Stephen Wall

In debating Patrick Devlin, H. L. A. Hart claimed that the “modern form” of the debate over the legal enforcement of morals centered on the “significance to be attached to the historical fact that certain conduct, no matter what, is prohibited by a positive morality.” This form of the debate was politically important in 1963 in Britain and America, and it remains politically important in these countries today and elsewhere; but it is not the philosophically most interesting form the debate can take. An older form of the debate appealed to natural law or critical morality. It centered on the question of whether political authorities could properly use the criminal law to enforce critical morality, including prohibitions on conduct that was not harmful or disrespectful to others. This paper engages with this older form of the debate. It offers some reasons for thinking that there is a presumption in favor of the view that it is a proper function of the criminal law to enforce critical morality, including that part of critical morality that is not directly concerned with preventing harm or disrespect to others. It then defends this presumption against some arguments recently pressed by Ronald Dworkin

Abstract In his early work in political philosophy, Amartya Sen advanced an interesting and provocative thesis ? the egalitarian thesis. This is the claim that every conception of social justice that has received support in recent times is egalitarian. This paper argues that Sen's account of capabilities and his more recent critique of transcendental justice have implications for the truth of the egalitarian thesis. It also discusses how the rejection of the egalitarian thesis bears on the larger, and more general, issue of the overall plausibility of egalitarian conceptions of social justice

This paper articulates and defends a novel hybrid account of well-being. We will call our view a Robust Hybrid. We call it robust because it grants a broad and not subservient role to both objective and subjective values. In this paper we assume, we think plausibly but without argument, that there is a significant objective component to well-being. Here we clarify what it takes for an account of well-being to have a subjective component. Roughly, we argue, it must allow that favoring attitudes that are not warranted by the lights of objective values can ground benefits. Given this understanding, we show that there is an important and unrecognized expansion in the resources available to fully objectivist views: namely that such views can help themselves to the value of warranted love of objective goods. Such a move by the objectivist can help them respond to concerns that, on their view, a person’s well-being can be too alien to them. We next argue that, nonetheless, such objectivist views are still unconvincing due to their lack of a subjective component. This motivates a move from fully objective accounts to hybrid accounts. We show that many prominent hybrid theories in the literature are inadequate because they implausibly minimize the subjective component. This motivates a move to a robust hybrid view that has an expanded subjectivist component. We conclude with some remarks about the interrelation between the subjective and objective components in the hybrid account that we favor and a role for resonance in a theory of well-being other than serving as a hard constraint on any benefit.

The ethical standards that regulate clinical research have multiple rationales. Among them is the need to protect potential subjects from making imprudent decisions, which extends beyond the soft paternalistic concern to protect people from making uninformed decisions to participate in trials. This article argues that a plausible risk/benefit restriction on clinical trials is presumptively justified by hard paternalism, which in turn is supported by a deeper fairness-based rationale. This presumptive case for hard paternalism in research is not defeated by the alleged right to participate in clinical trials, by concerns about insult or status, by the need to conduct early phase trials that promise little to no benefit to participants, or by the recognition that some potential subjects are altruistically motivated.

In this paper, we defend the ethics of clinical research against the charge of paternalism. We do so not by denying that the ethics of clinical research is paternalistic, but rather by defending the legitimacy of paternalism in this context. Our aim is not to defend any particular set of paternalistic restrictions, but rather to make a general case for the permissibility of paternalistic restrictions in this context. Specifically, we argue that there is no basic liberty-right to participate in clinical research and that considerations of distributive fairness justify some paternalistic protections of research subjects.

The term “exploitation” has gained wide currency in recent discussions of biomedical and research ethics. This is due in no small measure to the influence of Alan Wertheimer’s path-breaking work on the topic (Wertheimer 1999, 2011). Wertheimer presented a clear and compelling non-Marxist account of the concept of exploitation—one that stressed the connection between exploitation and unfair distributive outcomes. On this account, when one party exploits another, she takes advantage of the other to gain unfairly. A number of contemporary bioethicists have accepted Wertheimer’s account of exploitation and have proceeded to apply it to a range of issues in research ethics (Hawkins and Emanuel 2008; Miller and Brody ..

The allocation of vaccines and therapeutics for Covid‐19 obviously raises ethical questions, and physicians and ethicists have begun to address them. Writers have identified various criteria that should guide allocation decisions, but the criteria often conflict and need to be balanced against one another. This article proposes a model for thinking about how different considerations that are relevant to the distribution of vaccines and scarce treatments for Covid‐19 could be integrated into an allocation procedure. The model employs the construct of a weighted lottery, which is a construct that has been employed in other contexts that involve the distribution of scarce resources. The article highlights the advantages of applying a weighted lottery to the Covid‐19 context and offers an illustration for how it might work in practice. The primary aim of the article is to articulate the structural features of a weighted lottery for this context and to bring out its advantages over other methods for allocating Covid‐19 medications.

Drawing the line on physician assistance in physician-assisted death continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill.

I shall assume that a well-ordered state is one that promotes the freedom of its subjects. My question is what is the kind of freedom that the state ought to promote? This question is different from the question of what freedom is. It might be thought, for example, that freedom consists in the autonomous pursuit of valuable goals and projects, but that the state cannot directly promote this freedom. On this view, the state would not be able to make its citizens free. However, it might be able to do things that make it easier or more likely for them to be free. The freedom that the state promotes might be merely an aspect of or a condition for the freedom that really matters

The issue of just savings between generations presents an important,and for the most part unappreciated, problem for Rawls's theory ofdistributive justice. This paper argues that the just savingsprinciple, as Rawls formulates it in his recent work, standsin tension with the difference principle. When thought through,the just savings principle – and more precisely the foundationon which it rests – give us reason to reject the differenceprinciple in favor of a less egalitarian principle ofdistributive justice.

In his late work, Rawls makes strong claims about the status of political liberty. These claims, if accepted, would have significant implications for the content of "justice as fairness." I discuss the nature of these claims, clarifying Rawls's fair value guarantee of the political liberties and critically discussing the arguments that he and others have given for assigning special importance to the political liberties. I conclude that justice as fairness, properly understood, is not a deeply democratic conception of justice.

Many writers claim that democratic government rests on a principled commitment to the ideal of political equality. The ideal of political equality holds that political institutions ought to be arranged so that they distribute political standing equally to all citizens. I reject this common view. I argue that the ideal of political equality, under its most plausible characterizations, lacks independent justificatory force. By casting doubt on the ideal of political equality, I provide indirect support for the claim that democratic government is only instrumentally justified

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols.