Thomas Douglas

Parents typically favour their own children over others’. For example, most parents invest more time and money in their own children than in other children. This parental partiality is usually regarded as morally permissible, or even obligatory, but it can have undesirable distributive effects. For example, it may create unfair or otherwise undesirable advantages for the favoured child. A number of authors have found it necessary to justify parental partiality in the face of these distributive concerns, and they have typically done so by appealing to features of the parent–child relationship. Parental partiality is said to be justified, despite its undesirable distributive effects, in part because the parent enjoys a special kind of relationship with her child. In this paper, I raise a problem for such relational defences of parental partiality. I report empirical findings suggesting that parental partiality will frequently create advantages—sometimes undesirable—not only for one’s children, but also for one’s more distant descendants; I argue that the creation of these latter advantages stands as much in need of justification as does the creation of advantages for one’s own children; and I claim that existing relational defences do not clearly contain the resources necessary to deliver such a justification. I then examine three possible responses to this problem.

This article examines one kind of conscientious refusal: the refusal of healthcare professionals to treat sexual dysfunction in individuals with a history of sexual offending. According to what I call the orthodoxy, such refusal is invariably impermissible, whereas at least one other kind of conscientious refusal—refusal to offer abortion services—is not. I seek to put pressure on the orthodoxy by (1) motivating the view that either both kinds of conscientious refusal are permissible or neither is, and (2) critiquing two attempts to buttress it.

This chapter sets the scene for the subsequent philosophical discussions by surveying a number of biological interventions that have been used, or might in the future be used, for the purposes of crime prevention. These interventions are pharmaceutical interventions intended to suppress libido, treat substance abuse or attention deficit-hyperactivity disorder (ADHD), or modulate serotonin activity; nutritional interventions; and electrical and magnetic brain stimulation. Where applicable, we briefly comment on the historical use of these interventions, and in each case we discuss the evidence that they are effective, or might become so with further refinement. The chapter concludes with a comment on some potentially significant differences between the varieties of intervention that we canvass.

Interventions that modify a person’s motivations through chemically or physically influencing the brain seem morally objectionable, at least when they are performed nonconsensually. This chapter raises a puzzle for attempts to explain their objectionability. It first seeks to show that the objectionability of such interventions must be explained at least in part by reference to the sort of mental interference that they involve. It then argues that it is difficult to furnish an explanation of this sort. The difficulty is that these interventions seem no more objectionable, in terms of the kind of mental interference that they involve, than certain forms of environmental influence that many would regard as morally innocuous. The argument proceeds by comparing a particular neurointervention with a comparable environmental intervention. The author argues, first, that the two dominant explanations for the objectionability of the neurointervention apply equally to the environmental intervention, and second, that the descriptive difference between the environmental intervention and the neurointervention that most plausibly grounds the putative moral difference in fact fails to do so. The author concludes by presenting a trilemma that falls out of the argument.

Crime-preventing neurointerventions (CPNs) are increasingly being used or advocated for crime prevention. There is increasing use of testosterone-lowering agents to prevent recidivism in sexual offenders, and strong political and scientific interest in developing pharmaceutical treatments for psychopathy and anti-social behaviour. Recent developments suggest that we may ultimately have at our disposal a range of drugs capable of suppressing violent aggression, and it is not difficult to imagine possible applications of such drugs in crime prevention. But should neurointerventions be used in crime prevention, and may the state ever permissibly impose CPNs as part of the criminal justice process? It is widely thought that preventing recidivism is one of the aims of criminal justice, yet existing means of pursuing this aim are often poorly effective, restrictive of basic freedoms, and harmful. Incarceration, for example, tends to be disruptive of personal relationships and careers, detrimental to physical and mental health, highly restrictive of freedom of movement and association, and rarely more than modestly effective at preventing recidivism. Neurointerventions hold the promise of preventing recidivism in ways that are more effective and more humane, but the use of CPNs in criminal justice raises several ethical concerns. CPNs could be highly intrusive and may threaten fundamental human values, such as bodily integrity and freedom of thought, and humanity has a track record of misguided, harmful, and unwarrantedly coercive use of neurotechnological ‘solutions’ to criminality. This collection brings together original contributions from emerging scholars and internationally renowned moral and political philosophers to address these issues.

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 …

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.

Bioethicists sometimes defend compromise positions, particularly when they enter debates on applied topics that have traditionally been highly polarised, such as those regarding abortion, euthanasia and embryonic stem cell research. However, defending compromise positions is often regarded with a degree of disdain. Many are intuitively attracted to the view that it is almost always problematic to defend compromise positions, in the sense that we have a significant moral reason not to do so. In this paper, we consider whether this common sense view can be given a principled basis. We first show how existing explanations for the problematic nature of compromise fall short of vindicating the common sense view, before offering our own explanation, which, we claim, comes closer to vindicating that view. We argue that defending a compromise will typically have two epistemic costs: it will corrupt attempts to use the claims of ethicists as testimonial evidence, and it will undermine standards that are important to making epistemic progress in ethics. We end by suggesting that the epistemic costs of compromise could be reduced by introducing a stronger separation between ethical debate aimed at fulfilling the epistemic role of ethics, and ethical debate that aims to directly produce good policy or practice.

Recent advances in stem cell research suggest that in the future it may be possible to create eggs and sperm from human stem cells through a process that we term in vitro gametogenesis (IVG). IVG would allow treatment of some currently untreatable forms of infertility. It may also allow same-sex couples to have genetically-related children. For example, cells taken from one man could potentially be used to create an egg, which could then be fertilised using naturally produced sperm from another man to create a genetically-related child with half of its DNA from each of the men. In this chapter, we consider whether this technology could justifiably be denied to same-sex couples if it were made available as a fertility treatment to different-sex couples. We argue that it could not.

In this chapter I examine how expected-value theory might inform responses to what I call the dual-use problem. I begin by defining that problem. I then outline a procedure, which invokes expected-value theory, for tackling it. I first illustrate the procedure with the aid of a simplified schematic example of a dual-use problem, and then describe how it might also guide responses to more complex real-world cases. I outline some attractive features of the procedure. Finally, I consider whether and how the procedure might be amended to accommodate various criticisms of it.

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation.

Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism.

While geoengineering may counteract negative effects of anthropogenic climate change, it is clear that most geoengineering options could also have some harmful effects. Moreover, it is predicted that the benefits and harms of geoengineering will be distributed unevenly in different parts of the world and to future generations, which raises serious questions of justice. It has been suggested that a compensation scheme to redress geoengineering harms is needed for geoengineering to be ethically and politically acceptable. Discussions of compensation for geoengineering harms, however, sometimes presume geoengineering has presented new and unique challenges to compensation that cannot be readily accommodated by existing compensation practices. The most explicit formulation of this view was recently presented by Toby Svoboda and Peter J. Irvine, who argued that two forms of uncertainty in geoengineering — namely, ethical uncertainty and scientific uncertainty — make it immensely difficult to devise an ethically and politically satisfactory compensation scheme for geoengineering harms. In this paper, we argue against the view that geoengineering presents new and unique challenges relating to compensation. More specifically, we show that placing these challenges within the broader context of anthropogenic climate change reveals them to be less serious and less specific to geoengineering than some appear to believe.

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.

If I am injured in the course of medical investigation or treatment, I may be eligible to receive compensation for some of the adverse consequences of my injury—at least, if I live in a developed country. In most such countries, there exists some form of state-administered compensation scheme for medical injuries. However, even within the developed world, there is considerable variation in the eligibility criteria for compensation. Different countries would, for example, respond very differently to the following pair of cases...

Criminal offenders are sometimes required, by the institutions of criminal justice, to undergo medical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption that medical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms of medical intervention. I then consider whether it is possible to respond persuasively to this challenge by invoking the right to bodily integrity. I argue that it is not.

Kelly Sorensen defends a model of the relationship between effort and moral worth in which the effort exerted in performing a morally desirable action contributes positively to the action’s moral worth, but the effort required to perform the action detracts from its moral worth. I argue that Sorensen’s model, though on the right track, is mistaken in three ways. First, it fails to capture the relevance of counterfactual effort to moral worth. Second, it wrongly implies that exerting unnecessary effort confers moral worth on an action. Third, it fails to adequately distinguish between cases in which effort is required because of defects of moral character and those in which effort is required because of barriers external to moral character, such as social pressures or non-moral cognitive deficits. I suggest three amendments to Sorensen’s model that correct these three defects.

Synthetic biologists aim to generate biological organisms according to rational design principles. Their work may have many beneficial applications, but it also raises potentially serious ethical concerns. In this article, we consider what attention the discipline demands from bioethicists. We argue that the most important issue for ethicists to examine is the risk that knowledge from synthetic biology will be misused, for example, in biological terrorism or warfare. To adequately address this concern, bioethics will need to broaden its scope, contemplating not just the means by which scientific knowledge is produced, but also what kinds of knowledge should be sought and disseminated.

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 …

In this issue, Walter Sinnott-Armstrong and Franklin G. Miller argue that what makes killing wrong, when it is wrong, is not that it ends life, but that it causes complete and irreversible disability—what they call total disability. They hold that the wrongness of killing should be explained by reference to the harm that killing causes to the person who dies. And the only harm of this sort that killing causes, they argue, is the harm of being totally disabled: once one is totally disabled, there is no further harm to one in losing one's life. It is no worse to be dead, and thus totally disabled, than it is to be totally disabled but alive.In fact, Sinnott-Armstrong and Miller concede that the story may be more complicated than this. For example, it may be that what makes killing wrong, when it is wrong, is not that it causes harm, but that it is intended to do so, or that it violates a right which protects against harm. But either way, harm plays a crucial role in explaining the wrongness of killing, and the relevant harm, they claim, is the harm of being disabled, not that of losing one's life.The Authors’ argument has important implications for medical ethics. Their view implies that killing a person need not be wrong when that person is already completely and irreversibly disabled. This suggests, for example, that the dead donor rule in organ donation is mistaken. Contrary to the rule, it could be morally permissible to harvest organs from a living donor provided that the donor is totally disabled. Harvesting organs will kill the donor, but it will not disable her, since the donor has no abilities left to lose.Four …

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

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.

It is plausible that we have moral reasons to become better at conforming to our moral reasons. However, it is not always clear what means to greater moral conformity we should adopt. John Harris has recently argued that we have reason to adopt traditional, deliberative means in preference to means that alter our affective or conative states directly—that is, without engaging our deliberative faculties. One of Harris’ concerns about direct means is that they would produce only a superficial kind of moral improvement. Though they might increase our moral conformity, there is some deeper kind of moral improvement that they would fail to produce, or would produce to a lesser degree than more traditional means. I consider whether this concern might be justified by appeal to the concept of moral worth. I assess three attempts to show that, even where they were equally effective at increasing one’s moral conformity, direct interventions would be less conducive to moral worth than typical deliberative alternatives. Each of these attempts is inspired by Kant’s views on moral worth. Each, I argue, fails.