Thomas Douglas

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 …

This article presents a model for regulating cognitive enhancement devices. Recently, it has become very easy for individuals to purchase devices which directly modulate brain function. For example, transcranial direct current stimulators are increasingly being produced and marketed online as devices for cognitive enhancement. Despite posing risks in a similar way to medical devices, devices that do not make any therapeutic claims do not have to meet anything more than basic product safety standards. We present the case for extending existing medical device legislation to cover CEDs. Medical devices and CEDs operate by the same or similar mechanisms and pose the same or similar risks. This fact coupled with the arbitrariness of the line between treatment and enhancement count in favour of regulating these devices in the same way. In arguing for this regulatory model, the paper highlights potential challenges to its implementation, and suggests solutions.

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