James Stacey Taylor

Some of the most difficult ethical issues that arise in clinical bioethics concern the practice of medicine upon children. Unlike adults, children are incapable of providing informed consent either to undergoing the procedures that might be performed upon them, or to taking the drugs that might benefit them. Since this is so, children—like impaired adults—often have decisions made for them by competent adults who can consent on their behalf. This leads to a series of well-known philosophical problems concerning the basis upon which such decisions should be made. While it might seem clear that such decisions should be made to secure the best interests of the child, difficulties arise when there is disagreement between parents and others as to what those best interests would be. This might occur in the context of parents’ decisions being guided by their religious beliefs: For example, should a child whose parents are devout Jehovah’s Witnesses have a life-saving blood transfusion withhel

A common criticism of plurality voting is that it fails to reflect the degree of intensity with which voters prefer the candidate or policy that they vote for. To rectify this, many critics of plurality voting have argued that vote buying should be allowed. Persons with more intense preferences for a candidate could buy votes from persons with less intense preferences for the opposing candidate and then cast them for the candidate that they intensely support. This paper argues that instead of better reflecting voters’ weighted preferences, vote buying will lead to electoral outcomes that reflect them less accurately.

For the past three decades philosophical discussions of both personal autonomy and what it is for a person to “identify” with her desires have been dominated by the “hierarchical” analyses of these concepts developed by Gerald Dworkin and Harry Frankfurt. The longevity of these analyses is owed, in part, to the intuitive appeal of their shared claim that the concepts of autonomy and identification are to be analyzed in terms of hierarchies of desires, such that it is a necessary condition for a person to be autonomous with respect to a desire that moves her to act, that she desires that this desire so move her. Despite the intuitive appeal of these analyses, however, Irving Thalberg has argued that they should be rejected. This is because, he argues, a person who is forced to perform an action by being subjected to duress of a certain degree of harshness will desire to be moved by her desire to submit. Thus, he continues, the proponents of hierarchical analyses of autonomy and identification will be forced to hold that such a person acted willingly, and did not suffer from any impairment in her autonomy. This, Thalberg concludes, is so counterintuitive as to justify rejecting hierarchical analyses

How can healthcare systems gain self-sufficiency in their procurement and distribution of blood and blood products efficiently while maintaining a degree of relatively equitable access for patients? This is a question that, at first look, the World Health Organization has answered in detail by advocating for self-sufficiency through non-remunerated blood donation. This essay serves two purposes. First, it illustrates key differences between the WHO’s policy recommendations and the realities of healthcare. For example, it can be readily demonstrated that the WHO has no empirical foundation for their claim that blood and blood products from unpaid donors is safer or more efficient than other, more commercial, avenues of procurement. Indeed, the WHO appears to take an ideological stand against compensation for blood products, which the empirical data does not support. Whether donation for blood and blood products should be compensated is a pressing ethical issue of practical import, especially if it can be shown that more market-oriented procedures leads to greater self-sufficiency, as well as safer and easier access to blood products than other alternatives. Such policy decisions should be based on the best available empirical data and ethical argumentation, rather than on political ideological grounds. Second, this essay serves as an Introduction to a special thematic issue of HEC Forum, which aims critically to explore ethical arguments in light of the best available empirical data so as to orient the blood industry towards more efficient and effective, and morally honest, procurement procedures

Petersen and Lippert-Rasmussen argue that persons who decide to be organ donors should receive a tax break, and then defend their view against eight possible objections. However, they misunderstand the Titmuss-style concerns that might be raised against their proposal. This does not mean that it should be rejected, but, instead, that when it is reconfigured to meet the Titmuss-style charges against it, they should support legalizing markets in human organs rather than merely offering tax breaks to encourage their donation

In 2013 the World Health Organization published a Report in which it was argued that countries should become self-sufficient in safe blood and blood products, and that these should be secured through voluntary non-remunerated donation. These two claims were putatively supported by a wealth of citations to peer-reviewed academic papers, the results of Royal Commissions and Public Inquiries in both Canada and the United Kingdom, and data collected from Non-Government Organizations. Yet not only do many of the sources cited by the authors of this WHO Report fail to support their conclusions, many support conclusions that are the opposite of those that they draw. The aim of this paper is not, however, to argue against the conclusions of this Report. Instead, it is to argue that its authors were culpably negligent in its writing, in that they failed to take reasonable care to ensure that their conclusions were supported by the evidence, and in so doing exposed third parties to risks of harm to which they had not consented.

For almost the past three decades the model of autonomy which has dominated philosophical discussion of this concept has been the "hierarchical" model, which has been independently developed and defended by Harry Frankfurt, Gerald Dworkin and John Christman, and which is primarily concerned with what makes a person autonomous with respect to her first-order desires. It is argued that all versions of the hierarchical model of personal autonomy are based upon a theoretical mistake, and so should be rejected. This mistake is to focus upon the person's attitude towards the desire in question. Such attitude-based approaches will be mistaken because it is always possible to raise the question as to whether the person is autonomous with respect to this attitude itself. With this rejection of the hierarchical analyses of autonomy in hand it is argued that a person is autonomous with respect to her first-order desires to the extent that she has critically reflected upon the beliefs which lead her to have them. This belief-based approach to autonomy enjoys several advantages over its attitudebased rivals. It avoids all of the problems that are faced by the attitude-based models offered by Frankfurt et al., and it is also able to recognize a richer taxonomy of desire than they are. Moreover, this account of autonomy is not committed to either a Humean or an anti-Humean model of motivation. ;With the defense of the belief-based model of autonomy in hand, it is then applied to three distinct debates within applied ethics; social ethics , business ethics , and medical ethics' focus on the Principle of Respect for Autonomy. This part of the dissertation concludes by observing that in all three of these particular debates it is not autonomy that is of primary concern, but well-being, subjectively understood

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.