Ben Saunders

Smith and Mackie offer a conditional defence of vaccine mandates.1 Their argument is conditional, because it is based on Kiener’s interpersonal consenter-consentee account of consent.2 (Smith and Mackie do not defend this account of consent.) According to Kiener, whether an influence undermines consent depends not only on its effects, but on who exerts it (p372).2 If A coerces B, this would invalidate consent that B gives to A, but it does not invalidate consent that B gives to C. The fact of A’s coercion is irrelevant to the consent relationship between B and C, because A is a third party. Thus, a physician (consent-receiver) still acts permissibly when vaccinating a patient (consent-giver), even if the patient’s consent was involuntary because of some third-party mandate. One worry about this argument is whether the physician is sufficiently distanced from the coercion. Kiener notes that the patient’s consent …

Recent discussion has focused on whether or not to teach moral theories, and, if yes, to what extent. In this piece the author argues that the criticisms of teaching moral theories raised by Rob Lawlor should lead us to reconsider not whether but how to teach moral theories. It seems that most of the problems Lawlor identifies derive from an uncritical, theory-led approach to teaching. It is suggested that we might instead start by discussing practical cases or the desiderata of a successful moral theory, and then build up to comparing theories such as consequentialism, deontology, and so on. In this way, theories are taught but students do not take them to be the alpha and omega of moral thinking

Kevin J. Elliott has recently defended an institutional duty to vote. This duty is based on (1) the role obligation of citizens to do what is necessary for well-functioning representative institutions and (2) the claim that universal voting is ordinarily necessary for fair representation. This critical response takes issue with the second of these claims. I argue that neither the informational nor motivational problems that Elliott identifies require universal voting. Representatives have other ways of identifying citizens’ wants and interests and other incentives to respond to them. Indeed, some of Elliott’s own suggestions, for instance that representatives will respond to uncertain threats, seem to presuppose that these difficulties can be overcome. Thus, I argue that universal voting is not necessary for effective representation.

Johannes Kniess argues that a generational smoking ban, which prevents all those born after a certain date from buying tobacco, need not violate relational egalitarian commitments.1 Those denied the freedom to smoke need not be regarded as inferior, discriminated against, stigmatised or have their interests neglected. However, his argument focuses on a comparison between the younger cohort, who are permanently denied the freedom to smoke, and existing smokers, who retain the freedom to smoke because withdrawing this would impose greater burdens on them. As illustrated in table 1, there are three relevant groups in society: (1) older smokers, (2) older non-smokers and (3) younger non-smokers. (The ban, if effective, means that there will not be any smokers in the younger cohort, so the potential fourth category is empty.) The comparisons Kniess makes focus on groups 1 and 3, but neglect group 2: those who are old enough to smoke, but who are not already smokers. View this table: Table 1 Groups in society A generational ban involves differential treatment of older cohorts (groups 1 and 2) and younger cohorts (group 3). Kniess argues that such differential treatment can be …

The Nuffield Council on Bioethics introduced an ‘intervention ladder’ to guide policymakers on public health interventions. 1 The ladder’s vertical structure represents an ordering of interventions, from least to most intrusive. In his article, Paetkau acknowledges that this ladder is ‘a useful tool’ (p. 1) for evaluating public health interventions. 2 However, he objects that its focus on individual behaviour is too narrow and obscures ‘interventions that operate on the level of systems rather than individuals’ (p. 2). To be sure, some of the interventions on the original ladder do involve what might ordinarily be seen as ‘system’ or environmental changes. For instance, we might encourage active transport by building dedicated cycle lanes. However, these measures still have their intended effects through altering individual choices. What Paetkau means by a ‘systemic intervention’ is specifically one that improves public health _without_ changing individual behaviour change (pp. 2–3). For...

The Nuffield Council on Bioethics introduced an ‘intervention ladder’ to guide policymakers on public health interventions.1 The ladder’s vertical structure represents an ordering of interventions, from least to most intrusive. In his article, Paetkau acknowledges that this ladder is ‘a useful tool’ (p. 1) for evaluating public health interventions.2 However, he objects that its focus on individual behaviour is too narrow and obscures ‘interventions that operate on the level of systems rather than individuals’ (p. 2). To be sure, some of the interventions on the original ladder do involve what might ordinarily be seen as ‘system’ or environmental changes. For instance, we might encourage active transport by building dedicated cycle lanes. However, these measures still have their intended effects through altering individual choices. What Paetkau means by a ‘systemic intervention’ is specifically one that improves public health without changing individual behaviour change (pp. 2–3). For example, reducing pollution or improving public health infrastructure. He suggests that, because the Nuffield ladder focuses on individual behaviour, it may lead policymakers to overlook these possibilities. Paetkau proposes broadening the ladder to include systemic interventions. This results in what he calls a ‘stairway’ (p. 3). It …

John Stuart Mill's harm principle holds that an individual's freedom can only be restricted to prevent harm to others. However, there is an important ambiguity between a strong version, which limits legitimate interference to self-defense and therefore prohibits society from protecting third parties (those who are not its members), and a narrow version, which grants any society universal jurisdiction to prevent nonconsensual harms, no matter who is harmed. Mill sometimes appeals to the strong harm principle to preclude interference, but elsewhere endorses measures (including humanitarian foreign intervention and animal cruelty laws) to protect third parties, suggesting that he subscribes only to the weak harm principle. This ambiguity regarding who it is that society has standing to protect has important implications for the scope of individual freedom.

There has been much discussion of the justifiability of strikes by healthcare workers, but comparatively little discussion of the political processes through which strikes occur. This article focuses on the Trade Union Act 2016, which currently governs strike ballots in the UK. This legislation has important implications for healthcare workers being balloted on strikes (or other forms of industrial action). The article first explains the legal requirements for a strike mandate and illustrates how votes in strike ballots can be counterproductive, bringing about outcomes opposite of what the voter wanted. Second, it argues that the turnout threshold responsible for these surprising results is undemocratic, since it means that outcomes need not reflect the wishes of those balloted. Third, it suggests that this has consequences for how balloted workers ought to vote, if they want the process to be more democratic. In particular, I propose that those who are neutral or indifferent have reason to cast spoiled ballots, in order to negate the turnout threshold. Further, those who oppose a strike also have reasons—if they value democratic decision-making—to vote, even though this may be less effective than abstaining. As I write, in August 2023, junior doctors in the UK are once again being balloted over strike action.1 While the global picture is more varied, strikes by medical professionals have historically been rare in the UK. When British doctors went on strike in 2012, over changes to pensions, it was the first time since 1975.2 Since then, however, industrial action has become more common. Some attribute this to an erosion of patient-centred professional values, which has made workers more prepared to strike in response to deteriorating pay and conditions.3 4 Whether or not this is the explanation, the increased prevalence of strikes has caused some concern. It is often …

A number of authors criticise opt-out (or ‘deemed consent’) systems for failing to secure valid consent to organ donation. Further, several suggest that mandated choice offers a more ethical alternative. This article responds to criticisms that opt-out does not secure informed consent. If we assume current (low) levels of public awareness, then the explicit consent secured under mandated choice will not be informed either. Conversely, a mandated choice policy might be justifiable if accompanied by a significant public education campaign. However, if this entitles us to assume that members of the public are informed, then an opt-out system would also be justified in the same circumstances. The alleged advantages of mandated choice seem to rest on an unfair comparison, between mandated choice with a public education campaign and an opt-out system without one. While it may be that some countries with opt-out systems should do more to inform their publics, I see no reason to assume that this cannot be done. Indeed, advocates of mandated choice seem committed to thinking it possible to raise awareness. If opt-out systems adopt the same methods, such as writing to every individual, this should also address concerns about whether consent is informed.

Mill appears to subscribe to the hedonist view that happiness consists in pleasure and the absence of pain, yet he departs from the Benthamite tradition by suggesting that some pleasures are more valuable than others. I suggest that the value of a pleasure depends on its contribution to happiness. Other things equal, more pleasure is more conducive to happiness than less, but some pleasures are also more valuable than others, quantity being equal. These more valuable pleasures are those that Mill describes as higher in quality. Happiness, then, is a function of quality and quantity of pleasures (with quantity itself being a function of intensity and duration). Quality is distinct from quantity and might be traded off against it, since a great quantity of lower quality pleasure can produce more happiness than a smaller quantity of higher quality pleasure, but it is not a good independent of pleasure.

One way of increasing the supply of organs available for transplant would be to switch to an opt-out system of donor registration. This is typically assumed to operate on the basis of presumed consent, but this faces the objection that not all of those who fail to opt out would actually consent to the use of their cadaveric organs. This paper defuses this objection, arguing that people's actual, explicit or implicit, consent to use their organs is not needed. It borrows David Estlund's notion of ‘normative consent’ from the justification of political authority and applies it to the case of organ donation. According to this idea, when it is wrong to withhold consent to something, the moral force of that lack of consent may be null and void. If it is wrong of a person to refuse to donate their cadaveric organs to others, then it may be that their actual consent is not needed. This supports an opt-out system, which provides protection for those who have genuine reasons to refuse donation, and spares the worries as to what the deceased would actually have wanted

Until relatively recently, few democrats had much to say about the constitution of the ‘demos' that ought to rule. A number of recent writers have, however, argued that all those whose interests are affected must be enfranchised if decision-making is to be fully democratic. This article criticizes this approach, arguing that it misunderstands democracy. Democratic procedures are about the agency of the people so only agents can be enfranchised, yet not all bearers of interests are also agents. If we focus on agency, rather than who is affected, then this leads us to focus on the permissible limits of action, rather than who makes the decision. Just as individual sovereignty is ordinarily limited by the requirement not to injure others, we may apply similar restrictions to what a demos can permissibly do. Thus, any collection of individuals may choose to regulate their affairs collectively for mutual benefit, but should be prohibited from imposing negative externalities on outsiders. On this view, the constitution or definition of the demos is arbitrary, from the democratic point of view. Moreover, democracy does not require the expansion of the franchise, unless injuries cannot be avoided

Interference is paternalistic when it restricts an individual’s freedom for their own good. Anti-paternalists, such as John Stuart Mill, object to this for various reasons, including that the individual is usually a better judge of her own interests than the would-be paternalist. However, Wilkinson argues that a Parfitian reductivist approach to personal identity opens the door to what he calls ‘identity-relative paternalism’ where someone’s present action is restricted for the sake of a different future self.1 This is an interesting argument, but it is not clear whether it involves permissible paternalism. At the risk of stating the obvious, permissible paternalism must be both permissible and paternalistic. Wilkinson’s identity-relative paternalism could be either, but not obviously both. If the present and future selves are different individuals, then interference is potentially permissible but no longer paternalistic. Alternatively, they are identical, in which case the interference is genuine paternalism, but cannot be justified by appeal to their distinctness. Wilkinson may escape this dilemma by invoking Parfit, who challenges the common notion that identity is all or nothing.2 According to Parfit’s revisionary view, the present and future self may share some connections but not others. However, once we have identified these similarities and differences, there is no further question whether or not they …

Endörfer has recently argued that proponents of the harm principle are wrong to exempt market harms as potential justifications for state interference. I argue that – contrary to suggestions in Endörfer’s article – John Stuart Mill did not exempt market harms from his harm principle. On Mill’s view, the state can (as a matter of principle) legitimately interfere with free markets to prevent market harms where they occur but, on the whole, it is better policy not to interfere. Mill’s general preference for free trade rests on utilitarian considerations and not on his harm principle, which does not exclude market harms.

The spread of vaccine misinformation may contribute to vaccine refusal/hesitancy and consequent harms. Nonetheless, censorship is often rejected on the grounds of free expression. This article examines John Stuart Mill’s influential defence of free expression but finds that his arguments for freedom apply only to normal, reasonably favourable circumstances. In other cases, it may be permissible to restrict freedom, including freedom of speech. Thus, while Mill would ordinarily defend the right to express false views, such as that vaccines cause autism, he might have accepted restrictions on anti-vaccine misinformation during the present pandemic. This illustrates that even the staunchest defenders of free speech can permit temporary restrictions in exceptional circumstances.

The novel coronavirus (SARS-CoV-2) pandemic has refocused attention on the issue of mandatory vaccination. Some have suggested that vaccines ought to be mandatory, while others propose more moderate alternatives, such as incentives. This piece surveys a range of possible interventions, ranging from mandates through to education. All may have their place, depending on circumstances. However, it is worth clarifying the options available to policymakers, since there is sometimes confusion over whether a particular policy constitutes a mandate or not. Further, I illustrate a different kind of alternative to mandatory vaccination. Rather than seeking less coercive alternatives to a mandate, we might instead employ an alternative mandate, which requires people to do something less than get vaccinated. For instance, we might merely require people to attend an appointment at a vaccine clinic. Whether this mandatory attendance policy is justified will depend on specific circumstances, but it represents another way to promote vaccination, without mandating it. In some cases, this may represent an appropriate balance between promoting public health goals and respecting individual liberty.

This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have—by their silence—actually consented

Douglas Diekema influentially argues that interference with parental decisions is not in fact guided by the child’s best interests, but rather by a more permissive standard, which he calls the harm principle. This article first seeks to clarify this alternative position and defend it against certain existing criticisms, before offering a new criticism and alternative. This ‘harm principle’ has been criticized for (i) lack of adequate moral grounding, and (ii) being as indeterminate as the best interest standard that it seeks to replace. I argue that these are not serious problems. I take Diekema’s negative point to be right—our actual standard for intervention is not literally the best interests of the child—but I disagree with his proposed replacement. First, Diekema’s proposed harm threshold should be more carefully distinguished from Mill’s harm principle. Second, there is no reason to assume that the standard for permissible intervention coincides with the threshold for harm (or serious harm). Thus, I propose that the best alternative to the best interests standard is not a harm principle, but rather a sufficiency threshold between adequate (or ‘good enough’) and inadequate (or ‘substandard’) parenting.

It is widely assumed that the strongest case for permitting non‐medical sex selection is where parents aim at family balance. This piece criticizes one representative attempt to justify sex selection for family balance. Kluge (2007) assumes that some couples may seek sex selection because they hold discriminatory values, but this need not impugn those who merely have preferences, without evaluative commitments, for a particular sex. This is disputed by those who see any sex selection as inherently sexist because it upholds stereotypes about the sexes. This article takes an alternative approach. I argue that, even if we accept that preference‐based selection is unobjectionable, a policy permitting selection for family balancing does a poor job of distinguishing between value‐based and preference‐based selection. If we wish to permit only preference‐based sex selection we should seek to identify parents’ motives. If we wish to justify a family balancing policy, other arguments are needed.

It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good—either excessive or deficient—is intrinsically bad. Whether or not we accept the details of this account, recognising that altruistic motivations may be intrinsically bad has important implications for organ procurement. One possible response is to say that we should take further measures to ensure that donors have good motives—that they are altruistic is no longer enough. An alternative is to say that, since altruistic donation need not be intrinsically good, we have less reason to object to other motivations.