Richard Dees

Paternalistic actions interfere with the autonomy of an agent, so they can only be justified by strong moral considerations. Yet how seriously an action infringes on autonomy depends on how it affects autonomy. Autonomous actions require at least three independent elements: agents must act with an understanding of the risks of their actions, without the coercive influence of others and in accord with their most important values. Each of these elements exists along a spectrum, and by mapping measures in the resulting three-dimensional space, we get a better understanding of what is at stake in any debate about them, and we can understand when paternalistic measures might be justified and when they are not.

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention.

The experience of newborn screening for Krabbe disease in New York State demonstrates the ethical problems that arise when screening programs are expanded in the absence of true understanding of the diseases involved. In its 5 years of testing and millions of dollars in costs, there have been very few benefits, and the testing has uncovered potential cases of late-onset disease that raise difficult ethical questions in their own right. For these reasons, we argue that Krabbe screening should only be continued as a research project that includes the informed consent of parents to the testing.

Burke suggests that we should view society as a partnership between the past, the present, and the future. I defend this idea by outlining how we can understand the interests of the past and future people and the obligations that they have towards each other. I argue that we have forward-looking obligations to leave the world a decent place, and backward-looking obligations to respect the legacy of the past. The latter obligation requires an understanding of the role that traditions and meta-traditions should (and should not) play in tying together societies—especially national societies—over time.

Public health is concerned with increasing the health of the community at whole. Insofar as health is a ‘good’ and the community constitutes a ‘public’, public health by definition promotes a ‘public good’. But ‘public good’ has a particular and much more narrow meaning in the economics literature, and some commentators have tried to limit the scope of public health to this more narrow meaning of a ‘public good’. While such a move makes the content of public health less controversial, it also strips important goals from the realm of public health, goals that traditionally have been, and morally should be, a part of it. Instead, I will argue, while public health should be defined by public goods, it should be defined by a broader conception of public goods that I shall call ‘normative public goods’, goods that ought to be treated as if they were public goods in the more narrow sense.

From Rousseau and Marx to Alasdair MacIntyre and Michael Sandel, communitarians have argued that liberalism fails to understand and respect the values that arise from the practices of particular communities. But liberalism need not fall prey to this objection, once we understand the role that practices should play in a political theory. In the largely-unread historical and political works of David Hume, I argue, we can find the resources for a political theory that stresses the importance of the material and social conditions of a society that shape its practices and that can answer these and other critics of liberalism. ;The practices of a society, Hume suggests, are the best--and perhaps the only--means by which we can judge the legitimacy of its political structure. No abstract rules for revolution or absolute values for justification can ever do the task that is required. Only by constructing an interpretation of our own practices that is sensitive to the values that can be found within them can we, as political critics, determine when a revolution is justified. And only by seeing political justification itself as a social practice will we understand the dynamics of this process and the limits of its scope. ;Thus, liberal practices were justified in Britain after the Glorious Revolution of 1688, I argue, because they cohered best with the practices that had developed in Britain during the seventeenth century, and it is justified in the West today precisely because, despite the polemics of the communitarians, it is still the best system given our practices and our community.

In the world according to Hume, people are complicated creatures, with convoluted, often contradictory characters. Consider, for example, Hume's controversial assessment of Charles I: "The character of this prince, as that of most men, if not of all men, was mixed.... To consider him in the most favourable light, it may be affirmed, that his dignity was free from pride, his humanity from weakness, his bravery from rashness, his temperance from austerity, his frugality from avarice.... To speak the most harshly of him, we may affirm, that many of his good qualities were attended with some latent frailty, which, though seemingly inconsiderable, was able, when seconded by the extreme malevolence of his fortune, to disappoint them of all their influence: His beneficent disposition was clouded by a manner not very gracious; his virtue was tinctured with superstition; his good sense was disfigured by a deference to persons of a capacity inferior to his own; and his moderate temper exempted him not from hasty and precipitate resolutions." This sketch shows Charles in all his complexities, with his virtues, near virtues, and contradicting virtues. I have quoted it at length because it is hard to summarize without losing the subtleties that lie within it. Hume's moral theory is based fundamentally on judgments of character, 2 so those subtleties are important to his view. The character sketches that pervade the..

The limits of toleration are at the limits of trust. Without a minimal level of trust between different groups, any accommodation will quickly break down (Dees 1999). In many ways, the point here is obvious: people have to trust one another enough to make toleration possible. In other words, they have to feel that their fundamental moral interests are not threatened if they accept toleration. If that trust breaks down, then civil war—in either the hot or the cold variety—will break out. A society built on toleration, then, requires a delicate balance between the practices within it that sustain toleration and those that build the trust between disparate groups. I explore these issues by looking at two groups--the non-Trinitarian Socinians in the 17th century and homosexuals in the 21st--to understand where those boundaries should be.

After a long search, Jonathan has finally found someone willing to donate a kidney to him and thereby free him from dialysis. Meredith is Jonathan's second cousin, and she considers herself a generous person, so although she barely knows Jonathan, she is willing to help. However, as Meredith learns more about the donation process, she begins to ask questions about Jonathan: “Is he HIV positive? I heard he got it using drugs. Has he been in jail? He's already had one live donor, so what happened to the first kidney? Did he forget to take his drugs or something?” The transplant center must, then, decide if Meredith is, in fact, entitled to answers to these kinds of questions. According to the Consensus Statement on the Live Organ Donor, “It is incumbent on the transplant center to provide full and accurate disclosure to potential donors of all pertinent information regarding risk and benefit to the donor and recipient.” But whether answers to the Meredith's questions count as “pertinent information regarding the risk and benefit” is the issue at hand.