Thomas Douglas

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public.

Should an institutional scheme prioritize the rectification or compensation of harms it has wrongfully caused over provision of aid to persons it has not harmed? Some who think so rely on an analogy with the view that persons should give higher priority to rectification than to aid. Inference from the personal view to the institutional view would be warranted if either (i) the correct moral principles for institutional assessment are nearest possible equivalents of the correct personal moral principles, or (ii) the moral principles which ground the personal view also ground the institutional view. Neither claim can be justified. I briefly assess some alternative ways of defending the view that institutions should prioritize rectification over aid

When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies—have faced a series of criticisms. One holds that agents often fail to meet either the control or epistemic conditions on responsibility with regard to their unhealthy lifestyles or their outcomes. Another holds that even if patients sometimes are responsible for these items, we cannot know whether a particular patient is responsible for them. In this article, we propose a type of responsibility-sensitive policy that may be able to surmount these difficulties. Under this type of policy, patients are empowered to change to a healthier lifestyle by being given what we call a ‘Golden Opportunity’ to change. Such a policy would not only avoid concerns about patients’ fulfilment of conditions on responsibility for their lifestyles, it would also allow healthcare authorities to be justified in believing that a patient who does not change her lifestyle is responsible for the unhealthy lifestyle. We conclude with a discussion of avenues for further work, and place this policy in the broader context of the debate on responsibility for health.

It is sometimes claimed that those who succeed with the aid of enhancement technologies deserve the rewards associated with their success less, other things being equal, than those who succeed without the aid of such technologies. This claim captures some widely held intuitions, has been implicitly endorsed by participants in social–psychological research and helps to undergird some otherwise puzzling philosophical objections to the use of enhancement technologies. I consider whether it can be provided with a rational basis. I examine three arguments that might be offered in its favour and argue that each either shows only that enhancements undermine desert in special circumstances or succeeds only under assumptions that deprive the appeal to desert of much of its dialectic interest.

Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non-consensual. We argue that non-consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non-consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices.

Andreas Schmidt and Neil Levy have recently defended nudging against the objection that nudges fail to treat nudgees as rational agents. Schmidt rejects two theses that have been taken to support the objection: that nudges harness irrational processes in the nudgee, and that they subvert the nudgee’s rationality. Levy rejects a third thesis that may support the objection: that nudges fail to give reasons. I argue that these defences can be extrapolated from nudges to some nonconsensual neurointerventions; if Schmidt’s and Levy’s defences succeed, then some nonconsensual neurointerventions neither harness irrationality, nor subvert rationality, nor fail to give reasons. This, I claim, poses a challenge both to opponents of nonconsensual neurointerventions, and to defenders of nudging.

In 2014, American doctor Ian Crozier chose to travel to Sierra Leone to help fight the West African Ebola epidemic. He contracted Ebola himself and was evacuated to the US, where he received hospital treatment for 40 days. Crozier knowingly chose to expose himself to a risk of contracting Ebola, and thus appears to be at least somewhat morally responsible for his infection. Did this responsibility weaken his justice-based claim to publicly funded treatment? On one influential view—luck egalitarianism—the answer is ‘yes’. Or so Albertsen and Thaysen suggest in this issue.1 According to luck egalitarianism, justice requires the elimination of inequalities between people, but only when the relative harm borne by those on the wrong end of the inequality is a matter of luck. Albertsen and Thaysen understand luck egalitarianism to entail that, when one is responsible for befalling a harm, one has no claim in justice to the mitigation of that harm. On this view, they suggest, Crozier’s claim to treatment would be similar to that of a reckless Alpine skier who is injured in a skiing accident, and would be weaker than that of those with a normal claim to treatment—those who bear no responsibility for their illness. Both of these implications seem implausible, however. Intuitively, Crozier’s claim to treatment is no weaker than those with normal claims, and certainly stronger than the reckless skier’s. Can luck egalitarianism be ‘adjusted or interpreted’ so as to avoid these implausible implications? The authors suggest that it can. Their innovation is to distinguish heroic doctors like Crozier from reckless skiers by invoking a distinction between being responsible for creating harm and for incurring harm. Their thought is that one creates harm when one brings harm on oneself without also preventing at least as much harm to others. Thus, the harm that …

This article considers what can be learned regarding the ethical acceptability of intrusive interventions intended to halt the spread of infectious disease (‘Infection Control’ measures) from existing ethical discussion of intrusive interventions used to prevent criminal conduct (‘Crime Control’ measures). The main body of the article identifies and briefly describes six objections that have been advanced against Crime Control, and considers how these might apply to Infection Control. The final section then draws out some more general lessons from the foregoing analysis for the ethical acceptability of different kinds of Infection Control.

This issue includes a number of papers on reproductive ethics, broadly construed. In a recent book, Anja Karnein proposed that embryos created in vitro should be offered up for adoption before being discarded or used in research;1 here Timothy Murphy offers a critical response . Elsewhere, Tak Chan and Stark & Delatycki debate the role of medical professionals in providing parentage determination. Chan argues that doctors are obliged to provide parentage tests when this is requested by parents, provided there is a low risk that the child will be abandoned . Stark & Delatycki discuss some difficulties raised by the ‘risk of abandonment’ condition . Finally, papers by Kate Greasley and David Lang discuss the controversy surrounding the criminal prosecution of abortion doctor Kermit Gosnell. Greasley criticises the way in which some commentators capitalised on horror at Gosnell's extreme practices to advance more general anti-abortion objectives . Lang argues, against Greasley, that the dominant pro-life response to the case was neither self-contradictory nor intellectually dishonest .The issue is dominated, however, by discussions of ‘bioenhancement’ – the use of biomedical technologies to augment human capacities. A common criticism of bioenhancements is that they are anti-social: though they may benefit the user, they will have a negative effect on society-at-large. Such concerns are perhaps well placed in relation to the most obvious contemporary examples of bioenhancement: doping in sport, aesthetic medicine, and the use of stimulants to enhance examination performance. However, two varieties of bioenhancement discussed in this issue might be thought to have more positive social effects.David Shaw discusses the possible use of cognitive enhancing drugs to improve health outcomes in disadvantaged segments of society . Such enhancements might be thought to have desirable social …

The right to bodily integrity (RBI) may seem inapt for inclusion in this volume, which is supposed to address new human rights, for as A. M. Viens notes, the RBI is a long-standing fixture in the philosophical and legal discussion of rights. However, Viens does, I think, make a good case for the right’s inclusion here. Not only does he note the increasing recognition of a new right to genital integrity derived from the more general RBI, he also argues for a new conceptualisation of the RBI itself: he argues that we ought to decompose the RBI into several constituent rights, delineated according to the different values from which they derive – rights to bodily autonomy, bodily dignity, bodily ownership, well-being, and so on.

Some suggest that gene editing human embryos to prevent genetic disorders will be in one respect morally preferable to using genetic selection for the same purpose: gene editing will benefit particular future persons, while genetic selection would merely replace them. We first construct the most plausible defence of this suggestion—the benefit argument—and defend it against a possible objection. We then advance another objection: the benefit argument succeeds only when restricted to cases in which the gene-edited child would have been brought into existence even if gene editing had not been employed. Our argument relies on a standard account of comparative benefit which has recently been criticised on the grounds that it succumbs to the so-called ‘pre-emption problem’. We end by considering how our argument would be affected were the standard account revised in an attempt to evade this problem. We consider three revised accounts and argue that, on all three, our critique of the benefit argument stands.

It is commonly thought that when a patient is unable to make a treatment decision for herself, patient autonomy should be respected by consulting the views of a patient surrogate, normally either the next-of-kin or a person previously designated by the patient. On one view, the task of this surrogate is to make the treatment decision that the patient would have made if competent. But this so-called ‘substituted judgment standard’ (SJS) has come in for has come in for a good deal of criticism recently. For instance, some question whether surrogates are able to reliably predict what the patient would have chosen. Others wonder how respecting a patient's counter-factual, rather than actual, choices is supposed to respect her autonomy. Such concerns have lead some to reject the SJS and argue for alternative characterisations of the role of surrogate decision-makers.

There is growing interest in the use of neurointerventions to reduce the risk that criminal offenders will reoffend. Commentators have raised several ethical concerns regarding this practice. One prominent concern is that, when imposed without the offender’s valid consent, neurointerventions might infringe offenders’ right to bodily integrity. While it is commonly held that we possess a moral right to bodily integrity, the extent to which this right would protect against such neurointerventions is as-yet unclear. In this paper, we will assess whether, why, and how severely three forms of neurointervention might infringe the right to bodily integrity. We show that the severity of the infringement of the right to bodily integrity differs across different forms of neurointervention. Moreover, we argue that mental and behavioral effects of neurointerventions could in some cases be relevant to determining the severity of infringements of the right to bodily integrity.

In recent years, there has been increased academic interest in the human right to freedom of thought (RFoT). Scholars from various disciplines are currently debating the content and scope of this right. In his annual thematic report of 2021, the United Nations Special Rapporteur on Freedom of Religion or Belief paid explicit and comprehensive attention to the RFoT, encouraging further clarification of the content and scope of the right. This paper aims to contribute to this end, setting the stage for further research, by offering a multidisciplinary analysis of the RFoT’s scope, relation to other rights, practical significance and moral foundations.

In this article, we argue that rational persuasion can be a _pro tanto_ wrong and that online platforms possess features that are especially conducive to this wrong. We begin by setting out an account of rational persuasion. This consists of four jointly sufficient conditions for rational persuasion and is intended to capture the core, uncontroversial cases of such persuasion. We then discuss a series of wrong-making features which are present in methods of influence commonly thought of as _pro tanto_ wrong, such as manipulation and paternalism. It is next shown that these wrong-making features are also present in a range of cases that are, by the jointly sufficient conditions already established, rational persuasion, and so some forms of rational persuasion are _pro tanto_ wrong, including in some ways that have not previously been remarked upon. Finally, we demonstrate that online settings possess a number of features that are especially conducive to wrongful rational persuasion.

In discussions of nudging, transparency is often taken to be important; it is often suggested that a significant moral consideration to take into account when nudging is whether the nudge is transparent. Another consideration taken to be relevant is whether the nudge is easy to resist. Sometimes, these two considerations are taken to be importantly related: if we have reason to make nudges easy to resist, then we have reason to make them transparent, insofar as a nudge’s transparency is relevant to whether the nudge is easy to resist. In this paper, we critically scrutinize this view. First, we draw out the purported connections between transparency and resistibility, combining them into what we call the Resistibility-to-Transparency Argument (RTA). Then, we do some conceptual groundwork elaborating on different forms of transparency mentioned in the debate. With this in place, we argue that in order to be plausible, the RTA must appeal to certain forms of transparency; those on which the transparency of a nudge depends on the nudgee’s ability to become aware of the relevant facts about the nudge. We then argue against the common assumption that in order for a nudge to be easy to resist for an individual, that individual needs to have the capacity to easily become aware of the relevant nudge facts. We conclude that the connection between the easy resistibility of a nudge and its transparency is, at best, a weak one.

In an empirical study, we compared how lay people judge motivation enhancement as opposed to cognitive enhancement. We found alienation is not seen as a danger associated with either form of enhancement. Cognitive enhancement is seen as more morally wrong than motivation enhancement, and users of cognitive enhancement tend to be judged as less deserving of praise and success than users of motivation enhancement. These more negative judgments of cognitive enhancement may be driven by differences in perceived fairness rather than differences in effort exerted by the user, although lay people generally see effort as necessary to deservingness of praise and success.

In this paper, we considered several variants of the internal-external principle (IEP), and showed that each was susceptible to counterexamples. In the final section of the paper, we showed that our weakening of IEP has significant implications for the wrongness of interferences in the Practical Cases. We showed that on Conditionalized Autonomy Variant, many instances of the Practical Cases do not have special wrongness. Those who hold that interferences in these Practical Cases are particularly morally problematic even when the altered desires are all-things-considered disvaluable should either provide a different explanation for the wrongness of these interferences, or give up the view that these interferences are in one respect more pro tanto wrong than the external frustration of the same desires.

It is often said that the institutions of criminal justice ought or—perhaps more often—ought not to rehabilitate criminal offenders. But the term ‘criminal rehabilitation’ is often used without being explicitly defined, and in ways that are consistent with widely divergent conceptions. In this paper, we present a taxonomy that distinguishes, and explains the relationships between, different conceptions of criminal rehabilitation. Our taxonomy distinguishes conceptions of criminal rehabilitation on the basis of the aims or ends of the putatively rehabilitative measure, and the means that may be used to achieve the intended end. We also explore some of the implications of each conception, some of the payoffs of a taxonomy of the kind we offer, and some areas for future work.

One role of research ethics committees is to assess the ethics of proposed health research. In some countries, RECs are also instructed to assess its legality. However, in other countries they are explicitly instructed not to do so. In this paper, I defend the claim that public policy should instruct RECs not to assess the legality of proposed research . I initially defend a presumption in favour of the Claim, citing reasons for making research institutions solely responsible for assessing the legality of their own research. I then consider three arguments against the Claim which may over-ride this presumption—namely, that policy should instruct RECs to assess the legality of research because doing so would minimise the costs of assessing the legality of research, whether research is legal may partly determine whether it is ethical and whether research is legal may constitute evidence for whether it is ethical. I reject the first two arguments and note that whether the third succeeds depends on the answer to a more fundamental question about the appropriate nature of REC ethical deliberation. I end with a brief discussion of this question, tentatively concluding that the third argument also fails

Interventions designed to promote perspective taking are increasingly prevalent in educational settings, and are also being considered for applications in other domains. Thus far, these perspective-taking interventions (PTIs) have largely escaped philosophical attention, however they are sometimes prima facie morally problematic in at least two respects: they are neither transparent nor easy to resist. Nontransparent or hard-to-resist PTIs call for a moral defense and our primary aim in this paper is to provide such a defense. We offer two arguments for the view that an exemplar PTI is morally permissible even though it is plausibly neither transparent nor easy to resist. The first argument appeals to an analogy between PTIs and permissible deceptive research practices. The second appeals to the way in which PTIs draw participants’ attention to their reasons for action. We also respond to the objection that, by imposing a particular conception of the good, PTIs violate liberal neutrality.

A central question in the current neurolegal and neuroethical literature is how brain-reading technologies could contribute to criminal justice. Some of these technologies have already been deployed within different criminal justice systems in Europe, including Slovenia, Italy, England and Wales, and the Netherlands, typically to determine guilt, legal responsibility, or recidivism risk. In this regard, the question arises whether brain-reading could permissibly be used against the person's will. To provide adequate legal protection from such non-consensual brain-reading in the European legal context, ethicists have called for the recognition of a novel fundamental legal right to mental privacy. In this paper, we explore whether these ethical calls for recognising a novel legal right to mental privacy are necessary in the European context. We argue that a right to mental privacy could be derived from, or at least developed within in the jurisprudence of the European Court of Human Rights, and that introducing an additional fundamental right to protect against brain-reading is not necessary. What is required, however, is a specification of the implications of existing rights for particular neurotechnologies and purposes.

Sex offenders are sometimes offered or required to undergo pharmacological interventions intended to diminish their sex drive (anti-libidinal interventions or ALIs). In this paper, we argue that much of the debate regarding the moral permissibility of ALIs has been founded on an inaccurate assumption regarding their intended purpose—namely, that ALIs are intended solely to realise medical purposes, not correctional goals. This assumption has made it plausible to assert that ALIs may only permissibly be administered to offenders with their valid consent, in line with the approach taken to most other interventions with a medical aim. However, we argue that, contrary to this assumption, the state's intention in relation to at least some ALIs is, at least in part, to achieve correctional objectives. We evaluate two legal regimes for ALI provision—section 645 of the California Penal Code and the mental health regime in England and Wales. In each case, we identify the state's implicit purpose in imposing ALIs and argue that the Californian and English regimes both serve as counterexamples to the view that ALIs are intended solely for medical purposes. While the moral implications of our argument are not straightforward, it raises the question whether consent is required for permissible imposition of ALIs, and more generally, whether the moral permissibility of crime-preventing interventions using medical means should be assessed against the standards of medical ethics or against those of criminal justice ethics.

The possibility of neurotechnological interference with our brain and mind raises questions about the moral rights that would protect against the (mis)use of these technologies. One such moral right that has received recent attention is the right to mental integrity. Though the metaphysical boundaries of the mind are a matter of live debate, most defences of this moral right seem to assume an internalist (brain-based) view of the mind. In this article, we will examine what an extended account of the mind might imply for the right to mental integrity and the protection it provides against neurotechnologies. We argue that, on an extended account of the mind, the scope of the right to mental integrity would expand significantly, implying that neurotechnologies would no longer pose a uniquely serious threat to the right. In addition, some neurotechnologies may even be protected by the right to mental integrity, as the technologies would becomepart ofthe mind. We conclude that adopting an extended account of the mind has significant implications for the right to mental integrity in terms of its protective scope and capacity to protect against neurotechnologies, demonstrating that metaphysical assumptions about the mind play an important role in determining the moral protection provided by the right.

Robert Sparrow has recently raised the possibility that stem cell technology could in the future be used to create multiple generations of embryos in the laboratory before transferring one embryo to a woman’s womb to create a pregnancy. Sparrow argues that any children produced in this way would be genetic orphans—they would lack living genetic parents—and explores the possible moral implications of this. A number of other authors have raised objections to Sparrow’s moral claims, but his descriptive claim remains unchallenged. In this chapter, we challenge it, arguing that Sparrow’s imagined technology could be performed in such a way that the children produced would have living genetic parents.

Psychological literature indicates that actions performed with the assistance of cognition‐enhancing biomedical technologies are often deemed to be less praiseworthy than similar actions performed without such assistance. This study examines (i) whether this result extends to the bioenhancement of moral capacities, and (ii) if so, what explains the effect of moral bioenhancement on perceived praiseworthiness. The findings indicate that actions facilitated by morally bioenhanced individuals are considered less deserving of praise than similar actions facilitated by ‘traditional’ moral enhancement—for example, moral self‐education. This diminished praise does not seem to be driven by an aversion to (moral) bioenhancement per se. Instead, it appears to be primarily attributable to a perceived lack of effort exerted by bioenhanced individuals in the course of their moral enhancement. Our findings advance the philosophical discourse on the foundations of praise in the context of moral bioenhancement by elucidating the empirical basis underlying some assumptions commonly employed to argue for or against the permissibility of moral bioenhancement.

The opponents of enhancement do not all set out to defend a common and clearly specified thesis. However, several would either assent or be attracted to the following claim (henceforth, the bioconservative thesis): Even if it were technically possible and legally permissible for people to engage in biomedical enhancement, it would not be morally permissible for them to do so. The scope of this thesis needs to be clarified. This chapter argues that the bioconservative thesis, thus qualified, is false. There is clearly scope for most people to morally enhance themselves. According to every plausible moral theory, people often have bad or suboptimally good motives. The author tentatively argues that it would sometimes be morally permissible for people to biomedically mitigate their counter‐moral emotions. The chapter concludes with a scenario consisting of five assumptions that will be morally permissible for people to morally enhance themselves.