Nancy Jecker

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics’ (IAB’s) selection of Qatar to host the 2024 World Congress of Bioethics. IAB’s choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles.One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing?

In ‘Nothing to Be Ashamed of: Sex Robots for Older Adults with Disabilities,’1 I make the case that the unwanted absence of sex from a person’s life represents not just a loss of physical pleasure, but a loss of dignity. Since people aged 65 and over suffer disproportionately from disabilities that impair sexual functioning, I focus on this population. Drawing on an analysis of dignity developed at greater length elsewhere,2 I argue that sex robots can help older adults with disabilities and that societies ought to take reasonable steps to make them available to this population. Unlike other assistive technologies, robots invite human-robot relationships and can form close connections with older adults.3 In response to the proposal, four commentators have introduced objections that I address below. Sorell4 argues that people who are young and able-bodied may wish for sex in their lives too and its absence may be a bigger concern for them than for older people. In reply, while my focus is older adults with disabilities that impair sexual function, I also acknowledge that loss of sexual function can occur at any age as …

It is often assumed that the chief responsibility medical professionals bear is patient care and advocacy. The meeting of other duties, such as ensuring a more just distribution of medical resources and promoting the public good, is not considered a legitimate basis for curtailing or slackening beneficial patient services. It is argued that this assumption is often made without sufficient attention to foundational principles of professional ethics; that once core principles are laid bare this assumption is revealed as largely unwarranted; and, finally, that these observations at the level of moral theory should be reflected, in various ways, in medical practice. Specifically, this essay clarifies a tension that exists between different kinds of moral principles and explores the possibility of dissipating that tension by shoring up foundational principles. The paper begins by setting out three alternative models of how best to balance patient advocacy responsibilities with broader social responsibilities. It then turns to critically assess these models and argue that one has several advantages over the others.

Growing demand for direct care workers to assist care-dependent elderly people has created an opening for migrant workers from low- income nations to sell their services to middle and high-income nations. Using Singapore as a case example, we draw on capability theory to make the case that receiving nations that import direct care workers should be held to global justice standards that protect workers’ floor level human capabilities. Specifically, we (1) show that Singapore and other receiving nations fail to protect human capabilities at a threshold level required by dignity; (2) identify specific human capabilities placed at risk; and (3) recommend standards for receiving nations that support central capabilities. As populations in both developed and developing nations are rapidly aging, these concerns could not be timelier.

Global scarcity of COVID-19 vaccines raises ethical questions about their fair allocation between nations. Section I introduces the question and proposes that wealthy nations have a duty of justice to share globally scarce COVID-19 vaccines. Section II distinguishes justice from charity and argues that beneficiaries of unjust structures incur duties of justice when they are systematically advantaged at others expense. Section III gives a case-based argument describing three upstream structural injustices that systematically advantaged wealthy countries and disadvantaged poorer countries, contributing to global disparities of COVID-19 vaccines. Section IV examines more closely the duties of justice owed, including a duty to relinquish holdings, restitute victims, and restore relationships. Section V concludes that wealthy nations have a duty of justice to share COVID-19 vaccines with poor nations and to restore relationships damaged by injustice. All nations should take steps to transform unjust structures.

The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health.

We examined the ethical justification for a national policy governing public funding for the induced pluripotent stem cell stock project in Japan and argue that the initiation of the iPSC stock project in 2012, when no clinical trial using iPSC-derived products had yet succeeded, was premature and unethical. Our analysis considers a generally accepted justice criterion and shows it fails to justify public funding of the iPSC stock project. We also raise concerns related to the massive amounts of public funding at stake and the absence of evidence supporting claimed success rates. We conclude that the iPSC stock project should be re-considered and deferred until a substantial number of clinical trials using iPSC-derived products are deemed successful. This analysis should benefit others worldwide as they consider their own public funding policies.

The Aging Self and the Aging Society Ethical issues involving the elderly have recently come to the fore. This should come as no surprise: Since the turn of the century, there has been an eightfold in crease in the number of Americans over the age of sixty five, and almost a tripling of their proportion to the general population. Those over the age of eighty-five- the fastest growing group in the country-are twenty one more times as numerous as in 1900. Demographers expect this trend to accelerate into the twenty-first century. The aging of society casts into vivid relief a num ber of deep and troubling questions. On the one hand, as individuals, we grapple with the immediate experience of aging and mortality and seek to find in it philosophical or ethical significance. We also wonder what responsi bilities we bear toward aging family members and what expectations of others our plans for old age can reasona bly include. On the other hand, as a community, we must decide: What special role, if any, do older persons occupy in our society? What constitutes a just distribution of medical resources between generations? And, How can institutions that serve the old foster imperiled values, such as autonomy, self-respect, and dignity? Only recently have we begun to explore these themes, yet already a rich and fruitful literature has grown up around them.

This chapter addresses the close association between withholding and withdrawing futile life-sustaining medical treatments and assisting patients with hastening ending their lives. Section 12.2 sets forth a definition of medical futility and places this concept in the broader context of bioethical principles of autonomy, beneficence, nonmaleficence and justice. Section 12.3 draws out futility’s ethical implications and considers the view that physicians are ethically permitted to refrain from medically futile treatments, should be encouraged to refrain, or have a duty to refrain. Section 12.4 examines ethical arguments that physicians also have a positive duty to assist patients with terminal conditions who are imminently dying to end their lives. It explores ethical arguments for assisted dying that appeal to the physicians’ significant responsibility and relationship with patients, the claimed moral equivalence of actions and omissions, and the medical goal of helping patients have a peaceful and dignified death.

Our aims are to set forth a multiprinciple system for selecting among clinical trials competing for limited space in an immunotherapy production facility that supplies products under investigation by scientific investigators; defend this system by appealing to justice principles; and illustrate our proposal by showing how it might be implemented. Our overarching aim is to assist manufacturers of immunotherapeutic products and other potentially breakthrough experimental therapies with the ethical task of prioritizing requests from scientific investigators when production capacity is limited.

In lieu of an abstract, here is a brief excerpt of the content:130 Feminist Studies 46, no. 1. © 2020 by Feminist Studies, Inc. Laura Bisaillon, Alana Cattapan, Annelieke Driessen, Esther van Duin, Shannon Spruit, Lorena Anton, and Nancy S. Jecker Doing Academia Differently: “I Needed Self-Help Less Than I Needed a Fair Society” A great deal of harm is being done by belief in the virtuousness of work. — Bertrand Russell, “In Praise of Idleness” We are committed to doing academia in particular ways, and not in others. — Brocher Foundation Feminist Collective I had decided that becoming a university professor might be a good fit; friends and colleagues had suggested that I would be valuable to a university, so I prepared for a restructuring of my family life.1 I read Tokarczyk and Fay’s Working-Class Women in the Academy and Babcock and Laschever’s Women Don’t Ask to gather understandings of the milieu I was entering. I now see that my preparations had not shined sufficient light on the social and structural factors that organize the contemporary university.... As it turns out, the restructuring of our lives within the working conditions, priorities, and rationalities of this professional milieu triggered unanticipated and painful effects.... Had Mountz published her article “Women on the Edge” before I decided on a career migration into the university system and, had I been fortunate enough to discover it, I would have made other career choices.2 1. The authors, who describe themselves as the Brocher Foundation Feminist Collective, indicate their personal narratives in this text using italics. 2. Michelle M. Tokarczyk and Elizabeth A. Fay, eds., Working-Class Women in the Academy: Laborers in the Knowledge Factory (Amherst: University of Massachusetts Press, 1993); Linda Babcock and Sara Laschever, Women Don’t Ask: Negotiation and the Gender Divide (Princeton, NJ: Princeton University Bisaillon et al. 131 Introduction: Personal, Professional, and Political We are seven women who met at the Brocher Foundation in Hermance, Switzerland, in July 2017, where we had been selected to spend a few months as research fellows. This competitively awarded opportunity is open to persons fluent in English, from graduate students to senior scholars, with or without academic appointment, whose scholarship advances knowledge about the ethical, legal, and social implications of health and biotechnologies.3 When we found ourselves on the shores of Lake Leman with the gift of time, we began opening up to each other in unexpected, compelling ways. Whatever our vantage point in the hierarchy of the university system, we discovered that there was remarkable overlap in our experiences as women in academia. When we began writing, our authoring team was composed of two graduate students, four faculty members at the assistant professor rank, and one full professor, residing in Canada, the Netherlands, Romania, the United Kingdom, and the United States. Our plural subject position led us to underexplored and imaginative responses to broader social issues, which we share in this article as the “Brocher Foundation Feminist Collective.” We analyze our experiences from our standpoint as women health researchers laboring in the academy. Our similarities and differences were exciting entry points for discussion and analysis: we are all of eastern or western European descent. We have different countries of birth, mother tongues, ages, disciplinary training and career trajectories, relationships to chronic illness and disability, marital status, and experiences with parenthood. We bring the troubles and contradictions we experience as academics into conversation with each other. We seek to productively illustrate and emphasize that the tensions we see around us, and also feel within us, arise as a result of how the academic system is organized, produced, and sustained across time, place, and space. Press, 2003); Alison Mountz, “Women on the Edge: Workplace Stress at Universities in North America,” The Canadian Geographer 60, no. 2 (2016): 205–18. 3. We experienced this fellowship as a valuable opportunity. But we also recognized that our access to it was mediated by social, economic, or other obligations. As countries in the global north continue to tighten their national border regimes, marginalized academics, especially those from the global South, were less likely to succeed in getting a Swiss visa or securing relevant temporal and economic resources. 132 Bisaillon et al. The promise here, we posit...

Two recent policy statements by providers of critical care representing the United States and Europe have rejected the concept and language of “medical futility,” on the ground that there is no universal consensus on a definition. They recommend using “potentially inappropriate” or “inappropriate” instead. As Bosslet and colleagues state: The term “potentially inappropriate” should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Clinicians should explain and advocate for the treatment plan...

This paper gives an ethical argument for temporarily waiving intellectual property protections for COVID-19 vaccines. It examines two proposals under discussion at the World Trade Organization : the India/South Africa proposal and the WTO Director General proposal. Section I explains the background leading up to the WTO debate. Section II rebuts ethical arguments for retaining current IP protections, which appeal to benefiting society by spurring innovation and protecting rightful ownership. It sets forth positive ethical arguments for a temporary waiver that appeal to standing in solidarity and holding companies accountable. After examining built-in exceptions to existing agreements and finding them inadequate, the paper replies to objections to a temporary waiver and concludes, in section III, that the ethical argument for temporarily waiving IP protection for COVID-19 vaccines is strong. There are no data in this work.

This paper considers the proposal to pay people to get vaccinated against the SARS-CoV-2 virus. The first section introduces arguments against the proposal, including less intrusive alternatives, unequal effects on populations and economic conditions that render payment more difficult to refuse. The second section considers arguments favouring payment, including arguments appealing to health equity, consistency, being worth the cost, respect for autonomy, good citizenship, the ends justifying the means and the threat of mutant strains. The third section spotlights long-term and short-term best practices that can build trust and reduce ‘vaccine hesitancy’ better than payment. The paper concludes that people who, for a variety of reasons, are reluctant to vaccinate should be treated like adults, not children. Despite the urgency of getting shots into arms, we should set our sights on the long-term goals of strong relationships and healthy communities.