begin by suggesting thatresponsible behaviour has shifted from prohibiting orrequiring particular actions: we now exhibitresponsibility by our attitude towards our actions. I then examine where this new conception ofresponsibility has come from. Through an examinationof the work of post-liberal theorists, principallyMichael Sandel, I argue that a changing view ofpersonhood within post-liberal theory has led to aquestioning of the possibility of (...) choice, and that theabsence of choice necessitates a shift in thedefinition of responsible behaviour. If we are createdby our decisions then we cannot be held to account forour decisions, but only for the care we have takenover them. Responsibility is therefore measured notby our level of self-control but by our level ofself-awareness. Finally I examine the consequences ofthis shift in the meaning of responsibility. Withinthis framework autonomy is illusory thereforedecisions do not need to be respected. This explainswhy the implementation of Part II of the Family LawAct 1996 has been called into question. Within thisframework responsibility is relative therefore itextends indefinitely. This enables the Family Law Actto be uniquely intrusive and judgmental: everydivorcing couple, on being held up to scrutiny, isfound lacking. (shrink)

Mounting evidence documents the extraordinary toll on human health resulting from the consumption of unhealthy food products and physical inactivity. Diseases related to poor nutrition – such as diabetes, heart disease, stroke, and some cancers – are among the leading causes of disability and death in the United States. Poor diet and lack of exercise come second only to tobacco use in actual causes of preventable death in this country. It is estimated that 6% of all adult health (...) care, 7% of Medicare, and 11% of Medicaid expenditures are attributable to obesity. According to the Centers for Disease Control and Prevention, the direct medical cost associated with physical inactivity was nearly $76.6 billion in 2000.In response to America's growing obesity problem, local policymakers have been looking for legal strategies to adopt in their communities to encourage healthful behaviors. Taking the lead from the successful tobacco control movement, nutrition advocates are seeking strategies to “denormalize” unhealthy behaviors, rather than pursuing education-based approaches that encourage individuals to change their own personal behavior. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes (...) and case law, as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes (...) and case law, as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Recently, Canada’s National Post described in detail the death by lethal injection of a 94-year-old man, living alone, who had multiple medical problems but was not terminally ill. His son helped find a physician willing to administer lethal medication soon after his father told him he “wasn’t planning on adding another digit” to his age. The physician who complied with the request is a leading advocate for assisted death in Canada, who reportedly has been responsible for more than (...) 30 life-terminating acts within the few months since the law was passed in June 2016. The son of the man who died by active euthanasia declared, “Dad got the death he wanted.” Should a legal option of... (shrink)

COVID-19 has caused far-reaching humanitarian challenges. Amongst the emerging impacts of the pandemic is on the dynamics of human trafficking. This paper presents findings from a multi-methods study interrogating the impacts of COVID-19 on human trafficking in Sudan—a critical source, destination, and transit country. The analysis combines a systematic evidence review, semi-structured interviews, and a focus group with survivors, conducted between January and May of 2021. We find key risks have been exacerbated, and simultaneously, critical infrastructure for identifying victims, providing (...) support, and ensuring accountability of perpetrators has been impeded. Centrally, the co-occurrence of the pandemic and the democratic transition undercut the institutional and governance capacity, limiting the anti-trafficking response and exposing already vulnerable groups to increased risks of human trafficking. Findings point to increased vulnerabilities for individuals with one or more of the following identities: migrants, refugees, females, and informal labourers. (shrink)

Death, like many social problems, has become medicalized. In response to this medicalization, physician-assisted suicide has emerged as one alternative among many at the end of life. And although the practice is currently legal in the states of Oregon and Washington, opponents still argue that PAS is unethical, is inconsistent with a physician's role, and cannot be effectively regulated. In comparison, Switzerland, like Oregon, permits PAS, but unlike Oregon, non-physicians and private organizations play a significant role in assisted (...) death. Could the Swiss model be the answer? The following essay explores the Swiss model of assisted suicide for its potential to enhance the regulation of PAS, reduce physician involvement, and perhaps demedicalize the way we die. (shrink)

The distinction between killing and letting die has been a controversial element in arguments about the morality of euthanasia and physician-assisted suicide. The killing/letting die distinction is based on causation of death. However, a number of causal factors come into play in any death; it is impossible to state a complete cause of death. I argue that John Mackie’s analysis of causation in terms of ‘inus factors,’ insufficient but nonredundant parts of unnecessary but sufficient conditions, helps us (...) to see that moral responsibility for death cannot rest on causation alone. In specifying the cause of death, some factors can be considered alternatively as either causal factors or merely parts of the presupposed background conditions. If a factor is moved from the background field into the causal field, the result is a changed background field. Comparisons of cases of killing and letting die often do just this; hence, the cases depend on different presuppositions and the causation cannot be directly compared. Moral judgments determine how to apportion factors to the causal and background fields. (shrink)

According to the expressivist objection, laws that only allow assisted dying for those suffering from certain medical conditions express the judgement that their lives are not worth living. I have recently argued that an autonomy-based approach that legally allows assisted suicide for all who make an autonomous request is a way to avoid the expressivist objection. In response to this, Thomas Donaldson has argued that rather than avoiding the expressivist objection, an autonomy-based approach extends this objection. According to Donaldson, this (...) is because helping a person achieve a goal requires endorsement of that goal. In this reply, I show that Donaldson misunderstands the target of the expressivist objection: it is not aimed at an individual’s attitude towards another person’s death but rather at a legal regulation. Moreover, helping someone end their life does not necessarily require endorsing this goal—instead, respect for a person’s autonomous choice can be another reason for providing assisted suicide. Donaldson also assumes that the autonomy-based approach requires doctors to accept autonomous requests for assisted dying. Yet, this approach merely makes it legal for individuals (not necessarily only doctors) to provide assisted suicide to autonomous persons but does not require anyone to do so. (shrink)

Most readers believe that it is difficult, verging on the impossible, to extract concrete prescriptions from the ethics of Emmanuel Levinas. Although this view is largely correct, Levinas’ philosophy can, with some assistance, generate specific duties on the part of legal actors. In this paper, I argue that the fundamental premises of Levinas’ theory of justice can be used to construct a prohibition against capital punishment. After analyzing Levinas’ concepts of justice, responsibility, and interruption, I turn toward his (...) scattered remarks on legal institutions, arguing that they enable a sense of interruption specific to the legal domain. It is here that we find the conceptual resources most important to my Levinasian abolition. I argue that the interruption of legal justice by responsibility implies what I call the principle of revisability. The principle of revisability states a necessary condition of just legal institutions: To be just, legal institutions must ensure the possibility of revising any and all of their rules, principles, and judgments. From this, the argument against capital punishment easily follows. Execution is a legal act, perhaps the only legal act, that cannot be undone. An application of the principle of revisability to this fact leads to the conclusion that legal institutions cannot justly impose capital punishment. After defending these points at length, I conclude with some observations on the consequences of the principle of revisability for law more generally. (shrink)

A major appellate court decision from the United States seriously questions the legal sufficiency of prevailing medical criteria for the determination of death by neurological criteria. There may be a mismatch between legal and medical standards for brain death, requiring the amendment of either or both. In South Australia, a Bill seeks to establish a legal right for a defined category of persons suffering unbearably to request voluntary euthanasia. However, an essential criterion of a voluntary (...) decision is that it is not tainted by undue influence, and this Bill falls short of providing adequate guidance to assess for undue influence. (shrink)

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. (...) Against this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way. (shrink)

When laws or legal principles mention mental states such as intentions to form a contract, knowledge of risk, or purposely causing a death, what parts of the brain are they speaking about? We argue here that these principles are tacitly directed at our prefrontal executive processes. Our current best theories of consciousness portray it as a workspace in which executive processes operate, but what is important to the law is what is done with the workspace content rather than (...) the content itself. This makes executive processes more important to the law than consciousness, since they are responsible for channeling conscious decision-making into intentions and actions, or inhibiting action.We provide a summary of the current state of our knowledge about executive processes, which consists primarily of information about which portions of the prefrontal lobes perform which executive processes. Then we describe several examples in which legal principles can be understood as tacitly singling out executive processes, including principles regarding defendants’ intentions or plans to commit crimes and their awareness that certain facts are the case, as well as excusatory principles which result in lesser responsibility for those who are juveniles, mentally ill, sleepwalking, hypnotized, or who suffer from psychopathy. (shrink)

Background Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians’ attitudes toward assisted death vary across the globe, but little is known about physicians’ actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients’ requests for assisted death in countries where these actions are not legal. Methods A survey (...) including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. Results Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. Conclusions Finnish physicians’ actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal. (shrink)

In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, (...) values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

This Chapter provides a short undergraduate introduction to ethical and philosophical complexities surrounding the law’s attempt (or lack thereof) to regulate artificial intelligence. -/- Swedish philosopher Nick Bostrom proposed a simple thought experiment known as the paperclip maximizer. What would happen if a machine (the “PCM”) were given the sole goal of manufacturing as many paperclips as possible? It might learn how to transact money, source metal, or even build factories. The machine might also eventually realize that humans pose a (...) threat. Humans could turn the machine off at any point, and then it wouldn’t be able to make as many paperclips as possible! Taken to the logical extreme, the result is quite grim—the PCM might even start using humans as raw material for paperclips. -/- The predicament only deepens once we realize that Bostrom’s thought experiment overlooks a key player. The PCM and algorithms like it do not arise spontaneously (at least, not yet). Most likely, some corporation—say, Office Corp.—designed, owns, and runs the PCM. The more paperclips the PCM manufactures, the more profits Office Corp. makes, even if that entails converting some humans (but preferably not customers!) into raw materials. Less dramatically, Office Corp. may also make more money when PCM engages in other socially sub-optimal behaviors that would otherwise violate the law, like money laundering, sourcing materials from endangered habitats, manipulating the market for steel, or colluding with competitors over prices. The consequences are predictable and dire. If Office Corp. isn’t held responsible, it will not stop with the PCM. Office Corp. would have every incentive to develop more maximizers—say for papers, pencils, and protractors. -/- This chapter issues a challenge for tech ethicists, social ontologists, and legal theorists: How can the law help mitigate algorithmic harms without overly compromising the potential that AI has to make us all healthier, wealthier, and wiser? The answer is far from straightforward. (shrink)

The story of Judah and Tamar in Genesis 38 is one of the most intriguing stories in the Hebrew Bible. While it yields many useful insights into the character of God, the nature of sin and the aspiration of our redemption, it is equally offensive when one looks at it from a human rights perspective, considering, in particular, the vulnerable and defenceless woman, Tamar. Her being returned to her father’s house is portrayed as acting in accordance with the law for (...) a childless widow. However, using the critical hermeneutical lens, it becomes apparent that the real motive that drove Judah to send her away was his fear lest his only surviving son Shelah should share the fate of Er and Onan, whose deaths he plainly attributed to Tamar’s doing. As such, Tamar was deprived of the right to marry Shelah as provided for in the levirate marriage law. Using feministic hermeneutics and the comparative approach, this article foregrounds the vulnerability experienced by women, especially when their husbands mysteriously or suddenly pass away. Because of the patriarchal hegemony of African and Israelite societies, childless widows often find themselves ostracised from the same families which they thought they were now part and parcel of by virtue of having married into that family. Much of the ostracism emanates from the fact that they are usually fingered as the prime suspects responsible for having played a part in their husbands’ deaths. Hence, the crux of this article is to present the interface between the Israelite and African worldviews, highlighting the parallels between the plight of widows in the Israelite and Shona societies. (shrink)

Last November, soon after Colorado became the latest state to authorize physician-assisted suicide, National Public Radio's The Diane Rehm Show devoted a segment to legalization of “physician assistance in dying,” a label that refers to both physician-assisted suicide and voluntary active euthanasia. Although the segment initially focused on PAD in the context of terminal illness in general, it wasn't long before PAD's potential application to dementia patients came up. A caller said that her mother had Alzheimer's disease and was being (...) cared for at great expense. Suspecting that she will suffer the same fate, the caller reported that she had included in her will “my specific request that if I should be diagnosed, and it is legal to do so, I would like to opt out of a life and many years of suffering.” A few countries, such as the Netherlands and Belgium, already allow PAD for dementia in certain circumstances. It wouldn't be surprising to see a U.S. legalization effort in the coming years. (shrink)

In this chapter, we consider the plausibility and consequences of the use of the term “honest errors” to describe the accidental killings of civilians resulting from the US military’s drone campaigns in Iraq, Syria, Afghanistan, and elsewhere. We argue that the narrative of “honest errors” unjustifiably excuses those involved in these killings from moral culpability, and reinforces long-standing, pernicious assumptions about the moral superiority of the US military and the inevitability of civilian deaths in combat. Furthermore, we maintain that, given (...) the knowledge-distorting practices within the US military’s organizational structure, few if any civilian deaths from drone strikes meet the criteria of a genuinely morally excusing “honest mistake”. Instead, these accidental killings often reflect objectionable attitudes of relative disregard for the safety of civilians. These attitudes are, we argue, sufficient to warrant the attribution of blame and moral responsibility, both with respect to certain individual actions and with respect to the US military as an institution. In light of this, we propose incorporating a Principle of the Moral Equality of Non-combatants into military assessments of what counts as “acceptable risk” to civilians. This would go some way, we argue, to redressing the ongoing injustice inflicted on the victims of civilian killings by the failure of the US military and US political leadership to take moral responsibility for unjustified civilian deaths. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death Perception:How Temporary Ventilator Disconnection Helped my Family Accept Brain Death and Donate OrgansThomas B. FreemanThe night of my nephew’s closed head injury in Boston, I was on call as a neurosurgeon at Tampa General Hospital. I was therefore not shocked at first when my telephone rang at four o’clock in the morning, but I soon understood the severity of the tragic news. The next half hour (...) was a blur of frantic phone calls and devastating decisions leading to surgery to remove a subdural hematoma from my nephew’s head, even though he was only two brain stem reflexes away from brain death.I thought that my experience as a neurosurgeon would somehow help me. However, when my sister–in–law asked me if this was just like the other tragic closed head injuries that I had seen in 26 years of practice, my answer was very simple: this was the only severe closed head injury I had ever seen—in my family. At this point, I was no longer a neurosurgeon. I was an uncle. My nephew’s closed head injury overwhelmed both his brain’s capacity to survive and my entire family’s ability to think rationally or objectively while grieving so intensely.It is in this context that we were asked to consider organ donation. The appeal for organ donation is one of altruism. My nephew’s parents agreed that organ donation would be an important way to honor their son’s life, allow him to make one final contribution to save the lives of several patients, and help to bring peace to the family.I will never forget, however, my niece’s distraught response. She is altruistic by nature, but was tremendously conflicted by the choice to donate her own brother’s organs. At this point, all discussions about organ donation stopped until we could understand the source of her conflict. Since she did not have legal authority regarding the final decision, some family members wondered if organ donation should be allowed if she could not come to terms with the choice. She felt isolated, because she was the only person in the room who was experiencing conflict. As a neurosurgeon, I have always advised other families in this situation that they may have more peace if they can make such decisions unanimously, regardless of who has the ultimate legal authority for decision–making. This helps bring healing to the family, eliminates disruption of family values and unity, and reduces possible feelings of guilt.I asked my niece what she was feeling. She stated something that I had never heard before as a neurosurgeon. She had listened to the words that her brother was brain dead, but she felt that he was somehow still alive, since he was breathing on a ventilator and his heart was beating. She felt powerless due to her inability to do anything more for [End Page 9] him. She also wanted to be there when her brother “died,” which she would recognize by the cessation of his heartbeat. She would not abandon her brother.I searched for a way to respect my niece’s wishes and her legitimate request, while preserving the ability to proceed with organ donation. Solving this conundrum proved to be a pivotal part of the beginning of both her mourning process and acceptance of his death.As an uncle, I experienced the clear dissociation that modern medicine creates between medical care and the natural human process of recognizing and accepting death. My family observed the subtle difference between a deep coma and brain death. They noticed that my nephew’s color had changed when his temperature dropped to 94o F before the heating blanket was placed. They perceived the decrease in muscle tone when he stopped breathing faster than the ventilator rate. Outside of that, there was no significant difference in his appearance when he was “alive” or “dead.”In spite of heroic measures and superlative surgical and medical care, his closed head injury progressed unremittingly until he became brain dead 36 hours later. The diagnosis of “brain death” was pronounced to the family. Accepting the death of someone who is... (shrink)

BackgroundThe brain death standard allowing a declaration of death based on neurological criteria is legally endorsed and routinely practiced in the West but not in Asia. In China, attempts to legalize the brain death standard have occurred several times without success. Cultural, religious, and philosophical factors have been proposed to explain this difference, but there is a lack of empirical studies to support this hypothesis.Methods476 medical providers from three academic hospitals in Hunan, China, completed a selfadministered survey (...) including a 12-question brain death clinical knowledge assessment and hypothetical vignettes describing brain dead patients.ResultsThe response rate was 95.2 %. Almost all of the providers had heard of the term “brain death.” More than half have encountered presumed brain dead patients. Two-thirds accepted brain death as an ethical standard to determine human death. The mean knowledge score was 8.50 ± 1.83 out of 12. When given the description of a brain dead patient, 50.7 % considered the patient dead, 51.9 % would withdraw life support, and 40.6 % would allow organ procurement. Both provider and patient characteristics contributed to the providers’ decisions. Ethical acceptance was the most important independent predictor for brain death acknowledgement, followed by high knowledge scores, and the belief that the soul lives in the brain. Religious faith and associated beliefs did not have a significant effect.ConclusionsNotwithstanding scarce official accounts, recognition of the brain death standard is not uncommon in China. Chinese medical providers can adequately define the medical characteristics of brain death and accept it in theory, but hesitate to apply it to practice in the vignettes. Legalization is paramount in providing the protection providers need to comfortably declare brain death. However the medical decision-making surrounding brain death is complex and the provider's past experiences and emotions may also influence the process. (shrink)

It is staggering to observe the new normal in America: 37.9 percent of adults are obese, and 70.7 percent are either obese or overweight. One out of every five minors is obese. The real tragedy, of course, is the disability, suffering, and early death that devastates families and communities. But all of society pays, with the annual medical cost estimated at $147 billion. The causal pathways are complex, but if we drill down, sugar is a deeply consequential pathway to (...) obesity, and the single greatest dietary source is sugar-sweetened beverages. The copious amount of sugar in the American diet is no accident. Industry practices and regulatory failures have fueled this explosion. Yet there are sensible, effective interventions that would create the conditions for healthier behaviors. What are the key interventions, and how can we overcome the social, political, and constitutional roadblocks? Tobacco control offers a powerful model, suggesting that success requires a suite of interventions working in concert: labeling, warnings, taxation, portion sizes, product formulation, marketing restrictions, and bans in high-risk settings such as schools and hospitals. Each intervention deserves detailed analysis, but I'm kick-starting scholarly and policy conversation by systematically laying out the major legal tools. (shrink)

In this Second Edition of her best-selling ethics paperback text, renowned paralegal educator Therese Cannon clearly addresses pertinent case law, rules changes, and other developments involving this important area of the law. Organized in 10 concise chapters, Ethics and Professional Responsibility for Legal Assistants, Second Edition, covers key concepts, including unauthorized practice of law; confidentiality; conflicts of interest; fees; trends in legal malpractice; discovery abuse and other advocacy issues; pro bono work; and more. to help your students (...) grasp the material, the pedagogy features: chapter reviews discussion questions cases for further analysis helpful appendices, including the Model Guidelines, standards, and codes for ABA, NALA, and NFPA. Ideal for use in your next ethics class, this flexible paperback can also easily be used to add an ethics component to your Introduction to Law course, student internship program, or other courses in your curriculum. This superb book is also accompanied by a valuable Instructor's Guide, which provides answers to every discussion question in the text and the specific page numbers to find answers to all review questions. It also contains sample syllabi and references to additional source materials to help you adapt this book to your course. (shrink)

Respect for confidentiality is firmly established in codes of ethics and law. Medical care and the patients' trust depend on the ability of the doctors to maintain confidentiality. Without a guarantee of confidentiality, many patients would want to avoid seeking medical assistance The principle of confidentiality, however, is not absolute and may be overridden by public interests. On some occasions (birth, death, infectious disease) there is a legal obligation on the part of the doctor to disclose but only (...) to the appropriate authorities. Permissible disclosure can be granted by the patients' consent, for example, for the purpose of insurance they may wish to take out. Moreover, there are some ambivalent situations (such as criminal acts, or notification of sexual partner in case of a patient with AIDS) for which Greek law does not include relevant provisions, and the Codes of Medical Ethics do not offer clear guidelines. Therefore, the Greek doctor is called to estimate the situation and assume full responsibility for his decision. Finally, new considerations have arisen in the context of the recent advances in the field of telemedicine and electronic archiving. The paper discusses the current situation and legislation in Greece. (shrink)

In this article I will look into Corporate Legal Responsibility taking into account Levinas’s notion of infinite responsibility, as well as his understanding of ethical language. My account of Levinas’s philosophy will show that it challenges – breaking down – deeply entrenched distinctions in the dominant strands of moral philosophy, within which the theory of individual responsibility is embedded, such as between:(1) duty to others on the one hand and supererogation on the other; (2) perfect duty (...) to others on the one hand and imperfect duties to others on the other; (3) insiders and outsiders; kith and kin on the one hand and strangers on the other; Levinas’s moral vision is an inclusive one which embraces all of humanity (at least of those present today) irrespective of historical, linguistic, cultural differences and diversities. In other words, each has responsibilities for and duties towards all others. Of course, one might say that there is nothing new about a universalising ethics – after all Kantianism, liberalism as well as utilitarianism are well known instances. However, more crucially, all these traditional moral philosophies uphold the theory of individual responsibility, which is rooted in the philosophy of individualism. Such a philosophy can make sense only of the concept of individual moral/legal agency but not corporate agency. Therefore, in this article I will attempt to show that the Levinasian vision is able to help us change our view with respect to corporate responsibility. (shrink)

Death Talk asks why, when our society has rejected euthanasia for over two thousand years, are we now considering legalizing it? Has euthanasia been promoted by deliberately confusing it with other ethically acceptable acts? What is the relation between pain relief treatments that could shorten life and euthanasia? How do journalistic values and media ethics affect the public's perception of euthanasia? What impact would the legalization of euthanasia have on concepts of human rights, human responsibilities, and human ethics? Can (...) we imagine teaching young physicians how to put their patients to death? There are vast ethical, legal, and social differences between natural death and euthanasia. In Death Talk, Margaret Somerville argues that legalizing euthanasia would cause irreparable harm to society's value of respect for human life, which in secular societies is carried primarily by the institutions of law and medicine. Death has always been a central focus of the discussion that we engage in as individuals and as a society in searching for meaning in life. Moreover, we accommodate the inevitable reality of death into the living of our lives by discussing it, that is, through "death talk." Until the last twenty years this discussion occurred largely as part of the practice of organized religion. Today, in industrialized western societies, the euthanasia debate provides a context for such discussion and is part of the search for a new societal-cultural paradigm. Seeking to balance the "death talk" articulated in the euthanasia debate with "life talk," Somerville identifies the very serious harms for individuals and society that would result from accepting euthanasia. A sense of the unfolding euthanasia debate is captured through the inclusion of Somerville's responses to or commentaries on several other authors' contributions. (shrink)

Death Talk asks why, when our society has rejected euthanasia for over two thousand years, are we now considering legalizing it? Has euthanasia been promoted by deliberately confusing it with other ethically acceptable acts? What is the relation between pain relief treatments that could shorten life and euthanasia? How do journalistic values and media ethics affect the public's perception of euthanasia? What impact would the legalization of euthanasia have on concepts of human rights, human responsibilities, and human ethics? Can (...) we imagine teaching young physicians how to put their patients to death? There are vast ethical, legal, and social differences between natural death and euthanasia. In Death Talk, Margaret Somerville argues that legalizing euthanasia would cause irreparable harm to society's value of respect for human life, which in secular societies is carried primarily by the institutions of law and medicine. Death has always been a central focus of the discussion that we engage in as individuals and as a society in searching for meaning in life. Moreover, we accommodate the inevitable reality of death into the living of our lives by discussing it, that is, through "death talk." Until the last twenty years this discussion occurred largely as part of the practice of organized religion. Today, in industrialized western societies, the euthanasia debate provides a context for such discussion and is part of the search for a new societal-cultural paradigm. Seeking to balance the "death talk" articulated in the euthanasia debate with "life talk," Somerville identifies the very serious harms for individuals and society that would result from accepting euthanasia. A sense of the unfolding euthanasia debate is captured through the inclusion of Somerville's responses to or commentaries on several other authors' contributions. (shrink)

The article discusses retributive justice and punitive restraint in response to the worst types of crime. I take the Breivik Case as a starting point. Anders Behring Breivik was sentenced to 21 years of preventive detention for killing 69 people, mainly youths, at Utøya and 8 people in Oslo on July 22nd, 2011. Retributivist theories as well as commonly held retributive intuitions suggest that much harsher punishment is required for such crimes. According to some retributivist theories, most notably on the (...) influential theories of Kant and Hegel, the death penalty is warranted for murderers like Breivik. This suggests that the rationale for punitive restraint in a case like the Breivik Case can only be found in forward- looking, consequentialist theories of punishment, or by adding to retributivist theories a side-constraint in the form of a principle of parsimony. However, I argue that if we look closer at the function of punishment in the retributivist theories of Kant and Hegel, they too imply a rationale for punitive restraint, even for such horrific crimes as here discussed. Against Kant and Hegel’s own views on the death penalty, I argue that their broader “freedom theories” of retributive justice do not imply the justice of the death penalty or life imprisonment. In the last part of the article, I explore differences in the concepts of freedom entailed by Kant and Hegel’s theories, and I relate these to some of the background factors relevant to the Breivik Case. (shrink)

To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients (...) are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made. (shrink)

As sophisticated artificial intelligence software becomes more ubiquitously and more intimately integrated within domains of traditionally human endeavor, many are raising questions over how responsibility (be it moral, legal, or causal) can be understood for an AI’s actions or influence on an outcome. So called “responsibility gaps” occur whenever there exists an apparent chasm in the ordinary attribution of moral blame or responsibility when an AI automates physical or cognitive labor otherwise performed by human beings and (...) commits an error. Healthcare administration is an industry ripe for responsibility gaps produced by these kinds of AI. The moral stakes of healthcare are often life and death, and the demand for reducing clinical uncertainty while standardizing care incentivizes the development and integration of AI diagnosticians and prognosticators. In this paper, we argue that (1) responsibility gaps are generated by “black box” healthcare AI, (2) the presence of responsibility gaps (if unaddressed) creates serious moral problems, (3) a suitable solution is for relevant stakeholders to voluntarily responsibilize the gaps, taking on some moral responsibility for things they are not, strictly speaking, blameworthy for, and (4) should this solution be taken, black box healthcare AI will be permissible in the provision of healthcare. (shrink)

For at least the past 15 years, food safety stakeholders across all levels of government have recognized the critical role that state and local agencies play in our nation's food safety system. State and local agencies are the first responders to foodborne outbreaks and have primary responsibility for keeping their residents safe from foodborne disease through effective surveillance and rapid response to outbreaks. They also conduct the vast majority of food safety inspections across the nation's restaurants, grocery stores, and (...) other food service and food retail establishments.Recent efforts among industry and government officials alike have focused on creating a more integrated, prevention-oriented food safety system. The Food Safety Modernization Act, the first major overhaul of the nation's food safety laws since the 1930s, now mandates that most sectors of the food industry put preventive controls in place, changing the emphasis of what the FDA does from response to prevention. (shrink)

Influenced by James Bernat’s approach, the US President’s 1981 Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioural Research concluded that human death is an instant that separates the dying process from the cadaveric state. Death, as Bernat and the President’s Commission argue, cannot be a process. Because organisms cannot be both alive and dead, Bernat claims, the transition from one state to the other must be sudden and instantaneous. Since then, few have argued (...) the opposite notion that death is a process, and that the transition between living and perishing is not a discrete event. In this article we argue that human death is a process that comprises three distinct phases: dying (when the physiological responses against the shutdown of vital organs and systems are in an imminence of breaking down), decease (when events such as respiratory and cardiac arrest indicate the critical failure of vital organs or systems), and decay (the irreversible and accelerated systemic biological process of cellular death that eventually takes over the whole body). We also argue that human death differs from the ‘time of death’ indicated by death certificates, which is pointed out only to clinically and legally establish the irreversibility of the entire process. (shrink)

In the field of ?neurolaw?, reformists claim that recent scientific discoveries from the mind sciences have serious ramifications for how legal responsibility should be adjudicated, but conservatives deny that this is so. In contrast, I criticise both of these polar opposite positions by arguing that although scientific findings can have often-weighty normative significance, they lack the normative authority with which reformists often imbue them. After explaining why conservatives and reformists are both wrong, I then offer my own moderate (...) suggestions about what views we have reason to endorse. My moderate position reflects the familiar capacitarian idea which underlies much lay, legal, and philosophical thinking about responsibility ? namely, that responsibility tracks mental capacity. (shrink)

There are vast ethical, legal, and social differences between natural death and euthanasia. In Death Talk Margaret Somerville argues that legalizing euthanasia would cause irreparable harm to society's value of respect for human life, which in secular societies is carried primarily by the institutions of law and medicine. Death has always been a central focus of the discussion that we engage in as individuals and as a society in searching for meaning in life. Moreover, we accommodate (...) the inevitable reality of death into the living of our lives by discussing it, that is, through "death talk." Until the last twenty years this discussion occurred largely as part of the practice of organized religion. Today, in industrialized western societies, the euthanasia debate provides a context for such discussion and is part of the search for a new societal-cultural paradigm. Seeking to balance the "death talk" articulated in the euthanasia debate with "life talk," Somerville identifies the very serious harms for individuals and society that would result from accepting euthanasia. A sense of the unfolding euthanasia debate is captured through the inclusion of Somerville's responses to or commentaries on several other authors' contributions. (shrink)

Mass vaccination has been a successful public health strategy for many contagious diseases. The immunity of the vaccinated also protects others who cannot be safely or effectively vaccinated—including infants and the immunosuppressed. When vaccination rates fall, diseases like measles can rapidly resurge in a population. Those who cannot be vaccinated for medical reasons are at the highest risk of severe disease and death. They thus may bear the burden of others' freedom to opt out of vaccination. It is often (...) asked whether it is legitimate for states to adopt and enforce mandatory universal vaccination. Yet this neglects a related question: are those who opt out, where it is permitted, morally responsible when others are harmed or die as a result of their decision? In this article, we argue that individuals who opt out of vaccination are morally responsible for resultant harms to others. Using measles as our main example, we demonstrate the ways in which opting out of vaccination can result in a significant risk of harm and death to others, especially infants and the immunosuppressed. We argue that imposing these risks without good justification is blameworthy and examine ways of reaching a coherent understanding of individual moral responsibility for harms in the context of the collective action required for disease transmission. Finally, we consider several objections to this view, provide counterarguments and suggest morally permissible alternatives to mandatory universal vaccination including controlled infection, self-imposed social isolation and financial penalties for refusal to vaccinate. (shrink)