Neonatal intensive care units represent simultaneously one of the great success stories of modern medicine, and one of its most controversial developments. One particularly controversial issue is the resuscitation of extremely preterm infants. Physicians in the United States generally accept that they are required to resuscitate infants born as early as 25 weeks and that it is permissible to resuscitate as early as 22 weeks. In this article, I question the moral pressure to resuscitate by criticizing the idea that resuscitation (...) in this context “saves” a human life. Our radical medical advancements have allowed us to intervene in the life of a human before it makes sense to say that such an intervention “saves” someone; rather, what the physician does in resuscitating and treating an extremely preterm infant is to take over creating it. This matters, I argue, because “rescues” are much more morally urgent than “creations.”. (shrink)

Contrary to political and philosophical consensus, we argue that the threats posed by climate change justify population engineering, the intentional manipulation of the size and structure of human populations. Specifically, we defend three types of policies aimed at reducing fertility rates: choice enhancement, preference adjustment, and incentivization. While few object to the first type of policy, the latter two are generally rejected because of their potential for coercion or morally objectionable manipulation. We argue that forms of each policy type are (...) pragmatically and morally justified tools for preventing the harms of global climate change. (shrink)

ABSTRACT:This essay argues for the importance of formalizing public engagement efforts around bioethics as something we might call "bioethics communication," and it outlines the Johns Hopkins Berman Institute of Bioethics' plans for engaging in this effort. Because science is complex and difficult to explain to nonexperts, the field of science communication has arisen to meet this need. The field involves both a practice and a subject of empirical research. Like science, bioethics is also complex and difficult to explain, which is (...) why the world needs bioethics communication. The authors are engaged in a brand-new effort to establish the sort of public bioethics efforts that would constitute bioethics communication, through a program which they call the Dracopoulos-Bloomberg iDeas Lab. The authors invite colleagues to experiment and learn with them as they invest in the development of bioethics communicators and their products. (shrink)

Bioethics, Volume 36, Issue 3, Page 274-282, March 2022.

Several philosophers have recently argued that policies aimed at reducing human fertility are a practical and morally justifiable way to mitigate the risk of dangerous climate change. There is a powerful objection to such “population engineering” proposals: even if drastic fertility reductions are needed to prevent dangerous climate change, implementing those reductions would wreak havoc on the global economy, which would seriously undermine international antipoverty efforts. In this article, we articulate this economic objection to population engineering and show how it (...) fails. We argue, first, that the economic objection paints an inaccurate picture of the complicated relationship between demographic change and economic growth, and second, that any untoward economic effects of fertility reduction can be mitigated with additional policies. Specifically, we argue that supplementing fertility reduction with policies that facilitate the emigration of younger people from developing nations to developed nations could allow for both global reductions in GHG emissions and continued economic stability. Further, we show that moral arguments against such unprecedented increases in immigration are unsuccessful. We conclude that population engineering is a practical and morally justifiable tool for addressing the twin evils of climate change and global poverty. (shrink)

Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, g...

Mark Schroeder has, rather famously, defended a powerful Humean Theory of Reasons. In doing so, he abandons what many take to be the default Humean view of weighting reasons—namely, proportionalism. On Schroeder’s view, the pressure that Humeans feel to adopt proportionalism is illusory, and proportionalism is unable to make sense of the fact that the weight of reasons is a normative matter. He thus offers his own ‘Recursive View’, which directly explains how it is that the weight of reasons is (...) a normative matter. In this paper, I argue against Schroeder that a Humean ought to be a proportionalist. On my view, proportionalism is clearly an intuitive theory of weighting for a Humean, so we should resist it only if Schroeder can demonstrate either that there is a serious problem with the view, or that there is a better alternative. I then further argue that Schroeder fails to deliver on either condition. As a result, I conclude that there are good intuitive reasons for a Humean to be a proportionalist, and no good reason not to be. (shrink)

Many of us believe that we can and do have individual obligations to refrain from contributing to massive collective harms – say, from producing luxury greenhouse gas (GHG) emissions; however, our individual actions are so small as to be practically meaningless. Can we then, justify the intuition that we ought to refrain? In this paper, we argue that this debate may have been mis-framed. Rather than investigating whether or not we have obligations to refrain from contributing to collective action, perhaps (...) we should ask whether we have reason to do so. However, this framing brings challenges of its own, and so we close by asking what problems are generated if we focus on these questions of ‘contributory ethics’. (shrink)

The goal of this article is to evaluate the defensibility of wide-spread beliefs concerning the moral value of procreating. Very many of us are ‘pro-natal’ — that is, we have a positive moral view of making more people — but pro-natalism is under serious threat. In particular, I argue that combining several arguments in procreative ethics generates a powerful case for the Anti-Natal Pro-Adoption View, or the view that we are obligated not to procreate, but instead to satisfy any parenting (...) desires through adoption. Although this article ultimately serves as a defence against ANPA, it does so in a very limited way: while it is false that we are obligated to adopt-rather-than-procreate, I contend, this does not mean that we are off the moral hook altogether. Failing in our obligations is only one way to fail morality. Our procreative acts may yet be bad, dishonourable, selfish, and open to multiple other criticisms. And indeed, I'm afraid many of them are. (shrink)

Joshua Parker’s article on green inhaler prescribing is important and timely. I agree with much of it, specifically regarding the institutional duty to make climate-friendly changes (from environmentally expensive prescriptions to ‘greener,’ similarly effective ones). The challenge, however, comes in determining how that institutional obligation impacts the rights and duties of patients. In this commentary, I want to offer a friendly alternative to Parker’s view of individual patient obligation, which I suggest is important for reasons that go beyond this one (...) case. Parker’s broad view is that, because metered-dose inhalers (MDIs) emit far more greenhouse gases (GHG) than do dry powder inhalers (DPIs), and the two are equally effective for most patients, the healthcare system should switch most patients on MDIs to DPIs, and the patients have a pro tanto duty to accept this change.1 The problem is that no individual inhaler use causes harmful climate change, and so it is difficult to explain a duty not to use MDIs. It seems that my individual behaviour ‘makes no difference’ to climate change, so familiar more principles have a difficult time justifying a prohibition of such behaviour. Parker’s response to this worry fits into the consequentialist tradition,2 3 as he argues that each individual contribution to climate change causes some amount of ‘expected harm,’ because it contributes a little bit to future climate changes which will cause harm. And since we have a duty to minimise expected harm, we have a duty not to make such small contributions to climate change. I think we should be sceptical of this sort of argument. It makes the most sense if we endorse a bathtub metaphor, in which the atmosphere is like a bathtub, and once it is full, every …. (shrink)

This paper argues that individuals in many high-income countries typically have moral reasons to limit their beef consumption and consume plant-based protein instead, given the negative effects of beef production and consumption. Beef production is a significant source of agricultural greenhouse gas emissions and other environmental impacts, high levels of beef consumption are associated with health risks, and some cattle production systems raise animal welfare concerns. These negative effects matter, from a variety of moral perspectives, and give us collective moral (...) reasons to reduce beef production and consumption. But, as some ethicists have argued, we cannot draw a straight line from the ethics of production to the ethics of consumption: even if a production system is morally impermissible, this does not mean that any given individual has moral reasons to stop consuming the products of that system, given how miniscule one individual’s contributions are. This paper considers how to connect those dots. We consider three distinct lines of argument in support of the conclusion that individuals have moral reasons to limit their beef consumption and shift to plant-based protein, and we consider objections to each argument. This argument applies to individuals in high beef-consuming and high greenhouse gas-emitting high-income countries, though we make this argument with a specific focus on the United States. (shrink)

Brian Earp and his colleagues argue in this issue’s target article that racial justice requires ending the War on Drugs. In this they are absolutely correct. Indeed, de...

There are too many people on the planet. This isn’t a popular thing to say, but it’s becoming more and more obvious that it’s true, and that we need to do something to address it. Even in our radically unjust world, where billions of people do not have adequate access to food, water, energy, and other resources, we’re still living unsustainably—overcharging our ecological credit card and torching the climate. But discussing the link between these environmental problems and the population is (...) uncomfortable, because many people believe that procreation is an essentially private act that is morally and politically off-limits. In her new book, One Child, Sarah Conly argues that this belief is false: If... (shrink)

Among those who discuss America's opioid crisis, it is popular to claim that we know what we, as a society, ought to do to solve the problem—we simply don't want it badly enough. We don't lack knowledge; we lack the will to act and to fund the right policies. In fact, I've heard two versions of this. Among those who focus on prescription opioids, it is clear that we ought to stop prescribing so many powerful opioid painkillers. And among my (...) public health colleagues focusing on illicit drug use, it is clear that we ought to expand addiction treatment and harm‐reduction services. The problem, however, is that the second claim is not obvious (and, indeed, is denied by many Americans), and the first claim probably isn't even true (at least, not in so crude a form). In short, the opioid crisis presents not only a problem of political will but also one of ethics. It will take work to discover or justify our normative claims in this arena. (shrink)

Procreative limitarians, according to Kalle Grill, believe that we—especially the globally wealthy—should limit our procreative behaviors in order to reduce our impact on the natural environment. However, according to Grill, limitarians tend not to perform a complete moral analysis of procreating, as they cite the costs without noting the substantial benefits. In particular, Grill argues that procreation has benefits that consumption lacks, which is relevant for deciding where to focus in our efforts to mitigate environmental harms. As one of the (...) limitarians cited by Grill, I think this is an interesting argument to consider, but I will here suggest that it does not succeed in fully responding to the force of the limitarian position. (shrink)

It is with great pleasure and a sense of urgency that we present this KIEJ double issue on ethical issues raised by the COVID-19 pandemic. The sheer range of ethical concerns raised by the pandemic, combined with the speed with which these problems emerged, is staggering and unprecedented in our generation. We have tried to give space to papers that raise immediately pressing ethical issues that have not received much discussion in popular media. Topics range from fundamental questions about how (...) we set up our public health infrastructure, to ethical issues in scientific communication and the translation of science into policy, to the impact of the pandemic on people with intellectual disabilities, to the ethics of... (shrink)

A warm, personal guide to building a strong ethical and moral compass in the midst of today's confusing, scary, global problems. The moral challenges of today are unfamiliar in the history of philosophy. Climate change is the paradigm example of what Travis Rieder calls "The Puzzle" in the way your choices can seem at odds with what the planet urgently needs. How do we decide the right thing to do in the face of a massive collective challenge? Should you drink (...) water from a plastic bottle or not? Drive a Tesla? Or is that just what Elon and all the other corporations want you to think? What makes individual ethics difficult to think about in the case of catastrophic climate change makes ethics difficult to think about in many other contexts as well. The Puzzle, as he explains, is everywhere now. The chapters include a lively, meaningful tour of traditional moral reasoning looking at the contributions of Plato, Hegel, and Kant among others. But they could not grasp The Puzzle we now face. Old fashioned exercises like trolley problems involving sacrificing one person on this track for a bunch of people on the other don't address the huge consequential and complex crises our global community faces today. The tools most of us unthinkingly rely on when we try to do the right thing don't help when it comes to reasoning about individual responsibility for large collective problems. Expanding our suite of ethical concepts is now urgently required. Rieder defines exactly how to change our thinking, addressing mundane issues like bottled water to the biggies like whether to have children. This is a way to live a morally decent life in the scary, always complicated world we and our children live in. It's how to build your own Catastrophe Ethics. (shrink)

T. M. Scanlon’s contractualist account of morality is articulated alongside and built upon groundbreaking work on moral motivation. According to Scanlon, the central challenge of providing an account of moral motivation is navigating “Prichard’s Dilemma,” which requires that an account be both helpfully explanatory and morally relevant. Scanlon’s own solution is that one has a reason to act rightly because doing so is an aspect of living with others on terms they could accept. There is much to like about this (...) account, and so, in this paper, I begin with many of Scanlon’s assumptions. I then argue that Scanlon’s own account of moral motivation fails to navigate Prichard’s Dilemma, as does another solution that I derive from his broader view. I then close by suggesting that an account of moral motivation must be “complex,” involving different reasons to satisfy the competing desiderata of Prichard’s Dilemma. (shrink)

Nada Gligorov (2018), in this issue’s target article, covers a lot of ground concerning the science and ethics of pain management. I find substantial chunks of her argument compelling, including he...