Jonathan A. Hughes

In a recent Dutch euthanasia case, a woman underwent euthanasia on the basis of an advance directive, having first been sedated without her knowledge and then restrained by members of her family while the euthanasia was administered. This article considers some implications of the criminal court’s acquittal of the doctor who performed the euthanasia. Supporters of advance euthanasia directives have welcomed the judgement as providing a clarification of the law, especially with regard to the admissibility of contextual evidence in interpreting advance euthanasia directives, but suggested that the law regarding advance euthanasia directives should be further relaxed to remove the requirement of current suffering and that an unfortunate consequence of the prosecution is that it is likely to deter doctors from performing euthanasia even in more straightforward cases. This article argues that the court’s endorsement of the use of contextual evidence is problematic, that the case for prioritising prior decisions over current interests has not been advanced by the discussion surrounding this case and that worries about the alleged deterrent effect are not well founded.

In their recent article, ‘Why lockdown of the elderly is not ageist and why levelling down equality is wrong’, Savulescu and Cameron argue for selective isolation of the elderly as an alternative to general lockdown. An important part of their argument is the claim that the latter amounts to ‘levelling down equality’ and that this is ‘unethical’ or even ‘morally repugnant’. This response argues that they fail to justify either part of this claim: the claim that levelling down is always morally wrong is subject to challenges that Savulescu and Cameron do not consider; and a policy of maintaining general lockdown does not constitute levelling down, as it provides absolute benefits to those who would be worse off under selective isolation.

Questions about when it is right for police forces to investigate alleged offences committed in the more or less distant past have become increasingly pressing. Recent widely publicized cases of child sexual abuse (CSA) and exploitation, sometimes involving high profile individuals, have illustrated the ethical, psychological, and forensic complexities of investigating non-recent child sexual abuse. Hannah Maslen and Colin Paine have developed the Oxford CSA Framework to assist police to weigh the various ethical considerations that militate for and against initiating a CSA investigation. While such a tool is to be welcomed, and while there is much that is helpful in Maslen and Paine's approach, we suggest that the Oxford CSA framework could be strengthened. Our first suggestion is to abandon a proposed distinction between a set of considerations that is said to generate a “presumption” in favor of investigation and other considerations that may supplement or oppose this presumption. Our second suggestion is to review the weightings applied to the considerations within the model, which lack clear justification and create problematic effects. Finally, we suggest that referring the Oxford CSA Framework to a panel with lived and professional experience of CSA could serve important procedural justice goals and enhance the Framework's recommendations.

The neurodiversity paradigm is presented by its proponents as providing a philosophical foundation for the activism of the neurodiversity movement. Its central claims are that autism and other neurodivergent conditions are not disorders because they are not intrinsically harmful, and that they are valuable, natural and/or normal parts of human neurocognitive variation. This paper: (a) identifies the non‐disorder claim as the most central of these, based on its prominence in the literature and connections with the practical policy claims that the paradigm is supposed to support; (b) describes the heterogeneity of autism at the behavioural and causal levels, and argues that at the behavioural level this encompasses ways of being autistic that are harmful in ways that cannot be not wholly attributed to discrimination or unjust social arrangements, challenging the claim that autism is not a disorder; (c) considers and rejects responses to this challenge based on separation of high‐ and low‐functioning autism, separation of autism from co‐occurring conditions, and viewing autism as part of an individual’s identity. Two of these responses fail for reasons that are themselves connected with the behavioural and/or causal heterogeneity of autism.

In a recent article in this journal, Savulescu and Schuklenk defend and extend their earlier arguments against a right to medical conscientious objection in response to criticisms raised by Cowley. I argue that while it would be preferable to be less accommodating of medical conscientious than many countries currently are, Savulescu and Schuklenk's argument that conscientious objection is ‘simply unprofessional’ is mistaken. The professional duties of doctors should be defined in relation to the interests of patients and society, and for reasons set out in this article, these may support limited accommodation of conscientious objection on condition that it does not impede access to services. Moreover, the fact that conscientious objection appears to involve unjustifiable compromise from the objector's point of view is not a reason for society not to offer that compromise. Arguing for robust enforcement of the no-impediment condition, rather than opposing conscientious objection in principle, may be a more effective way of addressing the harms resulting from an over-permissive conscientious objection policy.

This paper considers the ethical issues raised by xenotransplantation underfour headings: interfering with nature; effects on the recipient; effects on other humans; and effects on donor animals. The first two issues raise no insuperable problems: charges of unnaturalness are misguided, and the risks that xenotransplantation carries for the recipient are a matter for properly informed consent. The other two issues raise more serious problems, however, and it is argued that if we take seriously the risk of transferring new infectious agents from animal to human populations and the interests of donor animals, then a moratorium on xenotransplantation is called for. The paperfinds that the recent Nuffield Council and Department of Health reports on xenotransplantation are insufficiently cautious in the conclusions that they draw from these considerations.

Michael Clark has recently argued that the slippery slope argument against voluntary euthanasia is ‘entirely consequentialist’ and that its use to justify continued prohibition of voluntary euthanasia involves a failure to treat patients who request assistance in ending their lives as ends in themselves. This article agues that in fact the slippery slope is consistent with most forms of deontology, and that it need not involve any violation of the principle that people should be treated as ends, depending upon how that principle is construed. It is concluded that supporters of voluntary euthanasia cannot dismiss the slippery slope argument on the basis of deontological principles but must take seriously the consequences that it postulates and engage in factual argument about their likely extent and about the likely effectiveness of any proposed safeguards.

A recent focus of the debate on conscientious objection in healthcare is the question of whether practitioners should have to justify their refusal to perform certain functions. A recent article by Cowley addresses a practical aspect of this controversy, namely the question of whether doctors claiming conscientious objector status in relation to abortion should be required, like their counterparts claiming exemption from military conscription, to defend their claim before a tribunal. Cowley argues against the use of tribunals in the medical case, on the grounds that there are likely to be fewer unjustified claims to conscientious objection in this context than in the military, and that in any case tribunals will not be an effective way of distinguishing genuine and false cases. I reject these arguments and propose a different conception of the role of a medical conscientious objection tribunal.

The precautionary principle has its origins in debates about environmental policy, but is increasingly invoked in bioethical contexts. John Harris and Søren Holm argue that the principle should be rejected as incoherent, irrational, and representing a fundamental threat to scientific advance and technological progress. This article argues that while there are problems with standard formulations of the principle, Harris and Holm's rejection of all its forms is mistaken. In particular, they focus on strong versions of the principle and fail to recognize that weaker forms, which may escape their criticisms, are both possible and advocated in the literature.

People often have a strong intuitive sense that we ought to rescue those in serious need, even in cases where we could produce better outcomes by acting in other ways. It has become common in such cases to refer to this as the Rule of Rescue. Within the medical field this rule has predominantly been discussed in relation to decisions about whether to fund particular treatments. Whilst in this setting the arguments in favour of the Rule of Rescue have generally been found to be unconvincing, there are some reasons for thinking that it may have more of a role to play at the clinical level. In this article we examine three lines that such reasoning might take. In each case we argue that the reasons given do not support the adoption of a Rule of Rescue in clinical practice.

What is the relation between professional standards and ethical policing? At first sight the answer to this question may seem obvious: in policing, as elsewhere, professional standards exist in order to promote ethical behaviour. This view, however, is both open to challenge and in need of elaboration. Sceptics can point to a range of non-moral functions and unintended consequences that may be associated with professional standards while those wishing to develop and implement professional standards need an account of how they can promote ethical behaviour. What are the ethical problems that professional standards can help to solve? Can professional standards succeed in solving those problems and if so how? What does this tell us about the sorts of ethical standards that we should seek to implement, and about how we should determine their content? The present chapter can only sketch the outline of an approach to such questions, but in doing so will hopefully identify some of the issues that need to be considered in developing or assessing professional standards.

Marxism has long been subject to criticism from the theorists of Political Ecology, and in recent years, as the concerns of Green thinkers have become harder to ignore, Marxists have begun to respond to this challenge, defending and sometimes amending Marxist theory in response to Green criticisms. This paper addresses one issue within this debate: the controversy over Marx’s commitment to the growth, or development, of the productive forces. My aim is to dispute the contention of Marx’s Green critics, that his concept of the development of the productive forces leads inevitably to the exacerbation of ecological problems, and, more speculatively, to suggest some advantages of using this concept to investigate ecological problems.

This book challenges the widely-held view that Marxism is unable to deal adequately with environmental problems. Jonathan Hughes considers the nature of environmental problems, and the evaluative perspectives that may be brought to bear on them. He examines Marx's critique of Malthus, his method, and his materialism, interpreting the latter as a recognition of human dependence on nature. Central to the book's argument is an interpretation of the 'development of the productive forces' which takes account of the differing ecological impacts of different productive technologies while remaining consistent with the normative and explanatory roles that this concept plays within Marx's theory. Turning finally to Marx's vision of a society founded on the communist principle 'to each according to his needs', the author concludes that the underlying notion of human need is one whose satisfaction presupposes only a modest and ecologically feasible expansion of productive output.

The question of when it is permissible to inflict risks on others without their consent is one that we all face in our everyday lives, but which is often brought to our attention in contexts of technological innovation and scientific uncertainty. Xenotransplantation, the transplantation of organs or tissues from animals to humans, has the potential to save or improve the lives of many patients but gives rise to the possibility of infectious agents being transferred from donor animals into the human population. As well as being an important ethical issue in its own right it therefore provides a useful vehicle for exploring the more general question of how to balance the benefits of a practice against the risks to third parties. This paper focuses on the Rawlsian, justice-based analysis of the risks of xenotransplantation proposed by Robert Veatch. It argues that Veatch is right to take considerations of distributive justice into account, but that his particular approach is flawed. It is hoped that consideration of Veatch’s arguments, and of the underlying assumptions will suggest better ways of executing a justice-based approach.

Advances in forensic techniques have expanded the temporal horizon of criminal investigations, facilitating investigation of historic crimes that would previously have been considered unsolvable. Public enthusiasm for pursuing historic crimes is exemplified by recent high-profile trials of celebrities accused of historic sexual offences. These circumstances give new urgency to the question of how we should decide which historic offences to investigate. A satisfactory answer must take into account the ways in which the passage of time can erode the benefits of criminal investigation, the costs associated with investigating old crimes, and the need to prioritize investigations in the face of limited police resources. This article emphasizes the first of these factors. It begins by considering the moral goals of a criminal justice system and the contribution of criminal investigations to the achievement of these goals, distinguishing between contributions that depend on further steps in the criminal justice process, such as prosecution and punishment, and contributions that can have value independently of these further steps. Using this important distinction, the article then examines a range of factors that relate the passage of time to criminal justice goals, including the seriousness of the crime; deterioration of evidence; death of the offender, victim and others affected by the crime; and diminished psychological connectedness between those affected by the crime and their current selves. While the range and non-uniformity of relevant factors preclude a simple answer to the question of when historic crimes should be investigated and call instead for case-by-case assessment, we find that the analysis does support some general conclusions that can guide such an assessment.

Practitioners of palliative care often argue for more resources to be provided by the state in order to lessen its reliance on charitable funding and to enable the services currently provided to some of those with terminal illnesses to be provided to all who would benefit from it. However, this is hard to justify on grounds of cost-effectiveness, since it is in the nature of palliative care that the benefits it brings to its patients are of short duration. In particular, palliative care fares badly under a policy of QALY-maximisation, since procedures which prevent premature death (provided the life is of reasonable quality) or improve quality of life for those with longer life expectancy will produce more QALYs. This paper examines various responses to this problem and argues that in order to justify increased resources for palliative care its advocates must reject the ‘atomistic’ view of the value of life implicit in the QALY approach in favour of a ‘holistic’ or ‘narrative’ account. This, however, has implications which advocates of palliative care may be reluctant to embrace.