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.

: The idea of enhancing our mental functions through medical means makes many people uncomfortable. People have a vague feeling that altering our brains tinkers with the core of our personalities and the core of ourselves. It changes who we are, and doing so seems wrong, even if the exact reasons for the unease are difficult to define. Many of the standard arguments against neuroenhancements—that they are unsafe, that they violate the distinction between therapy and enhancements, that they undermine equality, and that they will be used coercively—fail to show why the use of any such technologies is wrong in principle. Two other objections—the arguments that such changes undermine our integrity and that they prevent us from living authentic lives—will condemn only a few of the uses that are proposed. The result is that very few uses of these drugs are morally suspect and that most uses are morally permissible.

David Hume is an ardent supporter of the practice of religions toleration. For Hume, toleration forms part of the background that makes progress in philosophy possible, and it accounts for the superiority of philosophical thought in England in the eighteenth century. As he puts it in the introduction to the Treatise: “the improvements in reason and philosophy can only be owing to a land of toleration and of liberty” (T Intro.7; SBN xvii).1 Similarly, the narrator of part 11 of the First Enquiry comments: Our conversation began with my admiring the singular good fortune of philosophy, which, as it requires entire liberty above all other privileges, and chiefly flourishes from the free opposition of sentiments and argu­ mentation, received its first birth in an age and country of freedom and toleration. (EHU 11.2; SBN 132) The toleration to which Hume refers is broader than religious toleration, but in the context of the eighteenth century, religious toleration is clearly the paradigm case. Indeed, religious toleration represents one of the key accomplishments of the culminating event of Hume’s History of England: the Glorious Revolution of 1688. Yet even though religious toleration forms the background of philosophy in general—or perhaps just because it does so—Hume offers precious few arguments for it, and they are, for the most part, given implicitly rather than as formal argu­ ments. Nevertheless, we can distinguish three different, though interrelated, lines of support for toleration in Hume’s thought: (i) an argument based on a general skepticism; (ii) an argument based on a contempt for organized religion; and (iii) a pragmatic argument based on the need for peace and orderly government. From our point of view, what is striking about all of these argument is how un-Lockean they are: Hume does not rely on the idea of a fundamental conceptual separation of church and state, nor on a natural right to freedom of conscience that character­izes writers working in the Lockean tradition. However, of the arguments he gives, only the last, I will argue, has any hope to provide a useful case for toleration.