Vaccination and the prevention problem

This paper seeks to critically review a traditional objection to preventive medicine (which I call here the 'prevention problem'). The prevention problem is a concern about the supposedly inequitable distribution of benefits and risks of harm resulting from preventive medicine's focus on population-based interventions. This objection is potentially applicable to preventive vaccination programmes and could be used to argue that such programmes are unethical. I explore the structure of the prevention problem by focusing upon two different types of vaccination (therapeutic vaccination and preventive vaccination). I argue that the 'prevention problem' cannot be fairly applied to the case of preventive vaccination because such programmes do not just focus upon benefits at the level of populations (as is claimed by the prevention problem). Most such preventive vaccination programmes explicitly seek to create and maintain herd protection. I argue that herd protection is an important public good which is a benefit shared by all individuals in the relevant population. This fact can then be used to block the 'prevention problem' argument in relation to preventive vaccination programmes. I conclude by suggesting that whilst the future development and use of therapeutic vaccines does raise some interesting ethical issues, any ethical objections to prophylactic vaccination on the basis of the 'prevention problem' will not be overcome through the substitution of therapeutic vaccines for preventive vaccines; indeed, the 'prevention problem' fails on its own terms in relation to preventive vaccination programmes.     

The continuous and discontinuous person: two dimensions of ethical life

Whereas early liberal thinkers developed the concept of the ethically accountable continuous forensic modern European person in contrast to what they saw as the discontinuous and hence unaccountable mimetic person, I argue that forensic and mimetic are better understood both as ideologies of personhood and as dimensions of all persons rather than as fully distinctive kinds of persons. I present an account of persons as accountable for their acts but show that this is not limited to the maximally continuous and autonomous person of liberal ideology. I review other forms of personhood encountered cross‐culturally and suggest that the mimetic dimension offsets some of the problems inherent in an exclusively forensic model.     

Justice for children: the child as organ donor

I argue that parents ought to be allowed to authorize their child's participation as an organ donor for another family member. I introduce a model of decisionmaking for children in intimate families which I call Constrained Parental Autonomy. This model permits wide parental discretion which is constrained absolutely by a broadly defined principle of respect for persons. In general, parental authorization alone is sufficient but I argue that the respect for persons constraint prevents certain donations and requires the child's assent for other donations. I also consider two controversial implications of the application of this model: the objection that the model does not respect the child's right to bodily integrity, and the objection that the model does not and is unable to address intrafamilial disgreement.     

There May be Strict Empirical Laws in Biology, after All

This paper consists of four parts. Part 1 is an introduction. Part 2 evaluates arguments for the claim that there are no strict empirical laws in biology. I argue that there are two types of arguments for this claim and they are as follows: (1) Biological properties are multiply realized and they require complex processes. For this reason, it is almost impossible to formulate strict empirical laws in biology. (2) Generalizations in biology hold contingently but laws go beyond describing contingencies, so there cannot be strict laws in biology. I argue that both types of arguments fail. Part 3 considers some examples of biological laws in recent biological research and argues that they exemplify strict laws in biology. Part 4 considers the objection that the examples in part 3 may be strict laws but they are not distinctively biological laws. I argue that given a plausible account of what distinctively biological means, such laws are distinctively biological.     

Avoiding the Personhood Issue: Abortion,Identity, and Marquis's ‘Future‐Like‐Ours’ Argument

One reason for the persistent appeal of Don Marquis' ‘future like ours’ argument (FLO) is that it seems to offer a way to approach the debate about the morality of abortion while sidestepping the difficult task of establishing whether the fetus is a person. This essay argues that in order to satisfactorily address both of the chief objections to FLO – the ‘identity objection’ and the ‘contraception objection’ – Marquis must take a controversial stand on what is most essential to being the kind of entity that an adult human being is. Such a stand amounts to a controversial account of personhood. To the extent that FLO's success depends on accepting such a controversial metaphysical view, one apparent attraction of FLO proves illusory.     

Forget Evil: Autonomy,the Physician–Patient Relationship,and the Duty to Refer

Aulisio and Arora argue that the moral significance of value imposition explains the moral distinction between traditional conscientious objection and non-traditional conscientious objection. The former objects to directly performing actions, whereas the latter objects to indirectly assisting actions on the grounds that indirectly assisting makes the actor morally complicit. Examples of non-traditional conscientious objection include objections to the duty to refer. Typically, we expect physicians who object to a practice to refer, but the non-traditional conscientious objector physician refuses to refer. Aulisio and Arora argue that physicians have a duty to refer because refusing to do so violates the patient’s values. While we agree with Aulisio and Arora’s conclusions, we argue value imposition cannot adequately explain the moral difference between traditional conscientious objection and non-traditional conscientious objection. Treating autonomy as the freedom to live in accordance with one’s values, as Aulisio and Arora do, is a departure from traditional liberal conceptions of autonomy and consequently fails to explain the moral difference between the two kinds of objection. We outline how a traditional liberal understanding of autonomy would help in this regard, and we make two additional arguments—one that maintains that non-traditional conscientious objection undermines society’s autonomy, and another that maintains that it undermines the physician-patient relationship—to establish why physicians have a duty to refer.     

Hastening death and respect for dignity: Kantianism at the end of life

Suppose that a young athlete has just become quadriplegic. He expects to live several more decades, but out of self‐interest he autonomously chooses to engage in physician‐assisted suicide (PAS) or voluntary active euthanasia (VAE). Some of us are unsure whether he or his physician would be acting rightly in ending his life. One basis for such doubt is the notion that persons have dignity in a Kantian sense. This paper probes responses that David Velleman and Frances Kamm have suggested to the question of whether participating in PAS or VAE to benefit oneself, as the young man might, respects the dignity of persons, specified in an orthodox Kantian way. Velleman claims that it does not, while Kamm insists that, in certain circumstances, it does. I argue against Kamm's position. I go on to contend that while orthodox Kantianism might provide a basis for moral concern regarding the case of the young quadriplegic, it suffers from two serious shortcomings. First, it implies that terminally ill patients are wrong to request VAE or engage in PAS to avoid intense suffering, at least when this suffering has not yet overwhelmed their reason. Second, orthodox Kantianism implies that it is wrong for physicians to withdraw such patients from life‐sustaining treatments, even if they request it. To remedy these shortcomings, I sketch an unorthodox Kantian account of respect for the dignity of persons. This account promises to capture the idea that it would be morally problematic for doctors to help the young quadriplegic to die, but to avoid the shortcomings of an orthodox Kantian account.     

Saving the young before the old -- a reply to John Harris

For a distribution of health care resources to be fair, it should consider the consequences for the whole lives of the affected persons and not just how badly off they are at the present moment. Since, other things being equal, a person is worse off if he dies young than if he dies old, it is fair to give scarce vital health care resources to young rather than to old persons. In the paper this ageist view is restated and defended against a number of objections raised by John Harris. According to Harris' so-called anti-ageist argument the only relevant consideration in the distribution of vital health care resources is people's desire to go on living. On reflection, this is highly counterintuitive. Instead, it is argued that both present desires to go on living and possible future happiness should weigh together with considerations of fairness. Both fairness and possible future happiness will in most cases speak in favour of saving the young before the old. A number of other problems for the ageist view are discussed, and solutions are suggested.     

The metaphysics of brain death

The dominant conception of brain death as the death of the whole brain constitutes an unstable compromise between the view that a person ceases to exist when she irreversibly loses the capacity for consciousness and the view that a human organism dies only when it ceases to function in an integrated way. I argue that no single criterion of death captures the importance we attribute both to the loss of the capacity for consciousness and to the loss of functioning of the organism as a whole. This is because the person or self is one thing and the human organism is another. We require a separate account of death for each. Only if we systematically distinguish between persons and human organisms will we be able to provide plausible accounts both of the conditions of our ceasing to exist and of when it is that we begin to exist. This paper, in short, argues for a form of mind-body dualism and draws out some of its implications for various practical moral problems.     

Will cognitive enhancement create post‐persons? The use(lessness) of induction in determining the likelihood of moral status enhancement

The prospect of cognitive enhancement well beyond current human capacities raises worries that the fundamental equality in moral status of human beings could be undermined. Cognitive enhancement might create beings with moral status higher than persons. Yet, there is an expressibility problem of spelling out what the higher threshold in cognitive capacity would be like. Nicholas Agar has put forward the bold claim that we can show by means of inductive reasoning that indefinite cognitive enhancement will probably mark a difference in moral status. The hope is that induction can determine the plausibility of post‐personhood existence in the absence of an account of what the higher status would be like. In this article, we argue that Agar's argument fails and, more generally, that inductive reasoning has little bearing on assessing the likelihood of post‐personhood in the absence of an account of higher status. We conclude that induction cannot bypass the expressibility problem about post‐persons.     

Postmodern Personhood: A Matter of Consciousness

The concept of person is integral to bioethical discourse because persons are the proper subject of the moral domain. Nevertheless, the concept of person has played no role in the prevailing formulation of human death because of a purported lack of consensus concerning the essential attributes of a person. Beginning with John Locke's fundamental proposition that person is a 'forensic term', I argue that in Western society we do have a consensus on at least one necessary condition for personhood, and that is the capacity for conscious experience. When we consider the whole brain formulation of death, and the most prominent defense of it by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, we can readily identify the flaws that grow out of the failure to define human death as the permanent loss of the capacity for conscious experience. Most fundamental among these flaws is a definition of human death that reduces persons to the capacity of the brain to regulate purely physiological functioning. Such a formulation would, in theory, apply to any member of the animal kingdom. I suggest that an appropriate concept of death should capture what it is about a particular living being that is so essential to it that the permanent loss of that thing constitutes death. What is essential to being a human being is living the life of a person, which derives from the capacity for conscious experience.     

Transhumanism and moral equality

Conservative thinkers such as Francis Fukuyama have produced a battery of objections to the transhumanist project of fundamentally enhancing human capacities. This article examines one of these objections, namely that by allowing some to greatly extend their capacities, we will undermine the fundamental moral equality of human beings. I argue that this objection is groundless: once we understand the basis for human equality, it is clear that anyone who now has sufficient capacities to count as a person from the moral point of view will continue to count as one even if others are fundamentally enhanced; and it is mistaken to think that a creature which had even far greater capacities than an unenhanced human being should count as more than an equal from the moral point of view.     

Postmodern personhood: a matter of consciousness

The concept of person is integral to bioethical discourse because persons are the proper subject of the moral domain. Nevertheless, the concept of person has played no role in the prevailing formulation of human death because of a purported lack of consensus concerning the essential attributes of a person. Beginning with John Locke's fundamental proposition that person is a 'forensic term', I argue that in Western society we do have a consensus on at least one necessary condition for personhood, and that is the capacity for conscious experience. When we consider the whole brain formulation of death, and the most prominent defense of it by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, we can readily identify the flaws that grow out of the failure to define human death as the permanent loss of the capacity for conscious experience. Most fundamental among these flaws is a definition of human death that reduces persons to the capacity of the brain to regulate purely physiological functioning. Such a formulation would, in theory, apply to any member of the animal kingdom. I suggest that an appropriate concept of death should capture what it is about a particular living being that is so essential to it that the permanent loss of that thing constitutes death. What is essential to being a human being is living the life of a person, which derives from the capacity for conscious experience.     

Mind the Gaps: Intersex and (Re-productive) Spaces in Disability Studies and Bioethics

With a few notable exceptions disability studies has not taken account of intersexuality, and it is principally through the lenses of feminist and queer-theory oriented ethical discussions but not through ‘straight’ bioethics that modes valuing intersex difference have been proposed. Meanwhile, the medical presupposition that intersex characteristics are inherently disabling to social viability remains the taken-for-granted truth from which clinical practice proceeds. In this paper I argue against bioethical perspectives that justify extensive and invasive pre- and post-natal medical interference to eradicate intersex. I argue instead that to constitute the necessary conditions for the recognition of the intersexed child as a person, a life valid in its own right, clinicians must refrain from aggressive interference. Clinical specialists presuppose that intersexed children will be socially disabled and unrecognizable as persons; frustrated by the general failure of traditional interventions to assign a sex, clinicians are now pursuing prenatal technologies, including selective termination, to erase intersex.     

Should I want to live to 100?

Is it virtuous for someone to try to live to 100? Casting aside questions of intergenerational justice and internal obligations in families, what about the basic desire itself? Discussions of longevity and aging in bioethics are skewed to controversial end‐of‐life decisions, largely avoiding questions of how to age well before such decisions arise. Respected writers such as Atul Gawande, Daniel Callahan, and Ezekiel Emanuel champion accepting a natural life span and not trying to live beyond it. The Stoic Seneca says a desire to live to 100 is foolish because, however long people live, they waste most of their lives, so if they lived a thousand years, they would still waste most of it. Against Seneca and Emanuel, we argue that a functional, not a chronological, view of aging should guide us and that for some seniors, hoping to be centenarians may be neither foolish nor misguided. Using Cicero, we argue that the pleasures of seniors are not necessarily inferior to those of youth and may even surpass them. Finally, we agree with Emanuel that the “symptom burden” of some lives makes living to 100 unpalatable and with Seneca that, given life’s vicissitudes, we should not plan on living to 100, but heeding his wisdom, try to make the most of the time given to us.     

Giving Voice to Children's Voices: Practices and Problems, Pitfalls and Potentials

In this article, I explore the lessons that the anthropological debates of the 1980s about writing culture might have for contemporary childhood research within anthropology and the social sciences more generally. I argue that the current rhetoric about "giving voice to children," commonplace both inside and outside the academy, poses a threat to the future of childhood research because it masks a number of important conceptual and epistemological problems. In particular, these relate to questions of representation, issues of authenticity, the diversity of children's experiences, and children's participation in research, all of which need to be addressed by anthropologists in their own research practices with children. Unless anthropologists do so, childhood research risks becoming marginalized once more and will fail to provide an arena within which children are seen as social actors who can provide a unique perspective on the social world about matters that concern them as children.     

Preventive examinations of nuclear power plant operators and managers — Anthropological and medical research project

The greatest danger to the future of human life is Man. Environmental issues are becoming highly topical, with attention focusing on nuclear power plants and their operational hazards. The main concern tends to be their technological reliability rather than the fact that humans are in control. In its long-term research project, the Institute of Sports Medicine, which belongs to the 1st Medical School of Charles University in Prague, is primarily concerned with examinations of the most exposed workers in nuclear and thermal power plants. As all of them are under supervision of their plant physicians, the purpose of the project is to uncover possible hidden health hazards that could result in a sudden collapse of the person concerned and bring about a disaster with far-reaching consequences. This paper presents only a small fraction of the results obtained to date. In functional anthropology and functional exercise dianostics we focused on certain signs that could be interpreted as risk factors for cardiopulmonary failure especially due to CHD, frequently found in middle-aged men. We also discuss the changes that have taken place in the 76 investigated nuclear power plant operators and managers during the three-year observation period. Our methods included basic anthropological and clinical examinations, determination of body composition and of the primary and secondary somatotype components, spirography, ergometry on a bicycle ergometer, haematology and biochemistry, in the first place of serum lipids. Although the work performance of the men investigated was high, our results have in some cases indicated certain hazards. For every test person we drew up a specific regimen—nutrition, movement and when required, therapy—and gave it to the plant physician. The management provided for men with such risk factors (a specific form of regeneration). Regular annual check-ups revealed in the men who complied with the prescribed regimen a noticeable decrease of risk factors and their increase in the men who did not comply. For such persons we recommended a professionally controlled form of regeneration and supervision of their movement regimen. The research, which will continue for some time yet, highlights the fact that as much attention should be paid to the human factor as to the technological safety of nuclear power plants.     

DOES A NORMAL FOETUS REALLY HAVE A FUTURE OF VALUE? A REPLY TO MARQUIS

The traditional approach to the abortion debate revolves around numerous issues, such as whether the foetus is a person, whether the foetus has rights, and more. Don Marquis suggests that this traditional approach leads to a standoff and that the abortion debate 'requires a different strategy.' Hence his 'future of value' strategy, which is summarized as follows: (1) A normal foetus has a future of value. (2) Depriving a normal foetus of a future of value imposes a misfortune on it. (3) Imposing a misfortune on a normal foetus is prima facie wrong. (4) Therefore, depriving a normal foetus of a future of value is prima facie wrong. (5) Killing a normal foetus deprives it of a future value. (6) Therefore, killing a normal foetus is prima facie wrong. In this paper, I argue that Marquis's strategy is not different since it involves the concept of person--a concept deeply rooted in the traditional approach. Specifically, I argue that futures are valuable insofar as they are not only dominated by goods of consciousness, but are experienced by psychologically continuous persons. Moreover, I argue that his strategy is not sound since premise (1) is false. Specifically, I argue that a normal foetus, at least during the first trimester, is not a person. Thus, during that stage of development it is not capable of experiencing its future as a psychologically continuous person and, hence, it does not have a future of value.     

Preconception care: a parenting protocol: a moral inquiry into the responsibilities of future parents towards their future children

In the Netherlands fertility doctors increasingly formulate protocols, which oblige patients to quit their unhealthy lifestyle before they are admitted to IVF procedures. We argue that moral arguments could justify parenting protocols that concern all future parents. In the first part we argue that want-to-be parents have moral responsibilities towards their future children to prevent them from harm by diminishing or eliminating risk factors before as well as during the pregnancy. This is because of the future children's potential to become of a certain type, more specifically: a person that will be the want-to-be parents' child. Want-to-be parents intend to become pregnant and therefore have an additional moral reason to diminish the risks. Also, people who become pregnant unintentionally have the responsibility to prevent their children from harm, unless they become pregnant due to contraception failure. All people not wanting to become pregnant should use contraception methods carefully. In the second part of this paper we translate the want-to-be parents' responsibilities into practice. We distinguish four determinants of risk factors: modifiability, chance, severity and effort. We examine some evidence-based risk factors based on these variables and deduce levels of responsibility. In conclusion, formulating informal requirements for want-to-be parents is morally required and therefore also for want-to-be parents in need of medical assistance. The protocols developed by fertility doctors in the Netherlands could be seen as the precursor for a general, informal Parenting Protocol that could be developed on the basis of an extended and thoroughly debated risk-responsibility analysis.     

Latino racial choices: the effects of skin colour and discrimination on Latinos’ and Latinas’ racial self-identifications

Abstract

Are predictions that Hispanics will make up 25 per cent of the US population in 2050 reliable? The authors of this paper argue that these and other predictions are problematic insofar as they do not account for the volatile nature of Latino racial and ethnic identifications. In this light, the authors propose a theoretical framework that can be used to predict Latinos’ and Latinas’ racial choices. This framework is tested using two distinct datasets – the 1989 Latino National Political Survey and the 2002 National Survey of Latinos. The results from the analyses of both of these surveys lend credence to the authors’ claims that Latinas’ and Latinos’ skin colour and experiences of discrimination affect whether people from Latin America and their descendants who live in the US will choose to identify racially as black, white or Latina/o.