The person-affecting restriction, in its slogan form, states that an outcome can be better than another only if it is better for someone. It has a strong intuitive appeal and several theorists have suggested that it avoids certain counterintuitive implications in population ethics. At the same time, the restriction has highly counterintuitive implications and yields non-transitive orderings in some nonidentity cases. Many theorists have taken this criticism to be decisive. Recently, however, there have been some reformulations (...) of the restriction, suggesting that the restriction survives this “old” criticism. This paper investigates the viability of those reformulations, which are versions of “Comparativism,” and argues that most of them either have counterintuitive implications or are extensionally equivalent with impersonal theories, but that “Soft Comparativism” seems to have an advantage over impersonal theories. (shrink)

According to the person-affecting restriction, one distribution of welfare can be better than another only if there is someone for whom it is better. Extant problems for the person-affecting restriction involve variable-population cases, such as the nonidentity problem, which are notoriously controversial and difficult to resolve. This paper develops a fixed-population problem for the person-affecting restriction. The problem reveals that, in the presence of incommensurable welfare levels, the person-affecting restriction is (...) incompatible with minimal requirements of impartial beneficence even in fixed-population contexts. (shrink)

In this paper, I develop an approach to population ethics which explains what we are permitted to do in virtue of the possible complaints against our action. This task is made difficult by a serious problem that arises when we attempt to generalize the view from two-option to many-option cases. The solution makes two significant moves – first, accepting that complaints are essentially pairwise comparative, and second, reimagining decision-making as a tournament between options competing two at a time. (...) The right view about when one option defeats another with respect to complaints, paired with the right view about how to pick the winners of the tournament given the relations of defeat, leads to a uniquely attractive view in the person-affecting tradition. (shrink)

Person-affecting views in population ethics state that (in cases where all else is equal) we’re permitted but not required to create people who would enjoy good lives. In this paper, I present an argument against every possible variety of person-affecting view. The argument takes the form of a dilemma. Narrow person-affecting views must embrace at least one of three implausible verdicts in a case that I call ‘Expanded Non-Identity.’ Wide person-affecting (...) views run into trouble in a case that I call ‘Two-Shot Non-Identity.’ One plausible practical upshot of my argument is as follows: we individuals and our governments should be doing more to reduce the risk of human extinction this century. (shrink)

Traditional ethical theories have paradoxical implications in regards to questions concerning procreation and our moral duties to future people. It has been suggested that the crux of the problem resides in an all too ‘impersonal’ axiology and that the problems of population axiology can be solved by adopting a ‘Person Affecting Restriction’ which in its slogan form states that an outcome can only be better than another if it is better for people. This move has been especially (...) popular in the context of medical ethics where many of the problems of population axiology are actualized. Examples are embryo or egg selection, pre-implantation genetic testing, assisted reproduction programmes, abortion, just to mention a few. I discuss a number of different interpretations of the Restriction and in particular one interpretation which I call Comparativism. According to this view, we should draw a distinction between uniquely and non-uniquely realizable people. The former people only exist in one out of two possible outcomes, whereas the latter exist in both of the compared outcomes. The idea is that we should give more weight to the well-being of non-uniquely realizable people or take it into account in a different way as compared to the well-being of uniquely realizable people. I argue that the different versions of the Person Affecting Restriction and Comparativism either have counterintuitive implications of their own or are compatible with traditional theories such as Utilitarianism. (shrink)

In this paper, I develop an approach to population ethics which explains what we are permitted to do in virtue of the possible complaints against our action. This task is made difficult by a serious problem that arises when we attempt to generalize the view from two-option to many-option cases. The solution makes two significant moves – first, accepting that complaints are essentially pairwise comparative, and second, reimagining decision-making as a tournament between options competing two at a time. (...) The right view about when one option defeats another with respect to complaints, paired with the right view about how to pick the winners of the tournament given the relations of defeat, leads to a uniquely attractive view in the person-affecting tradition. (shrink)

This thesis consists of a series of papers in population ethics: a subfield of normative ethics concerned with the distinctive issues that arise in cases where our actions can affect the identities or number of people of who ever exist. Each paper can be read independently of the others. In Chapter 1, I present a dilemma for Archimedean views in population axiology: roughly, those views on which adding enough good lives to a population can make (...) that population better than any other. In Chapter 2, I extend Gustaf Arrhenius’s famous impossibility theorems in population axiology into the domain of choices under risk. My risky impossibility theorems dispense with the assumption that welfare levels are finitely fine-grained, and so tell against lexical views in population axiology. In Chapter 3, I present objections to critical-level and critical-range views in population axiology. I then sketch out what I call the ‘Imprecise Exchange Rates View’ and argue that it is an attractive alternative. In Chapter 4, I address critical-level and critical-range views again. This time, I note that they are vulnerable to objections from biographical identity: identity between lives. I suggest that these objections give us reason to reject critical-level and critical-range views and embrace the Total View. In Chapter 5, I argue that objections of the same form – objections from personal identity – tell against person-affecting views in population ethics. In Chapter 6, I draw out some counterintuitive implications of two recent complaints-based theories of the procreation asymmetry. (shrink)

Parfit (2017) proposed a novel principle for outcome betterness in different people and different number choices. It is claimed to solve the Non-Identity Problem while avoiding the Repugnant Conclusion, and it shall do so in person-affecting rather than in impersonal terms. According to this Wide Dual Person-Affecting Principle, one of two outcomes would be (i) in one way better if this outcome would together benefit people more, and (ii) in another way better if this outcome would (...) benefit each person more. I argue that a plausible construal of this principle has two features that make it vulnerable to objections. First, the most plausible interpretation of the second part of the principle turns out to incorporate an average function. Although this helps to avoid the Repugnant Conclusion, it implausibly implies that it can be better to add further people with less bad but still miserable lives to populations consisting only of lives full of suffering. Second, the principle is not based on a comparative but on an intrinsic notion of benefit. This allows to solve the Non-Identity Problem, yet it accounts only for a weak sense of person-affecting rather than for the more substantive person-affecting intuition that it is morally significant that particular people are made better (or worse) off. Eventually, I highlight what we can, nevertheless, learn from Parfit’s idea of combining different ways in which outcomes might be better. (shrink)

Personal Identity and Ethics provides a lively overview of the relationship between the metaphysics of personal identity and ethics. How does personal identity affect our ethical judgments? It is a commonplace to hold that moral responsibility for past actions requires that the responsible agent is in some relevant respect identical to the agent who performed the action. Is this true? On the other hand, can ethics constrain our account of personal identity? Do the practical requirements of moral (...) theory commit us to holding that persons do remain identical over time? Or is it the case that personal identity is not, in fact, relevant to ethics? -/- Shoemaker provides the first comprehensive examination of these issues for the undergraduate audience. Topics include personal identity and prudential rationality; personal identity's significance for moral responsibility and ethical theory; and the practical consequences of accounts of personal identity for issues such as abortion, stem cell research, cloning, advance directives, populations ethics, multiple personality disorder, and the definition of death. (shrink)

According to impersonal moralities, welfare is good, period. Therefore, it is good that welfare is realised, whether by the benefiting of individuals who already exist or by the bringing of new...

In the posthumously published ‘Future People, the Non-Identity Problem, and Person-Affecting Principles’, Derek Parfit presents a novel axiological principle which he calls the Wide Dual Person-Affecting Principle and claims that it does not imply the Repugnant Conclusion. This paper shows that even the best version of Parfit's principle cannot avoid this conclusion. That said, accepting such a principle makes embracing the Repugnant Conclusion more justifiable. This paper further addresses important questions which Parfit left unanswered concerning: the (...) relative importance of individual and collective goodness, comparisons involving unequal outcomes, how to understand individual goodness, and whether incomparability at the level of individual goodness implies incomparability at the level of overall goodness. (shrink)

Advances in technology have made it possible for us to take actions that affect the numbers and identities of humans and other animals that will live in the future. Effective and inexpensive birth control, child allowances, genetic screening, safe abortion, in vitro fertilization, the education of young women, sterilization programs, environmental degradation and war all have these effects. Although it is true that a good deal of effort has been devoted to the practical side of population policy, moral theory (...) has not dealt adequately with the new possibilities. The dilemma faced by moral theory is that traditional theories cannot answer moral questions involving the creation of people. Two related problems arise. The first concerns numbers: how many people should there be? The second asks what sort of people should live and what their levels of well-being should be. Conventional social-contract theories, including the work of Rawls (1971), are restricted to situations with a fixed number of individuals. Sumner (1978) attempts to extend a Rawlsian veil-of-ignorance approach to possible people but is aware of the difficulties involved. The main problem is that possible people must be thought to benefit when they move from non-existence to existence, a view that we reject (see Section 1, Heyd, 1992, Chapter 1; McMahan, 1996a; Parfit, 1984, Appendix G). Rights-based and duty-based theories suffer from a similar problem; there must be a person who has the right or a person to whom the duty is owed (see McMahan, 1981). (shrink)

This paper examines a dilemma in reproductive and population ethics that can illuminate broader questions in axiology and normative ethics. This dilemma emerges because most people have conflicting intuitions concerning whether the interests of non-existent beings can outweigh the interests of existing beings when those merely potential beings are expected to have overall net-good or overall net-bad lives. The paper claims that the standard approach to this issue, in terms of exemplifying the conflict between Narrow Person- (...) class='Hi'>Affecting Views and Impersonal Views, is not correct. It argues that, instead, we can approach the issue through the distinction between Symmetrical and Asymmetrical Views about the relative importance of positive and negative value. The paper also claims that Asymmetrical Views provide the most intuitively satisfactory solution to the dilemma and can in addition be defended independently on further grounds. Keywords: person-affecting views, impersonal views, symmetry, asymmetry. (shrink)

Two related asymmetries have been discussed in relation to the ethics of creating new lives: First, we seem to have strong moral reason to avoid creating lives that are not worth living, but no moral reason to create lives that are worth living. Second, we seem to have strong moral reason to improve the wellbeing of existing lives, but, again, no moral reason to create lives that are worth living. Both asymmetries have proven very difficult to account for in (...) any coherent moral framework. I propose an impersonal population axiology to underpin the asymmetries, which sidesteps the problematic issue of whether or not people can be harmed or benefited by creation or non-creation. This axiology yields perfect asymmetry from a deliberative perspective, in terms of expected value. The axiology also yields substantial asymmetry for large and realistic populations in terms of their actual value, beyond deliberative relevance. (shrink)

If a potential person would have a good life if he were to come into existence, can we regard his coming into existence as better for him than his never coming into existence? And can we regard the situation in which he never comes into existence as worse for him? In this paper, we argue that both questions should be answered affirmatively.

Can it be better or worse for a person to be than not to be, that is, can it be better or worse to exist than not to exist at all? This old 'existential question' has been raised anew in contemporary moral philosophy. There are roughly two reasons for this renewed interest. Firstly, traditional so-called “impersonal” ethical theories, such as utilitarianism, have counter-intuitive implications in regard to questions concerning procreation and our moral duties to future, not yet existing people. (...) Secondly, it has seemed evident to many that an outcome can only be better than another if it is better for someone, and that only moral theories that are in this sense “person affecting” can be correct. The implications of this Person Affecting Restriction will differ radically, however, depending on which answer one gives to the existential question. Melinda Roberts (2003) and Matthew Adler (2009) have defended an affirmative answer to the existential question using an assumption that one can asribe a zero level of wellbeing to a person in a world in which that person doesn't exist. Contrariwise, Derek Parfit (1984), John Broome (1999), and others have worried that if we take a person’s life to be better for her than non-existence, then we would have to conclude that it would have been worse for her if she did not exist, which is absurd: Nothing would have been worse or better for a person if she had not existed. The paper suggests that an affirmative answer to the existential question can avoid such absurdities: One can claim that, say, it is better for a person to exist than not to exist, without implying that it would have been worse for a person if she had not existed or that her level of wellbeing would then have been lower. (shrink)

Where there is a fixed population (i.e., who exists does not depend on what choice an agent makes), the deontic version of anonymous Paretian egalitarianism holds that an option is just if and only if (1) it is anonymously Pareto optimal (i.e., no feasible alternative has a permutation that is Pareto superior), and (2) it is no less equal than any other anonymously Pareto optimal option. We shall develop and discuss a version of this approach for the variable (...) class='Hi'>population case (i.e., where who exists does depend on what choice an agent makes). More specifically, we shall develop and discuss it in the context of a person-affecting framework—in which an option is just if and only if it wrongs no one according to certain plausible conditions on wronging. (shrink)

Jan Narveson has articulated a deeply held, widely shared intuition regarding what moral law has to say about bringing additional people into existence: while we are “in favour of making people happy,” we are “neutral about making happy people.” Various formulations of the Narvesonian intuition (closely related to the _person-affecting intuition_ or _restriction_) have been widely criticized. This present paper outlines an off-the-beaten-path alternate construction of the intuition—the _existence condition_—and argues that that particular construction has the resources to avoid (...) some of those criticisms. But still other considerably more widely recognized alternate constructions have been offered as well. Thus John Broome outlines what he calls the _neutrality intuition_. While Broome finds the underlying intuition “strongly attractive,” he nonetheless argues that the neutrality intuition itself leads us quickly into inconsistency. Wlodek Rabinowicz disagrees. On his view, Broome’s inconsistency argument shows, not that the neutrality intuition is false, but rather that it doesn’t follow, from the fact that the outcome, or possible future or _world_, that includes the additional person is neither better nor worse than the (otherwise similar) world that excludes that person, that the one world is exactly as good as the other. The better view, according to Rabinowicz, is that, on occasion, and specifically when the coming into existence of additional people is at stake, the one world is _incommensurate_ with the other. What is called the _principle of trichotomy_ is, in other words, false. Difficulties arise, however, when we try to reject that seemingly compelling conceptual principle. This present paper concludes with the argument that the availability of the existence condition—which, together with certain other uncontroversial moral principles and a handful of conceptual principles, forms the _existential approach_—shows that we can maintain the most intuitive parts of neutrality intuition while avoiding both Broome’s inconsistency worry and Rabinowicz’s commitment to incommensurability. Incommensurability may be correct on other grounds—but not, this present paper argues, on the grounds provided by Broome’s inconsistency argument. (shrink)

Various studies on the impact of religiousness on consumer ethics have produced mixed results and suggested further clarification on the issue. Therefore, this article examines the effect of religiousness, materialism, and long-term orientation on consumer ethics in Indonesia. The results from 356 respondents in Indonesia, the largest Muslim population in the world, showed that intrinsic religiousness positively affected consumer ethics, while extrinsic social religiousness negatively affected consumer ethics. However, extrinsic personal religiousness did not affect consumer (...) ethical beliefs dimensions. Unlike other studies in developed countries, materialism and long-term orientation influenced only a few of the consumer ethical beliefs dimensions in this study. To date, the study is one of the first empirical studies to explore the impact of religiousness on consumer ethics in Indonesia. The study contributes to the debate on the impact of religiousness on consumer ethics and can assist managers and public policymakers in their effort to mitigate unethical consumer activities in Indonesia. (shrink)

Every year, millions of people are affected by disasters and atrocities. Violent and disastrous life events can have significant effects on a person’s physical and psychological wellbeing. Post-tra...

(This is an earlier, working-paper version of a paper published open-access in Philosophy and Phenomenological Research. It contains some material not included in the journal version, and it does not include certain revisions. Please cite the journal version if possible.).

Background:Personal values influence nursing students’ development of professional values, which affect professional outcomes, and how nursing students react to different situations. Personal values can be shaped by different factors, including culture, gender, and age.Aims:To explore personal values held by nursing students, and to verify if and how gender and year of study affect nursing students’ personal values.Research design:A multicenter, cross-sectional study was used.Participants and research context:The whole population of nursing undergraduate students available at the time was recruited from eight (...) centers of two Universities, composing a sample of 947 students. Demographic data were collected and it was administered the Portrait Values Questionnaire.Ethical considerations:Ethical approval was obtained from the Institutional Review Boards of the University of the participating centers.Findings:The study sample was mainly composed of young (92.6%, n = 877), female (77.3%, n = 732), Italian (95.8%, n = 907), and unmarried (98.6%, n = 934) nursing students. The most important value for nursing students, consistently through the years of nursing school, was Self-transcendence, which has the motivational emphasis on helping others and selflessness. Then, we found that male students had higher levels of Power (p < 0.001) and Achievement (p = 0.031), while female students outscored male students in Benevolence (p = 0.005) and Security (p = 0.006). Year of study showed no statistically significant difference.Discussion:Nursing students express high levels in hetero-directed values. Male nursing students, although they choose a stereotypically feminine profession, outscored females in stereotypical masculine values such as dominance and success. This is the first study that describes the personal value profile of undergraduate nursing students, according to the Theory of Basic Human Values, and it is a starting point for future research.Conclusion:Nursing educators might want to consider the findings from this study while guiding students in developing awareness for their personal values. (shrink)

Armed conflict in Darfur, west Sudan since 2003 has led to the influx of about 100 international humanitarian UN and non-governmental organizations to help the affected population. Many of their humanitarian interventions included the collection of human personal data and/or biosamples, and these activities are often associated with ethical issues. A systematic review was conducted to assess the proportion of publicly available online reports of the research activities undertaken on humans in Darfur between 2004 and 2012 that mention obtaining (...) ethical approval and/or informed consent. This systematic review is based on a systematic literature search of Complex Emergency Database, ReliefWeb, PubMed), followed by a hand search for the hardcopies of the eligible reports archived in the Centre for Research on the Epidemiology of Disasters in Brussels. The online search showed that out of the 68 eligible studies, 13.2% reported gaining ethical approval and 42.6% that an informed consent was obtained from the participants. The CRED search included 138 eligible reports. None of these reports mentioned gaining ethical approval and 17 mentioned obtaining informed consent from their participants. The proportion of studies reporting ethical review and informed consent was smaller than might be expected, so we suggest five possible explanations for these findings. This review provides empirical evidence that can help in planning ethical conduct of research in humanitarian settings. (shrink)

Would direct genetic modification of human embryos affect the welfare of future persons? Sparrow’s approach to answering this question fails a core goal of bioethics: to generate perspectives capab...

Population axiology concerns how to evaluate populations in terms of their moral goodness, that is, how to order populations by the relations “is better than” and “is as good as”. The task has been to find an adequate theory about the moral value of states of affairs where the number of people, the quality of their lives, and their identities may vary. So far, this field has largely ignored issues about uncertainty and the conditions that have been discussed mostly (...) pertain to the ranking of risk-free outcomes. Most public policy choices, however, are decisions under uncertainty, including policy choices that affect the size of a population. Here, we shall address the question of how to rank population prospects—that is, alternatives that contain uncertainty as to which population they will bring about—by the relations “is better than” and “is as good as”. We start by illustrating how well-known population axiologies can be extended to population prospect axiologies. And we show that new problems arise when extending population axiologies to prospects. In particular, traditional population axiologies lead to prospect-versions of the problems that they praised for avoiding in the risk-free settings. Finally, we identify an intuitive adequacy condition that, we contend, should be satisfied by any population prospect axiology, and show how given this condition, the impossibility theorems in population axiology can be extended to (non-trivial) impossibility theorems for population prospect axiology. (shrink)

This thesis consists of several independent papers in population ethics. I begin in Chapter 1 by critiquing some well-known 'impossibility theorems', which purport to show there can be no intuitively satisfactory population axiology. I identify axiological vagueness as a promising way to escape or at least mitigate the effects of these theorems. In particular, in Chapter 2, I argue that certain of the impossibility theorems have little more dialectical force than sorites arguments do. From these negative arguments (...) I move to positive ones. In Chapter 3, I justify the use of a 'veil of ignorance', starting from three more basic normative principles. This leads to positive arguments for various kinds of utilitarianism - the best such arguments I know. But in general the implications of the veil depend on how one answers what I call 'the risky existential question': what is the value to an individual of a chance of non-existence? I chart out the main options, and raise some puzzles for non-comparativism, the view that life is incomparable to non-existence. Finally, in Chapter 4, I consider the consequences for population ethics of the idea that what is normatively relevant is not personal identity, but a degreed relation of psychological connectedness. In particular, I pursue a strategy based in population ethics for understanding the controversial 'time-relative interests' account of the badness of death. (shrink)

This paper develops a largely neglected parallel between prudence and population ethics. Prudence is generally understood to be concerned with the balancing of well-being over time. How, precisely, well-being ought to be balanced over time, however, is a fervently debated question. I argue that developing a standard guiding such evaluations is exceedingly challenging. This is due to an often overlooked fact about prudence, namely that it shares a structural similarity with population ethics: In both contexts, we (...) assess the comparative value of populations of personstages/people, which may vary in number and level of well-being. Based on this analogy, I show that the development of an adequate theory of prudence runs into very similar impossibility results as obtain in population ethics. In particular, I prove that Arrhenius’ fifth impossibility theorem can be applied to prudence. I develop and compare four possible answers to this challenge. First, I discuss the possibility of accepting the very repugnant conclusion intrapersonally. Second, I present and further develop Donald Bruckner’s Minimax Regret approach, which gives up Transitivity. Third, I apply Jacob Nebel’s Lexical Threshold View to prudence and critically evaluate it. Lastly, I introduce what I call the Negative Lexicality View, which is based on Lexical Threshold View but overcomes some of its problems. (shrink)

Ethical decision-making research has centered on Rest’s framework that represents a rational, nonaffective model for ethical decision making. However, research in human cognition suggesting a “dual-processing” framework, composed of both rational and affective components, has been relatively ignored in the ethical decision-making literature. Examining dual-processing literature, it seems affect might be an important factor in decision making when a person’s mood is congruent with the task or situational context frame. Given that ethical decisions are serious and complex tasks, it (...) is proposed here that inducing a negative affective state might produce mood congruence, reinforce the salience of emotion for ethical decision makers, and lead to differences in decision processing. Evidence is presented documenting differences in the decisions made by ethical decision makers in a negative affective state as compared to those in either a positive or neutral affective state. (shrink)

Ethical research conduct is a cornerstone of research practice particularly when research participants include vulnerable populations. This study mapped the extent of reporting ethical research practices in studies conducted among refugees and war-affected populations in the Arab World, and assessed variations by time, country of study, and study characteristics. An electronic search of eight databases resulted in 5668 unique records published between 2000 and 2013. Scoping review yielded 164 eligible articles for analyses. Ethical research practices, including obtaining institutional approval, access (...) to the community/research site, and informed consent/assent from the research participants, were reported in 48.2, 54.9, and 53.7% of the publications, respectively. Institutional approval was significantly more likely to be reported when the research was biomedical in nature compared to public health and social, when the study employed quantitative compared to qualitative or mixed methodologies, and when the journal required a statement on ethical declarations. Institutional approval was least likely to be reported in papers that were sole-authored, when these did not mention a funding source, or when published in national journals. Similar results were obtained for access to the community site and for seeking informed consent/assent from study participants. The responsibility of inadequacies in adherence to ethical research conduct in crisis settings is born by a multitude of stakeholders including funding agencies, institutional research boards, researchers and international relief organizations involved in research, as well as journal editors, all of whom need to play a more proactive role for enhancing the practice of ethical research conduct in conflict settings. (shrink)

According to prioritarianism, roughly, it is better to benefit a person, the worse off she is. This seems a plausible principle as long as it is applied only to fixed populations. However, once this restriction is lifted, prioritarianism seems to imply that it is better cause a person to exist at a welfare level of l than to confer l units on a person who already exists and is at a positive welfare level. Thus, prioritarianism seems to (...) assign too much weight to the welfare of possible future people. It is in this respect even more demanding than total utilitarianism. However, in this article, I argue that all told, it is not clear that prioritarian- ism is less plausible than total utilitarianism, even when it comes to Population Ethics. (shrink)

In earlier chapters, we described debates between objectivists and relativists over methodology in the sciences, and over science and values. We have been led to talk about the role of value judgments in various areas of thought, but in this final chapter we turn more directly to the age – old question of the objectivity of values. Objectivists and relativists populate debate over this question just as we found them populating other questions we have addressed. There is a general, deep (...) – seated worry about ascribing objectivity two things human – centered. Talk of the objectivity of values seems odd in light of any notion of objectivity that draws upon a mind–independence, since values and valuings are so clearly terms of relation with the judgments of valuers. But neither are judgments of value merely subjective if they result in actions likely to affect the interests of others, or if they are responsive to reasons and criticism. (shrink)

Individuals diagnosed with conduct disorder (CD) in childhood and adolescence are at risk for increasingly maladaptive and dangerous behaviors, which unchecked, can lead to antisocial personality disorder (ASPD) in adulthood. Children with CD, especially those with the callous unemotional subgroup qualifier (“limited prosocial emotions”/dsm‐5), present with a more severe pattern of delinquency, aggression, and antisocial behavior, all markings of prodrome ASPD. Given this recognized diagnostic trajectory, with a pathological course playing out tragically at the individual, familial, and societal level, and (...) lack of effective remediation via current standards of care, we posit an alternate treatment approach; case‐specific compulsory moral habilitation aimed at rectifying the undeveloped affective domain of adolescents and young adults suffering from these disorders. We begin with a brief historical overview of response to mental illness, review CD and ASPD diagnostic criteria and treatment limitations, and posit a unique neurohabilitative approach that focuses on the absent affective moral development of these populations. Next, we invoke a public health safety argument to justify case‐specific compulsory moral habilitation, discuss neurotechnologies to be considered in treatment, and conclude with ethical considerations and suggestions for further research. (shrink)

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment (...) and Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

Terminally ill elderly and long-term disabled persons under our system of health care are eligible for Medicare and may qualify for the hospice care benefit. Despite such provisions, research shows that individuals still frequently do not receive the health care they need. But, as inadequate as end-of-life care can be for the general population, these inadequacies are exacerbated for individuals incarcerated in U.S. prisons and jails. Although inmates are guaranteed a basic level of health care under the Eighth Amendment (...) and Due Process Clause, they lack the mobility or freedom to choose their health care coverage, and they are dependent on an institutional system for such care. Inside prison, security and access issues affect the care inmates receive. Further, the availability of adequate clinical resources, especially for high-cost procedures, may be problematic in some jurisdictions.In addition to the practical, institutional, and legal barriers to providing and improving general end-of-life care, efforts to improve end-of-life care for prisoners may also encounter a lack of public sympathy. (shrink)

BackgroundWhile ethicists have for many years called for human subject trial participants and, in some cases, local community members to benefit from participation in pharmaceutical and other intervention-based therapies, little is known about how these discussions are impacting the practice of research ethics boards that grant ethical approval to many of these studies.MethodsTelephone interviews were conducted with 23 REB members from across Canada, a major funder country for human subject research internationally. All interviews were digitally recorded and transcribed verbatim. (...) After coding, the data was analyzed to identify central themes and topics. Themes were identified, application of the themes was confirmed, and these themes were then used to populate the findings of this manuscript.ResultsOur analysis of the interviews identified two primary themes when considering what benefits are owed to research participants and their communities. 1) Most study participants felt that given that these studies are led by persons in the role of researcher rather than health care provider, they had a limited obligation to provide benefits to study participants. 2) These REB members were all working in Canada, a high income country where most residents enjoy high levels of access to health care. As a result of this context, the study participants tended to focus on ethical concerns including obtaining informed consent and avoiding undue inducement to participate in research rather than ensuring that study participants directly benefit from successful trials.ConclusionsResearch on REB members’ attitudes toward what benefits are owed to study participants and community members is needed in other countries in order to determine how context affects these attitudes. (shrink)

Derek Parfit has argued that (Teleological) Egalitarianism is objectionable by breaking a person-affecting claim to the effect that an outcome cannot be better in any respect - such as that of equality - if it is better for nobody. So, he presents the Priorty View, i.e., the policy of giving priority to benefiting the worse-off, which avoids this objection. But it is here argued, first, that there is another person-affecting claim that this view violates. Secondly, Egalitarianism (...) can be construed as person-affecting in a weaker sense. Thirdly, it is possible to construct a Relational version of the Priority View which incorporates the Egalitarian value of just equality in this sense. Two reasons are given for why this Relational View and Egalitarianism are superior to the Parfitian Absolute Priority View. However, no attempt is made to abjudicate between the first two views, the main point being that they both accept the value of just equality in the same sense. (shrink)

There is ongoing ethical and legal debate about withdrawing life sup- port for patients with disorders of consciousness (DOCs). Frequently fu- eling the debate are implicit assumptions about the value of life in a state of impaired consciousness, and persistent uncertainty about the quality of life (QoL) of these persons. Yet there are no validated methods for assessing QoL in this population, and a significant obstacle to doing so is their inability to communicate. Recent neuroscientific discoveries might circumvent that (...) problem and help shed light on QoL in DOCs. There is an ethical imperative to prioritize QoL research in this patient population, to provide evidence to inform treatment, research, and end of life decisions. A minimalist and pragmatic model of QoL is proposed, targeting positive and negative affect as domains for which there is po- tential to reach across the communication gap, and restore to these voiceless persons some measure of control. (shrink)

A number of theorists have argued that Scanlon's contractualist theory both "gets around" and "solves" the non-identity problem. They argue that it gets around the problem because hypothetical deliberation on general moral principles excludes the considerations that lead to the problem. They argue that it solves the problem because violating a contractualist moral principle in one's treatment of another wrongs that particular other, grounding a person-affecting moral claim. In this paper, I agree with the first claim but note (...) that all it shows is that the act is impersonally wrong. I then dispute the second claim. On Scanlon's contractualist view, one wrongs a particular other if one treats the other in a way that is unjustifiable to that other on reasons she could not reasonably reject. We should think of person-affecting wronging in terms of the reasons had by the actual agent and the actual person affected by the agent's action. In non-identity cases, interpersonal justifiability is therefore shaped both by the reason to reject the treatment provided by the bad suffered and the reason to affirm the treatment provided by the goods had as a result of existing. I argue it would be reasonable for the actual person to find the treatment justifiable, and so I conclude that Scanlon's contractualist metaethics does not provide a narrow person-affecting solution to the non-identity problem on its own terms. I conclude that the two claims represent a tension within Scanlon's contractualist theory itself. (shrink)

This article critically examines some of the inconsistency objections that have been put forward by John Broome, Larry Temkin and others against the so-called "person-affecting," or "person-based," restriction in normative ethics, including "extra people" problems and a version of the nonidentity problem from Kavka and Parfit. Certain Pareto principles and a version of the "mere addition paradox" are discussed along the way. The inconsistencies at issue can be avoided, it is argued, by situating the person- (...) class='Hi'>affecting intuition within a non-additive form of maximizing consequentialism – a theory which then competes with such additive, or aggregative, forms of maximizing consequentialism as "totalism" and "averagism.". (shrink)

Can it be better or worse for a person to exist than not to exist at all? This old and challenging existential question has been raised anew in contemporary moral philosophy, mainly for two reasons. First, traditional “impersonal” ethical theories, such as utilitarianism, have counterintuitive implications in population ethics, for example, the repugnant conclusion. Second, it has seemed evident to many that an outcome can be better than another only if it is better for someone, and that (...) only moral theories that are in this sense “person affecting” can be correct. The implications of this Person-Affecting Restriction will differ radically, however, depending on which answer one gives to the existential question. The negative answer, which we argue against, would make the restriction quite untenable. Hence, many of the problems regarding our moral duties to future generations turn around the issue at hand. (shrink)

Human Papilloma Virus (HPV) infection causes death of 270,000 people die from every year. Sexually transmitted HPV was found one of the major causes of cervical cancer. World Health Organization (WHO). Cervical cancer (CC) is one of the top five cancers that affect women around the world. In June 2006, the Food and Drug Administration (FDA) approved a new vaccine for women, Gardasil, produced by the pharmaceutical company Merck that protects against infection by certain strains of HPV, including the two (...) strains that cause most cases of cervical cancer. Vaccinations are counted as one of public health’s important development but there is an ethical dilemma between balancing personal autonomy and protection of the entire at risk population. The vaccine caused very few side effects like local reactions whereas signs or symptoms of greater importance were very. Moreover it was considered that the vaccine is has an efficacy of practically 100% in prevention of precancerous lesion caused by the viral genotypes included in the vaccine. Bioethicists were not convinced about compulsory vaccination laws as the values of patient autonomy and informed consent to be preeminent to them. Not surprisingly, some have expressed wariness about or opposition to mandating HPV vaccination. A critical question is whether achieving a higher level of coverage justifies the infringement on parental autonomy that compulsory vaccination inevitably entails. Recommendation of the universal vaccination of girls and young women may evolve ethical challenges which might make it difficult for smooth implementation of the vaccination campaigns. Review of the ethical issues in HPV vaccination will constitute the main part of our paper. (shrink)

A relevant problem in reproductive ethics is the moral evaluation of selection of the possible children that the parents can have. This article discusses one of the main attempts to solve this problem, the principle of Procreative Beneficence proposed by Julian Savulescu to define a strong pro-selection perspective. According to Savulescu, such a principle has an impersonal form and is balanced with a person-affecting principle of harm. The article proposes a new person-affecting interpretation of Procreative (...) Beneficence, distinguishing it from other pro-selection views and exploring its extension beyond selection to other problems of reproductive ethics. (shrink)

The repugnant conclusion can be formulated as follows: For any population consisting of people with very high positive welfare, there is a better population in which everyone has a very low positive welfare, other things being equal. As the name indicates, this conclusion appears unacceptable. Yet it has proven to be surprisingly difficult to find a theory that avoids it without implying other very counterintuitive conclusions. Moreover, the conclusion is a problem not just for total utilitarians or those (...) committed to welfarism but for all moral theories according to which welfare matters at least when all other things are equal, which arguably is a minimal adequacy condition for any moral theory. And, not the least, how to deal with it has implications for the present generations’ duties to future generations and intergenerational justice. The question as to how the repugnant conclusion should be dealt with has thus become one of the cardinal challenges of modern ethics, and the inquiry into what it shows about the nature of ethics has opened up many new avenues for research. This chapter covers the different suggestions in the literature on how to do deal with the conclusion, both on the axiological and on the normative levels. Moreover, the conclusion and different ways of deriving it are explained in detail. (shrink)

This paper sketches a theory of the reason‐giving force of well‐being that allows us to reconcile our intuitions about two of the most recalcitrant problem cases in population ethics: Jan Narveson's Procreation Asymmetry and Derek Parfit's Non‐Identity Problem. I show that what has prevented philosophers from developing a theory that gives a satisfactory account of both these problems is their tacit commitment to a teleological conception of well‐being, as something to be ‘promoted’. Replacing this picture with one according (...) to which our reasons to confer well‐being on people are conditional on their existence allows me to do better. It also enables us to understand some of the deep structural parallels between seemingly disparate normative phenomena such as procreating and promising. The resulting theory charts a middle way between the familiar dichotomy of narrow person‐affecting theories and totalist or wide‐person affecting theories in population ethics. (shrink)

Population ethics is the subfield of philosophy that focuses on the moral aspects of how actions affect who exists in a particular population and what quality of life they have. The choices regarding what policies are adopted in response to climate change will affect the identities of those who exist in the future, the size of future populations, and the quality of life that future people will have. This chapter examines the nonidentity problem, various theoretical outlooks on (...) population ethics, some recent policy proposals aimed at reducing fertility, and the relationship between population reduction and the impacts of climate change. After summarizing the relevant issues, the relevance of the discourse to climate policy is highlighted, and points of consensus and dissensus are noted. Disagreement on some of the key theoretical questions in population ethics is significant and poses a challenge for deriving meaningful conclusions about climate policy. Fortunately, emerging points of consensus on other aspects of climate policy and its relationship to population provide reasons to think moral decision-making about these matters is far from hopeless. (shrink)

Although there is consensus on the fact that ionizing radiation used in radiological examinations can affect health, the stochastic nature of risk makes it difficult to anticipate and assess specific health implications for patients. The issue of radiation protection is peculiar as any dosage received in life is cumulative, the sensitivity to radiation is highly variable from one person to another, and between 20 % and 50 % of radiological examinations appear not to be necessary. In this context, one (...) might reasonably assume that information and patient consent would play an important role in regulating radiological practice. However, there is to date no clear consensus regarding the nature and content of—or even need for—consent by patients exposed to ionizing radiation. While law and ethics support the same principles for respecting the dignity of the person, in the context of radiology practice, they do not provide a consistent message to guide clinical decision-making. This article analyzes the issue of healthcare professionals’ duty to inform and obtain patient consent for radiological examinations. Considering that both law and ethics have as one of their aims to protect vulnerable populations, it is important that they begin to give greater attention to issues raised by the use of ionizing radiation in medicine. While the situation in Canada serves as a backdrop for a reflective analysis of the problem, the conclusions are pertinent for professional practice in other jurisdictions because the principles underlying health law and jurisprudence are fairly general. (shrink)

With very advanced technology, a very large population of people living happy lives could be sustained in the accessible region of the universe. For every year that development of such technologies and colonization of the universe is delayed, there is therefore a corresponding opportunity cost: a potential good, lives worth living, is not being realized. Given some plausible assumptions, this cost is extremely large. However, the lesson for standard utilitarians is not that we ought to maximize the pace of (...) technological development, but rather that we ought to maximize its safety, i.e. the probability that colonization will eventually occur. This goal has such high utility that standard utilitarians ought to focus all their efforts on it. Utilitarians of a ‘person-affecting’ stripe should accept a modified version of this conclusion. Some mixed ethical views, which combine utilitarian considerations with other criteria, will also be committed to a similar bottom line. (shrink)