Mark Christopher Navin

A recent American Academy of Pediatrics (AAP) clinical report states that it is an acceptable option for pediatric care clinicians to dismiss families who refuse vaccines. This is a clear shift in guidance from the AAP, which previously advised clinicians to “endeavor not to discharge” patients solely because of parental vaccine refusal. While this new policy might be interpreted as encouraging or recommending dismissal of vaccine-refusing families, it instead expresses tolerance for diverse professional approaches. This is unlike the earlier guidance, which promoted a unified response to vaccine refusal. In fact, the resolution (which was presented at the AAP’s Annual Leadership Forum) that led to this clinical report also calls on the AAP “to continue to support pediatricians who continue to provide health care to children of parents who refuse to immunize their children.” However, the shift toward embracing dismissal as an acceptable response to vaccine refusal may erode professional solidarity. Pediatricians are clearly divided on this question; most do not dismiss vaccine-refusing families. By declaring that dismissal is an acceptable option, the AAP has sanctioned a practice that may be unfair to the many clinicians who do not dismiss these families. Clinicians who adopt a policy of dismissal toward families who refuse vaccines might impose burdens on colleagues who remain willing to offer care to those families, and their actions might show insufficient commitment to the efforts of their profession to promote health for all children.

When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional source of guidance for decisions about patients who lack decision-making capacity.

This paper builds on previous research about the potential downsides of food sovereignty activism in relatively wealthy societies by developing a three-part taxonomy of harms that may arise in such contexts. These are direct opposition, false equivalence, and diluted goals and methods. While this paper provides reasons to resist complacency about wealthy-world food sovereignty, we are optimistic about the potential for food sovereignty in wealthy societies, and we conclude by describing how wealthy-world food sovereignty can be a location of either transnational solidarity or nonharmful forms of cooptation.

In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally.

Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and voluntary parental involvement in pediatric decision making. This article provides a more expansive account of the value of parental permission. In particular, we suggest that an expansive role for parental permission may reveal facts and values relevant to their child's treatment, encourage resistance to suboptimal default practices, improve adherence to treatment, nurture children's autonomy, and promote the interests of other family members.

Many political philosophers argue that a principle of ‘fair equality of opportunity’ ought to extend beyond national borders. I agree that there is a place for FEO in a theory of global justice. However, I think that the idea of cross-border FEO is indeterminate between three different principles. Part of my work in this paper is methodological: I identify three different principles of cross-border fair equality of opportunity and I distinguish them from each other. The other part of my work in this paper is normative: I argue that we should endorse only two of the three principles of cross-border fair equality of opportunity and that we shouldreject the third. Importantly, I think that we should reject the one version of transnational fair equality of opportunity that most advocates of such a principle appear to endorse.

Alternative Food Networks (AFNs), which include local food and Fair Trade, work to mitigate some of the many shortcomings of mainstream food systems. If AFNs have the potential to make the world’s food systems more just and sustainable (and otherwise virtuous) then we may have good reasons to scale them up. Unfortunately, it may not be possible to increase the market share of AFNs while preserving their current forms. Among other reasons, this is because there are limits to both the productive capacities of small owner-operated farms and to the distribution capacities of Farmers Markets and Community Supported Agriculture (CSA). These limits tell in favor of AFN partnerships with larger producers and distributors. But some advocates of AFNs have worried that these partnerships would sacrifice too much.

Among Anglo-American philosophers, contemporary debates about global economic justice have often focused upon John Rawls’s Law of Peoples. While critics and advocates of this work disagree about its merits, there is wide agreement that, if today’s wealthiest societies acted in accordance with Rawls’s Duty of Assistance, there would be far less global poverty. I am skeptical of this claim. On my view, the Duty of Assistance is unlikely to require the kinds and amounts of assistance that would be sufficient to eradicate much global poverty. This is because the DA cannot require societies to rapidly or radically change their ways life, and because the kinds and amounts of assistance that are most likely to eradicate global poverty would cause rapid and radical changes to the ways of life of the societies that undertook them.

I argue that a parental prerogative to sometimes prioritize the interests of one’s children over the interests of others is insufficient to make the parental refusal of routine childhood vaccines morally permissible. This is because the moral permissibility of vaccine refusal follows from such a parental prerogative only if the only (weighty) moral reason in favor of vaccination is that vaccination is a means for promoting the interests of others. However, there are two additional weighty moral reasons in favor of routine vaccination: fairness and concern for the vulnerable. These moral reasons in favor of vaccination are not defeated by a parental prerogative to prioritize the interests of one’s children over the interests of others.

In Globalization and Global Justice, Nicole Hassoun advocates a political philosophy that is deeply-informed by empirical work and a utopianism that is constrained by considerations of real-world feasibility. As Hassoun acknowledges, these features are unusual for philosophical work, and she is right to think that the global justice literature needs to be more focused on practical questions and better-informed by facts about international political economy (15-7). However, it is also a mark of good political philosophy that its arguments succeed and that its analyses move philosophical discussions forward. Unfortunately, Globalization and Global Justice often fails on these points.

In The Idea of Human Rights (hereafter IHR), Charles Beitz advocates a different approach to questions about the nature and aims of human rights. He advances a ‘practical conception’, which turns to the role that human rights play in contemporary political discourse to arrive at answers about the structure and function of human rights. As Beitz says, ‘we take the functional role of human rights in international discourse and practice as basic: it constrains our conception of a human right from the start’ (103). Accordingly, we answer questions about the structure and function of human rights practice (eg, about the relevant participants in the practice or its public discursive role) with a sort of philosophical anthropology. Instead of looking to fundamental moral ideas to discover the nature and aims of human rights discourse, we instead turn to the ‘linguistic commitments one would undertake if one were to participate in good faith in the … practice’ (106). We interpret the relevant international texts, the public political culture of human rights practice, and actions by states, international institutions and non-governmental organisations so as to ‘attend to the practical inferences that would be drawn by competent participants in the practice from what they regard as valid claims of human rights’ (102). From these sources we can construct an interpretation of the nature and purpose of human rights.

Oppression can be unjust from a luck egalitarian point of view even when it is the consequence of choices for which it is reasonable to hold persons responsible. This is for two reasons. First, people who have not been oppressed are unlikely to anticipate the ways in which their choices may lead them into oppressive conditions. Facts about systematic phenomena (like oppression) are often beyond the epistemic reach of persons who are not currently subject to such conditions, even when they possess adequate information about the particular consequences of their choices. Second, people may be (much) less responsible for remaining in oppressive conditions, even if they are responsible for entering circumstances of oppression. Oppression that results from a person’s choice may cause or contribute to dramatic changes in that person, and these changes may be sufficient to undermine the person’s responsibility for the results of her earlier choice.

Leaders of the world’s largest food sovereignty movement, La Vía Campesina, have argued that gender justice is a core component of food justice. On their view, food justice requires an end to violence against women and a guarantee of women’s equal social and political status. However, some have wondered what gender justice has to do with food. In particular, they have worried that La Vía Campesina’s embrace of radical gender egalitarianism cannot be grounded in food-related concerns. My goal in this paper is to respond to these objections, and to show that La Vía Campesina’s efforts to promote gender justice may be grounded in its broader food justice goals.

Many want to justify the continued existence of the human species or the absolutism of human rights. In his recent book, George Kateb argues that moral values (which, in his view, focus primarily upon suffering) are insufficient for these tasks. Morality condemns humanity for its history of needless death and destruction; morality tolerates violations of human rights. Kateb claims that human dignity (which he characterizes as an existential value) must do some of the heavy lifting required to defend the continuation of the species and the absolutism of human rights. In his view, the idea of humanity dignity results from reflection upon the uniqueness of humanity. The core content of human dignity is that “on earth, humanity is the greatest type of beings…[and] every member deserves to be treated in a manner consonant with the high worth of the species” (pp. 3-4). Human dignity consists both of the superior stature of the species and the equal status of each individual human being. A commitment to the superior stature of the species bolsters the justification of the species. While humanity may have condemned itself from a moral point of view, it may be justified by its great achievements and by its capacity to serve nature. A commitment to the equal status of all individuals bolsters the case for human rights by protecting against rights violations that may achieve a greater moral good.

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges.

Many advocate practices of ‘local food’ or ‘locavorism’ as a partial solution to the injustices and unsustainability of contemporary food systems. I think that there is much to be said in favor of local food movements, but these virtues are insufficient to immunize locavorism from criticism. In particular, three duties of international ethics—beneficence, repair and fairness—may provide reasons for constraining the developed world’s permissible pursuit of local food. A complete account of why (and how) the fulfillment of these duties constrains locavorism will require extensive empirical evidence about the relationship between agricultural demand-led industrialization, international trade (rules), and local food practices. In this paper I can only gesture at some of this evidence and, for that reason, my policy prescriptions are merely provisional. Instead, the upshot of this paper is that advocates of locavorism ought to be attentive to the empirical-dependence of the moral permissibility of their projects. As local food ‘scales up’—and comes to be embraced as a goal of political communities—these concerns should receive even greater attention

Recent increases in the rates of parental refusal of routine childhood vaccination have eroded many countries’ “herd immunity” to communicable diseases. Some parents who refuse routine childhood vaccines do so because they deny the mainstream medical consensus that vaccines are safe and effective. I argue that one reason these vaccine denialists disagree with vaccine proponents about the reasons in favor of vaccination is because they also disagree about the sorts of practices that are conducive to good reasoning about healthcare choices. Vaccine denialists allocate epistemic authority more democratically than do mainstream medical professionals. They also sometimes make truth ascriptions for nonepistemic reasons, fail to recognize legitimate differences in expertiseand competence, and seek uncritical affirmation of their existing beliefs. By focusing on the different epistemic values and practices of vaccine denialists and mainstream medical professionals, I locate my discussion of vaccine denialism within broader debates about rationality. Furthermore, I argue that gender inequality and gendered conceptions of reason are important parts of the explanation of vaccine denialism. Accordingly, I draw upon feminist work—primarily feminist social epistemology—to help explain and evaluate this form of vaccine refusal.

Conscientious objectors to military service are either general objectors or selective objectors. The former object to all wars; the latter object to only some wars. There is widespread popular and political support in western liberal democracies for exemptions for general objectors, but currently there is little support for exemptions for selective objectors. Many who advocate exemptions for selective objectors attempt to build upon the strength of support that is enjoyed by exemptions for general objectors. They argue that selective objectors ? like general objectors ? sincerely believe that it would be deeply morally wrong for them to fight in the wars to which they object. I argue that a stronger moral case for exemptions for selective objectors relies upon a different claim: selective objections are often accurate. It is often immoral to fight in the wars to which selective objectors object. While some advocates of exemptions for selective objectors have identified accuracy as a reason for offering exemptions, they have usually not adequately distinguished sincerity from accuracy. However, keeping these two moral reasons for exemptions distinct clarifies and strengthens the moral case for exemptions for selective conscientious objectors

The United States may justifiably exclude unvaccinated aliens, perhaps even under the assumption of Open Borders, according to which people should generally be permitted to settle in countries of their choosing. Furthermore, there are good reasons to endorse the Centers for Disease Control and Prevention’s (CDC’s) current vaccination-related exclusion criteria, which were last revised in 2009. I frame my discussion around CDC’s 2008 decision to permit immigrant girls and women to be excluded if they were not vaccinated against human papillomavirus (HPV)—a decision that was quickly reversed and that led to the 2009 revisions to CDC’s vaccination-related immigrant exclusion criteria.

Parents in the US and other societies are increasingly refusing to vaccinate their children, even though popular anti-vaccine myths – e.g. ‘vaccines cause autism’ – have been debunked. This book explains the epistemic and moral failures that lead some parents to refuse to vaccinate their children. First, some parents have good reasons not to defer to the expertise of physicians, and to rely instead upon their own judgments about how to care for their children. Unfortunately, epistemic self-reliance systematically distorts beliefs in areas of inquiry in which expertise is required. Second, vaccine refusers and mainstream medical authorities are often committed to different values surrounding health and safety. For example, while vaccine advocates stress that vaccines have low rates of serious complications, vaccine refusers often resist vaccination because it is ‘unnatural’ and because they view vaccine-preventable diseases as a ‘natural’ part of childhood. Finally, parents who refuse vaccines rightly resist the utilitarian moral arguments – ‘for the greater good’ – that vaccine advocates sometimes make. Unfortunately, vaccine refusers also sometimes embrace a pernicious hyper-individualism that sanctions free-riding on herd immunity and that cultivates indifference to the interpersonal and social harms that unvaccinated persons may cause.