In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give (...) insufficient weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally. (shrink)

In a paper recently published in this journal, Navin and Largent argue in favour of a type of policy to regulate non-medical exemptions from childhood vaccination which they call ‘Inconvenience’. This policy makes it burdensome for parents to obtain an exemption to child vaccination, for example, by requiring parents to attend immunization education sessions and to complete an application form to receive a waiver. Navin and Largent argue that this policy is preferable to ‘Eliminationism’, i.e. to policies that (...) do not allow non-medical exemptions, because Inconvenience has been shown to maintain exemption rates low while not harming parents by forcing them to do something that goes against their beliefs. We argue that it is at least doubtful that Inconvenience is ethically preferable to Eliminationism: while the latter disregards the value of liberty, Inconvenience disregards the value of fairness in the distribution of the burdens entailed by the preservation of a public good like herd immunity. We propose a variant of Inconvenience, which we call ‘Contribution’, which we think is preferable to the versions of Inconvenience discussed by Navin and Largent in that it successfully strikes a balance between the values of parents’ liberty, fairness and expected utility. (shrink)

The use of genetic technologies within the equine industries has become increasingly common since the horse genome was published in 2009 (Wade et al. 2009). Testing for genes coding for disease in...

In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case‐by‐case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, harm (...) mitigation, exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case‐by‐case exemptions for individual patients. We propose a process for ethical decision‐making that provides a shared language and structure to decrease the risks and burdens of decision‐making when clinicians or managers are considering requests for exemptions. (shrink)

Within the health care industry, the move from regulatory cost controls to market competition has generated rapid and dramatic restructuring of providers. To enhance their competitive positions in the evolving market, many health care organizations are pursuing the ownership and integration of all elements and stages of health care delivery and payment, with the goal of increasing access to capital and lowering costs through administrative efficiencies and economies of scale. As of July 1994, 24 percent of hospitals were members of (...) an integrated delivery system, and 47 percent were involved in IDS development.IDSs pose a singular challenge to the Internal Revenue Service. The IRS recognizes that its traditional policies for granting tax exempt status are not flexible enough for the competitive and rapidly changing health care market. In recent years, the IRS has taken a more active role in scrutinizing emerging health care institutions seeking taxexempt status. (shrink)

Mental retardation is an invented bureaucratic category, currently undergoing radical rethinking and likely renaming, that includes many who have biologically based brain disorders, but is itself determined on functional criteria that are purely arbitrary. People with MR are socially vulnerable and thus are more likely to be "naíve confessors," "naíve defendants," and "naíve offenders." That is most likely the rationale and justification for the Supreme Court's decision, in Atkins v. Virginia, to exempt the class from execution. Although the decision is (...) to be applauded as a step in a more humane direction, it is problematic to use an indirect, artificial, and insufficiently inclusive category to determine who should or should not be executed. Limited social intelligence is a characteristic of a wide range of brainbased syndromes and disorders, including many who fall above the upper IQ limit and, thus, are ineligible for the MR label and the legal protections associated with it. A more equitable, and logical, policy would be to extend execution exemption to all who demonstrate the same kinds of vulnerabilities, especially if they can be linked to some brain-based medical condition, regardless of whether one qualifies for the label of MR. (shrink)

In this article, I defend the view that conscience exemption clauses for medical practitioners (doctors, nurses, technicians, pharmacists) should be limited by patient protection clauses. This view was also defended by Mark Wicclair, in his book on conscience exemptions in medicine (Cambridge UP, 2011). In this article, I defend Wicclair’s view by supplementing it with Hegelian ethical theory and feminist critical theory. Conscience exemptions are important to support as a matter of human rights. They support an individual’s right to (...) protect their deepest value-commitments. A true understanding of conscience is dialectical, however, and it requires patient protection clauses because they, too, protect individuals in their deepest value-commitments. In this article, I show that the defense of patient protection clauses is historically supported by the theory of “conscience [Gewissen]” developed by G.W.F. Hegel in the nineteenth century (mostly in the Phenomenology of Spirit (1807)). (shrink)

There is a regulatory option for conscientious objection in health care that has yet to be systematically examined by ethicists and policymakers: granting a liberty to request exemption from prescribed work tasks without a companion guarantee that the request is accommodated. For the right-holder, the liberty’s value lies in the ability to seek exemption without duty-violation and a tangible prospect of reassignment. Arguing that such a liberty is too unreliable to qualify as a right to conscientious objection leads (...) to the problem of consistently distinguishing its effects from those of a right to conscientious objection that is made conditional on an individual assessment of the objector’s motivation. These properties require that we distinguish the liberty to request exemption from more restrictive policy choices, and that we subject it to greater scrutiny in the wider moral discourse as a possible variant of a right to conscientious objection. (shrink)

Background: While employers are increasingly considering and implementing COVID-19 vaccination requirements, little is known about the reasons offered by employees seeking religious exemptions.Methods: We conducted a mixed methods analysis of all the requests for religious exemptions submitted during the initial implementation of a COVID-19 vaccination requirement at a single academic medical center in the United States.Results: Five hundred sixty-five (3.4%) employees requested religious exemptions. At least 305 (54.0%) requesters had job titles suggesting that they had direct patient contact. Four hundred (...) ninety-nine (88.3%) of requesters self-identified as Christian, of whom 120 (21.2%) identified as Roman Catholic. Requesters offered 0 to 8 (mean 2.7) categories of reasons for their request. The most frequently stated reasons pertained to the use of fetal cell lines in vaccine development and manufacturing (382, 67.6%), interest in maintaining purity (221, 39.1%), or belief in divine healing (172, 30.4%). Some requesters also volunteered evidence of the sincerity of their beliefs including examples of their religious practices (116, 20.5%), other practices (66, 11.7%), and emotional states (32, 5.7%). One hundred fifty-two applications (26.9%) contained text copied without attribution, primarily from sample religious exemption request letters available on the Internet.Conclusions: Most requesters focused on the use of fetal cell lines in the development or manufacturing of the vaccines as the justification for their request. The development of vaccines that are not reliant on fetal cell lines may increase vaccination rates. Understanding reasons for religious exemption requests may inform vaccine education and vaccination policies. (shrink)

Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities. In 1996, the Medical Student Section of the American Medical Association introduced a resolution calling on the AMA to adopt a policy in support of exemptions for students with ethical or religious objections. In that report, students identified abortion, sterilization, and procedures performed on animals as examples of activities that might prompt requests for conscience-based (...) exemptions. In response to the student initiative, the Council on Medical Education recommended the adoption of seven “principles to guide exemption of medical students from activities based on conscience.” The House of Delegates adopted these principles in their entirety. (shrink)

Marshall and O’Leary’s thoughtful response to our article suggests that dismissal policies are ethically justifiable because they might induce parents to immunize their children. This outcome is conceivable, but we have only anecdotes about how often it occurs. Such evidence became the thin reed on which the American Academy of Pediatrics rested its new policy of tolerating the practice of dismissing vaccine-hesitant parents. It seems likely that relatively few parents would agree to vaccinate because they were threatened with dismissal. (...) Other heavy-handed interventions have failed to move most such parents. When Washington state made nonmedical exemptions more difficult to obtain, nearly two-thirds of vaccine refusers were unmoved and their children remained unvaccinated. Even if dismissal threats led some parents to accept vaccines, this alone would not justify a dismissal policy. The benefits would still have to be weighed against the risks of dismissing those families who do not change their minds. (shrink)

The 1981 Uniform Determination of Death Act (UDDA) established the validity of both cardio-respiratory and neurological criteria of death. However, many religious traditions including most forms of Haredi Judaism (ultra-orthodox) and many varieties of Buddhism strongly disagree with death by neurological criteria (DNC). Only one state in the U.S., New Jersey, allows for both religious exemptions to DNC and provides continuation of health insurance coverage when an exception is invoked in its 1991 Declaration of Death Act (NJDDA). There is yet (...) no quantitative or qualitative data on the frequencies of religious exemptions in New Jersey. This study gathered information about the frequency of religious exemptions and policy in New Jersey that was created out of respect for religious beliefs. Literature and internet searches on topics related to religious objections to DNC were conducted. Fifty-three chaplains and heads of bioethics committees in New Jersey hospitals were contacted by phone or email requesting a research interview. Respondents answered a set of questions about religious exemptions to DNC at the hospital where they worked that explored the frequency of such religious exemptions in the past five years, the religious tradition indicated, and whether any request for a religious exemption had been denied. This study was approved by the Northeastern University Institutional Review Board (IRB #: 16–03-15). Eighteen chaplains and bioethics committee members participated in a full research interview. Of these, five reported instances of religious exemptions to DNC occurring at the hospital at which they worked for a total of approximately 30–36 known exemptions in the past five years. Families sought religious exemptions because of faith in an Orthodox Judaism tradition and nonreligious reasons. No failed attempts to obtain an exemption were reported. Religious exemptions to DNC in New Jersey do occur, although very infrequently. Prior to this study, there was no information on their frequency. Considering religious exemptions do occur, there is a need for national or state policies that addresses both religious objections to DNC and hospital resources. More information is needed to better understand the impact of granting religious exemptions before new policy can be established. (shrink)

Supporters of neutrality as benign neglect argue that a neutral state should not grant any type of recognition to cultural or religious groups. Liberal multiculturalists argue instead that due to the non-neutral nature of public institutions, democratic states must adopt policies that recognize and accommodate the distinctive needs of ethnocultural groups. This article examines a different way of conceiving the principle of neutrality. In this conception, developed by Alan Patten in the framework of liberal multiculturalism, a state can only (...) be neutral when it extends equivalent levels of assistance/hindrance to rival conceptions of the good. Neutrality is thus reinterpreted to become a principle justifying the religious exemptions. The article highlights some aspects of this theory that should be reconsidered.// -/- Les défenseurs de la neutralité bienveillante soutiennent qu’un État neutre ne doit accorder aucun type de reconnaissance aux groupes culturels ou religieux. Les multiculturalistes libéraux avancent pour leur part que, en raison de la nature non neutre des institutions publiques, les États démocratiques doivent adopter des politiques vi-sant la reconnaissance et l’accommodement des besoins distinctifs des groupes ethnoculturels. Cet article examine une manière diffé-rente de concevoir le principe de neutralité. Dans cette conception, développée par Alan Patten dans le cadre du multiculturalisme libé-ral, un État ne peut être neutre que s’il assiste ou entrave de manière équivalente les différentes conceptions du bien. La neutralité est ainsi réinterprétée pour devenir un principe permettant de justifier les exemptions religieuses. L’article souligne certains aspects de cette théorie qui méritent d’être repensés. (shrink)

Medical and public health research includes surveys, interviews, and biospecimens — techniques that do not present substantial risks to subjects. Consequently, this research is exempt from regulation under the Federal Common Rule. Nevertheless, at many institutions, exempt research is frequently subject to the same regulatory process that is required for non-exempt research, requiring the consumption of time and resources for review by Institutional Review Board members or staff. The federal government has indicated an intention to reform and centralize this system, (...) but has not yet specified the form that it will use instead. By examining the policies of the top 50 research institutions, this article assesses institutional practices surrounding exempt research, quantifies the extent of exempt-research review requirements, documents a problem of “over-compliance,” and makes recommendations for reform. (shrink)

We would like to thank each of the commentators on our feature article for their thoughtful engagement with our arguments. All the commentaries raise important questions about our proposed justification for natural immunity exemptions to COVID-19 vaccine mandates. Thankfully, for some of the points raised, we can simply signal our agreement. For instance, Reiss is correct to highlight that our article did not address the important US-centric considerations she helpfully raises and fruitfully discusses. We also agree with Williams about the (...) need to provide a clear rationale for mandates, and to obtain different kinds of data in support of possible policies.Unfortunately, we lack the space to engage with every one of the more critical comments raised in this rich set of commentaries; as such, in this response, we shall focus on a discussion of hybrid immunity, which underlies a number of different arguments evident in the commentaries, before concluding with some reflections responding to Lipsitch’s concern about the appropriate standard of proof in this context. (shrink)

The U.S. 2010 Patient Protection and Affordable Care Act exempts members of health care sharing ministries from the individual mandate to have minimum essential insurance coverage. Little is generally known about these religious organizations and even less critical attention has been brought to bear on them and their ACA exemption. Both deserve close scrutiny due to the exemption’s less than clear legislative justification, their potential influence on the ACA’s policy and ethical success, and their salience to current religious (...) liberty debates surrounding the expansion of religious exemptions from ACA responsibilities for both individuals and corporations. Analyzing documents of the United States’ three largest health care sharing ministries and related material, I examine these organizations and their ACA exemption with particular consideration of their ethical dimensions. Here a thick description of the nature and workings of health care sharing ministries precedes a similar account of the ACA exemption. From these empirical analyses, five ethical and policy concerns emerge: the charity versus insurance status of these ministries; the conflation of two ACA religious exemptions; the tension between the values of religious liberty and of justice; the potential undermining of ACA policy goals; and the questionable compliance of health care sharing ministries with ACA exemption requirements. An accurate and informed understanding of HCSMs is required for policymakers and others to justify the ACA exemption of health care sharing ministry members. A sufficient justification would address at least the five ethical and policy concerns raised here. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 15.2 (2005) 199-210 [Access article in PDF] Conflict-of-Interest Policy at the National Institutes of Health: The Pendulum Swings Wildly* Evan G. DeRenzo **This article addresses the National Institutes of Health (NIH) employee conflict-of-interest (COI) policy that went into effect February 2005. It is not, however, merely an account of another poorly crafted government policy that cries out for revision. Instead, it is also a (...) story about one of our nation's most important and prestigious institutions and its struggles to navigate the crosscurrents of scientific aspirations, power politics, public ambivalence toward capitalist economics in the biosciences, and the media's inclination to exaggerate problems and under report complicated facts. It is also a tale of greed, politics, purgatory, and redemption. The dramatic and abrupt change in the NIH COI policy demonstrates the difficulty of balancing the production of cutting-edge science with the demands for transparency resulting from work performed in the public interest on the public tab. It is an unhappy chapter in the life of a government agency that is also a national treasure. And, one hopes, it will be an example of how harmful and ill-conceived law can be revised and amended to advance national health and well-being. What is the New NIH COI Policy? The new NIH COI employee policy, more accurately referred to as the Interim Final Rule (Federal Register 2005), is a sweeping set of prohibitions on activities and holdings to reduce the possibility that NIH employees will have any actual [End Page 199] or apparent conflicts of interest. For the most part, the prohibitions are applied across-the-board—i.e., without distinction to employee category or function. The new policy includes prohibitions on outside activities, stock holdings, and awards. It prohibits all NIH employees from engaging in any compensated or uncompensated employment, including consulting, serving on advisory or other such boards, and compensated teaching, speaking, writing, or editing with certain kinds of entities. The first class of such entities is referred to as substantially affected organizations, defined as biotechnology, pharmaceutical, medical device companies, and others with similar interests. But these are not the only entities included in the prohibitions. Other organizations from which NIH employees now are cut off are hospitals, clinics, and other health care institutions; health, science, or health research-related professional associations and consumer and advocacy groups. Included also are educational institutions and not-for-profit independent research institutes that are, or were, recent NIH funding applicants, grantees, contractors, or cooperative research and development agreement (CRADA) partners. The only exemptions appear to be for health care institutions at which NIH employees provide clinical care and some forms of writing—e.g., an NIH physician who moonlights at her/his local hospital's emergency room or submits a manuscript to a peer-reviewed journal that receives only unrestricted funding from a prohibited entity. Prohibited and/or restricted holdings include stock in biotechnology, pharmaceutical, and medical device companies and others in research, development, or manufacture of medical devices, equipment, preparations, treatments, or products. The prohibitions apply to senior NIH employees; restrictions in the amount of such holdings apply to all remaining employees. Both apply to the spouses and minor children of NIH employees. If an NIH employee wins an award, the monetary allowance in most cases is limited to $200. In sum, the scope of this policy is vast, too vast to be reasonable. Too many employees are restricted in too many ways. Where appropriate restrictions have been placed on senior NIH employees, even these constructive aspects of the policy are overshadowed by the unfairness and destructiveness of other aspects. This policy far exceeds anything that could be considered sound. Fortunately, the policy has a built-in assessment process to begin at the end of the policy's first year of implementation. One can only hope that a fair and open evaluation will be conducted, the results of which surely must result in major revisions to what is now bad regulation. Why the Policy... (shrink)

Background Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input.Methods We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood (...) vaccination.Results 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children.Conclusions We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination. (shrink)

This book describes the foreign policy of John Rawls and Amartya Sen while building up towards a policy recommendation. By redirecting some military spending to development goals, the core needs of more civilians can be better met – while simultaneously advancing human security.

The welfare reform law of 1996 completely overhauled the nation's system of assistance to low-income families. The reauthorization of that law, now several months overdue because of congressional delays, presents an opportunity for religious social ethicists to evaluate the adequacy of our nation's anti-poverty efforts. This paper surveys policy developments from 1996 to 2003 and analyzes five key issues in the reauthorization debate: the size and structure of welfare block grants; work requirements; welfare time limits, sanctions, and exemptions; marriage promotion (...) and the family cap; and ancillary programs providing work supports such as food stamps, Medicaid, and child care subsidies. A variety of ethical critiques of policy proposals is offered, some of them from the perspective of Catholic social teaching. The trail of missed opportunities in welfare reform will probably continue, as American social policy fails to act upon an accurate portrayal of the challenges facing poor families today. (shrink)

Intelligent design creationism (ID) is a religious belief requiring a supernatural creator's interventions in the natural order. ID thus brings with it, as does supernatural theism by its nature, intractable epistemological difficulties. Despite these difficulties and despite ID's defeat in Kitzmiller v. Dover Area School District (2005), ID creationists' continuing efforts to promote the teaching of ID in public school science classrooms threaten both science education and the separation of church and state guaranteed by the U. S. Constitution. I examine (...) the ID movement's failure to provide either a methodology or a functional epistemology to support their supernaturalism, a deficiency that consequently leaves them without epistemic support for their creationist claims. My examination focuses primarily on ID supporter Francis Beckwith, whose published defenses of teaching ID, as well as his other relevant publications concerning education, law, and public policy, have been largely exempt from critical scrutiny. Beckwith's work exhibits the epistemological deficiencies of the supernaturally grounded views of his ID associates and of supernaturalists in general. I preface my examination of Beckwith's arguments with (1) philosopher of science Susan Haack's clarification of the established naturalistic methodology and epistemology of science and (2) discussions of the views of Beckwith's ID associates Phillip Johnson and William Dembski. Finally, I critique the religious exclusionism that Beckwith shares with his ID associates and the implications of his exclusionism for public policy. (shrink)

To claim that companies should not discriminate on the basis of race, gender or religion seems almost as trivial as stating that they should not use forced labor or dump radioactive waste into the local river. Among other things, non-discrimination seems to imply that companies recognize and respect a range of religious preferences, including allowing religious clothing, e.g., by allowing Muslim women to wear headscarves. However, many companies do not believe that employees generally should be allowed to wear the kind (...) of clothes they please. In this paper, we discuss the asymmetry between the status of religious and secular clothing. We conclude that religious exemptions to dress codes can discriminate wrongfully. To solve this problem, companies should not ban religious clothing. Instead, companies should liberalize their dress codes, so that employees would be allowed to wear secular and religious types of clothing on an equal footing. (shrink)

To claim that companies should not discriminate on the basis of race, gender or religion seems almost as trivial as stating that they should not use forced labor or dump radioactive waste into the local river. Among other things, non-discrimination seems to imply that companies recognize and respect a range of religious preferences, including allowing religious clothing, e.g., by allowing Muslim women to wear headscarves. However, many companies do not believe that employees generally should be allowed to wear the kind (...) of clothes they please. In this paper, we discuss the asymmetry between the status of religious and secular clothing. We conclude that religious exemptions to dress codes can discriminate wrongfully. To solve this problem, companies should not ban religious clothing. Instead, companies should liberalize their dress codes, so that employees would be allowed to wear secular and religious types of clothing on an equal footing. (shrink)

Luck egalitarianism assigns a central role to personal responsibility in egalitarian justice. In the context of healthcare, luck egalitarianism is the view that the distribution of medical and healthcare resources—or common resources in general—should respond to the (im)prudence of individuals. Recently, Joar Björk, Gert Helgesson, and Niklas Juth have argued that it is impractical to use luck egalitarianism as a normative framework in healthcare because it has no reasonable way of dealing with the imprudent. In response to their argument, this (...) paper first suggests that the epistemic problems of applying luck egalitarianism to the healthcare context raised by Björk et al. can be circumvented by using the exemption system as a policy application of luck egalitarian healthcare justice. This paper then shows that an _ex ante_ policy, a tax system with refunds, can reasonably be adopted as a luck egalitarian institutional design of healthcare policy. We argue that the proposed conception of luck egalitarianism can deal with the problem of differential option luck. Finally, we show that the threshold problem for the definition of imprudence does not refute the proposed _ex ante_ policy. (shrink)

Intelligent design creationism (ID) is a religious belief requiring a supernatural creator’s interventions in the natural order. ID thus brings with it, as does supernatural theism by its nature, intractable epistemological difficulties. Despite these difficulties and despite ID’s defeat in Kitzmiller v. Dover Area School District (2005), ID creationists’ continuing efforts to promote the teaching of ID in public school science classrooms threaten both science education and the separation of church and state guaranteed by the U.S. Constitution. I examine the (...) ID movement’s failure to provide either a methodology or a functional epistemology to support their supernaturalism, a deficiency that consequently leaves them without epistemic support for their creationist claims. My examination focuses primarily on ID supporter Francis Beckwith, whose published defenses of teaching ID, as well as his other relevant publications concerning education, law, and public policy, have been largely exempt from critical scrutiny. Beckwith’s work exhibits the epistemological deficiencies of the supernaturally grounded views of his ID associates and of supernaturalists in general. I preface my examination of Beckwith’s arguments with (1) philosopher of science Susan Haack’s clarification of the established naturalistic methodology and epistemology of science and (2) discussions of the views of Beckwith’s ID associates Phillip Johnson and William Dembski. Finally, I critique the religious exclusionism that Beckwith shares with his ID associates and the implications of his exclusionism for public policy. (shrink)

The first stage of the human embryonic stem(ES) cell research debate revolved aroundfundamental questions, such as whether theresearch should be done at all, what types ofresearch may be done, who should do theresearch, and how the research should befunded. Now that some of these questions arebeing answered, we are beginning to see thenext stage of the debate: the battle forproperty rights relating to human ES cells. The reason why property rights will be a keyissue in this debate is simple and (...) easy tounderstand: it costs a great deal of money todo this research, to develop new products, andto implement therapies; and private companies,researchers, and health professionals requirereturns on investments and reimbursements forgoods and services. This paper considersarguments for and against property rightsrelating to ES cells defends the followingpoints: (1) It should be legal to buy and sellES cells and products. (2) It should be legalto patent ES cells, products, and relatedtechnologies. (3) It should not be legal tobuy, sell, or patent human embryos. (4) Patentson ES cells, products, and related technologiesshould not be excessively broad. (5) Patents onES cells, products, and related technologiesshould be granted only when applicants statedefinite, plausible uses for their inventions. (6) There should be a research exemption in EScell patenting to allow academic scientists toconduct research in regenerative medicine. (7)It may be appropriate to take steps to preventcompanies from using patents in ES cells,products, and related technologies only toblock competitors. (8) As the field ofregenerative medicine continues to develop,societies should revisit issues relating toproperty rights on a continuing basis in orderto develop policies and develop regulations tomaximize the social, medical, economic, andscientific benefits of ES cell research andproduct development. (shrink)

"Whole brain death" (neurological death) is well-established as a legal standard of death across the country. Recently, New Jersey became the first state to enact a statute recognizing a personal religious exemption (a conscience clause) protecting the rights of those who object to neurological death. The Act also mandates adoption through the regulatory process of uniform and up-to-date clinical criteria for determining neurological death.

In September 2020, relationships and sex education (RSE) became compulsory in all English secondary schools, and relationships education became compulsory in all English primary schools, marking a significant step forward in the fight to establish children's rights. Although the new RSE regime will help to ensure that many English schools provide pupils with a far more comprehensive RSE curriculum than ever before, the statutory guidance underpinning it includes a number of caveats that mean, although the subject is compulsory, not all (...) children will receive the same content. Arguably, along with the right to withdraw (which is often exercised on religious grounds), the most insidious of these ‘carve-outs’ allows faith schools to teach RSE according to their ‘distinctive religious character’. This exemption has been used to defend the use of religious RSE resources that critics maintain are misogynistic, homophobic and often draw heavily on pseudoscience, as well as to justify leaving certain topics (such as same-sex relationships or trans rights) out of classroom discussion altogether. Drawing on empirically informed normative case studies and recent reforms to the curriculum in Wales, I argue that faith-based carve-outs to RSE policy imperil children's access to a distinct package of educational goods. Using a recent framework for educational decision-making based on these goods developed by Brighouse et al. I go on to conclude that such policies are politically and morally unjustifiable (at least if one agrees that the relevant package of goods is desirable). I further maintain that, even when considered from the perspective of human rights law—which is often given as a pragmatic reason to allow more permissive policies with respect to teaching topics that may impinge upon parents’ deeply held convictions—there are no necessary grounds for governments to legislate for the subject to be circumscribed by the religious beliefs of parents or the faith ethos of the schools children attend. (shrink)

Australian states exclude unvaccinated children from early education and care via ‘No Jab No Play’ policies, but some offer exemptions for the socially disadvantaged. Such mandatory vaccination policies provoke heated arguments about morality and potential downstream impacts, and the politics of which kinds of people get exempted from mandates are often fraught. Synthesising existing frameworks for considering the role of moral principles and rational-technical justifications in policymaking, we show how the same values can be the focus of both (...) ‘rational-instrumental’ and ‘morality’ frames, while ‘pragmatic’ approaches are crowded out by high epistemic or moral certainty. (shrink)

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local authorities have (...) gone beyond the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area. (shrink)

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local authorities have (...) gone beyond the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area. (shrink)

This book approaches the problems and circumstances confronting blacks in the context of black values, the black community, and the role of government. ^BContents:: The Black Community's Values as a Basis for Action; The Community as Agent of Change; and The Government's Role in Meeting New Challenges.

Vaccine mandates can take many forms, and different kinds of mandates can implicate an array of values in diverse ways. It follows that good ethics arguments about particular vaccine mandates will attend to the details of individual policies. Furthermore, attention to particular mandate policies—and to attributes of the communities they aim to govern—can also illuminate which ethics arguments may be more salient in particular contexts. If ethicists want their arguments to make a difference in policy, they should attend (...) to these kinds of empirical considerations. This paper focuses on the most common and contentious vaccine mandate reform in the contemporary United States: the elimination of nonmedical exemptions (NMEs) to school and daycare vaccine mandates. It highlights, in particular, debates about California's Senate Bill 277 (SB277), which was the first successful recent effort to eliminate NMEs in that country. We use media, secondary sources, and original interviews with policymakers and activists to identify and evaluate three ethics arguments offered by critics of SB277: parental freedom, informed consent, and children's rights to care and education. We then turn to one ethics argument often offered by advocates of SB277: harm prevention. We note, however, that three arguments for mandates that are common in the immunization ethics literature—fairness/free-riding, children's rights to vaccination, and utilitarianism—did not play a role in debates about SB277. (shrink)

In Why Tolerate Religion?, Brian Leiter argues against the special legal status of religion, claiming that religion should not be the only ground for exemptions to the law and that this form of protection should be, in principle, available for the claims of secular conscience as well. However, in the last chapter of his book, he objects to a universal regime of exemptions for both religious and secular claims of conscience, highlighting the practical and moral flaws associated with it. We (...) believe that Leiter identifies a genuine and important contemporary legal and philosophical problem. We find much to admire in his reasoning. However, we raise questions about two claims that are crucial for his argument. The first claim is that it is not religion as such, but conscience that deserves toleration and respect. The second claim is that respect for religion and conscience demands ‘principled toleration’ but does not entail stronger policies of legal exemptions. Against the first claim, we argue that Leiter does not successfully distinguish religious belief from secular conscience and morality; and he does not explain why secular conscience deserves respect. Against the second claim, we argue that the most promising theories of legal exemptions are not classical theories of liberal toleration. (shrink)

A number of health care professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone; nor should they suffer any undesirable consequences of such refusal. Those who claim this right err by blurring or conflating three (...) issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true: a conscientious professional should not do her professional duty AND others need not permit or excuse her refusal. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt for that failure. Finally, there are compelling reasons why we could not implement a consistent moral policy giving advocates what they want, likely not even in qualified form. (shrink)

"Public Bioethics collects the most influential essays and articles of James F. Childress, a leading figure in the field of contemporary bioethics. These essays, including new, previously unpublished material, cohere around the idea of "public bioethics," which involves analyzing and assessing public policies in biomedicine, health care, and public health, often through public deliberative bodies. The volume is divided into four sections. The first concentrates on the principle of respect for autonomy and paternalistic policies and practices. The second (...) explores the tension among bioethics, public policy, and religious convictions. It pays particular attention to the role of religious convictions in the formation of public policies and to the basis and limits of exemptions of health care providers who conscientiously oppose providing certain legal and patient-sought services. The third section looks at practices and policies related to organ transplantation. Childress focuses particularly on determining death, obtaining first-person consent for deceased organ donation, and allocating donated organs effectively and fairly. The book's fourth and final section maps the broad terrain of public health ethics, proposes a triage framework for the use of resources in public health crises, addresses public health interventions that potentially infringe civil liberties, and sheds light on John Stuart Mill's misunderstood legacy for public health ethics."--Provided by publisher. (shrink)

This paper explores the potential of a contextual approach to multicultural conflict. It reconstructs two cases that were hotly debated in the Netherlands—Islamic headscarves for police officers and for court officers—and asks whether a contextual approach reaches compromises and thus promotes social stability more easily than a deductive approach. The argument is that a deductive approach accepts standing interpretations of normative principles, whereas a contextual approach reinterprets these principles in the light of the circumstances and that, whether or not it (...) promotes social stability, a contextual approach makes us attend to otherwise neglected perspectives and thus yields greater normative insights. (shrink)

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school (...) employees (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors. (shrink)

The study investigates effects of the implementation of a law authorizing educational leave in Germany on individual participation in adult learning and education (ALE). In 2015, the federal state of Baden-Württemberg introduced the so-calledBildungszeitgesetz, legitimating an exemption for eligible employees of up to 5 days per year with continued payment of salary. Explaining participation in ALE is a central subject of educational research at national and international level. Current theoretical assumptions of rational choice and empirical findings of educational and (...) socio-statistical research suggest that within the general population, individuals’ availability of time affects the decision to participate and therefore lastly determines participation in ALE. However, current academia mainly discusses time as either a prerequisite for learning activities or as an observable outcome of participation and not as an explanatory factor. Furthermore, since recent studies remain on a descriptive level regarding influences of time on participation in ALE, no causal effects of the availability of time on participation are estimated. Hence, our study addresses this research gap by investigating effects of educational policy interventions such as theBildungszeitgesetzon participation in ALE. Policy interventions are ideally suited to examine the significance of time resources for participation, as the implementation of theBildungszeitgesetzprovides a specific timeframe for employees to participate in ALE outside of their working time. Drawing on data from the German National Educational Panel Study, we employ a difference-in-differences estimation strategy with propensity score matching and instrumental variable to identify the direct causal effect of the implementation of theBildungszeitgesetzon participation in ALE (N= 709). This combination toward causal inference controls for observed and unobserved baseline differences as well as heterogeneous treatment effects. The results reveal a non-significant but heterogeneous treatment effect of the implementation of theBildungszeitgesetzon individual participation in ALE. Contrary to our theoretical assumptions derived from rational choice approaches, we cannot confirm the hypothesis that the availability of time resources due to the implementation of theBildungszeitgesetzcauses a positive effect on participation in ALE. Furthermore, the results reveal that the implementation causes decreasing participation rates for younger adults, women and significantly for migrants. (shrink)