Jasmine Gunkel

In recent decades, theorists of disability rights have made the moral and legal case for supported decision-making. Whereas surrogate decision-making, the long upheld legal standard, looks to a third party to make a decision for a person deemed to lack the capacity to make that decision for themselves, support in decision-making empowers that person to make their own decisions. In this article, we argue for a significant shift in the norms governing enrollment in clinical trials. Rather than assume that support is only appropriate for individuals who cannot independently make sufficiently informed enrollment decisions, we propose “support in decision-making for all” when research protocols are beyond a certain risk threshold. Drawing inspiration from the universal design movement and feminist insights about autonomy, we argue that making support in decision-making the presumption has substantial expressive and practical benefits, and better empowers all potential research participants to make more informed, autonomous decisions.

Recruiting incarcerated individuals as firefighters to slow the spread of wildfires is a controversial practice. We argue that, provided certain important conditions are met, this practice can be made ethically permissible. While these conditions have not yet been satisfied, we contend that achievable and promptly operable reforms—short of more comprehensive reforms to the criminal-legal system—could fulfill them. In this paper, we address three main arguments against this contentious practice: (1) firefighting is too risky for incarcerated individuals; (2) incarcerated firefighters are both unduly induced into participation and exploited in their work; and (3) the future employment prospects for incarcerated firefighters are unsatisfactory. In response to these concerns, we propose actions including more comprehensive and frequent health screening, ensuring adequate safety training and equipment, and improving pathways to future firefighting employment. While the first two actions only reduce the chances of exploitation, we show how improving future firefighting employment can simultaneously reduce the chances of both exploitation and undue inducement.

Xenotransplantation is increasingly touted as the solution to the organ crisis. Some bioethicists, however, have raised concerns about xenotransplantation's implications for health justice and animal welfare. We develop and sharpen these worries, and we explore how they might be mitigated. We compare xenotransplantation with several alternatives for addressing the organ crisis, including directing more money toward public health interventions, and argue that these alternatives are ethically preferable. In light of this, we argue that xenotransplantation is not a justifiable method of addressing the organ crisis. Societal funds and attention ought instead be directed toward more efficient and ethically superior solutions.

Artificial intelligence (AI) methods have been proposed for the prediction of social behaviors that could be reasonably understood from patient-reported information. This raises novel ethical concerns about respect, privacy, and control over patient data. Ethical concerns surrounding clinical AI systems for social behavior verification can be divided into two main categories: (1) the potential for inaccuracies/biases within such systems, and (2) the impact on trust in patient-provider relationships with the introduction of automated AI systems for “fact-checking”, particularly in cases where the data/models may contradict the patient. Additionally, this report simulated the misuse of a verification system using patient voice samples and identified a potential LLM bias against patient-reported information in favor of multi-dimensional data and the outputs of other AI methods (i.e., “AI self-trust”). Finally, recommendations were presented for mitigating the risk that AI verification methods will cause harm to patients or undermine the purpose of the healthcare system.

During the vulnerable, painful time around my diagnosis with a chronic illness, my physician shared with me a story from her own life. Her act of self-disclosure was profoundly impactful, reminding me that the gulf between myself and other people was not as vast as it felt. In this essay, I share my story and the conclusions I’ve drawn from it in the years since, using my tools as a philosopher and bioethicist. I explore what “patient-centered self-disclosure” might look like. I hope that these reflections might deepen our understanding of the intimacy and vulnerability of receiving medical care, and of the power of physician self-disclosure.

There are few moral principles less controversial than “don’t touch people’s private parts without consent.” Though the principle doesn’t make explicit that there are exceptions, there clearly are some. Parents must wipe their infants. If an unconscious patient is admitted to the emergency room with a profusely bleeding laceration on their genitals, a doctor must give them stitches. The researchers who proposed the study in question, which would look for a connection between burn patients’ microbiomes and their clinical outcomes, presumably believed they had identified an additional exception to the aforementioned principle. I argue that they did not. Rather, because of their tremendous inherent risks, we ought only to perform intimate procedures on those who can’t consent when the procedure is for their own good. Intimate violations have been overlooked in both philosophy and medicine. Because of this, we have lacked an adequate conceptual framework for identifying certain kinds of harms research can inflict. When we understand these special risks, we see that the IRB was right to deny a waiver of consent.

Why is it more violating to grab a stranger’s thigh or stroke their face than it is to grab their forearm? Why is it worse to read someone’s dream journal without permission than it is to read their bird watching field notes? Why are gestation mandates so incredibly intrusive? Intimacy is key to understanding these cases, and to explaining many of our most stringent rights. I present two ways of thinking about intimacy, Relationship-First Accounts and the Intimate Zones Account. I argue that only the Intimate Zones Account lets us cohesively understand intimacy’s importance, and the scope of our intimate rights. I characterize our intimate zones as meeting the Hiddenness and Importance Conditions. A feature’s meeting these conditions makes it a locus of special vulnerability by which our persons can be fundamentally altered. This special vulnerability explains why our duties to respect the intimate boundaries of others are so strict.

I give an argument for veganism by drawing parallels between a) bestiality and animal fighting, and b) animal product consumption. Attempts to draw principled distinctions between the practices fail. The wrong-making features of bestiality and animal fighting are also found in animal product consumption. These parallels give us new insight into why popular objections to veganism, such as the Inefficacy Argument, are inadequate. Because it is often difficult to enact significant life changes, I hope that seeing the parallels between animal product consumption and acts we are already so strongly motivated to avoid can help us abstain from animal products.