• Seven COVID-19 vaccines are now being distributed and administered around the world, with more on the horizon. It is widely accepted that healthcare workers should have high priority. However, questions have been raised about what we ought to do if members of priority groups refuse vaccination. Using the case of influenza vaccination as a comparison, we know that coercive approaches to vaccination uptake effectively increase vaccination rates among healthcare workers and reduce patient morbidity…Read more
  •  22
    Queue questions: Ethics of COVID‐19 vaccine prioritization
    with Julian Savulescu and Dominic Wilkinson
    Bioethics 35 (4): 348-355. 2021.
    Bioethics, EarlyView.
  •  5
    Bioethics, EarlyView.
  •  2
    Conscientious Objection, Conflicts of Interests, and Choosing the Right Analogies. A Reply to Pruski
    with Julian Savulescu
    Journal of Bioethical Inquiry 18 (1): 181-185. 2021.
    In this response paper, we respond to the criticisms that Michal Pruski raised against our article “Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests.” We defend our original position against conscientious objection in healthcare by suggesting that the analogies Pruski uses to criticize our paper miss the relevant point and that some of the analogies he uses and the implications he draws are misplaced.
  •  3
    Fair go: pay research participants properly or not at all
    with Olivia Grimwade, Julian Savulescu, Justin Oakley, and Anne-Marie Nussberger
    Journal of Medical Ethics 46 (12): 837-839. 2020.
    We thank the authors of the five commentaries for their careful and highly constructive consideration of our paper,1 which has enabled us to develop our proposal. Participation in research has traditionally been viewed as altruistic. Over time, payments for inconvenience and lost wages have been allowed, as have small incentives, usually in kind. The problem, particularly with controlled human infection model research or ‘challenge studies’, is that they are unpleasant and time-consuming. Resear…Read more
  •  8
    Return to Status Quo Ante: The Need for Robust and Reversible Pandemic Emergency Measures
    Cambridge Quarterly of Healthcare Ethics 30 (2): 222-233. 2021.
    This paper presents a normative analysis of restrictive measures in response to a pandemic emergency. It applies to the context presented by the Corona virus disease 2019 global outbreak of 2019, as well as to future pandemics. First, a Millian-liberal argument justifies lockdown measures in order to protect liberty under pandemic conditions, consistent with commonly accepted principles of public health ethics. Second, a wider argument contextualizes specific issues that attend acting on the jus…Read more
  •  11
    Payment in challenge studies: ethics, attitudes and a new payment for risk model
    with Olivia Grimwade, Julian Savulescu, Justin Oakley, Joshua Osowicki, Andrew J. Pollard, and Anne-Marie Nussberger
    Journal of Medical Ethics 46 (12): 815-826. 2020.
    Controlled Human Infection Model research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion an…Read more
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    Regulating Genome Editing: For an Enlightened Democratic Governance
    Cambridge Quarterly of Healthcare Ethics 28 (1): 76-88. 2019.
    How should we regulate genome editing in the face of persistent substantive disagreement about the moral status of this technology and its applications? In this paper, we aim to contribute to resolving this question. We first present two diametrically opposed possible approaches to the regulation of genome editing. A first approach, which we refer to as “elitist,” is inspired by Joshua Greene’s work in moral psychology. It aims to derive at an abstract theoretical level what preferences people w…Read more
  •  7
    Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests
    with Julian Savulescu
    Journal of Bioethical Inquiry 17 (2): 229-243. 2020.
    Conflict of interests in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of “interests” cannot be reduced to its financial component. Individuals in general, and…Read more
  •  6
    Governing the Global Antimicrobial Commons: Introduction to Special Issue
    with Steven J. Hoffman, Julian Savulescu, Claas Kirchhelle, Susan Rogers Van Katwyk, Isaac Weldon, Brooke Campus, Mark Harrison, Hannah Maslen, and Angela McLean
    Health Care Analysis 1-8. forthcoming.
    Antimicrobial resistance is one of the greatest public health crises of our time. The natural biological process that causes microbes to become resistant to antimicrobial drugs presents a complex social challenge requiring more effective and sustainable management of the global antimicrobial commons—the common pool of effective antimicrobials. This special issue of Health Care Analysis explores the potential of two legal approaches—one long-term and one short-term—for managing the antimicrobial …Read more
  •  2
    Making Use of Existing International Legal Mechanisms to Manage the Global Antimicrobial Commons: Identifying Legal Hooks and Institutional Mandates
    with Susan Rogers Van Katwyk, Isaac Weldon, Claas Kirchhelle, Mark Harrison, Angela McLean, Julian Savulescu, and Steven J. Hoffman
    Health Care Analysis 1-16. forthcoming.
    Antimicrobial resistance is an urgent threat to global public health and development. Mitigating this threat requires substantial short-term action on key AMR priorities. While international legal agreements are the strongest mechanism for ensuring collaboration among countries, negotiating new international agreements can be a slow process. In the second article in this special issue, we consider whether harnessing existing international legal agreements offers an opportunity to increase collec…Read more
  •  14
    The Ethics of Vaccination
    Springer Verlag. 2019.
  •  4
    Exploring Models for an International Legal Agreement on the Global Antimicrobial Commons: Lessons from Climate Agreements
    with Susan Rogers Van Katwyk, Claas Kirchhelle, Isaac Weldon, Mark Harrison, Angela McLean, Julian Savulescu, and Steven J. Hoffman
    Health Care Analysis 1-22. forthcoming.
    An international legal agreement governing the global antimicrobial commons would represent the strongest commitment mechanism for achieving collective action on antimicrobial resistance. Since AMR has important similarities to climate change—both are common pool resource challenges that require massive, long-term political commitments—the first article in this special issue draws lessons from various climate agreements that could be applicable for developing a grand bargain on AMR. We consider …Read more
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    An Argument for Compulsory Vaccination: The Taxation Analogy
    Journal of Applied Philosophy 37 (3): 446-466. 2020.
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    Vaccination, Risks, and Freedom: The Seat Belt Analogy
    with Julian Savulescu
    Public Health Ethics. forthcoming.
    We argue that, from the point of view public health ethics, vaccination is significantly analogous to seat belt use in motor vehicles and that coercive vaccination policies are ethically justified for the same reasons why coercive seat belt laws are ethically justified. We start by taking seriously the small risk of vaccines’ side effects and the fact that such risks might need to be coercively imposed on individuals. If millions of individuals are vaccinated, even a very small risk of serious s…Read more
  •  23
    Nudging Immunity: The Case for Vaccinating Children in School and Day Care by Default
    with Lucius Caviola, Hannah Maslen, Thomas Douglas, Anne-Marie Nussberger, Nadira Faber, Samantha Vanderslott, Sarah Loving, Mark Harrison, and Julian Savulescu
    HEC Forum 31 (4): 325-344. 2019.
    Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children…Read more
  •  26
    Demandingness and Public Health Ethics
    with Julian Savulescu
    Moral Philosophy and Politics 6 (1): 65-87. 2019.
    Public health policies often require individuals to make personal sacrifices for the sake of protecting other individuals or the community at large. Such requirements can be more or less demanding for individuals. This paper examines the implications of demandingness for public health ethics and policy. It focuses on three possible public health policies that pose requirements that are differently demanding: vaccination policies, policy to contain antimicrobial resistance, and quarantine and iso…Read more
  •  25
    Enhancing Equality
    Journal of Medicine and Philosophy 44 (3): 335-354. 2019.
    The range of opportunities people enjoy in life largely depends on social, biological, and genetic factors for which individuals are not responsible. Philosophical debates about equality of opportunities have focussed mainly on addressing social determinants of inequalities. However, the introduction of human bioenhancement should make us reconsider what our commitment to equality entails. We propose a way of improving morally relevant equality that is centred on what we consider a fair distribu…Read more
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    We argue that individuals who have access to vaccines and for whom vaccination is not medically contraindicated have a moral obligation to contribute to the realisation of herd immunity by being vaccinated. Contrary to what some have claimed, we argue that this individual moral obligation exists in spite of the fact that each individual vaccination does not significantly affect vaccination coverage rates and therefore does not significantly contribute to herd immunity. Establishing the existence…Read more
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    Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should…Read more
  •  15
    Defending after-birth abortion: Responses to some critics
    Monash Bioethics Review 30 (2): 49-61. 2012.
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    We describe a form of moral artificial intelligence that could be used to improve human moral decision-making. We call it the “artificial moral advisor”. The AMA would implement a quasi-relativistic version of the “ideal observer” famously described by Roderick Firth. We describe similarities and differences between the AMA and Firth’s ideal observer. Like Firth’s ideal observer, the AMA is disinterested, dispassionate, and consistent in its judgments. Unlike Firth’s observer, the AMA is non-abs…Read more
  •  34
    Influenza Vaccination Strategies Should Target Children
    with Ben Bambery, Thomas Douglas, Michael J. Selgelid, Hannah Maslen, Andrew J. Pollard, and Julian Savulescu
    Public Health Ethics 11 (2): 221-234. 2018.
    Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be …Read more
  •  28
    The treatment-enhancement distinction is often used to delineate acceptable and unacceptable medical interventions. It is likely that future assistive and augmenting technologies will also soon develop to a level that they might be considered to provide users, in particular those with disabilities, with abilities that go beyond natural human limits, and become in effect an enhancing technology. In this paper, we describe how this process might take place, and discuss the moral implications of su…Read more
  •  32
    Antimicrobial resistance kills people. According to a recent estimate, ‘7 00 000 people die of resistant infections every year’, and ‘by 2050 10 million lives a year are at risk due to drug resistant infections, as are 100 trillion USD of economic output’.1 Today, ‘bacteria are resistant to nearly all antibiotics that were earlier active against them’.2 For all these reasons, antimicrobial resistance is considered a ‘slowly emerging disaster’3 and a ‘global health security issue’.4 The prospect …Read more
  •  39
    I argue that appeals to conscience do not constitute reasons for granting healthcare professionals exemptions from providing services they consider immoral. My argument is based on a comparison between a type of objection that many people think should be granted, i.e. to abortion, and one that most people think should not be granted, i.e. to antibiotics. I argue that there is no principled reason in favour of conscientious objection qua conscientious that allows to treat these two cases differen…Read more
  •  38
    Taxing Meat: Taking Responsibility for One’s Contribution to Antibiotic Resistance
    with Hannah Maslen, Julian Savulescu, Thomas Douglas, and Patrick Birkl
    Journal of Agricultural and Environmental Ethics 30 (2): 179-198. 2017.
    Antibiotic use in animal farming is one of the main drivers of antibiotic resistance both in animals and in humans. In this paper we propose that one feasible and fair way to address this problem is to tax animal products obtained with the use of antibiotics. We argue that such tax is supported both by deontological arguments, which are based on the duty individuals have to compensate society for the antibiotic resistance to which they are contributing through consumption of animal products obta…Read more
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    International Journal of Applied Philosophy 27 (1): 35-46. 2013.
    The current impasse in the old debate about the morality of euthanasia is mainly due to the fact that the actual source of conflict has not been properly identified—or so I shall argue. I will first analyse the two different issues involved in the debate, which are sometimes confusingly mixed up, namely: (a) what is euthanasia?, and (b) why is euthanasia morally problematic? Considering documents by physicians, philosophers and the Roman Catholic Church, I will show that (a) ‘euthanasia’ is defi…Read more