James Stacey Taylor

Legal prohibitions on the financial compensation of donors are frequently justified by appealing either to concerns about patient safety or to concerns about the putatively unethical nature of such compensation. But jurisdictions that legally prohibit the financial compensation of donors routinely import plasma that has been collected from financially compensated donors—and they do so knowing its origins. I outline some possible ways in which this puzzle could be resolved and find them all wanting. Focusing on Canada I draw upon public documents to explain how many provinces came to have its apparently puzzling approach to plasma procurement. I then argue that the actions of those who support this approach to plasma procurement are immoral.

The title of this paper is deliberately ambiguous. It could refer either to the central val­ue that philosophical counseling has for philosophy in general, or else it could refer to something (such as personal autonomy, or personal well-being) that philosophical counselors believe to be of value, and that they are able to help their clients pursue. In fact, this paper will be addressing both of these topics in order to demonstrate the links that hold between them, and, in so doing, will attempt to further elucidate the nature of philosophical counseling itself.

Over the last two decades the practice of applied philosophy has undergone re­surgence. It is now common for philosophers to sit on ethics committees in hospitals, or to provide ethical advice to businesses, and many universities and colleges now offer courses in practical philosophy. Despite this, practical philosophy is subject to increasing criticism, with persons charging that (1) it is philosophically shallow, and (2) it has little to offer persons grappling with concrete ethical problems, either because (a) its techniques or too removed from such problems, or (b) because ethical theory is too abstract. In this paper I develop responses to these criticisms, and offer suggestions as to how practical philosophy should be developed.

This paper comments on Cohen’s “Philosophy with Teeth” (also in this issue), and raises four questions surrounding the relationship between philosophy and psychology, most of which are requests for clarification from Cohen but two of which are more critical in character: Against Cohen’s claim that APPE disavows any intrinsic connection between philosophical counseling and psychology, it is suggested that this still leaves open the pos­sibility of an instrumental connection. And against Cohen’s claim that pure philosophy is “grist for the classroom” or for “stimulating discussions over coffee,” it is maintained that pure philosophy may have more “teeth” than what this suggests.

Normativism holds that there is a close conceptual link between disease and disvalue. We challenge normativism by advancing an argument against a popular normativist theory, Jerome Wakefield’s harmful dysfunction account. Wakefield maintains that medical disorders are breakdowns in evolved mechanisms that cause significant harm to the organism. We argue that Wakefield’s account is not a promising way to distinguish between disease and health because being harmful is neither necessary nor sufficient for a dysfunction to be a disorder. Counterexamples to the harmful dysfunction account are considered, such as mild infections, perceptual deficits, and beneficial illnesses. Then we consider two ways of amending the harmful dysfunction account to address these cases and argue that the proposed amendments raise even more serious problems for this account. These problems apply generally to any normativist theory and raise doubts about the entire normative approach to the philosophy of health and disease.

Jason Brennan and Peter M. Jaworski have recently developed an argument against semiotic objections to markets. They argue that all such semiotic arguments are unsound because they fail to recognize that the meaning of market transactions is a contingent socially-constructed fact. They attribute this type of argument to Debra Satz. This paper argues both that Brennan and Jaworski are mistaken to attribute this particular semiotic objection to Satz and that they are mistaken to attribute to her a semiotic objection of this type. It then argues that Brennan and Jaworski have fundamentally misunderstood the nature of Satz’s project. It concludes by defending Satz against Brennan and Jaworski’s charge that one of her criticisms of markets is based on an equivocation.

The Western focus on personal autonomy as the normative basis for securing persons’ consent to their treatment renders this autonomy-based approach to informed consent vulnerable to the charge that it is based on an overly atomistic understanding of the person. This leads to a puzzle: how does this generally-accepted atomistic understanding of the person fits with the emphasis on familial consent that occurs when family members are provided with the opportunity to veto a prospective donor’s wish to donate after she has died and her organs are being considered for harvesting? It is argued in this paper that this charge can be met and this puzzle dissolved once it is recognized that autonomy is an inherently social concept.

It is widely believed that the nature of love and friendship precludes them from being bought or sold. It will be argued in this paper that this view is false: There is no conceptual bar to the commodification of love and friendship. The arguments offered for this view will lead to another surprising conclusion: That these goods are asymmetrically alienable goods, goods whose nature is such that separate arguments must be provided for the views that they can be bought and sold. The possibility of asymmetric alienability has not yet been recognized in the literature on commodification.

In recent years, there has been a considerable increase in the degree of philosophical attention devoted to the question of the morality of offering financial compensation in an attempt to increase the medical supply of human body parts and products, such as plasma. This paper will argue not only that donor compensation is ethically acceptable, but that plasma donors should not be prohibited from being offered compensation if they are to give their informed consent to donate. Regulatory regimes that prohibit donor compensation thus unethically prevent the typical donor from being able to give her informed consent to donate.

In a recent paper entitled “The Case for Colonialism” Bruce Gilley argued that Western colonialism was “as a general rule” both beneficial to those subject to it and considered by them to be legitimate. He then advocated for a return to the Western colonization of the Third World. Gilley’s article provoked a furious response, with calls for its retraction being followed by the resignation of much of the publishing journal’s editorial board. In this paper I note that Gilley’s article meets none of the criteria required to justify its retraction, and that instead of retracting it it should be rebutted. I then argue that his arguments against those who oppose colonialism are all fatally flawed, and that he has provided no justification for his claims that colonialism was either beneficial to those who lived under it, or considered by them to be legitimate.

Jacob Sparks has developed a semiotic critique of markets that is based on the fact that “market exchanges express preferences.” He argues that some market transactions will reveal that the purchaser of a market good inappropriately prefers it to a similar non-market good. This avoids Brennan and Jaworski’s criticism that semiotic objections to markets fail as the meaning of market transactions are contingent social facts. I argue that Sparks’ argument is both incomplete and doomed to fail. It can only show that some preferences are morally problematic, not that the transactions that they lead to are immoral.

Christopher Freiman, Jason Brennan, and Peter M. Jaworski have recently defended markets in votes. While their views differ in several respects they all believe that the primary justificatory burden lies not with those who defend markets in votes but with those who oppose them. Yet while the burden of proof should typically rest with those who wish to prohibit markets in certain goods this does not hold for the debate over markets in votes. Votes are crucially different from other goods in that for a market in them to exist, it is not enough that it be legalized; it must also be provided with institutional support so that the buyer of a vote would know that it has been cast as she wished. Defenders of markets in votes must thus provide positive arguments for the view that markets in votes should be institutionally facilitated—they cannot simply try to shift the burden of proof onto those who oppose them. This is bad news for those who defend the legalization of vote-buying, for none of the positive arguments that Freiman has offered in favor of the legalization of this type of vote-buying are sound.

The UCLA Medical Center has initiated a “voucher program” under which a person who donated a kidney would receive a voucher that she could provide to someone of her choosing who could then use it to move to the top of the renal transplantation waiting list. If the use of such vouchers as incentives for donors is morally permissible, then cash payments for kidneys are also morally permissible. But, that argument faces five objections. First, there are some goods whose nature allows them to be exchanged for similar goods but renders them monetarily inalienable. Hence, kidneys might be exchanged for kidneys but not sold for cash. Second, voucher programs respect donor autonomy, whereas the offer of cash payments does not. Third, the burden of proof lies with the advocates of cash payments for kidneys to show that their benefits would outweigh the costs of their legalization. Fourth, allowing cash payments for kidneys would stifle medical innovation. Fifth, allowing cash payments for kidneys would result in these organs being used as collateral to secure loans—and that this would disadvantage potential borrowers who did not want to risk their kidneys in this way. This paper will rebut all these objections.

Autonomy has recently become one of the central concepts in contemporary moral philosophy and has generated much debate over its nature and value. This 2005 volume brings together essays that address the theoretical foundations of the concept of autonomy, as well as essays that investigate the relationship between autonomy and moral responsibility, freedom, political philosophy, and medical ethics. Written by some of the most prominent philosophers working in these areas, this book represents research on the nature and value of autonomy that will be essential reading for a broad swathe of philosophers as well as many psychologists.

Nancy Scheper-Hughes is one of the most prominent critics of markets in human organs. Unfortunately, Scheper-Hughes rejects the view that markets should be used to solve the current shortage of transplant organs without engaging with the arguments in favour of them. Scheper-Hughes’s rejection of such markets is of especial concern, given her influence over their future, for she holds, among other positions, the status of an adviser to the World Health Organization on issues related to global transplantation. Given her influence, it is important that Scheper-Hughes’s moral condemnation of markets in human organs be subject to critical assessment. Such critical assessment, however, has not generally been forthcoming. A careful examination of Scheper-Hughes’s anti-market stance shows that it is based on serious mischaracterisations of both the pro-market position and the medical and economic realities that underlie it. In this paper, the author will expose and correct these mischaracterisations and, in so doing, show that her objections to markets in human organs are unfounded

A standard objection to a market in political votes is that it will enable the rich politically to dominate the poor. If a market in votes was allowed then the poor would be the most likely sellers and the rich the most likely buyers. The rich would thus accumulate the votes of the poor, and so the candidates elected and the policies passed would represent only their interests and not those of the electorate as a whole. To ensure that the poor do not become de facto disenfranchised, then, markets in votes should be disallowed. This objection seems so straightforward and compelling that it has received almost no critical scrutiny. This is unfortunate, for close examination reveals that this argument is not as straightforward as it initially appears. Indeed, there are four different ways of understanding this objection. It could be understood as expressing: the concern that markets in votes would enable candidates to win elections who would otherwise lose them; the concern that they would enable the election of candidates opposed by the majority of the electorate; the concern that they would lead to the poor having disproportionately low political influence; and the concern that they would lead to the rich having disproportionately high political influence. I will argue in this paper that only and could plausibly ground objections to markets in votes. Moreover, these will only plausibly ground objections to unrestricted markets in votes; they will not ground objections to markets in votes per se. Thus, if we are to continue to object to markets in political votes we will have to do this on grounds other than that were they to be allowed the rich will politically dominate the poor.

The papers in this special thematic issue of HEC Forum critically and carefully explore key issues at the intersection of patient privacy and commodification. For example, should hospitals be required to secure a person’s consent to any possible uses to which his discarded body parts might be put after his treatment or should it only be concerned with securing his informed consent to his treatment? Should a hospital be required to raise the possibility of the commodification of such body parts, or should it only be required to address this issue if the patient asks about it? Should persons be paid to engage in medical research, or should they only be compensated for their time, on the grounds, perhaps, that such payment would be coercive or exploitative, for it might move some persons to agree to participate in research who otherwise would not have done? This number of HEC Forum illustrates the widespread implications of these issues upon which healthcare ethics committees are called to deliberate.

The Affordable Care Act has been touted as a long‐overdue remedy for what is perceived to be the chronic problem of large numbers of Americans living without adequate health insurance. While much of the discussion of the ACA has focused on its legality, it should also be assessed on the basis of its economic implications and its moral acceptability. On its face, the ACA appears to do well on both counts. Given that the uninsured often secure their health care from expensive emergency room treatment (from which they cannot be excluded and whose cost is often borne by third parties), expanding insurance to cover them (and hence to give them access to less expensive treatments) appears to make economic sense. Similarly, it might appear that providing access to insurance for people who otherwise could not afford it, or who would be denied it as a result of having medical conditions that they are not responsible for, would be morally laudable. But these appearances deceive: The ACA is neither economically sound nor morally acceptable. To paraphrase Oscar Wilde, to fail on one of these criteria may be misfortune; to fail on both looks like carelessness.

Schweda and Schicktanz argue that the debate over the ethics of using financial incentives to procure human transplant organs rests on socioempirical premises that need to be critically assessed. They contend that once this is achieved a completely new perspective on the debate should be adopted, with organ donation being viewed primarily as a reciprocal social interaction between donor and recipient. This paper challenges this conclusion, arguing that rather than supporting a new perspective on the debate over the commercial procurement of organs, the observations of Schweda and Schicktanz support the view that human organs should be commercialized