As assisted reproductive technologies become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or child protection (...) order, are given a “presumption against treatment.” This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a “presumption against treatment” is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child. (shrink)

In a recent paper, Charles Foster argued that the epistemic uncertainties surrounding prolonged disorders of consciousness make it impossible to prove that the withdrawal of life-sustaining treatment can be in a patient’s best interests and, therefore, the presumption in favour of the maintenance of life cannot be rebutted. In the present response, I argue that, from a legal perspective, Foster has reached the wrong conclusion because he is asking the wrong question. According to the reasoning in two leading (...) cases —Bland and James —the principle of respect for autonomy creates a persuasive presumption against treatment without consent. Therefore, it is the continuation of treatment that requires justification, rather than its withdrawal. This presumption also works as the tiebreaker determining that treatment should stop if there is no persuasive evidence that its continuation is in the best interests of the patient. The presumption in favour of the maintenance of life, on the other hand, should be understood as an evidential presumption on a factual issue that is assumed to be true if unchallenged. However, the uncertainties regarding PDOC actually give reasons for displacing this evidential presumption. Consequently, decision-makers will have to weigh up the pros and cons of treatment having the presumption against treatment without consent as the tiebreaker if the evidence is inconclusive. In conclusion, when the right question is asked, Foster’s argument can be turned on its head and uncertainties surrounding PDOC weigh in to justify the interruption of treatment in the absence of compelling contrary evidence. (shrink)

Many believe that the treatment-enhancement distinction marks an important ethical boundary that we should use to shape public policy on biomedical interventions. A common justification for this purported normative force appeals to the idea that, whereas treatments respond to genuine medical needs, enhancements can only satisfy mere preferences or “expensive tastes”. This article offers a critique of that justification, while still accepting the TED as a conceptual tool, as well as some of the key ethical axioms endorsed by its (...) proponents. I begin by laying out the TED, the practical implications that tend to be drawn from it, and the justification just sketched for these implications. Using examples drawn from preventive medicine, biomedical technology, and other categories of biomedical interventions, I then go on to challenge both the presupposition of a fundamental dichotomy between treatments and enhancements, and the assumption that enhancements – barring rare exceptions – cannot serve legitimate medical needs. Finally, I consider some ways in which supporters of the TED might try re-formulating the distinction to blunt the force of my critique. I conclude that such a move cannot fully succeed, and that while the TED does have some degree of normative force, it nevertheless cannot play the role that its advocates expect from it. Seeking to justify a general presumption against enhancements based on the rationale I critique here would mean ignoring their various potential benefits, including medical or therapeutic, and would reflect a prejudice – which I refer to as “treatment fetishism”. (shrink)

Competent adults should be permitted to determine the course of their own lives. We may try to influence them. We may ask them, perhaps even implore them, to change their minds. But in the end, they are in charge of their lives. They get to choose their careers, whether and whom to marry, whether to exercise, and whether to have surgery.This emphasis on respect for patients’ autonomy may seem to imply that allowing patients to make their own decisions should always (...) take precedence over other considerations. Given this presumption, there has been almost no discussion in the medical literature or elsewhere about how important this value is and whether it should sometimes be balanced against and give way to other values. This absence of guidance is especially problematic in cases where respect for patient autonomy conflicts with promoting patients’ clinical interests. (shrink)

Fairness and justice are core issues in stakeholder theory. Although such considerations receive more attention in the ‘normative’ branch of the stakeholder literature, they have critical implications for ‘instrumental’ stakeholder theory as well. In research in the instrumental vein, although the position has seldom been articulated in significant detail, a stakeholder’s inclination to take action against the firm or, conversely, to cooperate with it, is often taken to be a function of its perceptions concerning the fairness or unfairness of (...) the treatment it receives in its relationship with the firm. Thus, from various works in this domain can be distilled what might be termed a ‘fairness-based perspective on stakeholder behaviour’. This perspective, as it currently stands, assumes a high degree of homogeneity in stakeholders’ responses to fair, unfair, or munificent treatment by the firm. This supposition is itself typically based on a presumption that stakeholders consistently and uniformly adhere to norms of equity and reciprocity in their relationships with firms. However, research developments in equity theory and social exchange theory suggest that such assumptions are likely untenable. Accordingly, in this work, after outlining the fairness-based perspective on stakeholder behaviour, I undertake to augment it by presenting propositions concerning the possible influences of stakeholders’ equity preferences and exchange ideologies on their propensities to sanction or support the firm. Incorporating these stakeholder traits into the fairness-based perspective should enhance the predictive validity of its propositions concerning stakeholder behaviour in response to fairness or unfairness in the firm–stakeholder relationship. (shrink)

MOST of us feel an aversion to lying and believe that it always stands in need of justification. One expression of this is to say that there is a prima facie duty not to lie. Another is Sissela Bok's "Principle of Veracity" which holds that lying has an "initial negative weight" so that there is always a presumption against telling a particular lie. Still a third variation can be found in Arnold Isenberg's "constancy principle" which holds that what (...) is inherently bad in any lie is the same for all, constant from one lie to the next. While these sorts of view are plausible, the literature on lying provides little in the way of a specific account for the negative weight inherent in all lies--their common disvalue. What follows is proposed as such an account, one which should also help clarify why some lies are worse than others, why some are excusable and others justifiable. Without presuming to be exhaustive, the view offered maintains that there are at least two inherent negative components of all lies; further, each of these inherent disvalues disposes the liar toward a particular, contingent harm. The inherent disvalues and the harms they threaten collectively constitute sufficient grounds for the presumption against lying. (shrink)

The deceased's prior consent to posthumous reproduction is a common requirement in many common law jurisdictions. This paper critically evaluates four arguments advanced to justify the presumption against consent. It is argued that, in situations where death is caused by sudden trauma, not only is there inadequate justification for the presumption against consent, but there are good reasons to reverse the presumption. The article concludes that the precondition of prior consent may be inappropriate in these (...) situations. (shrink)

The so-called war on terror has recently revived interest in the just-war tradition . George Weigel has played an important role in this renaissance, and his recent article on JWT has occasioned a new debate concerning its merits. At the heart of this debate is the nature of violence. Weigel holds that the JWT is not based on a presumption against violence, whereas his critics argue that it is. After critically summarizing Weigel’s position, I counter his divorcing of (...) the JWT from the presumption against violence. By looking closely at the terms used in the debate concerning this presumption, I show that violence, in the scholastic tradition that nurtured the JWT, is understood as disordered force. As disordered, violence is contrary to reason, and thus also to justice . If just war aims at order, it itself may not be disordered. Thus, I argue that the JWT is best described as a two-fold presumption against violence: a just war is waged to counter violence, and a just war may not itself use violence. Consequently, since the JWT, grasped as a presumption against violence, concludes the link between justice and ordered force as the link between end and means, it avoids abstract ethical intentionalism: the proper end of the just war, as opposed to a mere intention, dictates the means that it has at its disposal. (shrink)

Current law in Victoria, Australia requires that all prospective assisted reproduction patients provide a criminal background check and child protection order check prior to being eligible for treatment. These presumptions against treatment stipulated in the Assisted Reproductive Treatment Act are discriminatory against all people that are infertile. Requiring assistance in founding a family says nothing about whether someone will be a minimally decent parent to their child. The most plausible justifications for this differential treatment (...) of family builders that require assistance are unsound. The wellbeing of the resulting child is something that the prospective patient should be presumed to have at heart, as this is the default assumption with other kinds of family builders that do not require assistance. That assisted reproduction treatment is publicly funded does not mean that the state is thereby justified in putting moral conditions on access to treatment. As we should not accept discriminatory laws, especially about practices that are of fundamental importance to the lives of citizens, the presumptions against treatment stipulated in ARTA should be eradicated. (shrink)

Warren Quinn suggests a presumption against usefully involving others in foreseeably harmful agency. Frances Kamm offers her Party Case, in which one throws a party only because one expects one’s guests will feel indebted to clean up, to argue that Quinn’s presumption should not apply to all agency undertaken because it will bring about this involvement but only to agency in which this involvement is intended. I offer impermissible and intentional variants of Party Case and consider other (...) cases to argue that the permissibility of usefully involving others depends on their independent rights, rather than whether their involvement is intended. (shrink)

The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient’s best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge’s job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.The (...) presumption is best regarded as a presumption of law. It has long been recognised as part of the way in which the English law discharges its obligations under Article 2 of the European Convention on Human Rights. But even if it is a ‘mere’ evidential presumption it cannot, on the facts of most cases involving applications for the withdrawal of life-sustaining treatment from patients in prolonged disorders of consciousness, be rebutted. (shrink)

Ronald Dworkin introduced the example of Margo, who was so severely demented that she could not recognise any family or friends, and could not remember anything of her life. At the same time, however, she seemed full of childish delight. Dworkin also imagines that, before her dementia, Margo signed an advance refusal of life-saving treatment. Now severely demented, she develops pneumonia, easy to treat, but lethal if untreated. Dworkin argues that the advance refusal ought to be heeded and Margo (...) be allowed to die of that pneumonia, on the basis that the prior refusal expresses her true wishes. In this paper I want to challenge Dworkin’s understanding of identity and his conclusion about advance refusals, and I develop my argument in two directions. First, I argue that the demented Margo is not some ‘lesser’ version of the ‘true’ Margo, but instead that the present Margo’s wishes should take precedence over those of the past Margo, on the grounds that all of us are entitled to change our minds. Second, I argue for a stronger role for friends and family members in sustaining the demented Margo’s identity through her years of decline. Based on this, I argue for a presumption against the advance refusal, but I allow that in extreme cases, a friend might have the authority to demand that it be heeded. (shrink)

Pickering et al. argue that patients who refuse doctor-recommended treatments should in some cases be deemed incompetent to decide about their own medical care—in part because of their decis...

In a recent paper, Mpofu, Sen Gupta, and Hays attempt to outline the obligations of recruiting high-income countries and would-be emigrant health workers to tackle the effects of mass exodus of health workers from underserved regions. They reconstruct Rawlsian and Kantian global justice approaches to argue for moral obligations of HICs and an individual justice approach to point to non-enforceable social responsibilities of HWs to assist their compatriots. This critical commentary demonstrates that the argumentation within their individual justice approach is (...) problematic on the basis of three reasons: their discussion under-theorizes and undervalues individual rights and more specifically the right to exit, their argumentation in the latter part, even if problematically, does rather point to moral obligations in lieu of social responsibilities of HWs, and they overlook many other important freedoms, interests, and values pertinent to the issue of retention. (shrink)

Zygon®, Volume 57, Issue 2, Page 467-489, June 2022.

Pickering, Newton-Howes, and Young assert that the traditional view of decisional capacity, premised on assessing patients’ abilities to communicate, understand, appreciate,...

Ectopic pregnancy, when not resolved naturally, can be fatal to the mother if left untreated. A number of medical solutions exist, though none that save the life of the embryo. This article assesses the ethical value of one of these solutions, the salpingostomy, by examining the moral object of the salpingostomy and whether the procedure constitutes a direct abortion. The author responds with William E. May and Maria DeGoede to salpingostomy proponents Albert Moraczewski, Christopher Kaczor, John Tuohey, and others. Because (...) of the lack of moral certitude that the trophoblast is neither a vital organ of the fetus nor a member of the fetus’s body, the author concludes that the salpingostomy may not be considered a licit procedure in the treatment of ectopic pregnancy, and challenges readers to admit that medical science lacks a direct, active solution to ectopic pregnancy. (shrink)

This CQ department is dedicated to bringing noted bioethicsts together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St. #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

Written by a multi-disciplinary group of leading practitioners, _Sexual Offending Against Children_ provides an account of the practice, policy and management issues involved in the assessment and treatment of adult and adolescent sexual offenders against children. Written for practitioners from all disciplines concerned with this area of work, it is underpinned by a strong theoretical base, giving a practical and detailed description of the management of sexual offenders, as well as the potential impact on service providers.

The rapid rise in interest in geoengineering the climate as a response to global warming presents a clear and significant challenge to environmental ethics. The paper articulates what I call the 'presumptive argument' against geoengineering from environmental ethics, a presumption strong enough to make geoengineering almost 'unthinkable' from within that tradition. Two rationales for suspending that presumption are next considered. One of them is a 'lesser evil' argument, the other makes connections between the presumptive argument, ecofacism, and (...) the anthropocentrism/non-anthropocentrism debate. The discussion is designed to prompt reflection on how environmental ethicists should orient themselves to the rapidly moving geoengineering debate and what they should think about the moral significance of the earth's large-scale biogeochemical processes compared to the moral significance of individuals, species, and ecosystems. (shrink)

This paper joins the voices warning against hasty transference of legal concepts of presumption to other kinds of argumentation, especially to deliberation about future acts and policies. Comparison of the pragmatics which respectively constitute the illocutionary acts of accusing and proposing reveals important differences in the ways presumptions prompt accusers and proposers to undertake probative responsibilities and, also, points to corresponding differences in their probative duties. This comparison has theoretically important implication regarding the norms governing persuasive argumentation. The (...) paper is based on a broadly Gricean account of speech acts. (shrink)

Presumption of Equality requires that individuals be treated equally in the absence of relevant information that would discriminate between them. Our objective is to make this principle more precise, if viewed as a principle of fairness, and to determine why and under what conditions it should be obeyed. Presumption norms are procedural constraints, but their justification can be sought in the possible or expected outcomes of the procedures they regulate. This is the avenue pursued here. The suggestion is (...) that in the absence of information that would discriminate between the individuals, equal treatment minimizes the expected unfairness of the outcome. A related suggestion is that equal treatment under these circumstances also minimizes the maximal possible unfairness of the outcome. Whether these suggestions are correct or not depends on the properties of the underlying unfairness measure. The required properties are specified. The essay also considers the normative status of equal lotteries on unequal treatments. (shrink)

Presumption of Equality requires that individuals be treated equally in the absence of relevant information that would discriminate between them. Our objective is to make this principle more precise, if viewed as a principle of fairness, and to determine why and under what conditions it should be obeyed. Presumption norms are procedural constraints, but their justification can be sought in the possible or expected outcomes of the procedures they regulate. This is the avenue pursued here. The suggestion is (...) that in the absence of information that would discriminate between the individuals, equal treatment minimizes the expected unfairness of the outcome. A related suggestion is that equal treatment under these circumstances also minimizes the maximal possible unfairness of the outcome. Whether these suggestions are correct or not depends on the properties of the underlying unfairness measure. The required properties are specified. The essay also considers the normative status of equal lotteries on unequal treatments. (shrink)

in Undetermined Presumption of Equality enjoins that individuals be treated equally in the absence of discriminating information. My objective in this paper is to make this principle more precise, viewing it as a norm of fairness, in order to determine why and under what conditions it should be obeyed. Presumption norms are procedural constraints, but their justification might come from the expected outcomes of the procedures they regulate. This outcome-oriented approach to fairness is pursued in the paper. The (...) suggestion is that in the absence of information that would discriminate between the individuals, equal treatment minimizes the expected unfairness in the outcome. Another suggestion is that, under these circumstances, equal treatment also minimizes maximal possible unfairness, i.e., it is minimally unfair if ‘worst comes to worst’. Whether these suggestions are correct depends on the properties of the underlying unfairness measure. (shrink)

in Undetermined Presumption of Equality enjoins that individuals be treated equally in the absence of discriminating information. My objective in this paper is to make this principle more precise, viewing it as a norm of fairness, in order to determine why and under what conditions it should be obeyed. Presumption norms are procedural constraints, but their justification might come from the expected outcomes of the procedures they regulate. This outcome-oriented approach to fairness is pursued in the paper. The (...) suggestion is that in the absence of information that would discriminate between the individuals, equal treatment minimizes the expected unfairness in the outcome. Another suggestion is that, under these circumstances, equal treatment also minimizes maximal possible unfairness, i.e., it is minimally unfair if ‘worst comes to worst’. Whether these suggestions are correct depends on the properties of the underlying unfairness measure. (shrink)

The presumption of innocence undergirds the American criminal justice system. It is so fundamental that it is derived from the concepts of due process and the importance of a fair trial. An informed, historical understanding of the interaction between the presumption of innocence and key tenets of due process can help clarify the meaning and application of the presumption of innocence in the modern day. Due process, as developed throughout English and US. Colonial history leading up to (...) the formation of the US. Constitution, has two important implications. First, due process provides a general guarantee of liberty against punishment or imprisonment without a fair trial. Second, due process requires that a jury, as opposed to a judge, determine the factual guilt of a defendant at trial. These two key tenets were historically fundamental to due process and should guide how the presumption of innocence impacts various stages of trial, including pretrial detention decisions and sentencing. Returning to a historical understanding of due process requires that judges not determine facts or punish individuals before a trial has occurred. (shrink)

Within contemporary metaethics, it is widely held that there is a “presumption of realism” in moral thought and discourse. Anti-realist views, like error theory and expressivism, may have certain theoretical considerations speaking in their favor, but our pretheoretical stance with respect to morality clearly favors objectivist metaethical views. This article argues against this widely held view. It does so by drawing from recent discussions about so-called “subjective attitude verbs” in linguistics and philosophy of language. Unlike pretheoretically objective predicates (...) (e.g., “is made of wood”, “is 185 cm tall”), moral predicates embed felicitously under subjective attitude verbs like the English “find”. Moreover, it is argued that the widespread notion that moral discourse bears all the marks of fact-stating discourse is rooted in a blinkered focus on examples from English. Cross-linguistic considerations suggest that subjective attitude verbs are actually the default terms by which we ascribe moral views to people. Impressions to the contrary in English have to do with some unfortunate quirks of the term “think”. (shrink)

By executive order—later passed into law—President Obama closed legal loopholes used to justify torture by his predecessor. Less often discussed, his administration also instituted scientific research into the most effective interrogation techniques. This dual-track approach already demands the use of two different methods to properly discuss the policy, and in this article, a third is put forward for a fuller interdisciplinary view. That is to say, although there are notable shortcomings, scientific and legal developments will be explored to illuminate how (...) he also clarified a moral stance for the nation. Put all together, this article will show that Obama indeed achieved laudable steps towards preventing the reintroduction of torture. (shrink)

I argue that a compelling way to articulate what is wrong with racial profiling in policing is to view racial profiling as a violation of the presumption of innocence. I discuss the communicative nature of the presumption of innocence as an expression of social trust and a protection against the social condemnation of being undeservingly investigated, prosecuted, and convicted for committing a crime. I argue that, given its communicative dimension, failures to extend the presumption of innocence (...) are an expression of disrespect. I take the New York Police Department’s stop-and-frisk policy as an example of racial profiling and argue that its use of race-based forms of suspicion as reasons for making stops is a violation of the presumption of innocence. I maintain that this systemic failure to extend the presumption of innocence to profiled groups reveals the essentially disrespectful nature of the NYPD policy. (shrink)

The starting frame with which jurors begin trials and the approach which they should take toward the presentation of evidence by the prosecution and defense are distinguished. A robust interpretation of the starting frame, according to which jurors should begin trials by presuming the material innocence of defendants, is defended. Alternative starting frames which are less defendant-friendly are shown to cohere less well with the notion that criminal trials should constitute stern tests of the government's case against those it (...) has charged with crimes. The intuitive case for the robust presumption of innocence is supplemented with empirical evidence concerning the psychology of belief formation and preservation. Various objections to the proposed starting frame are addressed. (shrink)

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”Genesis 3:16There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for (...) their pain.One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men. (shrink)

This paper analyses the role played by members of the Curie family in the visual diplomacy of cancer treatments. This relationship started in 1921, when Marie Curie travelled to the US, accompanied by her two daughters, Ève and Irène, to receive a gram of radium at the White House from President Warren Harding. In the years that followed, Ève Curie, as the biographer and natural heir of radium discoverers Marie and Pierre Curie, continued to contribute to the visual diplomacy of (...) cancer campaigning. Two events will be analysed through an interdisciplinary lens, merging history of science and visual-diplomacy studies, to show how the legacy of the Curies played out in the international consolidation of pre-war transnational alliances in the fight against cancer. One involves the picture of the chargé d'affaires of the France Republic, Jules Henry, receiving the biography authored by Ève,Madame Curie, at the French embassy in Washington. The other concerns the photograph of Ève visiting the Portuguese Oncology Institute (IPO) in 1940, which was immediately reproduced in the Institute's bulletin in order to raise awareness of cancer prevention strategies, and also captured in film as a propaganda tool for the Estado Novo regime (1933–74). (shrink)