Nancy Jecker

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.

This article sets forth a solidaristic approach to global distribution of vaccines against the SARS‐CoV‐2 virus. Our approach draws inspiration from African ethics and from the characterization of the Covid‐19 crisis as a syndemic, a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis. The first section elaborates the twin ideas of syndemic and solidarity. The second section argues that these ideas lend support to global health alliances to distribute vaccines beyond national borders. The third section introduces ethical criteria to guide global distribution, emphasizing priority to low‐ and middle‐income countries, which have the least ability to obtain vaccines on their own. It also justifies giving priority to people at high risk of infection and high risk of severe disease and death.

Previously, we introduced a capability approach to assess the responsible use of brain-computer interface. In this commentary, we say more about the ethical basis of our capability view and respond to three objections. The first objection holds that by stressing that capability lists are provisional and subject to change, we threaten the persistence of human dignity, which is tied to capabilities. The second objection states that we conflate capabilities and abilities. The third objection claims that the goal of using neuroenhancements should be preserving capabilities, not altering them.

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand in a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant.

Social isolation and loneliness are growing concerns around the globe that put people at increased risk of disease and early death. One much‐touted approach to addressing them is deploying artificially intelligent agents to serve as companions for socially isolated and lonely people. Focusing on digital humans, we consider evidence and ethical arguments for and against this approach. We set forth and defend public health policies that respond to concerns about replacing humans, establishing inferior relationships, algorithmic bias, distributive justice, and data privacy.

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.

This paper argues for global sharing of COVID‐19 treatments during the COVID‐19 pandemic and beyond based on principles of global solidarity. It starts by distinguishing two types of COVID‐19 treatments and models sharing strategies for each in small‐group scenarios, contrasting groups that are solidaristic with those composed of self‐interest maximizers to show the appeal of solidaristic reasoning. It then extends the analysis, arguing that a similar logic should apply within and between nations. To further elaborate global solidarity, the paper distinguishes morally voluntary, sliding‐scale, and mandatory versions. It argues for an all‐hands‐on‐deck approach and gives examples to illustrate. The paper concludes that during the COVID‐19 crisis, global solidarity is a core value, and global sharing of COVID‐19 treatments should be considered a duty of justice, not of charity.

Programmes serving international patients are increasingly common throughout the USA. These programmes aim to expand access to resources and clinical expertise not readily available in the requesting patients’ home country. However, they exist within the US healthcare system where domestic healthcare needs are unmet for many children. Focusing our analysis on US children’s hospitals that have a societal mandate to provide medical care to a defined geographic population while simultaneously offering highly specialised healthcare services for the general population, we assume that, given their mandate, priority will be given to patients within their catchment area over other patients. We argue that beyond prioritising patients within their region and addressing inequities within US healthcare, US institutions should also provide care to children from countries where access to vital medical services is unavailable or deficient. In the paper, we raise and attempt to answer the following: (1) Do paediatric healthcare institutions have a duty to care for all children in need irrespective of their place of residence, including international patients? (2) If there is such a duty, how should this general duty be balanced against the special duty to serve children within a defined geographical area to which an institution is committed, when resources are strained? (3) Finally, how are institutional obligations manifest in paradigm cases involving international patients? We start with cases, evaluating clinical and contextual features as they inform the strength of ethical claim and priority for access. We then proceed to develop a general prioritisation framework based on them.

This paper addresses bioethics in the context of the coronavirus disease 2019 (COVID‐19) pandemic. The Introduction (Section 1) highlights that at the field's inception, infectiousness was not front and center. Instead, infectious disease was widely perceived as having been conquered. This made it possible for bioethicists to center values such as individual autonomy, informed consent, and a statist conception of justice. Section 2 urges shifting to values more fitting for the moment the world is in. To find these, it directs attention to the Global South, and in particular, Africa, and to the values of ubuntu, solidarity, dignity, kinship, and humility. The paper concludes (in Section 3) that 21st‐century challenges facing bioethics are increasingly global, and calls on bioethicists themselves to be more globally inclusive in their approaches.

In ‘Does zero-COVID neglect health disparities?’ we made the case that strict zero-COVID policies implemented during the coronavirus 2019 disease (COVID-19) pandemic raise health equity concerns so serious that these policies are not ethically sustainable.1 Zero-COVID, which has dominated many Pacific Rim societies, sets zero deaths from COVID-19 as a goal, and aims to reach it by forcefully containing transmission through short-term lockdowns, followed by stringent find, test, trace and isolate methods. Since the paper appeared in 2021, the Omicron variant and subvariants took hold, making a strict zero goal unattainable and leading many countries to abandon it. Careful ethical analysis of zero-COVID’s impact remains crucially important, however, not only because the novel coronavirus continues to surprise us, but also to ensure lessons learnt from this pandemic are carried forward to future pandemics. In ‘Zero-COVID and health inequities’,2 Schaefer argues that it is possible to pursue zero-COVID yet offset any negative impacts on disadvantaged groups. Citing Singapore, where zero-COVID led to outbreaks in crowded and unsanitary migrant workers dormitories, Schaefer notes the government offset these effects, setting up less densely populated ‘quick build dormitories’ that caused daily case counts to drop, even while zero-COVID remained …

This paper argues for global sharing of COVID‐19 treatments during the COVID‐19 pandemic and beyond based on principles of global solidarity. It starts by distinguishing two types of COVID‐19 treatments and models sharing strategies for each in small‐group scenarios, contrasting groups that are solidaristic with those composed of self‐interest maximizers to show the appeal of solidaristic reasoning. It then extends the analysis, arguing that a similar logic should apply within and between nations. To further elaborate global solidarity, the paper distinguishes morally voluntary, sliding‐scale, and mandatory versions. It argues for an all‐hands‐on‐deck approach and gives examples to illustrate. The paper concludes that during the COVID‐19 crisis, global solidarity is a core value, and global sharing of COVID‐19 treatments should be considered a duty of justice, not of charity.

This chapter draws on the sub-Saharan African concept of ubuntu (humanness) to identify salient features within African ethics that can shed important light on central topics in contemporary bioethics. It describes three specific areas where ubuntu is well positioned to make transformative and lasting changes. First, an ubuntu-informed conception of what it means to be a person in the moral sense can enhance standard bioethical understandings of who qualifies as a subject of moral concern and who can be a strong claimant of moral rights. This carries implications for bioethics topics such as abortion and the treatment of newly deceased patients. Second, ubuntu can reinvigorate debates about respect for human dignity. This has both theoretical and practical implications. Theoretically, an ubuntu-informed understanding of human dignity can contribute insights to capability approaches to justice; practically, it can enhance bioethics in both pediatric and geriatric settings. Finally, an ubuntu-guided environmental philosophy can help address urgent issues in global bioethics, such as those related to emerging infectious diseases and climate change.

Over the next 15 years, the government-funded human genome project will map and sequence each of the human cell’s estimated 100,000 genes. The project’s first fruits will be a vast quantity of information about genetic disease. This information will contribute to the design of quicker, cheaper and more accurate tests for identifying deleterious genes in individuals. Because genetic conditions are often regarded as “immutable, heritable taints that intrinsically implicate the bearer’s identity,” overly-deterministic interpretations of genetic information can readily distort genetic risk and become enshrined in institutional policies of social isolation and discrimination.