Rights, indirect harms and the non-identity problem

The non‐identity problem is the problem of grounding moral wrongdoing in cases in which an action affects who will exist in the future. Consider a woman who intentionally conceives while on medication that is harmful for a fetus. If the resulting child is disabled as a result of the medication, what makes the woman's action morally wrong? I argue that an explanation in terms of harmful rights violations fails, and I focus on Peter Markie's recent rights‐based defense. Markie's analysis rests on the notion of an indirect harm, and I show that the calculation of an indirect harm relies on an improper baseline for the determination of whether or not an action adversely affects a patient's interests. I also defend an impersonal duty‐based analysis of the wrongdoing in non‐identity cases against an objection by Markie. I close by arguing that the rights‐based analysis is insensitive to context and that context is morally relevant in the determination of the moral valence of actions in cases of non‐identity. This failure provides a pro tanto reason to favor an impersonal duty‐based analysis of the wrongdoing in non‐identity cases.     

Misplaced Paternalism and other Mistakes in the Debate over Kidney Sales

Erik Malmqvist defends the prohibition on kidney sales as a justifiable measure to protect individuals from harms they have not autonomously chosen. This appeal to ‘group soft paternalism’ requires that three conditions be met. It must be shown that some vendors will be harmed, that some will be subject to undue pressure to vend, and that we cannot feasibly distinguish between the autonomous and the non‐autonomous. I argue that Malmqvist fails to demonstrate that any of these conditions are likely to obtain. His argument involves two common errors. First, he, like many, proceeds on a mistaken understanding of how to assess harm. What matters is not the balance of costs and benefits of vending, but a comparison of potential vendors’ welfare across two possible courses of action. Second, Malmqvist's concerns about third‐party pressure are predicated on an empirically unrealistic understanding of the operation of a regulated market. A widely underappreciated fact is that kidney sales will be relatively rare, and most who try to vend will be unable to. Because pressure on another to vend will not result in the desired outcome, few will exert it.     

THE NON-IDENTITY PROBLEM AND GENETIC HARMS – THE CASE OF WRONGFUL HANDICAPS

The Human Genome Project will produce information permitting increasing opportunities to prevent genetically transmitted harms, most of which will be compatible with a life worth living, through avoiding conception or terminating a pregnancy. Failure to prevent these harms when it is possible for parents to do so without substantial burdens or costs to themselves or others are what J call "wrongful handicaps". Derek Parfit has developed a systematic difficulty for any such cases being wrongs — when the harm could be prevented only by preventing the existence of the individual who would have a worthwhile life even with the handicap, then bringing him into existence with the handicap does not make him worse off and so does not wrong him. I argue that a non "person-affecting" principle requiring the avoidance of suffering and limited opportunity correctly accounts for cases of wrongful handicaps without requiring that the individuals with the handicap have been made worse off and therefore wronged. It is an advantage, not a difficulty, of this account that it does not imply that the person with the handicap has been wronged or is a victim with a special moral complaint.     

The harm principle as a mid-level principle?: three problems from the context of infectious disease control

Effective infectious disease control may require states to restrict the liberty of individuals. Since preventing harm to others is almost universally accepted as a legitimate (prima facie) reason for restricting the liberty of individuals, it seems plausible to employ a mid-level harm principle in infectious disease control. Moral practices like infectious disease control support - or even require - a certain level of theory-modesty. However, employing a mid-level harm principle in infectious disease control faces at least three problems. First, it is unclear what we gain by attaining convergence on a specific formulation of the harm principle. Likely candidates for convergence, a harm principle aimed at preventing harmful conduct, supplemented by considerations of effectiveness and always choosing the least intrusive means still leave ample room for normative disagreement. Second, while mid-level principles are sometimes put forward in response to the problem of normative theories attaching different weight to moral principles, employing a mid-level harm principle completely leaves open how to determine what weight to attach to it in application. Third, there appears to be a trade-off between attaining convergence and finding a formulation of the harm principle that can justify liberty-restrictions in all situations of contagion, including interventions that are commonly allowed. These are not reasons to abandon mid-level theorizing altogether. But there is no reason to be too theory-modest in applied ethics. Morally justifying e.g. if a liberty-restriction in infectious disease control is proportional to the aim of harm-prevention, promptly requires moving beyond the mid-level harm principle.     

POST‐ABORTION SYNDROME: CREATING AN AFFLICTION

The contention that abortion harms women constitutes a new strategy employed by the pro‐life movement to supplement arguments about fetal rights. David C. Reardon is a prominent promoter of this strategy. Post‐abortion syndrome purports to establish that abortion psychologically harms women and, indeed, can harm persons associated with women who have abortions. Thus, harms that abortion is alleged to produce are multiplied. Claims of repression are employed to complicate efforts to disprove the existence of psychological harm and causal antecedents of trauma are only selectively investigated. We argue that there is no such thing as post‐abortion syndrome and that the psychological harms Reardon and others claim abortion inflicts on women can usually be ascribed to different causes. We question the evidence accumulated by Reardon and his analysis of data accumulated by others. Most importantly, we question whether the conclusions Reardon has drawn follow from the evidence he cites.     

Harming the non-conscious

Peter Singer has argued that nothing done to a fetus before it acquires consciousness can harm it. At the same time, he concedes that a child can be harmed by something done to it when it was a non-conscious fetus. But this implies that the non-conscious fetus can be harmed. The mistake lies in thinking that, since existence can be intrinsically bad for a being only if it is conscious, it can be harmed only if it is conscious. In fact, its being harmed only implies that it could have been conscious (and led a good life).     

Does Sympathy Motivate Prosocial Behaviour in Great Apes?

Prosocial behaviours such as helping, comforting, or sharing are central to human social life. Because they emerge early in ontogeny, it has been proposed that humans are prosocial by nature and that from early on empathy and sympathy motivate such behaviours. The emerging question is whether humans share these abilities to feel with and for someone with our closest relatives, the great apes. Although several studies demonstrated that great apes help others, little is known about their underlying motivations. This study addresses this issue and investigates whether four species of great apes (Pongo pygmaeus, Gorilla gorilla, Pan troglodytes, Pan paniscus) help a conspecific more after observing the conspecific being harmed (a human experimenter steals the conspecific’s food) compared to a condition where no harming occurred. Results showed that in regard to the occurrence of prosocial behaviours, only orangutans, but not the African great apes, help others when help is needed, contrasting prior findings on chimpanzees. However, with the exception of one population of orangutans that helped significantly more after a conspecific was harmed than when no harm occurred, prosocial behaviour in great apes was not motivated by concern for others.     

Sentient Nonpersons and the Disvalue of Death

Implicit in our everyday attitudes and practices is the assumption that death ordinarily harms a person who dies. A far more contested matter is whether death harms sentient individuals who are not persons, a category that includes many animals and some human beings. On the basis of the deprivation account of the harm of death, I argue that death harms sentient nonpersons (whenever their lives would be worth continuing). I next consider possible bases for the commonsense judgment that death ordinarily harms persons more than it harms sentient nonpersons. Contrary to what some philosophers believe, it is doubtful that the familiar resources of prudential value theory can vindicate this judgment. I show that the approach that at first glance seems most promising for supporting this judgment – namely, invoking an objective account of well‐being – faces substantial challenges, before arguing that McMahan's time‐relative interest account supplies the needed theoretical basis. I then go on to extract a significant practical implication of the first thesis, that death ordinarily harms sentient nonpersons: We should find a way to discontinue the routine killing of animal subjects following their use in experiments.     

A Defence of the Counterfactual Account of Harm

In order to determine whether a particular course of conduct is ethically permissible it is important to have a concept of what it means to be harmed. The dominant theory of harm is the counterfactual account, most famously proposed by Joel Feinberg. This determines whether harm is caused by comparing what actually happened in a given situation with the ‘counterfacts’ i.e. what would have occurred had the putatively harmful conduct not taken place. If a person's interests are worse off than they otherwise would have been, then a person will be harmed. This definition has recently faced challenges from bioethicists such as John Harris, Guy Kahane and Julian Savulescu who, believing it to be severely flawed, have proposed their own alternative theories of the concept. In this article I will demonstrate that the shortcomings Harris, Kahane and Savulescu believe are present in Feinberg's theory are illusory and that it is their own accounts of harm that are fraught with logical errors. I maintain that the arguments presented to refute Feinberg's theory not only fail to achieve this goal and can be accommodated within the counterfactual account but that they actually undermine the theories presented by their respective authors. The final conclusion will be that these challenges are misconceived and fail to displace the counterfactual theory.     

The non-identity problem and genetic harms -- the case of wrongful handicaps

The Human Genome Project will produce information permitting increasing opportunities to prevent genetically transmitted harms, most of which will be compatible with a life worth living, through avoiding conception or terminating a pregnancy. Failure to prevent these harms when it is possible for parents to do so without substantial burdens or costs to themselves or others are what I call "wrongful handicaps". Derek Parfit has developed a systematic difficulty for any such cases being wrongs -- when the harm could be prevented only by preventing the existence of the individual who would have a worthwhile life even with the handicap, then bringing him into existence with the handicap does not make him worse off and so does not wrong him. I argue that a non "person-affecting" principle requiring the avoidance of suffering and limited opportunity correctly accounts for cases of wrongful handicaps without requiring that the individuals with the handicap have been made worse off and therefore wronged. It is an advantage, not a difficulty, of this account that it does not imply that the person with the handicap has been wronged or is a victim with a special moral complaint.     

No conscientious objection without normative justification: Against conscientious objection in medicine

Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims are a manifestation of personal beliefs, they cannot be subject to this kind of public justification. In order to preserve an element of constraint without requiring normative justification of conscientious beliefs, they shift the justificatory burden from the belief motivating the conscientious claim to the condition of the patient being refused service. This generally involves a claim along the lines that conscientious refusals should be permitted to the extent that they do not cause unwarranted harm to the patient. I argue that explaining what would constitute warranted harm requires an explanation of what it is about the conscientious claim that makes the harm warranted. ‘Warranted’ is a normative operator, and providing this explanation is the same as providing normative justification for the conscientious claim. This shows that resorting to facts about the patient’s condition does not avoid the problem of providing normative justification, and that the onus remains on advocates of conscientious objection to provide normative justification for the practice in the context of medical care.     

International ethical regulations on placebo-use in clinical trials: a comparative analysis

The ethical aspects of placebo control in clinical trials have been extensively and controversially debated in the last decade. However, a thorough analytical comparison of the different existing international regulations, their terminologies and their ethical principles concerning placebo, is still missing. The central issue in the ongoing controversy is the justification of placebo-use, if proven treatment exists. All present versions of the examined guidelines propose such justifications, but each guideline differs from the others in relevant details. Therefore the conditions justifying placebo-use according to each guideline are the focus of our attention. We will first propose a formalized general principle that defines the ethical acceptability of placebo-use. Then we will analyse three categories of conditions put forward by the different documents: the risk of harm or burden, compelling scientific reasons, and the availability of proven treatment. The analysis shows important normative discrepancies and contradictions between the examined guidelines. Especially striking is the fact that some guidelines allow the participants in clinical trials to be exposed to a risk of serious harm, while others do not. Finally, we try to show how the normative difference of each guideline could influence the decision of researchers or IRBs concerning the ethical acceptability of placebo-use.     

Bystanders,risks, and consent

This paper considers the moral status of bystanders affected by medical research trials. Recent proposals advocate a very low threshold of permissible risk imposition upon bystanders that is insensitive to the prospective benefits of the trial, in part because we typically lack bystanders' consent. I argue that the correct threshold of permissible risk will be sensitive to the prospective gains of the trial. I further argue that one does not always need a person's consent to expose her to significant risks of even serious harm for the sake of others. That we typically need the consent of participants is explained by the fact that trials risk harmfully using participants, which is very hard to justify without consent. Bystanders, in contrast, are harmed as a side-effect, which is easier to justify. I then consider whether the degree of risk that a trial may impose on a bystander is sensitive to whether she is a prospective beneficiary of that trial.     

How is it between us? Relational ethics and transcendence

In this article, I engage the recent debate on transcendence/the transcendental within the anthropology of ethics with the claim that ‘How is it between us?’ is the most fundamental of all ethical questions. In doing so, I contrast relational ethics with ordinary ethics to show that ethics begins with a demand that emerges from a situation within which one finds oneself with others; a demand that pulls one out of oneself to respond in a modality of concern and care for the between where we dwell together. This attuned response is both an ethical and a political one; a response that opens possibilities for being-together-otherwise. Such possibilities, I argue throughout, can only begin with a relational ethics. I illustrate this with an ethnographic example from harm reduction practice and anti-drug war political activity in both New York City and Vancouver, Canada.     

Organic amendment additions to rangelands: A meta‐analysis of multiple ecosystem outcomes

Interest in land application of organic amendments—such as biosolids, composts, and manures—is growing due to their potential to increase soil carbon and help mitigate climate change, as well as to support soil health and regenerative agriculture. While organic amendments are predominantly applied to croplands, their application is increasingly proposed on relatively arid rangelands that do not typically receive fertilizers or other inputs, creating unique concerns for outcomes such as native plant diversity and water quality. To maximize environmental benefits and minimize potential harms, we must understand how soil, water, and plant communities respond to particular amendments and site conditions. We conducted a global meta‐analysis of 92 studies in which organic amendments had been added to arid, semiarid, or Mediterranean rangelands. We found that organic amendments, on average, provide some environmental benefits (increased soil carbon, soil water holding capacity, aboveground net primary productivity, and plant tissue nitrogen; decreased runoff quantity), as well as some environmental harms (increased concentrations of soil lead, runoff nitrate, and runoff phosphorus; increased soil CO₂ emissions). Published data were inadequate to fully assess impacts to native plant communities. In our models, adding higher amounts of amendment benefitted four outcomes and harmed two outcomes, whereas adding amendments with higher nitrogen concentrations benefitted two outcomes and harmed four outcomes. This suggests that trade‐offs among outcomes are inevitable; however, applying low‐N amendments was consistent with both maximizing benefits and minimizing harms. Short study time frames (median 1–2 years), limited geographic scope, and, for some outcomes, few published studies limit longer‐term inferences from these models. Nevertheless, they provide a starting point to develop site‐specific amendment application strategies aimed toward realizing the potential of this practice to contribute to climate change mitigation while minimizing negative impacts on other environmental goals.     

The deprivation argument against abortion

The most plausible pro-life argument claims that abortion is seriously wrong because it deprives the foetus of something valuable. This paper examines two recent versions of this argument. Don Marquis's version takes the valuable thing to be a 'future like ours', a future containing valuable experiences and activities. Jim Stone's version takes the valuable thing to be a future containing conscious goods, which it is the foetus's biological nature to make itself have. I give three grounds for rejecting these arguments. First, they lead to unacceptable inequalities in the wrongness of killing. Second, they lead to counterintuitive results in a range of imaginary cases. Third, they ignore the role of psychological connectedness in determining the magnitude or seriousness of deprivation-based harms: because the foetus is only weakly psychologically connected to its own future, it cannot be seriously harmed by being deprived of that future.     

Benefiting from 'evil': an incipient moral problem in human stem cell research

When does benefiting from others’ wrongdoing effectively make one a moral accomplice in their evil deeds? If stem cell research lives up to its therapeutic promise, this question (which has previously cropped up in debates over fetal tissue research or the use of Nazi research data) is likely to become a central one for opponents of embryo destruction. I argue that benefiting from wrongdoing is prima facie morally wrong under any of three conditions: (1) when the wrongdoer is one’s agent; (2) when acceptance of benefit directly encourages the repetition of the wrongful deed (even though no agency relationship is involved); and (3) when acceptance of a benefit legitimates a wrongful practice. I conclude by showing that, because of the ways in which most embryonic stem cell lines come into being, people who oppose embryo destruction may use human embryonic stem cells without incurring moral blame.     

Volunteer health professionals and emergencies: assessing and transforming the legal environment

Volunteer health professionals (VHPs) are essential in emergencies to fill surge capacity and provide needed medical expertise. While some VHPs are well-organized and trained, others arrive spontaneously at the site of a disaster. Lacking organization, training, and identification, they may actually impede emergency efforts. Complications involving medical volunteers in New York City after September 11, 2001, led Congress to authorize federal authorities to assist states and territories in developing emergency systems for the advance registration of volunteer health professionals (ESARVHP). Through advance registration, volunteers can be vetted, trained, and mobilized more effectively during emergencies. The use of VHPs, however, raises multiple legal questions: What constitutes an emergency, how is it declared, and what are the consequences? When are volunteers liable for their actions? When may volunteers who are licensed or certified in one state legally practice their profession in another state? Are volunteers entitled to compensation for harms they incur? This article examines the legal framework underlying the registration and use of volunteers during emergencies and offers recommendations for legal reform, including: (1) establish minimum standards to facilitate interjurisdictional emergency response, improve coordination, and enhance reciprocity of licensing and credentialing; (2) develop liability provisions for VHPs that balance their need to respond without significant fear of civil liability with patients' rights to legal recourse for egregious harms; and (3) provide basic levels of protections for VHPs harmed, injured, or killed while responding to emergencies.     

Female genital cutting: a harmless practice?

A recent article in Medical Anthropology Quarterly (Obermeyer 1999) argues that the "facts" about the "harmful effects" of female genital cutting (FGC) are "not sufficiently supported by the evidence" (p. 79). The article suggests three further hypotheses, among others: (1) FGC may be of minimal harm because the more educated continue the practice just as much as the less educated; (2) FGC may be of minimal harm because it is so widespread and persistent; (3) FGC may be of minimal harm because the supposed link between the clitoris and female sexual pleasure is a social construction rather than a physiological reality. I challenge these hypotheses. I say that by appropriate standards of evaluation, FGC is harmful. Finally, I submit that most FGC is a proper matter of concern because it is the irreversible reduction of a human capacity in the absence of meaningful consent.