Presumed consent to organ donation looks increasingly unlikely to be a palatable option for increasing organ procurement in the UK following the publication of the report into events at Alder Hey and elsewhere. Yet, given that the alternative to increasing the number of cadaveric organs available is either to accept a greater number of live donations, or accept that people will continue to die for the want of an organ, public policy makers remain obliged to consider other means of increasing (...) the procurement rate.In this paper, we meet the main objections to mandated choice . We have modified the traditional approach to mandated choice to take into account the force of the objection that mandated donation is preferable, by accepting that people can and do make bad decisions about organ donation and proposing that all accompanying public education and information about cadaveric donation should be directed in favour of donation. (shrink)

A number of authors criticise opt-out (or ‘deemed consent’) systems for failing to secure valid consent to organ donation. Further, several suggest that mandated choice offers a more ethical alternative. This article responds to criticisms that opt-out does not secure informed consent. If we assume current (low) levels of public awareness, then the explicit consent secured under mandated choice will not be informed either. Conversely, a mandated choice policy might be justifiable if accompanied by (...) a significant public education campaign. However, if this entitles us to assume that members of the public are informed, then an opt-out system would also be justified in the same circumstances. The alleged advantages of mandated choice seem to rest on an unfair comparison, between mandated choice with a public education campaign and an opt-out system without one. While it may be that some countries with opt-out systems should do more to inform their publics, I see no reason to assume that this cannot be done. Indeed, advocates of mandated choice seem committed to thinking it possible to raise awareness. If opt-out systems adopt the same methods, such as writing to every individual, this should also address concerns about whether consent is informed. (shrink)

Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, (...) billed at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts. (shrink)

Organ transplant shortages are ubiquitous in healthcare systems around the world. In response, several commentators have argued for the adoption of an opt-out policy for organ transplantation, whereby individuals would by default be registered as organ donors unless they informed authorities of their desire to opt-out. This may potentially lead to an increase in donation rates. An opt-out system, however, presumes consent even when it is evident that a significant minority are resistant to organ donation. In this article, we defend (...) a mandated choice framework for consent to deceased organ donation. A mandated choice framework, coupled with good public education, would likely increase donation rates. More importantly, however, a mandated choice framework would respect the autonomous preferences of people who do not wish to donate. We focus in particular on the Australian healthcare context, and consider how a mandated choice system could function as an ethical means to increase the organ donation rate in Australia. We make the novel proposal that all individuals who vote at an Australian federal election be required to state their organ donation preferences when voting. (shrink)

Approximately 62,000 people in this country await organ transplants. Ten years ago the waiting list numbered 16,000. The line gets longer every day. Up to 30% of those waiting in line will die waiting. We face a chronic shortage of organs. While demand for organs steadily increases, the number of cadaveric organ donors remains relatively constant: approximately 4,000 in 1988, and approximately 5,500 in 1997. In response to this environment of scarcity, policymakers have considered initiatives in a number of domains.

In this study, we examine investor and firm response to the California Transparency in Supply Chains Act of 2010. The CTSCA requires large retail and manufacturing firms to disclose efforts to eradicate slavery and human trafficking from their supply chains and is a rare example of mandated corporate social responsibility disclosure. Based on a sample of 105 retail companies subject to the CTSCA, we find a significant negative market reaction to the passing of the CTSCA. Furthermore, we find that (...) the reaction is significantly more negative for larger firms and companies facing greater supply chain risks, suggesting that investors place a negative value on exposure to legitimacy threats in the social domain. With respect to company disclosure response, we document relatively high compliance with the legislation, although we also find that the disclosure response appeared to be more symbolic than substantive in nature. Finally, our analysis indicates that both disclosure choice and disclosure extensiveness were significantly higher for the high-supply chain risk companies, suggesting that the response was influenced by concerns with strategic legitimation. Overall, the limited quality of disclosure suggests that, without additional rules and guidance, mandates alone may not lead to meaningful social disclosure. (shrink)

This article argues that the Supreme Court should not require a religious exemption from vaccine mandates. For children, who cannot yet make autonomous religious decision, religious exemptions would allow parents to make a choice that puts the child at risk and makes the shared environment of the school unsafe — risking other people’s children. For adults, there are still good reasons not to require a religious exemption, since vaccines mandates are adopted for public health reasons, not to target religion, (...) are an area where free riding is a real risk, no religion actually prohibits vaccinating under a mandate, and policing religious exemptions is very difficult. (shrink)

I critically examine a common liberal egalitarian view about the justification for, and proper content of, mandatory health insurance. This view holds that a mandate is justified because it is the best way to ensure that those in poor health gain health insurance on equitable terms. It also holds that a government should mandate what a representative prudent individual would purchase for themselves if they were placed in fair conditions of choice. I argue that this common justification for a (...) mandate is incomplete. A further reason for mandated insurance is that it helps secure social egalitarian public goods that would be underprovided if insurance were optional. I also argue that rather than mandating what a representative individual would choose for themselves, we should design the mandatory package by appealing to a pluralistic egalitarian view, which cares about improving people’s well-being, reducing unfair inequality, and maintaining egalitarian social relations. (shrink)

This Ideas and Opinions article revisits an argument from Judith Jarvis Thomson in her essay “A Defense of Abortion” that abortion can be an ethical choice even if we assume that fetuses have full moral personhood and moral rights. The authors examine the implications of laws that require a pregnant person to care for another with their body and what other impositions states may also require of citizens to care for others.

Health ethics can justify the use of vaccination mandates. However, policies that pressurize parents to vaccinate their children can undermine traditional clinical ethics standards. The aim of this paper is to argue that the ethical impact of vaccination mandates can only be determined in the context of the clinical encounter. Public debate on the topic tends to be general in nature and, as a result, issues that require clarification to help sustain the trust of service users are underexamined. In addition, (...) ethical debates are hampered by a toxic dichotomy in the public sphere between those who claim a move away from parental choice is necessarily a serious ethical violation; and others who neglect serious consideration of ethical issues. This predicament permits flawed ethical claims to be made, and to remain unchallenged. Despite this, ethical concerns – including those relating to trust and individual freedom – are fundamental to sustaining confidence in vaccination. This has recently been highlighted by the Covid-19 pandemic which made accessing childhood vaccinations harder, leading to a further decline in uptake. The pandemic has also revealed the strength of public feeling towards infection control measures that restrict peoples’ freedoms. In this paper I argue that to minimize the ethical disruption associated with the use of vaccination mandates, it is essential to focus more attention on their impact in the clinic and to accurately identify the drivers of such tensions. (shrink)

As a medical ethicist, I want to explain why college vaccination requirements decidedly do not violate the core principles of medical ethics which include avoiding or lessening harms, promoting benefits, respecting people and their informed and free choices, and promoting justice and fairness. In particular, vaccine requirements do not violate the respect-related requirement to not selfishly “use” and abuse others as “means” for someone else’s benefit. Since false claims on important issues often have dire consequences, it’s important to explain why (...) medical ethics supports vaccinating college students. (shrink)

In this paper, I would like to discuss two recent attempts to incorporate groupdifferentiated rights and entitlements into a broadly liberal conception of distributive justice. The first is John Roemer’s “pragmatic theory of responsibility,” and the second is Will Kymlicka’s defense of minority rights in “multinational” states.1 Both arguments try to show that egalitarianism, far from requiring a “color-blind” system of institutions and laws that is insensitive to ethnic, linguistic or subcultural differences, may in fact mandate special types of rights, (...) entitlements, or compensatory arrangements for members of minority groups. These proposals are attractive because they attempt to ground these special rights without reference to controversial philosophical doctrines, but merely through appeal to the widely accepted political norm of equality. Furthermore, if either of these arguments were to succeed, it would allow liberals to avoid many of the difficulties that have often led proponents of “the politics of difference” or the “politics of recognition” to adopt an oppositional stance toward more traditional forms of liberalism.2.. (shrink)

The Patient Protection and Affordable Care Act of 2010 is the law of the land. But it faces an uncertain future.During congressional deliberations on the 2,700-page legislation leading up to its enactment, from February to March 2010, not one major survey recorded majority support for the legislation. Since its enactment, popular opposition to the Affordable Care Act has hardened, and was a significant factor in the 2010 congressional election, in which Democrats lost 63 seats and Republicans regained the majority in (...) the House of Representatives. Ballot initiatives in Missouri and Ohio, showcasing popular opposition to the individual mandate, passed in 2010 with overwhelming majorities. While the United States Supreme Court in National Federation of Independent Business et al. v. Sebelius, 132 S. Ct. 2566, declared the mandate on the states to expand Medicaid unconstitutionally coercive, the majority of the Justices also upheld the individual mandate as a permissible tax. The new law thus emerged as a central topic in the 2012 election. (shrink)

The belief in heaven's mandate (tianming 天命) in earlier documents referred to divine‐ethical sanctions of political rulers. It later developed multiple implications such as an individual's destiny or fate and became one of the most fundamental concepts in Chinese intellectual and cultural history. In modern times, this concept has received long‐lasting attention in the field of Chinese philosophy, and almost all major scholars have more or less been involved in discussions and debates, especially on the topic of the classical Confucian (...) conception of heaven's mandate. Their discussions on this topic have largely focused on two major controversies: (i) whether early Confucians view heaven's mandate as prescriptive ethical command or descriptive amoral fate, and (ii) whether their attitude toward heaven's mandate is voluntarist or fatalistic. While this scholarship has been fruitful and insightful, it has continued for almost a century with certain variants. Therefore, it is time to address this topic with new approaches and hermeneutic horizons. In this essay, I propose a new approach and horizon to viewing the classical Confucian conception of heaven's mandate as their reflections on individual existence and self‐realization under the constraints of mandate or destiny. I examine the texts associated with Confucius and Mencius such as the Analects and the Mencius, as well as some recently unearthed texts, to suggest that early Confucians accommodate individual initiative and self‐determination of life choices through their conceptualization of heaven's mandate. To them, the vocabulary of heaven's mandate empowers individuals, especially through situating their places in society and the cosmos. By knowing and standing firmly on one's mandate or destiny, the individual not only realizes the value of their existence but also goes beyond the ultimate destiny of death. This fresh reading of heaven's mandate is grounded in the context of the development of Confucian ideas in the early period and presents an optimistic vision of Confucian humanism. (shrink)

Many “anti-vaxxers” oppose COVID-19 vaccination mandates on the grounds that they wrongfully infringe on bodily autonomy. Their view has been expressed with the slogan “My Body, My Choice,” co-opted from the pro-choice abortion rights movement. Yet, many of those same people are pro-life and support abortion restrictions that are effectively a kind of gestation mandate. Both vaccine and gestation mandates impose restrictions on bodily autonomy in order to prevent serious harms. This article evaluates the defensibility of the anti-vax (...) pro-life position. We argue that the case for opposing gestation mandates on grounds of bodily autonomy is much stronger than the case for opposing vaccine mandates—even if fetuses have full moral status. Thus, there is a deep tension in being a pro-life, COVID anti-vaxxer concerned with bodily autonomy. (shrink)

This paper addresses and challenges the pronatalist marginalization and oppression of voluntarily childless women in the Global North. These conditions call for philosophical analyses and for sociopolitical responses that would make possible the necessary moral spaces for resistance. Focusing on the relatively privileged subgroups of women who are the targets of pronatalist campaigns, the paper explores the reasons behind their choices, the nature and methods of Western pronatalism, and distinguishes three specific sources of some of the more lasting, and stigmatizing (...) attacks: popular culture, law and policy, and medicine itself. I then argue that because they are construed by motherhood-essentializing, and increasingly popular, pronatalist narratives as, among other things, “failed” or “selfish,” voluntarily childless women are subsequently burdened with damaged identities that can leave them personally othered and uniquely liminal in ways that are destructive to moral agency. Finally, I conclude with a challenge to the pronatalist master narratives by suggesting the possibility of counter narratives to the voluntarily childless woman's liminality that might serve as the ground of moral and political solidarity among differently situated women, regardless of their motherhood status. (shrink)

Neoliberal cultural frames of individual choice inform mothers’ accounts of why they refuse state-mandated vaccines for their children. Using interviews with 25 mothers who reject recommended vaccines, this article examines the gendered discourse of vaccine refusal. First, I show how mothers, seeing themselves as experts on their children, weigh perceived risks of infection against those of vaccines and dismiss claims that vaccines are necessary. Second, I explicate how mothers see their own intensive mothering practices—particularly around feeding, nutrition, and (...) natural living—as an alternate and superior means of supporting their children’s immunity. Third, I show how they attempt to control risk through management of social exposure, as they envision disease risk to lie in “foreign” bodies outside their networks, and, therefore, individually manageable. Finally, I examine how these mothers focus solely on their own children by evaluating—and often rejecting—assertions that their choices undermine community health, while ignoring how their children benefit from the immunity of others. By analyzing the gendered discourse of vaccines, this article identifies how women’s insistence on individual maternal choice as evidence of commitment to their children draws on and replicates structural inequality in ways that remain invisible, but affect others. (shrink)

Cass Sunstein and Richard Thaler's proposal that social and legal institutions should steer individuals toward some options and away from others-a stance they dub "libertarian paternalism"-has provoked much high-level discussion in both academic and policy settings. Sunstein and Thaler believe that steering, or "nudging," individuals is easier to justify than the bans or mandates that traditional paternalism involves. -/- This Article considers the connection between libertarian paternalism and the regulation of reproductive choice. I first discuss the use of nudges (...) to discourage women from exercising their right to choose an abortion, or from becoming or remaining pregnant. I then argue that reproductive choice cases illustrate the limitations of libertarian paternalism. Where choices are politicized or intimate, as reproductive choices often are, nudges become not much easier to justify than traditional mandates or prohibitions. Even beyond the context of reproductive choice, it is not obvious how much easier nudges are to justify than bans or mandates. -/- Part I of this Article briefly introduces Sunstein and Thaler's libertarian paternalism. Part II then turns to the context of reproductive choice. Part II.A reviews restrictions on the right to choose an abortion-particularly post-Casey regulations such as waiting periods, requirements that women receive certain types of information, and requirements that women undergo ultrasound-that pitch themselves as steering choice without entirely closing off the right to choose an abortion. This distinction between nudges and prohibitions echoes Sunstein and Thaler's proposals, but works to subordinate women's choices to the judgment of (often male) experts and administrators-hence my term "libertarian patriarchalism." Part II.B reviews efforts to nudge women-particularly teenagers, HIV-positive women, and others thought to be unsuitable mothers-to avoid pregnancy. -/- Part III considers the normative implications of nudging reproductive decisions. In Part III.A, I argue that the political nature of reproductive choices presents a problem for nudges. I do so by considering a parallel with voting rights. Empirical research shows that voters are more likely to choose the candidate listed first on the ballot. Yet we do not empower the administrator in charge of ballot design to choose a default rule that nudges individuals toward the candidate he sincerely believes would promote choosers' welfare. Given the political nature of reproductive choices, a policymaker's attempting to nudge reproductive decisionmaking in the direction he prefers-or indeed in any direction-fails to show adequate respect for the chooser's agency. In Part III.B, I offer an argument that targets the use of nudges in the context of pregnancy. Finally, in Part III.C, I argue that nudges do not merely add choices to an existing menu, but change the substantive choices available to individuals and thereby impose more-than-trivial costs on them. I conclude by exploring the implications of my arguments for nudges more generally. (shrink)

There have been calls for mandatory vaccination legislation to be introduced into the UK in order to tackle the national and international rise of vaccine-preventable disease. While some countries have had some success associated with mandatory vaccination programmes, the Royal College of Paediatrics and Child Health insist this is not a suitable option for the UK, a country which has seen historical opposition to vaccine mandates. There is a lack of comprehensive data to demonstrate a direct link between mandatory vaccination (...) legislation and increased uptake. While there are examples whereby there has been an improvement, some studies suggest that comparable results can be obtained by strongly recommending vaccinations instead. The RCPCH insist that healthcare workers are ideally placed to engage and inform parents to make every interaction a ‘vaccine opportunity’. This paper calls for a principled, rational approach to interpretations of autonomy which underpin parental informed consent. MacLean’s concept of mutual persuasion could be a vehicle to ensuring parents are suitably informed of both the material risks associated with vaccine choices and to consider the rationality of their decisions, while ultimately upholding parental autonomy. It is argued that this, alongside infrastructural improvement, could create a more sustainable, long-term improvement in childhood vaccination rates in the UK than mandatory vaccination. (shrink)

Based upon the demarcation between Elementalism and Atomism Chemistry from the perspective of the long-term history of chemistry, the authors re-examine the Berthollet-Proust controversy on the three types of chemical compounds, pointing out that Berthollet proposed the law of indefinite proportions by deduction, while Proust proposed the law of definite proportions by induction. The controversy is beyond the framework of affinity chemistry and entail a synthesis of meta-chemical thinking and experiments. Proust’s discovery of the law of definite proportions not only (...) function as Bacon’s “instances of lamp” to invoke Dalton and other atomism chemists to envision atomism, but also served as a bridge linking the two meta-chemistries. John Dalton, the third choice, envisioned his atomism by abduction. The case study on “the Berthollet-Proust controversy and Dalton’s resolution” mandates a reinvestigation of the crucial role of the system of experiments and the evolution of chemistry according to the demarcation between the established branches of Elementalism and Atomism Chemistry. (shrink)

This case study explored how a teacher, Mr. Smith, and his students experienced a mandated performance assessment while simultaneously preparing for an end of the year high-stakes, multiple-choice assessment. We employed qualitative research methods to examine how the teacher enacted a mandated performance assessment during a unit on Byzantium and how students described their learning and classroom experiences from the unit. Drawing on Grant's idea of ambitious teaching and learning of history and Ball's work on policy realization, (...) analysis of these data indicated that Mr. Smith interpreted and enacted a performance assessment in ways that differed from how district and state policy makers intended. Despite an assessment that the district designed to promote historical thinking skills, students learned primarily factual knowledge. (shrink)

The ethical and philosophical issues of choosing disability accommodations, particularly regarding human service provider accommodations, have not received much attention in the academic literature. Signed language interpreting is an especially complex accommodation that requires assessment of the deaf person's language knowledge and facility in a society where the many varieties of deaf education have generated a continuum of American Sign Language and signed English. Signed language interpreters with variable levels of skill and proficiency flock to work in locations with high (...) demand for their services, sometimes with little regulation and consumer protection, due to laws that mandate the provision of... (shrink)

Hijab – covering of a Muslim woman's body – is the most visible Islamic mandate. For a century it has been a major site of ideological struggle between traditionalism and modernity, and a yardstick for measuring the emancipation or repression of Muslim women. In recent decades hijab has become an arena where Islamist and secular feminist rhetoric have clashed. For Islamists, hijab represents their distinct identity and their claim to religious authenticity: it as a divine mandate that protects women and (...) defines their place in society. For secular feminists, hijab represents women's oppression: it is a patriarchal mandate that denies women the right to control their bodies and to choose what to wear. The clash has been particularly strident in Iran, where the state has twice intervened with legislation to an extent that no other Muslim country has experienced. Iran, too, has been a prime site for the emergence of `Islamic feminist' discourses that speak of hijab not as a `duty,' but as a `right,' and as a social rather than a religious mandate, and finds juristic arguments to support this position. This article traces the genealogy of this new juristic position from notions of hijab in classical Islamic jurisprudence (fiqh). It documents how jurisprudential positions and notions of hijab in Iran evolved in response to socio-political factors. It concludes by highlighting wider implications of the new juristic position on hijab for establishing common ground between secular feminist and Islamic discourses. (shrink)

Asymptomatic COVID‐19 testing programmes are being introduced in higher education institutions, but stakeholder views regarding the acceptability of mandating or incentivizing participation remain little understood. A mixed‐method study (semi‐structured interviews and a survey including open and closed questions) was undertaken in a case study university with a student testing programme. Survey data were analysed descriptively; analysis for interviews was based on the framework method. Two hundred and thirty‐nine people participated in the study: 213 in the survey (189 students, 24 staff), (...) and 26 in interviews (19 students, 7 staff). There was majority (62%) but not universal support for voluntary participation, with a range of concerns expressed about the potentially negative effects of mandating testing. Those who supported mandatory testing tended to do so on the grounds that it would protect others. There was also majority (64%) opposition to penalties for refusing to test. Views on restricting access to face‐to‐face teaching for non‐participants were polarized. Three‐quarters (75%) supported incentives, though there were some concerns about effectiveness and unintended consequences. Participants emphasized the importance of communication about the potential benefits of testing. Preserving the voluntariness of participation in student asymptomatic testing programmes is likely to be the most ethically sound policy unless circumstances change. (shrink)

An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people’s choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further (...) conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums. (shrink)

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (shrink)

In this paper, we thoroughly investigate the various solutions proposed to solve the problems of transplantation system in Romania. Three types of solutions are especially envisaged: legislative ones, institutional ones and cultural/religious ones. We carefully analyze the main ethical and logistical arguments on presumed consent and its alternatives in Romania: family consent provided by the relatives and mandated choice. Special attention is dedicated both to institutional solutions (organizational, educational and information issues) and to religious arguments and motivations, for (...) there were several indicators of their importance for Romanian bioethical discourse in general and for their prevalence in transplantation debates in particular. . (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

Richard Thaler and Cass Sunstein (2008) contend that mandated choice is the most practical nudge for increasing organ donation. We argue that they are wrong, and their mistake results from failing to appreciate how perceptions of meaning can influence people's responses to nudges. We favor a policy of default to donation that is subject to immediate family veto power, includes options for people to opt out (and be educated on how to do so), and emphasizes the role of (...) organ procurement organizations and in-house transplant donation coordinators creating better environments for increasing the supply of organs and tissues obtained from cadavers. This policy will provide better opportunities for offering nudges in contexts where in-house coordinators work with families. We conclude by arguing that nudges can be introduced ethically and effectively into these contexts only if nudge designers collaborate with in-house coordinators and stakeholders. (shrink)

Endotracheal intubation (ETI) is a valuable procedure which must be learnt and practised, and performing ETI on cadavers is probably the best way to do this, although lesser alternatives do exist. Performing ETI on a cadaver is viewed with a real and reasonable repugnance and if it is done without proper authorisation it might be illegal. Some form of consent is required. Presumed consent would preferably be governed by statute and should only occur if the community is well informed and (...) therefore in a position of being able to decline. Currently neither statute nor adequate informing exists. Endotracheal intubation on the newly dead may be justifiable according to a Guttman scale if the patient has already consented to organ donation and if further research supports the relevance of the Guttman scale to this question. A "mandated choice" with prior individual consent as a matter of public policy is the best of these solutions, however until such a solution is in place we may not practise endotracheal intubation on the newly dead. (shrink)

This essay appreciatively and critically engages the late Robert Veatch’s extensive and important contributions to transplantation ethics, in the context of his overall ethical theory and his methods for resolving conflicts among ethical principles. It focuses mainly on ways to obtain and allocate organs from deceased persons, with particular attention to express donation, mandated choice, and presumed consent/routine salvaging in organ procurement and to conflicts between medical utility and egalitarian justice in organ allocation. It concludes by examining the (...) unclear relations between Veatch’s ideal moral theory and his nonideal moral theory, especially in organ allocation. (shrink)

Recent psychological research concerning determinantsof and barriers to organ donation is reviewed with theintention of ascertaining acceptable and potentiallyeffective ways of improving organ retrieval. On thebasis of this review, five recommendations are made.(1) Individuals' donation wishes, where explicit,should be decisive. (2) Next of kin should witnessdonor decisions. (3) Mandated choice should replacevoluntary `opting-in'. (4) Initial donation choicesshould be repeatedly re-evaluated. (5) Those involvedin organ procurement should distance themselves frommodel of bodies as machines or gardens and embracemodels where bodies (...) are viewed as sacred extensions ofself. In combination, these recommendations are arguedto be preferable in several ways to opt-out/presumedconsent procurement options. (shrink)

The dominant legal and regulatory approach to protecting information privacy is a form of mandated disclosure commonly known as “notice-and-consent.” Many have criticized this approach, arguing that privacy decisions are too complicated, and privacy disclosures too convoluted, for individuals to make meaningful consent decisions about privacy choices—decisions that often require us to waive important rights. While I agree with these criticisms, I argue that they only meaningfully call into question the “consent” part of notice-and-consent, and that they say little (...) about the value of notice. We ought to decouple notice from consent, and imagine notice serving other normative ends besides readying people to make informed consent decisions. (shrink)

This article explores the circulation of #MyBodyMyChoice in a series of deeply divisive political debates – abortion rights and mask wearing during COVID-19. We trace the appropriation of this slogan for differing ideological purposes, and its shifts from collective political action concerning pro-choice to the rights of individuals to refuse to comply with mask mandates. Underpinning the values of each is a white liberal racism that operates to uphold dominant gender, class and economic structures.

Group decisions raise a number of substantial philosophical and methodological issues. We focus on the goal of the group decision exercise itself. We ask: What should be counted as a good group decision-making result? The right decision might not be accessible to, or please, any of the group members. Conversely, a popular decision can fail to be the correct decision. In this paper we discuss what it means for a decision to be "right" and what components are required in a (...) decision process to produce happy decision-makers. Importantly, we discuss how "right" decisions can produce happy decision-makers, or rather, the conditions under which happy decision-makers and right decisions coincide. In a large range of contexts, we argue for the adoption of formal consensus models to assist in the group decision-making process. In particular, we advocate the formal consensus convergence model of Lehrer and Wagner (1981), because a strong case can be made as to why the underlying algorithm produces a result that should make each of the experts in a group happy. Arguably, this model facilitates true consensus, where the group choice is effectively each person's individual choice. We analyse Lehrer and Wagner's algorithm for reaching consensus on group probabilities/utilities in the context of complex decision-making for conservation biology. While many conservation decisions are driven by a search for objective utility/probability distributions (regarding extinction risks of species and the like), other components of conservation management primarily concern the interests of stakeholders. We conclude with cautionary notes on mandating consensus in decision scenarios for which no fact of the matter exists. For such decision settings alternative types of social choice methods are more appropriate. (shrink)

Health incentive schemes aim to produce healthier behaviors in target populations. They may do so both by making incentivized options more salient and by making them less costly. Changes in costs only result in healthier behavior if the individual rationally assesses the cost change and acts accordingly. Not all people do this well. Those that fail to respond rationally to incentives will typically include those who are least able to make prudent choices more generally. This group will typically include the (...) least advantaged more generally, since disadvantage inhibits one's effective ability to choose well and since poor choices tend to cause or aggravate disadvantage. Therefore, within the target population, health benefits to the better off may come at the cost of aggravated inequity. This is one instance of a problem I name the Able Chooser Problem, previously emphasized by Richard Arneson in relation to coercive paternalism. I describe and discuss this problem by distinguishing between policy options and their effects on the choice situation of individuals. Both positive and negative incentives, as well as mandates that are less than perfectly effective, require some sort of rational deliberation and action and so face the Able Chooser Problem. In contrast, effective restriction of what options are physically available, as well as choice context design that makes some options more salient or appealing, do not demand rational agency. These considerations provide an equity-based argument for preferring smart design of our choice and living environment to incentives and mandates. (shrink)

The evolution of the human mind through natural selection mandates that our conscious experiences are causally potent in order to leave a tangible impact upon the surrounding physical world. Any attempt to construct a functional theory of the conscious mind within the framework of classical physics, however, inevitably leads to causally impotent conscious experiences in direct contradiction to evolution theory. Here, we derive several rigorous theorems that identify the origin of the latter impasse in the mathematical properties of ordinary differential (...) equations employed in combination with the alleged functional production of the mind by the brain. Then, we demonstrate that a mind--brain theory consistent with causally potent conscious experiences is provided by modern quantum physics, in which the unobservable conscious mind is reductively identified with the quantum state of the brain and the observable brain is constructed by the physical measurement of quantum brain observables. The resulting quantum stochastic dynamics obtained from sequential quantum measurements of the brain is governed by stochastic differential equations, which permit genuine free will exercised through sequential conscious choices of future courses of action. Thus, quantum reductionism provides a solid theoretical foundation for the causal potency of consciousness, free will and cultural transmission. (shrink)

Objective Recent legislation mandating the inclusion of children in clinical trials has resulted in an increase in the number of children participating in research. We reviewed the literature regarding the reasons parents chose to accept or decline an invitation to enrol their children in clinical research. Methods We searched for qualitative studies, written in the English language that considered the experiences of parents who had been invited to enrol their children in research. SCOPUS and Web of Knowledge electronic databases and (...) reference lists of retrieved articles and review papers were searched. Retrieved articles were synthesised using the narrative synthesis method. Results 16 qualitative studies exploring the experiences of parents living in five countries whose children had a range of health conditions of varying severity were included. The health status of the child appeared to influence parents' reasons for participation. Parents whose children had life threatening conditions often considered they had no choice but to participate and many welcomed the innovation offered through research participation. Such parents also viewed the risks of research less negatively than those whose children were healthy or in the stable stage of a chronic condition. This raises questions regarding the voluntariness of informed consent by such parents. Conclusions A tailored approach is needed when discussing research participation with parents of eligible children. While parents of healthy children may be more open to discussions of altruism, those whose children have life threatening illnesses should be given adequate information about the alternatives to, and risks of, research participation. (shrink)

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility (...) carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically. (shrink)

In recent years, 'nudge units' or 'behavioral insights teams' have been created in the United States, the United Kingdom, Germany, and other nations. All over the world, public officials are using the behavioral sciences to protect the environment, promote employment and economic growth, reduce poverty, and increase national security. In this book, Cass R. Sunstein, the eminent legal scholar and best-selling co-author of Nudge, breaks new ground with a deep yet highly readable investigation into the ethical issues surrounding nudges, (...) class='Hi'>choice architecture, and mandates, addressing such issues as welfare, autonomy, self-government, dignity, manipulation, and the constraints and responsibilities of an ethical state. Complementing the ethical discussion, The Ethics of Influence: Government in the Age of Behavioral Science contains a wealth of new data on people's attitudes towards a broad range of nudges, choice architecture, and mandates. (shrink)