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De Marco G, Simons J, Forsberg L, Douglas T. What makes a medical intervention invasive? A reply to commentaries. J Med Ethics 2024; 50:244-245. [PMID: 38316514 DOI: 10.1136/jme-2024-109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Gabriel De Marco
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Jannieke Simons
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Forsberg
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Somerville College, University of Oxford, Oxford, UK
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Jesus College, University of Oxford, Oxford, UK
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2
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De Marco G, Simons J, Forsberg L, Douglas T. What makes a medical intervention invasive? J Med Ethics 2024; 50:226-233. [PMID: 37722810 DOI: 10.1136/jme-2023-109301] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/27/2023] [Indexed: 09/20/2023]
Abstract
The classification of medical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, a medical intervention is invasive if and only if it involves either breaking the skin ('incision') or inserting an object into the body ('insertion'). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in relation to medical interventions-namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of an intervention can depend on the characteristics of the salient alternative interventions, and (3) that medical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account.
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Affiliation(s)
- Gabriel De Marco
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Jannieke Simons
- Julius Centre for Health Sciences and Primary Care, Department of Bioethics and Health Humanities, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lisa Forsberg
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Somerville College, University of Oxford, Oxford, UK
| | - Thomas Douglas
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Jesus College, University of Oxford, Oxford, UK
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3
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Tesink V, Douglas T, Forsberg L, Ligthart S, Meynen G. Right to mental integrity and neurotechnologies: implications of the extended mind thesis. J Med Ethics 2024:jme-2023-109645. [PMID: 38408854 DOI: 10.1136/jme-2023-109645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/14/2024] [Indexed: 02/28/2024]
Abstract
The possibility of neurotechnological interference with our brain and mind raises questions about the moral rights that would protect against the (mis)use of these technologies. One such moral right that has received recent attention is the right to mental integrity. Though the metaphysical boundaries of the mind are a matter of live debate, most defences of this moral right seem to assume an internalist (brain-based) view of the mind. In this article, we will examine what an extended account of the mind might imply for the right to mental integrity and the protection it provides against neurotechnologies. We argue that, on an extended account of the mind, the scope of the right to mental integrity would expand significantly, implying that neurotechnologies would no longer pose a uniquely serious threat to the right. In addition, some neurotechnologies may even be protected by the right to mental integrity, as the technologies would become part of the mind. We conclude that adopting an extended account of the mind has significant implications for the right to mental integrity in terms of its protective scope and capacity to protect against neurotechnologies, demonstrating that metaphysical assumptions about the mind play an important role in determining the moral protection provided by the right.
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Affiliation(s)
- Vera Tesink
- Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Jesus College, University of Oxford, Oxford, UK
| | - Lisa Forsberg
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Sjors Ligthart
- Department of Criminal Law, Tilburg University, Tilburg, Netherlands
- Willem Pompe Institute for Criminal Law and Criminology and UCALL, Utrecht University, Utrecht, Netherlands
| | - Gerben Meynen
- Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Willem Pompe Institute for Criminal Law and Criminology and UCALL, Utrecht University, Utrecht, Netherlands
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4
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Lucas S, Douglas T, Faber NS. How moral bioenhancement affects perceived praiseworthiness. Bioethics 2024; 38:129-137. [PMID: 37929918 DOI: 10.1111/bioe.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
Psychological literature indicates that actions performed with the assistance of cognition-enhancing biomedical technologies are often deemed to be less praiseworthy than similar actions performed without such assistance. This study examines (i) whether this result extends to the bioenhancement of moral capacities, and (ii) if so, what explains the effect of moral bioenhancement on perceived praiseworthiness. The findings indicate that actions facilitated by morally bioenhanced individuals are considered less deserving of praise than similar actions facilitated by 'traditional' moral enhancement-for example, moral self-education. This diminished praise does not seem to be driven by an aversion to (moral) bioenhancement per se. Instead, it appears to be primarily attributable to a perceived lack of effort exerted by bioenhanced individuals in the course of their moral enhancement. Our findings advance the philosophical discourse on the foundations of praise in the context of moral bioenhancement by elucidating the empirical basis underlying some assumptions commonly employed to argue for or against the permissibility of moral bioenhancement.
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Affiliation(s)
- Simon Lucas
- Institute for History, Theory and Ethics of Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Jesus College, Oxford, UK
| | - Nadira S Faber
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Department of Psychology, University of Bremen, Bremen, Germany
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5
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De Marco G, Douglas T, Forsberg L, Savulescu J. On the Relative Intrusiveness of Physical and Chemical Restraints. AJOB Neurosci 2024; 15:26-28. [PMID: 38207188 DOI: 10.1080/21507740.2023.2292499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
| | | | - Lisa Forsberg
- Oxford University
- University of Oxford Somerville College
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Ligthart S, Ienca M, Meynen G, Molnar-Gabor F, Andorno R, Bublitz C, Catley P, Claydon L, Douglas T, Farahany N, Fins JJ, Goering S, Haselager P, Jotterand F, Lavazza A, McCay A, Wajnerman Paz A, Rainey S, Ryberg J, Kellmeyer P. Minding Rights: Mapping Ethical and Legal Foundations of 'Neurorights'. Camb Q Healthc Ethics 2023:1-21. [PMID: 37183686 DOI: 10.1017/s0963180123000245] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty - often framed as "neurorights" in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.
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Affiliation(s)
- Sjors Ligthart
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, Denmark; Department of Criminal Law, Tilburg University, Tilberg, The Netherlands
| | - Marcello Ienca
- School of Medicine, Technical University of Munich (TUM), Germany & College of Humanities, Swiss Federal Institute of Technology in Lausanne (EPFL), Lausanne, Switzerland
| | - Gerben Meynen
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, Utrecht, Denmark; Department of Philosophy, Faculty of Humanities, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Roberto Andorno
- Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| | | | - Paul Catley
- School of Law, The Open University, Milton Keynes, UK
| | - Lisa Claydon
- School of Law, The Open University, Milton Keynes, UK
| | | | | | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
| | - Sara Goering
- Department of Philosophy, University of Washington, Seattle, WA, USA
| | - Pim Haselager
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Fabrice Jotterand
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Allan McCay
- The University of Sydney Law School, Sydney, NSW, Australia
| | - Abel Wajnerman Paz
- Instituto de Éticas Aplicadas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Stephen Rainey
- Ethics and Philosophy of Technology Section, Delft University, Delft, The Netherlands
| | - Jesper Ryberg
- Department of Philosophy, Roskilde University, Roskilde, Denmark
| | - Philipp Kellmeyer
- Department of Neurosurgery, University of Freiburg - Medical Center, Freiburg im Breisgau, Germany
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Ligthart S, Tesink V, Douglas T, Forsberg L, Meynen G. The Normative Evaluation of Neurointerventions in Criminal Justice: From Invasiveness to Human Rights. AJOB Neurosci 2023; 14:23-25. [PMID: 36524945 DOI: 10.1080/21507740.2022.2150714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Douglas T. Pragmatic argument for an acceptance-refusal asymmetry in competence requirements. J Med Ethics 2022; 48:799-800. [PMID: 36316033 DOI: 10.1136/jme-2022-108662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Jesus College, University of Oxford, Oxford, UK
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Douglas T. The Mere Substitution Defence of Nudging Works for Neurointerventions Too. J Appl Philos 2022; 39:407-420. [PMID: 36636526 PMCID: PMC9828860 DOI: 10.1111/japp.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/21/2021] [Accepted: 10/22/2021] [Indexed: 06/17/2023]
Abstract
Nudges are often defended on the basis that they merely substitute existing influences on choice with other influences that are similar in kind; they introduce no new kind of influence into the choice situation. I motivate the view that, if this defence succeeds in establishing the moral innocuousness of typical nudges, it also establishes the moral innocuousness of an intuitively wrongful neurochemical intervention. I then consider two attempts to rebut this view and argue that both fail. I end by spelling out four stances that the proponent of the defence might adopt in response to my argument.
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Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical EthicsFaculty of Philosophy, University of OxfordOxfordUK
- Jesus CollegeUniversity of OxfordOxfordUK
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10
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Abstract
Some suggest that gene editing human embryos to prevent genetic disorders will be in one respect morally preferable to using genetic selection for the same purpose: gene editing will benefit particular future persons, while genetic selection would merely replace them. We first construct the most plausible defence of this suggestion-the benefit argument-and defend it against a possible objection. We then advance another objection: the benefit argument succeeds only when restricted to cases in which the gene-edited child would have been brought into existence even if gene editing had not been employed. Our argument relies on a standard account of comparative benefit which has recently been criticised on the grounds that it succumbs to the so-called 'pre-emption problem'. We end by considering how our argument would be affected were the standard account revised in an attempt to evade this problem. We consider three revised accounts and argue that, on all three, our critique of the benefit argument stands.
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Ligthart S, Douglas T, Bublitz C, Kooijmans T, Meynen G. Forensic Brain-Reading and Mental Privacy in European Human Rights Law: Foundations and Challenges. NEUROETHICS-NETH 2021; 14:191-203. [PMID: 35186162 PMCID: PMC7612400 DOI: 10.1007/s12152-020-09438-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/07/2020] [Indexed: 01/09/2023]
Abstract
A central question in the current neurolegal and neuroethical literature is how brain-reading technologies could contribute to criminal justice. Some of these technologies have already been deployed within different criminal justice systems in Europe, including Slovenia, Italy, England and Wales, and the Netherlands, typically to determine guilt, legal responsibility, or recidivism risk. In this regard, the question arises whether brain-reading could permissibly be used against the person's will. To provide adequate legal protection from such non-consensual brain-reading in the European legal context, ethicists have called for the recognition of a novel fundamental legal right to mental privacy. In this paper, we explore whether these ethical calls for recognising a novel legal right to mental privacy are necessary in the European context. We argue that a right to mental privacy could be derived from, or at least developed within in the jurisprudence of the European Court of Human Rights, and that introducing an additional fundamental right to protect against (forensic) brain-reading is not necessary. What is required, however, is a specification of the implications of existing rights for particular neurotechnologies and purposes.
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Affiliation(s)
- Sjors Ligthart
- Department of Criminal Law, Tilburg University, Warandelaan 2, 5037AB Tilburg, Netherlands
| | - Thomas Douglas
- Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Christoph Bublitz
- Faculty of Law, Universität Hamburg, Rothenbaumchaussee 33, 20148 Hamburg, Germany
| | - Tijs Kooijmans
- Department of Criminal Law, Tilburg University, Warandelaan 2, 5037AB Tilburg, Netherlands
| | - Gerben Meynen
- Willem Pompe Institute for Criminal Law and Criminology and UCALL, Utrecht University, Utrecht, Netherlands; Faculty of Humanities, VU University Amsterdam, De Boelelaan 1105, 1081HV Amsterdam, Netherlands
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12
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De Marco G, Douglas T, Savulescu J. Healthcare, Responsibility and Golden Opportunities. Ethical Theory Moral Pract 2021; 24:817-831. [PMID: 34720680 PMCID: PMC8550409 DOI: 10.1007/s10677-021-10208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
When it comes to determining how healthcare resources should be allocated, there are many factors that could-and perhaps should-be taken into account. One such factor is a patient's responsibility for his or her illness, or for the behavior that caused it. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account-responsibility-sensitive policies-have faced a series of criticisms. One holds that agents often fail to meet either the control or epistemic conditions on responsibility with regard to their unhealthy lifestyles or their outcomes. Another holds that even if patients sometimes are responsible for these items, we cannot know whether a particular patient is responsible for them. In this article, we propose a type of responsibility-sensitive policy that may be able to surmount these difficulties. Under this type of policy, patients are empowered to change to a healthier lifestyle by being given what we call a 'Golden Opportunity' to change. Such a policy would not only avoid concerns about patients' fulfilment of conditions on responsibility for their lifestyles, it would also allow healthcare authorities to be justified in believing that a patient who does not change her lifestyle is responsible for the unhealthy lifestyle. We conclude with a discussion of avenues for further work, and place this policy in the broader context of the debate on responsibility for health.
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Affiliation(s)
- Gabriel De Marco
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Thomas Douglas
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Jesus College, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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Sweet C, Koo C, Treaster L, Cofer H, Long K, Barker A, Douglas T, Gallaher S, Colston S, Smith J. Investigating the structure of cold microbiomes: The Chesapeake Bay in winter and arctic North Slope in summer. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Sophie Colston
- Center for BioMolecular Science and EngineeringNaval Research LaboratoryWashingtonDC
| | - Joseph Smith
- OceanographyUnited States Naval AcademyAnnapolisMD
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14
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De Marco G, Douglas T. The Expressivist Objection to Nonconsensual Neurocorrectives. Crim Law Philos 2021; 16:373-393. [PMID: 35757016 PMCID: PMC9209385 DOI: 10.1007/s11572-021-09566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 06/15/2023]
Abstract
Neurointerventions-interventions that physically or chemically modulate brain states-are sometimes imposed on criminal offenders for the purposes of diminishing the risk that they will recidivate, or, more generally, of facilitating their rehabilitation. One objection to the nonconsensual implementation of such interventions holds that this expresses a disrespectful message, and is thus impermissible. In this paper, we respond to this objection, focusing on the most developed version of it-that presented by Elizabeth Shaw. We consider a variety of messages that might be expressed by nonconsensual neurointerventions. Depending on the message, we argue either that such interventions do not invariably express this message, that expressing this message is not invariably disrespectful, or that the appeal to disrespect is redundant.
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Affiliation(s)
- Gabriel De Marco
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House 16/17 St Ebbe’s Street, Oxford, OX1 1PT UK
| | - Thomas Douglas
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House 16/17 St Ebbe’s Street, Oxford, OX1 1PT UK
- Jesus College, Turl Street, Oxford, OX1 3DW UK
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15
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Abstract
It is often said that the institutions of criminal justice ought or-perhaps more often-ought not to rehabilitate criminal offenders. But the term 'criminal rehabilitation' is often used without being explicitly defined, and in ways that are consistent with widely divergent conceptions. In this paper, we present a taxonomy that distinguishes, and explains the relationships between, different conceptions of criminal rehabilitation. Our taxonomy distinguishes conceptions of criminal rehabilitation on the basis of (i) the aims or ends of the putatively rehabilitative measure, and (ii) the means that may be used to achieve the intended end. We also explore some of the implications of each conception, some of the payoffs of a taxonomy of the kind we offer, and some areas for future work.
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Affiliation(s)
- Lisa Forsberg
- British Academy Postdoctoral Fellow, Faculty of Law, University of Oxford, St Cross Building, St Cross Road, Oxford, OX1 3UL UK
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, 16/17 St. Ebbe’s St., Oxford, OX1 1PT UK
- Somerville College, University of Oxford, Woodstock Road, Oxford, OX2 6HD UK
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, 16/17 St. Ebbe’s St., Oxford, OX1 1PT UK
- Hugh Price Fellow, Jesus College, Turl Street, Oxford, OX1 3DW UK
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Douglas T, Forsberg L, Pugh J. Compulsory medical intervention versus external constraint in pandemic control. J Med Ethics 2020; 47:medethics-2020-106435. [PMID: 32820018 PMCID: PMC8639959 DOI: 10.1136/medethics-2020-106435] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 05/27/2023]
Abstract
Would compulsory treatment or vaccination for COVID-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints-such as quarantine, isolation and 'lockdown'-that have already been authorised to control the pandemic in this jurisdiction. We argue that, if the permissive English approach to external constraints for COVID-19 has been justified, then there is a case for a similarly permissive approach to compulsory medical interventions.
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Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Oxford University, Oxford, Oxfordshire, UK
- Jesus College, Oxford, Oxfordshire, UK
- Faculty of Philosophy, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Lisa Forsberg
- Oxford Uehiro Centre for Practical Ethics, Oxford University, Oxford, Oxfordshire, UK
- Faculty of Law, Oxford University, Oxford, Oxfordshire, UK
- Somerville College, Oxford, Oxfordshire, UK
| | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, Oxford University, Oxford, Oxfordshire, UK
- Faculty of Philosophy, University of Oxford, Oxford, Oxfordshire, United Kingdom
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Rojas-Muñoz E, Lin C, Sanchez-Tamayo N, Cabrera ME, Andersen D, Popescu V, Barragan JA, Zarzaur B, Murphy P, Anderson K, Douglas T, Griffis C, McKee J, Kirkpatrick AW, Wachs JP. Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies. NPJ Digit Med 2020; 3:75. [PMID: 32509972 PMCID: PMC7242344 DOI: 10.1038/s41746-020-0284-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 04/28/2020] [Indexed: 11/09/2022] Open
Abstract
Telementoring platforms can help transfer surgical expertise remotely. However, most telementoring platforms are not designed to assist in austere, pre-hospital settings. This paper evaluates the system for telementoring with augmented reality (STAR), a portable and self-contained telementoring platform based on an augmented reality head-mounted display (ARHMD). The system is designed to assist in austere scenarios: a stabilized first-person view of the operating field is sent to a remote expert, who creates surgical instructions that a local first responder wearing the ARHMD can visualize as three-dimensional models projected onto the patient's body. Our hypothesis evaluated whether remote guidance with STAR could lead to performing a surgical procedure better, as opposed to remote audio-only guidance. Remote expert surgeons guided first responders through training cricothyroidotomies in a simulated austere scenario, and on-site surgeons evaluated the participants using standardized evaluation tools. The evaluation comprehended completion time and technique performance of specific cricothyroidotomy steps. The analyses were also performed considering the participants' years of experience as first responders, and their experience performing cricothyroidotomies. A linear mixed model analysis showed that using STAR was associated with higher procedural and non-procedural scores, and overall better performance. Additionally, a binary logistic regression analysis showed that using STAR was associated to safer and more successful executions of cricothyroidotomies. This work demonstrates that remote mentors can use STAR to provide first responders with guidance and surgical knowledge, and represents a first step towards the adoption of ARHMDs to convey clinical expertise remotely in austere scenarios.
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Affiliation(s)
- Edgar Rojas-Muñoz
- School of Industrial Engineering, Purdue University, West Lafayette, IN USA
| | - Chengyuan Lin
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | | | - Maria Eugenia Cabrera
- Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA USA
| | - Daniel Andersen
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | - Voicu Popescu
- Department of Computer Science, Purdue University, West Lafayette, IN USA
| | | | - Ben Zarzaur
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | - Patrick Murphy
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | - Kathryn Anderson
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
| | | | | | - Jessica McKee
- Department of Surgery, and the Regional Trauma Services, University of Calgary, Calgary, AB Canada
| | - Andrew W. Kirkpatrick
- Department of Surgery, and the Regional Trauma Services, University of Calgary, Calgary, AB Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB Canada
- Canadian Forces Medical Services, Ottawa, ON Canada
| | - Juan P. Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN USA
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN USA
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Devolder K, Yip LJ, Douglas T. The Ethics of Creating and Using Human-Animal Chimeras. ILAR J 2020; 60:434-438. [PMID: 32325492 DOI: 10.1093/ilar/ilaa002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 01/09/2023] Open
Abstract
Rapid advances in gene-editing and stem-cell technology have expanded the range of possible future applications in human-animal chimera research. Most notably, recent developments may allow researchers to generate whole personalized human organs in pigs for the purpose of transplantation into human patients. Though human-animal chimera research in small animals, such as mice, is routine, human-animal chimeric techniques are now increasingly being applied to larger animals. Moreover, these chimeras include increasing amounts of human material, which is potentially present in more morally significant locations, such as the brain and the reproductive system. These developments raise important ethical questions about whether we should create such chimeras, and if so, how we should treat them. Answers to these ethical questions are needed to inform the development of policies regulating human-animal chimera research and its applications. Here, we provide a review of some of the most important or widespread ethical concerns.
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Affiliation(s)
- Katrien Devolder
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Lauren J Yip
- Monash University, Melbourne, Victoria, Australia
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK, and Jessus College, Oxford, UK
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Giubilini A, Caviola L, Maslen H, Douglas T, Nussberger AM, Faber N, Vanderslott S, Loving S, Harrison M, Savulescu J. Nudging Immunity: The Case for Vaccinating Children in School and Day Care by Default. HEC Forum 2019; 31:325-344. [PMID: 31606869 PMCID: PMC6841646 DOI: 10.1007/s10730-019-09383-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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 would be vaccinated at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is (1) likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, (2) ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and (3) likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public.
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Affiliation(s)
- Alberto Giubilini
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
- Oxford Martin School, University of Oxford, Oxford, UK.
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK.
| | - Lucius Caviola
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hannah Maslen
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK
| | - Thomas Douglas
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK
| | | | - Nadira Faber
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Samantha Vanderslott
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Sarah Loving
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Australia
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Douglas T. Punishing Wrongs from the Distant Past. Law Philos 2019; 38:335-358. [PMID: 31249431 PMCID: PMC6597344 DOI: 10.1007/s10982-019-09352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
On a Parfit-inspired account of culpability, as the psychological connections between a person's younger self and older self weaken, the older self's culpability for a wrong committed by the younger self diminishes. Suppose we accept this account and also accept a culpability-based upper limit on punishment severity. On this combination of views, we seem forced to conclude that perpetrators of distant past wrongs should either receive discounted punishments or be exempted from punishment entirely. This article develops a strategy for resisting this conclusion. I propose that, even if the perpetrators of distant past wrongs cannot permissibly be punished for the original wrongs, in typical cases they can permissibly be punished for their ongoing and iterated failures to rectify earlier wrongs. Having set out this proposal, I defend it against three objections, before exploring how much punishment it can justify.
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Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8, Littlegate House, 16-17 St Ebbes Street, Oxford, OX1 1PT, UK
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Abstract
Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies (Rich, J. D., McKenzie, M., Larney, S., Wong, J. B., Tran, L., Clarke, J. et al. (2015). Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350-359). This novel evidence raises questions as to the justification for current policies of forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries.
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Affiliation(s)
- Daniel D’Hotman
- Oxford Uehiro Centre for Practical Ethics, University of Oxford
- Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Jonathan Pugh
- Oxford Uehiro Centre for Practical Ethics, University of Oxford
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford
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Douglas T, Van den Borre L. Asbestos neglect: Why asbestos exposure deserves greater policy attention. Health Policy 2019; 123:516-519. [PMID: 30770142 DOI: 10.1016/j.healthpol.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/18/2022]
Abstract
While many public health threats are now widely appreciated by the public, the risks from asbestos exposure remain poorly understood, even in high-risk groups. This article makes the case that asbestos exposure is an important, ongoing global health threat, and argues for greater policy efforts to raise awareness of this threat. It also proposes the extension of asbestos bans to developing countries and increased public subsidies for asbestos testing and abatement.
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Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, United Kingdom.
| | - Laura Van den Borre
- Interface Demography, Sociology Department, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
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Abstract
It is sometimes claimed that those who succeed with the aid of enhancement technologies deserve the rewards associated with their success less, other things being equal, than those who succeed without the aid of such technologies. This claim captures some widely held intuitions, has been implicitly endorsed by participants in social-psychological research and helps to undergird some otherwise puzzling philosophical objections to the use of enhancement technologies. I consider whether it can be provided with a rational basis. I examine three arguments that might be offered in its favour and argue that each either shows only that enhancements undermine desert in special circumstances or succeeds only under assumptions that deprive the appeal to desert of much of its dialectic interest.
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Affiliation(s)
- Thomas Douglas
- Thomas Douglas, Oxford Uehiro Centre for Practical
Ethics, University of Oxford, Oxford OX1 1PT, UK.
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Abstract
We seek to develop a plausible conception of genetic parenthood, taking a recent discussion by Heidi Mertes as our point of departure. Mertes considers two conceptions of genetic parenthood-one invoking genetic resemblance and the other genetic inheritance-and presents counter-examples to both conceptions. We revise Mertes' second conception so as to avoid these and related counter-examples.
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Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical EthicsOxfordUnited Kingdom
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Dao B, Douglas T, Giubilini A, Savulescu J, Selgelid M, Faber NS. Impartiality and infectious disease: Prioritizing individuals versus the collective in antibiotic prescription. AJOB Empir Bioeth 2019; 10:63-69. [PMID: 30908114 PMCID: PMC6446247 DOI: 10.1080/23294515.2019.1576799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND 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 prescribe antibiotics. It also does not explore the ethical significance of public views or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. METHODS An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. RESULTS Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). CONCLUSIONS Participants' attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial "ideal observer," their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society.
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Affiliation(s)
- Bernadine Dao
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Alberto Giubilini
- Oxford Martin School and Wellcome Centre for Ethics and Humanities, University of OxfordOxford, United Kingdom
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Michael Selgelid
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
| | - Nadira S. Faber
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
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Giubilini A, Douglas T, Savulescu J. The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Med Health Care Philos 2018; 21:547-560. [PMID: 29429063 PMCID: PMC6267229 DOI: 10.1007/s11019-018-9829-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
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 of a moral obligation to be vaccinated (both for adults and for children) despite the negligible contribution each vaccination can make to the realisation of herd immunity is important because such moral obligation would strengthen the justification for coercive vaccination policies. We show that two types of arguments-namely a utilitarian argument based on Parfit's Principle of Group Beneficence and a contractualist argument-can ground an individual moral obligation to be vaccinated, in spite of the imperceptible contribution that any single vaccination makes to vaccine coverage rates. We add a further argument for a moral obligation to be vaccinated that does not require embracing problematic comprehensive moral theories such as utilitarianism or contractualism. The argument is based on a "duty of easy rescue" applied to collectives, which grounds a collective moral obligation to realise herd immunity, and on a principle of fairness in the distribution of the burdens that must be borne to realise herd immunity.
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Affiliation(s)
- Alberto Giubilini
- Oxford Martin School and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK.
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, St Ebbes St, Oxford, OX1 1PT, UK
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D'Hotman D, Pugh J, Douglas T. When is coercive methadone therapy justified? Bioethics 2018; 32:405-413. [PMID: 29883516 PMCID: PMC6174954 DOI: 10.1111/bioe.12451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 02/20/2018] [Accepted: 02/27/2018] [Indexed: 06/08/2023]
Abstract
Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non-consensual. We argue that non-consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non-consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices.
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Zohny H, Douglas T, Savulescu J. Biomarkers for the Rich and Dangerous: Why We Ought to Extend Bioprediction and Bioprevention to White-Collar Crime. Crim Law Philos 2018; 13:479-497. [PMID: 31404215 PMCID: PMC6661018 DOI: 10.1007/s11572-018-9477-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is a burgeoning scientific and ethical literature on the use of biomarkers-such as genes or brain scan results-and biological interventions to predict and prevent crime. This literature on biopredicting and biopreventing crime focuses almost exclusively on crimes that are physical, violent, and/or sexual in nature-often called blue-collar crimes-while giving little attention to less conventional crimes such as economic and environmental offences, also known as white-collar crimes. We argue here that this skewed focus is unjustified: white-collar crime is likely far costlier than blue-collar crime in money, health, and lives lost. Moreover, attempts to biopredict and bioprevent blue-collar crime may entail adopting potentially unfair measures that target individuals who are already socio-economically disadvantaged, thus compounding pre-existing unfairness. We argue, therefore, that we ought to extend the study of bioprediction and bioprevention to white-collar crime as a means of more efficiently and fairly responding to crime. We suggest that identifying biomarkers for certain psychopathic traits, which appear to be over-represented among senior positions in corporate and perhaps political organisations, is one avenue through which this research can be broadened to include white-collar crime.
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Affiliation(s)
- Hazem Zohny
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, 16–17 St Ebbes St., Oxford, OX11PT UK
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, 16–17 St Ebbes St., Oxford, OX11PT UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, 16–17 St Ebbes St., Oxford, OX11PT UK
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Savulescu J, Douglas T, Wilkinson D. Philosophical medical ethics: more necessary than ever. J Med Ethics 2018; 44:434-435. [PMID: 29945989 DOI: 10.1136/medethics-2018-104993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Visiting Professorial Fellow in Biomedical Ethics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- John Radcliffe Hospital, Oxford, UK
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Frith L, Hooper C, Camporesi S, Douglas T, Smajdor A, Nottingham E, Fritz Z, Ekberg M, Huxtable R. Institute of Medical Ethics Guidelines for confirmation of appointment, promotion and recognition of UK bioethics and medical ethics researchers. J Med Ethics 2018; 44:289-291. [PMID: 29572338 DOI: 10.1136/medethics-2018-104816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK's Research Excellence Framework (REF), it is not intended to be a detailed analysis of the place of bioethics in the REF.
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Affiliation(s)
- Lucy Frith
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | | | - Silvia Camporesi
- Department of Social Science Health & Medicine, King's College London, London, UK
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | | | | | - Zoe Fritz
- Department of Acute Medicine, Warwick university, and Cambridge University Hospitals, Cambridge, UK
| | | | - Richard Huxtable
- Centre for Ethics in Medicine, University of Bristol, School of Social and Community Medicine, Bristol, UK
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Devolder K, Douglas T. The epistemic costs of compromise in bioethics. Bioethics 2018; 32:111-118. [PMID: 29280164 DOI: 10.1111/bioe.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 04/28/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
Bioethicists sometimes defend compromise positions, particularly when they enter debates on applied topics that have traditionally been highly polarised, such as those regarding abortion, euthanasia and embryonic stem cell research. However, defending compromise positions is often regarded with a degree of disdain. Many are intuitively attracted to the view that it is almost always problematic to defend compromise positions, in the sense that we have a significant moral reason not to do so. In this paper, we consider whether this common sense view can be given a principled basis. We first show how existing explanations for the problematic nature of compromise fall short of vindicating the common sense view, before offering our own explanation, which, we claim, comes closer to vindicating that view. We argue that defending a compromise will typically have two epistemic costs: it will corrupt attempts to use the claims of ethicists as testimonial evidence, and it will undermine standards that are important to making epistemic progress in ethics. We end by suggesting that the epistemic costs of compromise could be reduced by introducing a stronger separation between ethical debate aimed at fulfilling the epistemic role of ethics, and ethical debate that aims to directly produce good policy or practice.
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Bambery B, Douglas T, Selgelid MJ, Maslen H, Giubilini A, Pollard AJ, Savulescu J. Influenza Vaccination Strategies Should Target Children. Public Health Ethics 2017; 11:221-234. [PMID: 30135702 PMCID: PMC6093440 DOI: 10.1093/phe/phx021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Strategies to increase influenza vaccination rates have typically targeted healthcare professionals (HCPs) and individuals in various high-risk groups such as the elderly. We argue that they should (instead or as well) 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 more effective in reducing influenza-related morbidity and mortality than those targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies.
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Douglas T. Going above and beneath the call of duty: the luck egalitarian claims of healthcare heroes, and the accomodation of professionally-motivated treatment refusal. J Med Ethics 2017; 43:801-802. [PMID: 29170198 DOI: 10.1136/medethics-2017-104656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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Abstract
We address the issue of whether, why and under what conditions, quarantine and isolation are morally justified, with a particular focus on measures implemented in the developing world. We argue that the benefits of quarantine and isolation justify some level of coercion or compulsion by the state, but that the state should be able to provide the strongest justification possible for implementing such measures. While a constrained form of consequentialism might provide a justification for such public health interventions, we argue that a stronger justification is provided by a principle of State Enforced Easy Rescue: a state may permissibly compel individuals to engage in activities that entail a small cost to them but a large benefit to others, because individuals have a moral duty of easy rescue to engage in those activities. The principle of State Enforced Easy Rescue gives rise to an Obligation Enforcement Requirement: the state should create the conditions such that submitting to coercive or compulsive measures becomes a fundamental moral duty of individuals, i.e. a duty of easy rescue. When the state can create such conditions, it has the strongest justification possible for implementing coercive or compulsive measures, because individuals have a moral duty to temporarily relinquish the rights that such measures would infringe. Our argument has significant implications for how public health emergencies in the developing world should be tackled. Where isolation and quarantine measures are necessary, states or the international community have a moral obligation to provide certain benefits to those quarantined or isolated.
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Giubilini A, Douglas T, Savulescu J. Liberty, Fairness and the ‘Contribution Model’ for Non-medical Vaccine Exemption Policies: A Reply to Navin and Largent. Public Health Ethics 2017. [DOI: 10.1093/phe/phx014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In a paper recently published in this journal, Navin and Largent argue in favour of a type of policy to regulate non-medical exemptions from childhood vaccination which they call ‘Inconvenience’. This policy makes it burdensome for parents to obtain an exemption to child vaccination, for example, by requiring parents to attend immunization education sessions and to complete an application form to receive a waiver. Navin and Largent argue that this policy is preferable to ‘Eliminationism’, i.e. to policies that do not allow non-medical exemptions, because Inconvenience has been shown to maintain exemption rates low while not harming parents by forcing them to do something that goes against their beliefs. We argue that it is at least doubtful that Inconvenience is ethically preferable to Eliminationism: while the latter disregards the value of liberty, Inconvenience disregards the value of fairness in the distribution of the burdens entailed by the preservation of a public good like herd immunity. We propose a variant of Inconvenience, which we call ‘Contribution’, which we think is preferable to the versions of Inconvenience discussed by Navin and Largent in that it successfully strikes a balance between the values of parents’ liberty, fairness and expected utility.
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Abstract
Germline Gene Editing (GGE) has enormous potential both as a research tool and a therapeutic intervention. While other types of gene editing are relatively uncontroversial, GGE has been strongly resisted. In this article, we analyse the ethical arguments for and against pursuing GGE by allowing and funding its development. We argue there is a strong case for pursuing GGE for the prevention of disease. We then examine objections that have been raised against pursuing GGE and argue that these fail. We conclude that the moral case in favour of pursuing GGE is stronger than the case against. This suggests that pursuing GGE is morally permissible and indeed morally desirable.
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Affiliation(s)
- Christopher Gyngell
- Oxford Uehiro Centre for Practical EthicsUniversity of OxfordLittlegate HouseSt Ebbes StreetOxfordOX1 1PTUK
| | - Thomas Douglas
- Oxford Uehiro Centre for Practical Ethics and Mansfield CollegeUniversity of Oxford
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical EthicsUniversity of Oxford & Visiting FellowFaculty of LawQueensland University of Technology
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Douglas T, Pugh J, Singh I, Savulescu J, Fazel S. Risk assessment tools in criminal justice and forensic psychiatry: The need for better data. Eur Psychiatry 2017; 42:134-137. [PMID: 28371726 PMCID: PMC5408162 DOI: 10.1016/j.eurpsy.2016.12.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/04/2016] [Accepted: 12/11/2016] [Indexed: 11/20/2022] Open
Abstract
Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.
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Affiliation(s)
- T Douglas
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - J Pugh
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - I Singh
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - J Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford OX1 1PT, United Kingdom
| | - S Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
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Giubilini A, Birkl P, Douglas T, Savulescu J, Maslen H. Taxing Meat: Taking Responsibility for One's Contribution to Antibiotic Resistance. J Agric Environ Ethics 2017; 30:179-198. [PMID: 29515330 PMCID: PMC5837014 DOI: 10.1007/s10806-017-9660-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
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 (a) 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 obtained with the use of antibiotics; and (b) a cost-benefit analysis of taxing such animal products and of using revenue from the tax to fund alternatives to use of antibiotics in animal farming. Finally, we argue that such a tax would be fair because individuals who consume animal products obtained with the use of antibiotics can be held morally responsible, i.e. blameworthy, for their contribution to antibiotic resistance, in spite of the fact that each individual contribution is imperceptible.
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Affiliation(s)
| | - Patrick Birkl
- Department of Animal Bioscience, University of Guelph, Guelph, Canada
| | | | - Julian Savulescu
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Hannah Maslen
- Oxford Martin School, University of Oxford, Oxford, UK
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Birks D, Douglas T. Two Ways to Frustrate a Desire. J Value Inq 2017; 51:417-434. [PMID: 28890575 PMCID: PMC5569147 DOI: 10.1007/s10790-017-9586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- David Birks
- University of Kiel, Arnold-Heller-Straße 3, Haus 28, 24105 Kiel, Germany
- The Oxford Research Centre in the Humanities (TORCH), University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Thomas Douglas
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, St Ebbes Street, Oxford, OX1 1PT UK
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Abstract
Within biology, molecules are arranged in hierarchical structures that coordinate and control the many processes that allow for complex organisms to exist. Proteins and other functional macromolecules are often studied outside their natural nanostructural context because it remains difficult to create controlled arrangements of proteins at this size scale. Viruses are elegantly simple nanosystems that exist at the interface of living organisms and nonliving biological machines. Studied and viewed primarily as pathogens to be combatted, viruses have emerged as models of structural efficiency at the nanoscale and have spurred the development of biomimetic nanoparticle systems. Virus-like particles (VLPs) are noninfectious protein cages derived from viruses or other cage-forming systems. VLPs provide incredibly regular scaffolds for building at the nanoscale. Composed of self-assembling protein subunits, VLPs provide both a model for studying materials' assembly at the nanoscale and useful building blocks for materials design. The robustness and degree of understanding of many VLP structures allow for the ready use of these systems as versatile nanoparticle platforms for the conjugation of active molecules or as scaffolds for the structural organization of chemical processes. Lastly the prevalence of viruses in all domains of life has led to unique activities of VLPs in biological systems most notably the immune system. Here we discuss recent efforts to apply VLPs in a wide variety of applications with the aim of highlighting how the common structural elements of VLPs have led to their emergence as paradigms for the understanding and design of biological nanomaterials.
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Affiliation(s)
- B Schwarz
- Indiana University, Bloomington, IN, United States
| | - M Uchida
- Indiana University, Bloomington, IN, United States
| | - T Douglas
- Indiana University, Bloomington, IN, United States.
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Abstract
Sex offenders are sometimes offered or required to undergo pharmacological interventions intended to diminish their sex drive (anti-libidinal interventions or ALIs). In this paper, we argue that much of the debate regarding the moral permissibility of ALIs has been founded on an inaccurate assumption regarding their intended purpose—namely, that ALIs are intended solely to realise medical purposes, not correctional goals. This assumption has made it plausible to assert that ALIs may only permissibly be administered to offenders with their valid consent, in line with the approach taken to most other interventions with a medical aim. However, we argue that, contrary to this assumption, the state's intention in relation to at least some ALIs is, at least in part, to achieve correctional objectives. We evaluate two legal regimes for ALI provision—section 645 of the California Penal Code and the mental health regime in England and Wales. In each case, we identify the state's implicit purpose in imposing ALIs and argue that the Californian and English regimes both serve as counterexamples to the view that ALIs are intended solely for medical purposes. While the moral implications of our argument are not straightforward, it raises the question whether consent is required for permissible imposition of ALIs, and more generally, whether the moral permissibility of crime-preventing interventions using medical means should be assessed against the standards of medical ethics or against those of criminal justice ethics.
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Affiliation(s)
- Lisa Forsberg
- Centre of Medical Law and Ethics, King's College London, Strand, London WC2R 2LS, UK
| | - Thomas Douglas
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
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Abstract
A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. Yet it occasionally seems morally permissible to carry out non-consensual medical interventions on competent individuals for the purpose of infectious disease control (IDC). We describe two different moral frameworks that have been invoked in support of non-consensual IDC interventions and identify five desiderata that might be used to guide assessments of the moral permissibility of such interventions on either kind of fundamental justification. We then consider what these desiderata imply for the justifiability of carrying out non-consensual medical interventions that are designed to facilitate rehabilitation amongst serious criminal offenders. We argue that these desiderata suggest that a plausible case can be made in favor of such interventions.
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Affiliation(s)
| | - Thomas Douglas
- Thomas Douglas is a Senior Research Fellow at the Uehiro Centre for Practical Ethics and the Faculty of Philosophy, University of Oxford, U.K.
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Abstract
In some situations a number of agents each have the ability to undertake an initiative that would have significant effects on the others. Suppose that each of these agents is purely motivated by an altruistic concern for the common good. We show that if each agent acts on her own personal judgment as to whether the initiative should be undertaken, then the initiative will be undertaken more often than is optimal. We suggest that this phenomenon, which we call the unilateralist's curse, arises in many contexts, including some that are important for public policy. To lift the curse, we propose a principle of conformity, which would discourage unilateralist action. We consider three different models for how this principle could be implemented, and respond to an objection that could be raised against it.
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Affiliation(s)
| | - Thomas Douglas
- Correspondence to: Thomas Douglas, Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, Suite 8, Littlegate House, St Ebbe’s Street, Oxford OX1 1PT, UK.
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Barbato RA, Garcia-Reyero N, Foley K, Jones R, Courville Z, Douglas T, Perkins E, Reynolds CM. Removal of Exogenous Materials from the Outer Portion of Frozen Cores to Investigate the Ancient Biological Communities Harbored Inside. J Vis Exp 2016. [PMID: 27403572 DOI: 10.3791/54091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The cryosphere offers access to preserved organisms that persisted under past environmental conditions. In fact, these frozen materials could reflect conditions over vast time periods and investigation of biological materials harbored inside could provide insight of ancient environments. To appropriately analyze these ecosystems and extract meaningful biological information from frozen soils and ice, proper collection and processing of the frozen samples is necessary. This is especially critical for microbial and DNA analyses since the communities present may be so uniquely different from modern ones. Here, a protocol is presented to successfully collect and decontaminate frozen cores. Both the absence of the colonies used to dope the outer surface and exogenous DNA suggest that we successfully decontaminated the frozen cores and that the microorganisms detected were from the material, rather than contamination from drilling or processing the cores.
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Affiliation(s)
- Robyn A Barbato
- Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Hanover, NH;
| | - Natàlia Garcia-Reyero
- Environmental Processes Branch, Environmental Laboratory, US Army Engineer Research & Development Center, Vicksburg, MS
| | - Karen Foley
- Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Hanover, NH
| | - Robert Jones
- Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Hanover, NH
| | - Zoe Courville
- Terrestrial and Cryospheric Scienes Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Hanover, NH
| | - Thomas Douglas
- Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Fairbanks, AK
| | - Edward Perkins
- Environmental Processes Branch, Environmental Laboratory, US Army Engineer Research & Development Center, Vicksburg, MS
| | - Charles M Reynolds
- Biogeochemical Sciences Branch, Cold Regions Research and Engineering Laboratory, US Army Engineer Research & Development Center, Fairbanks, AK
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Branch-Smith C, Pooley J, Shields L, Stick S, Douglas T. WS10.2 The lived experience of parenting children with cystic fibrosis undergoing surveillance for early-life lung disease: parents' accounts of diagnosis and treatment management. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30115-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- Julian Savulescu
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, OX1 1PT, UK
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Faber NS, Savulescu J, Douglas T. Why is Cognitive Enhancement Deemed Unacceptable? The Role of Fairness, Deservingness, and Hollow Achievements. Front Psychol 2016; 7:232. [PMID: 26925027 PMCID: PMC4759582 DOI: 10.3389/fpsyg.2016.00232] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
We ask why pharmacological cognitive enhancement (PCE) is generally deemed morally unacceptable by lay people. Our approach to this question has two core elements. First, we employ an interdisciplinary perspective, using philosophical rationales as base for generating psychological models. Second, by testing these models we investigate how different normative judgments on PCE are related to each other. Based on an analysis of the relevant philosophical literature, we derive two psychological models that can potentially explain the judgment that PCE is unacceptable: the "Unfairness-Undeservingness Model" and the "Hollowness-Undeservingness Model." The Unfairness-Undeservingness Model holds that people judge PCE to be unacceptable because they take it to produce unfairness and to undermine the degree to which PCE-users deserve reward. The Hollowness-Undeservingness Model assumes that people judge PCE to be unacceptable because they find achievements realized while using PCE hollow and undeserved. We empirically test both models against each other using a regression-based approach. When trying to predict judgments regarding the unacceptability of PCE using judgments regarding unfairness, hollowness, and undeservingness, we found that unfairness judgments were the only significant predictor of the perceived unacceptability of PCE, explaining about 36% of variance. As neither hollowness nor undeservingness had explanatory power above and beyond unfairness, the Unfairness-Undeservingness Model proved superior to the Hollowness-Undeservingness Model. This finding also has implications for the Unfairness-Undeservingness Model itself: either a more parsimonious single-factor "Fairness Model" should replace the Unfairness-Undeservingness-Model or fairness fully mediates the relationship between undeservingness and unacceptability. Both explanations imply that participants deemed PCE unacceptable because they judged it to be unfair. We conclude that concerns about unfairness play a crucial role in the subjective unacceptability of PCE and discuss the implications of our approach for the further investigation of the psychology of PCE.
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Affiliation(s)
- Nadira S. Faber
- Department of Experimental Psychology, University of OxfordOxford, UK
- Oxford Martin School, University of OxfordOxford, UK
| | - Julian Savulescu
- Oxford Martin School, University of OxfordOxford, UK
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of OxfordOxford, UK
| | - Thomas Douglas
- Oxford Martin School, University of OxfordOxford, UK
- Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of OxfordOxford, UK
- Brasenose College, University of OxfordOxford, UK
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