In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and (...) make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. (shrink)

This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare (...) burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness. (shrink)

In this paper I develop an account of member obligation: the obligations that fall on the members of an obligated collective in virtue of that collective obligation. I use this account to argue that unorganized collections of individuals can constitute obligated agents. I argue first that, to know when a collective obligation entails obligations on that collective’s members, we have to know not just what it would take for each member to do their part in satisfying the collective obligation, but (...) also what they should do if they cannot do their part because others will not do theirs. I go on to argue (contra recent proposals) that it is not good enough for members in this situation to reasonably believe that others will not do their part. Rather, for a member of an obligated collective to permissibly escape doing her part in a collective obligation, she must both reasonably doubt that others will do their part and stand ready to act in case others do as well. -/- This necessary condition for collective obligation points the way to plausible sufficient conditions – conditions that, I argue, allow unstructured collectives to bear obligations. For (a) if a collective’s members are individually obligated to be ready to do their part, in a given collective action, and (b) if that individual readiness makes it sufficiently likely that the collective will in fact act, then it is hard to see what could block an attribution of collective obligation. In particular, in that case there ought to be no additional objection that there is no existing, organized “agent” on which the obligation might fall. For agents are, simply, things that can act. To be able to act is just to be able to succeed by trying. Unstructured collectives try to do something, I argue, when each member acts on their willingness to do their part in that thing if others do theirs; sometimes they succeed, producing a collective action. Some unstructured collectives, therefore, can succeed by trying; therefore, they can act; therefore they are agents. (shrink)

What makes something a part of my body, for moral purposes? Is the body defined naturalistically: by biological relations, or psychological relations, or some combination of the two? This paper approaches this question by considering a borderline case: the status of prostheses. I argue that extant accounts of the body fail to capture prostheses as genuine body parts. Nor, however, do they provide plausible grounds for excluding prostheses, without excluding some paradigm organic parts in the process. I conclude by suggesting (...) that embodiment is moralized all the way down: to be a body part is to be the sort of thing that ought to be protected, in a certain way, by social practices. (shrink)

In The Minority Body, Elizabeth Barnes rejects prevailing social constructionist accounts of disability for two reasons. First, because they understand disability in terms of oppressive social responses to bodily impairment, they cannot make sense of disability pride. Second, they maintain a problematic distinction between impairment and disability. In response to these challenges, this paper defends a version of the social model of disability, which we call the Social Exclusion Model. On our account, to be disabled is to be in a (...) bodily or psychological state that is represented as an impairment in the prevailing ideology of one’s society, and to be excluded from valuable activities on the basis of this representation. While this model refers to a distinction between disability and impairment, it makes no presuppositions about which bodies function ‘normally’ and which do not. It is the ideology of impairment rather than impairment itself that does any work to determine whether a person is disabled. We argue that this model answers some of the important objections that Barnes raises against prevailing social constructionist accounts of disability, and that it’s focus on the oppressive social positioning of disabled people gives it explanatory power that Barnes’s own account lacks. (shrink)

In this paper, we explore the perspectives of expert stakeholders about who owns data in a medical information commons and what rights and interests ought to be recognized when developing a governance structure for an MIC. We then examine the legitimacy of these claims based on legal and ethical analysis and explore an alternative framework for thinking about participants' rights and interests in an MIC.

This paper argues that disabled people can be healthy. I argue, first, following the well-known ‘social model of disability’, that we should prefer a usage of ‘disabled’ which does not imply any kind of impairment that is essentially inconsistent with health. This is because one can be disabled only because limited by false social perception of impairment and one can be, if impaired, disabled not because of the impairment but rather only because of the social response to it. Second, I (...) argue that it is often wrong to use the term ‘healthy’ in a way that makes health inconsistent with any degree whatsoever of health-relevant bodily dysfunction. Whether someone is ‘healthy’ properly-so-called depends on standards of health presupposed in conversational context. Sometimes, I argue, these standards are or ought to be lax enough to allow some people with some health deficits still to count as ‘healthy’ per se. Taking inspiration from David Lewis and Mary Kate Mcgowan, I go on to argue that denying that someone is ‘healthy’ in a context typically succeeds in shifting going presuppositions to require standards strict enough to make that denial acceptable. And this, I conclude by arguing, often constitutes an abuse of conversational power. (shrink)

This paper examines the moral import of a distinction between natural and social inequalities. Following Thomas Nagel, it argues for a “denatured” distinction that relies less on the biological vs. social causation of inequalities than on the idea that society is morally responsible for some inequalities but not others. It maintains that securing fair equality of opportunity by eliminating such social inequalities has particularly high priority in distributive justice. Departing from Nagel, it argues that society can be responsible for inequalities (...) not only when they are the unintended result of justifiable projects, but even when their alleviation would be very costly. Sharing Nagel’s general concept of ‘social inequality’, then, this paper proposes a far more expansive conception. We argue that many disadvantages due to disability fall under this conception. Eliminating or alleviating those disadvantages should be regarded as securing fair equality of opportunity, not improving the condition of the worst-off. (shrink)

Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them—and sometimes, permissibly doing so. Stopping a patient’s heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, however, about cases (...) at the boundary—procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it—particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively “bodily” rights and restrictions in at least some implantable devices. (shrink)

This article asks whether personal ventilators should be redistributed to maximize lives saved in emergency condition, like the COVID-19 pandemic. It begins by examining extant claims that items like ventilators are literally parts of their user’s bodies. Arguments in favor of incorporation for ventilators fail to show that they meet valid sufficient conditions to be body parts, but arguments against incorporation also fail to show that they fail to meet clearly valid necessary conditions. Further progress on this issue awaits clarification (...) of difficult normative, conceptual, and metaphysical questions about the possible boundaries of a person’s body. Rather than relying solely on incorporation arguments, we propose an argument against reallocation from widely accepted anti-discrimination principles. Possession of a personal ventilator is an obvious marker of disability identity; thus, reallocating ventilators from those that already possess them discriminates on the basis of a stigmatized trait – a paradigm case of presumptively wrongful discrimination. This discrimination claim, taken together with uncertainty about the bodily status of ventilators, yields a strong presumption against personal ventilator reallocation. (shrink)

Technological measures meant to change sexual orientation are, we have argued elsewhere, deeply alarming, even and indeed especially if they are safe and effective. Here we point out that this in part because they produce a distinctive kind of ‘clinical collective action problem’, a sort of dilemma for individual clinicians and researchers: a treatment which evidently relieves the suffering of particular patients, but in the process contributes to a practice that substantially worsens the conditions that produce this suffering in the (...) first place. We argue that the role obligations of clinicians to relieve the suffering of their patients put them in a poor position to solve this problem, though they can take measures to avoid complicity in the harms that would result from widespread use of individually safe and effective reorientation biotechnology. But in the end the medical community as a whole still seems obligated to provide these measures, if they become technologically feasible. Medical researchers are in a better position to prevent the harms that would result if reorientation techniques were safe, effective and widely available. We argue that the harms attendant on the development of safe and effective re-orientation techniques give researchers reason to avoid ‘applied‘ research aimed at developing these techniques, and to be careful in the conduct of basic orientation research which might be applied in this way. (shrink)

This paper argues for Serious Distributive Egalitarianism – the view that some material inequalities are seriously objectionable as such; not merely, say, because such inequalities tend to generate inequalities in status. Social justice requires equality, I argue, because basic social institutions produce important goods and are produced in turn by the relevantly equal contributions of all those that comply with them. E.g., basic social institutions make it much easier to produce cooperatively than it would be in their absence; therefore, these (...) institutions produce, among other things, opportunities to participate in particular productive enterprises. But basic social institutions are themselves produced, in large part, by the compliance of those subject to them; these subjects, therefore, contribute to the production of the goods that basic institutions produce. This gives (at least) every compliant subject of basic social institutions a claim on these goods. And, I argue that, though some do contribute more to the maintenance of basic institutions than others, those who contribute more are too responsible for the fact that others contribute less to point to the consequences of this difference as a reason they should get greater returns. I conclude that all subjects of basic social institutions have equally forceful and forcefully equal claims on the goods these institutions produce; claims that render inequalities in the Distribution of these goods Seriously objectionable as such. (shrink)

I argue here that our rights in our bodies are not well explained by self-ownership – and thus, also, that we cannot infer any further distributive implications of self-ownership from intuitions about body rights via inference to the best explanation. And I sketch an alternative view, on which we do indeed own our bodies, but not because we own ourselves. Self-ownership, I argue, provides a satisfying explanation only if we take it seriously: not as a mere metaphor, but as an (...) expression of a literal, reflexive ownership relation between me and myself, whatever I myself am. I go on to canvas the most prominent theories of what human beings like me literally are, arguing that each of these theories makes it hard to see how our self-ownership can ground our rights in our bodies. In the second half I consider and refine alternative, interest-based, explanations of our rights in our bodies, drawing on suggestions in this direction from Kasper Lippert-Rasmussen and Alan Wertheimer. I show how it is possible in principle to affirm that body ownership rights remain (in a sense) natural rights, even on the sort of interest-based view of ownership that many (including myself) take to preclude all or most fully natural property rights. I argue that many body rights can be grounded prefiguratively, in facts about the possible emergence of sufficiently just authority-assigning practices, rather than (as with most property rights) in their actual existence. Finally, I return to the distributive issues that motivated much interest in self-ownership in the first place – particularly, the question of whether and in what way our rights in our bodies generate rights in other things, by labor or otherwise. Without actually answering this question, I show how the account developed here would proceed in doing so: not by positing body rights as a methodologically prior constraint on rights of other kinds, but rather by considering the implications entire systems of rights and duties have for the interests of those who possess and are bound by them. (shrink)

The social model of disability claims that disadvantage from disability is primarily a result of the social response to bodily difference. Social modellers typically draw two normative conclusions: first, that society has a responsibility to address disability disadvantage as a matter of justice, not charity; second, that the appropriate way of addressing this disadvantage is to change social institutions themselves, to better fit for bodily difference, rather than to normalize bodies to fit existing institutions. This paper offers a qualified defense (...) of both inferences. Social institutions have reasons of justice to fix disability disadvantage, because the choice of institutions that contingently favor those whose bodies are statistically typical incurs responsibilities to compensate those who disfavored, in that choice. Among other things, this responsibility implies that societies should not simultaneously materially disadvantage disabled people, and also withhold symbolic resources, by demanding a presumption in favor of personal transformation – thereby, undermining the social conditions for disability pride. (shrink)

This chapter argues that standard accounts of health are ill-suited to constructing a plausible theory of health justice, particularly a sufficientarian theory. The problem in these accounts is revealed by their treatment of disability. Theorists of health justice need to define “health” more narrowly to capture the legitimate claims of people with disabilities. Following Ronald Amundson and Peter Hucklenbroich, this chapter proposes such a definition. Health, as defined in this chapter, is the absence of conditions that directly cause, or threaten (...) to directly cause, certain kinds of bodily harm, such as pain and premature death. It is concluded that on a plausible sufficientarian theory of health justice, a society that achieves health justice is one that ensures that none of its members face too much of those kinds of bodily harm. (shrink)

A person’s body can, it seems, survive well after losing the capacity to support Lockean personhood. If our rights in our bodies are, basically, rights in our selves or persons, this seems to imply that we do not after all have a right to direct the disposition of our living remains via advance directive. Govind Persad argues that our rights over our bodies persist after the loss of our personhood; we have a right to insist that our bodies die after (...) we are gone for much the same reason that we have a right to decide whether or not to donate organs, after our death. Persad’s conclusion may be right; however, his arguments regarding body rights are insufficient. Persad’s suggestion that our rights in our bodies come from a history of acting and sensing through them cannot, quite, be right, since we act and sense through tools, as well. Nor should we accept Persad’s arguments, from intuitions in cases involving posthumous pregnancy, that our posthumous body rights are powerful enough to allow choices that will result in the death of beings that need our living remains to survive. Problems with these intuitions point to a more general concern for this sort of case-based intuitionistic method: it presupposes that what body rights we have is a matter of ‘natural right’, accessible to all, rather than a function of how social institutions do or should resolve conflicts about the proper way of defining our authority over our bodies. (shrink)

Bioethics: 50 Puzzles, Problems, and Thought Experiments collects 50 cases—both real and imaginary—that have been, or should be, of special interest and importance to philosophical bioethics. Cases are collected together under topical headings in a natural order for an introductory course in bioethics. Each case is described in a few pages, which includes bioethical context, a concise narrative of the case itself, and a discussion of its importance, both for broader philosophical issues and for practical problems in clinical ethics and (...) health policy. Each entry also contains a brief, annotated, list of suggested readings. In addition to the classic cases in bioethics, the book contains discussion of cases that involve several emerging bioethical issues: especially, issues around disability, social justice, and the practice of medicine in a diverse and globalized world. (shrink)

Jesse Wall's Being and Owning: The Body, Bodily Material, and the Law addresses the legal status of 'bodily material'; items which used to be, but are no longer, part of a living human organism: especially, 'separated' materials like gametes or tissue samples, and cadavers and other mortal remains. Wall's discussion, however, ranges widely across jurisprudential and philosophical issues concerning our relation to our bodies and our rights in them. His central, plausible contention is that body rights, though a kind of (...) ownership right, need not and often should not be protected by property law. Rather, in many cases, rights in body parts should be protected by a legal regime that more closely... (shrink)