I am a senior lecturer in practical philosophy at the Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, and docent (associate professor) of medical ethics.
The birth of the world’s first genetically edited babies in 2018 provoked considerable ethical ou... more The birth of the world’s first genetically edited babies in 2018 provoked considerable ethical outrage. Nonetheless, many scientists and bioethicists now advocate the pursuit of clinical uses of human germline gene editing. Progress towards this goal will require research, including clinical trials where genetically edited embryos are implanted into a woman’s uterus, gestated, and brought to term. This paper argues that such trials would likely conflict with the fundamental research ethical requirement of non-exploitation. This is because they would expose people who are in a vulnerable situation to risks and burdens that are substantial and not obviously offset by compensating benefits. I consider how the potential for exploitation in such trials might be mitigated, arguing that a feasible and justifiable approach is not easily found. If this analysis is correct, there is a significant ethical obstacle on the path towards clinical use of human germline gene editing.
I denna artikel diskuterar vi hur de svårigheter som finns med att hantera fenomenet antibiotikar... more I denna artikel diskuterar vi hur de svårigheter som finns med att hantera fenomenet antibiotikaresistens aktualiserar socialistiska lösningar på centrala samhällsutmaningar. Efter en kort inledning där vi förklarar vad vi avser med socialism i artikeln och beskriver socialismens plats i nutida politisk debatt, följer ett avsnitt där vi översiktligt beskriver den samhällsutmaning som antibiotikaresistens utgör. Därefter diskuterar vi hur denna utmaning på olika vis ger tyngd åt argument för socialistiska lösningar på centrala åtgärdsområden. Avslutningsvis resonerar vi mer spekulativt kring dels i vad mån dessa argument kan utsträckas till andra strukturella samhällsutmaningar, t.ex. klimatfrågan, dels vad sådan socialistisk argumentation kan betyda för socialismens plats i framtida politisk filosofi.
We propose a principle of sustainability to complement established principles used for justifying... more We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness give rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.
Antibiotic resistance is widely recognized as a major threat to public health and healthcare syst... more Antibiotic resistance is widely recognized as a major threat to public health and healthcare systems worldwide. Recent research suggests that pollution from antibiotics manufacturing is an important driver of resistance development. Using Sweden as an example, this paper considers how industrial antibiotic pollution might be addressed by public actors who are in a position to influence the distribution and use of antibiotics in high-income countries with publicly funded health systems. We identify a number of opportunities for these actors to incentivize industry to increase sustainability in antibiotics production. However, we also show that each alternative would create tensions with other significant policy goals, necessitating trade-offs. Since justifiable trade-offs require ethical consideration, we identify and explore the main underlying normative issues, namely, the weighing of local versus global health interests, the weighing of present versus future health interests, and the role of individualistic constraints on the pursuit of collective goals. Based on this analysis, we conclude that the actors have weighty principled reasons for prioritizing the goal of addressing pollution, but that translating this stance into concrete policy requires accommodating significant pragmatic challenges.
The concept of exploitation and potentially exploitative real-world practices are the subject of ... more The concept of exploitation and potentially exploitative real-world practices are the subject of increasing philosophical attention. However, while philosophers have extensively debated what exploitation is and what makes it wrong, they have said surprisingly little about what might be required to remediate it. By asking how the consequences of exploitation should be addressed, this paper seeks to contribute to filling this gap. We raise two questions. First, what are the victims of exploitation owed by way of remediation? Second, who ought to remediate? Our answers to these questions are connected by the idea that exploitation cannot be fully remediated by redistributing the exploiter’s gain in order to repair or compensate the victim’s loss. This is because exploitation causes not only distributive but also relational harm. Therefore, redistributive measures are necessary but not sufficient for adequate remediation. Moreover, this relational focus highlights the fact that exploitative real-world practices commonly involve agents other than the exploiter who stand to benefit from the exploitation. Insofar as these third parties are implicated in the distributive and relational harms caused by exploitation, there is, we argue, good reason to assign part of the burden of remediation to them.
There is a growing philosophical interest in the concept of exploitation as well as in putatively... more There is a growing philosophical interest in the concept of exploitation as well as in putatively exploitative real-world practices. However, exploitation theory remains underdeveloped in an important way. Philosophers have mainly focused on cases where one party to a transaction or relationship, A, unduly takes advantage of another party, B, in order to secure a gain for him-/herself. At the same time, they have largely ignored cases where A takes advantage of B, but the gains A extracts from B accrue not (only) to A but (also) to a third party, C. The aim of this paper is to fill this gap. We distinguish between three different ways in which third parties can be involved in exploitative arrangements: (i) by non-culpably benefiting from exploitation; (ii) by culpably benefiting, without joint action; and (iii) culpably, through joint action with the exploiter. Drawing on joint action theory, we explore the relevance of this threefold distinction for the attribution of moral responsibility and blame to third parties, and defend it against potential objections. Then we argue that the distinction has important implications for the remedial duties of third-party beneficiaries of exploitation towards those who were exploited. We end by briefly highlighting the usefulness of our approach for ethical analyses of exploitative practices in the real world.
A growing literature documents the existence of individuals who make a living by participating in... more A growing literature documents the existence of individuals who make a living by participating in phase I clinical trials for money. Several scholars have noted that the concerns about risks, consent, and exploitation raised by this phenomenon apply to many (other) jobs, too, and therefore proposed improving subject protections by regulating phase I trial participation as work. The present paper contributes to the debate over this proposal by exploring a largely neglected worry. Unlike most (other) workers, subjects are not paid to produce or achieve anything but to have things done to them. I argue that this passivity is problematic for reasons of distributive justice. Specifically, it fails to enable subjects to realize what Gheaus and Herzog call " the goods of work " —a failure not offset by adequate opportunities to realize these goods outside of the research context. I also consider whether granting subjects worker-type protections would accommodate this concern.
Clinical research is increasingly ‘offshored’ to developing countries, a practice that has genera... more Clinical research is increasingly ‘offshored’ to developing countries, a practice that has generated considerable controversy. It has recently been argued that the prevailing ethical norms governing such research are deeply puzzling. On the one hand, sponsors are not required to offshore trials, even when participants in developing countries would benefit considerably from these trials. On the other hand, if sponsors do offshore, they are required not to exploit participants, even when the latter would benefit from and consent to exploitation. How, it is asked, can it be worse to exploit the global poor than to neglect them when exploitation is voluntary and makes them better off? The present paper seeks to respond to this challenge. I argue that mutually beneficial and voluntary exploitation can be worse than neglect when – as is typically true of exploitative international research – it takes advantage of unjust background conditions. This is because, in such cases, exploitation overlaps with another, less familiar wrong: complicity in injustice. Recognizing complicity as a distinct wrong should make us judge exchanges arising from background injustice more harshly than we typically do, in research and elsewhere.
International Journal of Legal Medicine, published online 11 Nov 2017, 2017
According to European regulations and the legislations of individual member states, children who ... more According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analyzed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.
The idea of paying donors in order to make more human bodily material available for therapy, assi... more The idea of paying donors in order to make more human bodily material available for therapy, assisted reproduction, and biomedical research is notoriously controversial. However, while national and international donation policies largely oppose financial incentives they do not treat all parts of the body equally: incentives are allowed in connection to the provision of some parts but not others. Taking off from this observation, I discuss whether body parts differ as regards the ethical legitimacy of incentives and, if so, why. I distinguish two approaches to this issue. On a " principled " approach, some but not all body parts are inherently special in a way that proscribes payment. On a " pragmatic " approach, the appropriateness of payment in relation to a specific part must be determined through an overall assessment of e.g. the implications of payment for the health and welfare of providers, recipients, and third parties, and the quality of providers' consent. I argue that the first approach raises deep and potentially divisive questions about the good life, whereas the second approach invokes currently unsupported empirical assumptions and requires difficult balancing between different values and the interests of different people. This does not mean that any attempt to distinguish between body parts in regard to the appropriateness of payment necessarily fails. However, I conclude, any plausible such attempt should either articulate and defend a specific view of the good life, or gather relevant empirical evidence and apply defensible principles for weighing goods and interests.
Proponents of permitting living kidney sales often argue as follows. Many jobs involve significan... more Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.
What, if anything, is wrong with taking advantage of people’s unjust circumstances when they both... more What, if anything, is wrong with taking advantage of people’s unjust circumstances when they both benefit from and consent to the exchange? The answer, some believe, is that such exchanges are wrongfully exploitative. I argue that this answer is incomplete at best, and I elaborate a different one: to take advantage of injustice is to become complicit in its reproduction. I also argue that the case for third-party interference with mutually beneficial and consensual exchanges, while normally considered weak, is strengthened once these exchanges are understood as implicated in broader unjust structures.
It is often argued that it does not matter morally whether biomedical interventions treat or prev... more It is often argued that it does not matter morally whether biomedical interventions treat or prevent diseases or enhance non-disease traits; what matters is whether and how much they promote wellbeing. Therapy and enhancement both promote wellbeing, the argument goes, so they are not morally distinct but instead continuous. I provide three reasons why this argument should be rejected when it is applied to choices concerning the genetic make-up of future people. First, it rests on too simple a conception of the badness of disease. Second, it wrongly assumes that diseaseavoidance and enhancement can proceed with similar accuracy. Third, it overlooks that disease-avoidance tends to be more urgent than enhancement from the point of view of distributive justice. While none of these reasons establishes a firm therapy-enhancement distinction, they show that a continuum model is not an attractive alternative.
This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is... more This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is, that they unduly deny people the freedom to make decisions about their own bodies in order to protect them from harm. I argue that not even principled anti-paternalists need to reject such bans. This is because their rationale is not hard paternalism, which anti-paternalists repudiate, but soft paternalism, which they in principle accept. More precisely, I suggest that their rationale is what Franklin Miller and Alan Wertheimer call ‘group soft paternalism’. Group soft paternalistic policies restrict the freedom of autonomous individuals, not for their own good (hard paternalism), but as an unavoidable consequence of seeking to protect other, non-autonomous individuals from harms that they have not voluntarily chosen (soft paternalism). Group soft paternalism supports prohibiting kidney sales on three conditions: (1) that such sales are potentially harmful to vendors, (2) that many vendors would suffer impaired autonomy, and (3) that distinguishing between autonomous and non-autonomous vendors and interfering only with the latter is unfeasible. I provide reasons for thinking that these conditions will often hold.
Many countries are now implementing human papillomavirus vaccination. There is disagreement about... more Many countries are now implementing human papillomavirus vaccination. There is disagreement about who should receive the vaccine. Some propose vaccinating both boys and girls in order to achieve the largest possible public health impact. Others regard this approach as too costly and claim that only girls should be vaccinated. We question the assumption that decisions about human papillomavirus vaccination policy should rely solely on estimates of overall benefits and costs. There are important social justice aspects that also need to be considered. Policy makers should consider how to best protect individuals who will remain unvaccinated through no fault of their own. This is especially important if these individuals are already disadvantaged in other ways and if vaccinating other people increases their risk of infection.
A common argument in favor of using reprogenetic technologies to enhance children goes like this:... more A common argument in favor of using reprogenetic technologies to enhance children goes like this: parents have always aimed at enhancing their children through upbringing and education, so why not use new tools to accomplish the same goal? But reprogenetics differs significantly from good childrearing and education, in its means, if not its ends.
The decision to terminate a clinical trial earlier than planned is often described as ethically p... more The decision to terminate a clinical trial earlier than planned is often described as ethically problematic, but it is rarely systematically analyzed as an ethical issue in its own right. This paper provides an overview of the main ethical considerations at stake in such decisions and of the main tensions between these considerations. Arguments about informed consent and the impact of early stopping on research and society are explored. We devote particular attention to a familiar conflict that arises with special urgency when early data suggest that the experimental treatment is superior. Should the trial be stopped so that participants in the control group will not be allocated a seemingly inferior treatment, or should it continue in pursuit of evidence conclusive enough to improve the care of future patients? We scrutinize three ways to address this problem. Rather than dissolving the tension, they represent different trade-offs between the respective welfare interests of subjects and future patients.
Human papillomavirus (HPV) infection is the world’s most common sexually transmitted infection. I... more Human papillomavirus (HPV) infection is the world’s most common sexually transmitted infection. It is a prerequisite for cervical cancer, the second most common cause of death in cancer among women worldwide, and is also believed to cause other anogenital and head and neck cancers. Vaccines that protect against the most common cancer-causing HPV types have recently become available, and different countries have taken different approaches to implementing vaccination. This paper examines the ethics of alternative HPV vaccination strategies. It devotes particular attention to the major arguments for and against one strategy: voluntary, publicly funded vaccination for all adolescent boys and girls. This approach seems attractive because it would protect more people against cervical cancer and other HPV-related cancers than less inclusive alternatives, without the sacrifice of autonomy that a comparably broad compulsory programme would require. Also, the herd immunity that it would likely generate would protect those who remain unvaccinated, a major advantage from a justice perspective. However, there is a possibility that a HPV vaccination programme targeting all adolescents of both sexes is not considered sufficiently cost-effective. Also, it might pose more difficulties for achieving informed consent than comparable vaccination programmes against other diseases. Ultimately, society’s choice of HPV vaccination strategy requires careful consideration not only of the values at stake but also of available and emerging scientific evidence.
The term exploitation is notoriously hard to define. Yet it is frequently invoked to frame moral ... more The term exploitation is notoriously hard to define. Yet it is frequently invoked to frame moral concerns about clinical research. Recently, a group of influential authors have proposed a so-called “non-exploitation framework” for the ethics of randomized controlled trials that appears to address these concerns. In this paper, I challenge one basic assumption of that framework: the idea that non-exploitation in research requires participants to be protected from excessive risks, understood as risks that are not outweighed by the benefits that the research is expected to lead to. Drawing on examples of exploitation in other contexts, I show that this idea has highly counterintuitive implications. I conclude that the non-exploitation framework obscures concerns about exploitation in biomedical research rather than clarifying them.
The birth of the world’s first genetically edited babies in 2018 provoked considerable ethical ou... more The birth of the world’s first genetically edited babies in 2018 provoked considerable ethical outrage. Nonetheless, many scientists and bioethicists now advocate the pursuit of clinical uses of human germline gene editing. Progress towards this goal will require research, including clinical trials where genetically edited embryos are implanted into a woman’s uterus, gestated, and brought to term. This paper argues that such trials would likely conflict with the fundamental research ethical requirement of non-exploitation. This is because they would expose people who are in a vulnerable situation to risks and burdens that are substantial and not obviously offset by compensating benefits. I consider how the potential for exploitation in such trials might be mitigated, arguing that a feasible and justifiable approach is not easily found. If this analysis is correct, there is a significant ethical obstacle on the path towards clinical use of human germline gene editing.
I denna artikel diskuterar vi hur de svårigheter som finns med att hantera fenomenet antibiotikar... more I denna artikel diskuterar vi hur de svårigheter som finns med att hantera fenomenet antibiotikaresistens aktualiserar socialistiska lösningar på centrala samhällsutmaningar. Efter en kort inledning där vi förklarar vad vi avser med socialism i artikeln och beskriver socialismens plats i nutida politisk debatt, följer ett avsnitt där vi översiktligt beskriver den samhällsutmaning som antibiotikaresistens utgör. Därefter diskuterar vi hur denna utmaning på olika vis ger tyngd åt argument för socialistiska lösningar på centrala åtgärdsområden. Avslutningsvis resonerar vi mer spekulativt kring dels i vad mån dessa argument kan utsträckas till andra strukturella samhällsutmaningar, t.ex. klimatfrågan, dels vad sådan socialistisk argumentation kan betyda för socialismens plats i framtida politisk filosofi.
We propose a principle of sustainability to complement established principles used for justifying... more We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness give rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.
Antibiotic resistance is widely recognized as a major threat to public health and healthcare syst... more Antibiotic resistance is widely recognized as a major threat to public health and healthcare systems worldwide. Recent research suggests that pollution from antibiotics manufacturing is an important driver of resistance development. Using Sweden as an example, this paper considers how industrial antibiotic pollution might be addressed by public actors who are in a position to influence the distribution and use of antibiotics in high-income countries with publicly funded health systems. We identify a number of opportunities for these actors to incentivize industry to increase sustainability in antibiotics production. However, we also show that each alternative would create tensions with other significant policy goals, necessitating trade-offs. Since justifiable trade-offs require ethical consideration, we identify and explore the main underlying normative issues, namely, the weighing of local versus global health interests, the weighing of present versus future health interests, and the role of individualistic constraints on the pursuit of collective goals. Based on this analysis, we conclude that the actors have weighty principled reasons for prioritizing the goal of addressing pollution, but that translating this stance into concrete policy requires accommodating significant pragmatic challenges.
The concept of exploitation and potentially exploitative real-world practices are the subject of ... more The concept of exploitation and potentially exploitative real-world practices are the subject of increasing philosophical attention. However, while philosophers have extensively debated what exploitation is and what makes it wrong, they have said surprisingly little about what might be required to remediate it. By asking how the consequences of exploitation should be addressed, this paper seeks to contribute to filling this gap. We raise two questions. First, what are the victims of exploitation owed by way of remediation? Second, who ought to remediate? Our answers to these questions are connected by the idea that exploitation cannot be fully remediated by redistributing the exploiter’s gain in order to repair or compensate the victim’s loss. This is because exploitation causes not only distributive but also relational harm. Therefore, redistributive measures are necessary but not sufficient for adequate remediation. Moreover, this relational focus highlights the fact that exploitative real-world practices commonly involve agents other than the exploiter who stand to benefit from the exploitation. Insofar as these third parties are implicated in the distributive and relational harms caused by exploitation, there is, we argue, good reason to assign part of the burden of remediation to them.
There is a growing philosophical interest in the concept of exploitation as well as in putatively... more There is a growing philosophical interest in the concept of exploitation as well as in putatively exploitative real-world practices. However, exploitation theory remains underdeveloped in an important way. Philosophers have mainly focused on cases where one party to a transaction or relationship, A, unduly takes advantage of another party, B, in order to secure a gain for him-/herself. At the same time, they have largely ignored cases where A takes advantage of B, but the gains A extracts from B accrue not (only) to A but (also) to a third party, C. The aim of this paper is to fill this gap. We distinguish between three different ways in which third parties can be involved in exploitative arrangements: (i) by non-culpably benefiting from exploitation; (ii) by culpably benefiting, without joint action; and (iii) culpably, through joint action with the exploiter. Drawing on joint action theory, we explore the relevance of this threefold distinction for the attribution of moral responsibility and blame to third parties, and defend it against potential objections. Then we argue that the distinction has important implications for the remedial duties of third-party beneficiaries of exploitation towards those who were exploited. We end by briefly highlighting the usefulness of our approach for ethical analyses of exploitative practices in the real world.
A growing literature documents the existence of individuals who make a living by participating in... more A growing literature documents the existence of individuals who make a living by participating in phase I clinical trials for money. Several scholars have noted that the concerns about risks, consent, and exploitation raised by this phenomenon apply to many (other) jobs, too, and therefore proposed improving subject protections by regulating phase I trial participation as work. The present paper contributes to the debate over this proposal by exploring a largely neglected worry. Unlike most (other) workers, subjects are not paid to produce or achieve anything but to have things done to them. I argue that this passivity is problematic for reasons of distributive justice. Specifically, it fails to enable subjects to realize what Gheaus and Herzog call " the goods of work " —a failure not offset by adequate opportunities to realize these goods outside of the research context. I also consider whether granting subjects worker-type protections would accommodate this concern.
Clinical research is increasingly ‘offshored’ to developing countries, a practice that has genera... more Clinical research is increasingly ‘offshored’ to developing countries, a practice that has generated considerable controversy. It has recently been argued that the prevailing ethical norms governing such research are deeply puzzling. On the one hand, sponsors are not required to offshore trials, even when participants in developing countries would benefit considerably from these trials. On the other hand, if sponsors do offshore, they are required not to exploit participants, even when the latter would benefit from and consent to exploitation. How, it is asked, can it be worse to exploit the global poor than to neglect them when exploitation is voluntary and makes them better off? The present paper seeks to respond to this challenge. I argue that mutually beneficial and voluntary exploitation can be worse than neglect when – as is typically true of exploitative international research – it takes advantage of unjust background conditions. This is because, in such cases, exploitation overlaps with another, less familiar wrong: complicity in injustice. Recognizing complicity as a distinct wrong should make us judge exchanges arising from background injustice more harshly than we typically do, in research and elsewhere.
International Journal of Legal Medicine, published online 11 Nov 2017, 2017
According to European regulations and the legislations of individual member states, children who ... more According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analyzed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.
The idea of paying donors in order to make more human bodily material available for therapy, assi... more The idea of paying donors in order to make more human bodily material available for therapy, assisted reproduction, and biomedical research is notoriously controversial. However, while national and international donation policies largely oppose financial incentives they do not treat all parts of the body equally: incentives are allowed in connection to the provision of some parts but not others. Taking off from this observation, I discuss whether body parts differ as regards the ethical legitimacy of incentives and, if so, why. I distinguish two approaches to this issue. On a " principled " approach, some but not all body parts are inherently special in a way that proscribes payment. On a " pragmatic " approach, the appropriateness of payment in relation to a specific part must be determined through an overall assessment of e.g. the implications of payment for the health and welfare of providers, recipients, and third parties, and the quality of providers' consent. I argue that the first approach raises deep and potentially divisive questions about the good life, whereas the second approach invokes currently unsupported empirical assumptions and requires difficult balancing between different values and the interests of different people. This does not mean that any attempt to distinguish between body parts in regard to the appropriateness of payment necessarily fails. However, I conclude, any plausible such attempt should either articulate and defend a specific view of the good life, or gather relevant empirical evidence and apply defensible principles for weighing goods and interests.
Proponents of permitting living kidney sales often argue as follows. Many jobs involve significan... more Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it.
What, if anything, is wrong with taking advantage of people’s unjust circumstances when they both... more What, if anything, is wrong with taking advantage of people’s unjust circumstances when they both benefit from and consent to the exchange? The answer, some believe, is that such exchanges are wrongfully exploitative. I argue that this answer is incomplete at best, and I elaborate a different one: to take advantage of injustice is to become complicit in its reproduction. I also argue that the case for third-party interference with mutually beneficial and consensual exchanges, while normally considered weak, is strengthened once these exchanges are understood as implicated in broader unjust structures.
It is often argued that it does not matter morally whether biomedical interventions treat or prev... more It is often argued that it does not matter morally whether biomedical interventions treat or prevent diseases or enhance non-disease traits; what matters is whether and how much they promote wellbeing. Therapy and enhancement both promote wellbeing, the argument goes, so they are not morally distinct but instead continuous. I provide three reasons why this argument should be rejected when it is applied to choices concerning the genetic make-up of future people. First, it rests on too simple a conception of the badness of disease. Second, it wrongly assumes that diseaseavoidance and enhancement can proceed with similar accuracy. Third, it overlooks that disease-avoidance tends to be more urgent than enhancement from the point of view of distributive justice. While none of these reasons establishes a firm therapy-enhancement distinction, they show that a continuum model is not an attractive alternative.
This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is... more This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is, that they unduly deny people the freedom to make decisions about their own bodies in order to protect them from harm. I argue that not even principled anti-paternalists need to reject such bans. This is because their rationale is not hard paternalism, which anti-paternalists repudiate, but soft paternalism, which they in principle accept. More precisely, I suggest that their rationale is what Franklin Miller and Alan Wertheimer call ‘group soft paternalism’. Group soft paternalistic policies restrict the freedom of autonomous individuals, not for their own good (hard paternalism), but as an unavoidable consequence of seeking to protect other, non-autonomous individuals from harms that they have not voluntarily chosen (soft paternalism). Group soft paternalism supports prohibiting kidney sales on three conditions: (1) that such sales are potentially harmful to vendors, (2) that many vendors would suffer impaired autonomy, and (3) that distinguishing between autonomous and non-autonomous vendors and interfering only with the latter is unfeasible. I provide reasons for thinking that these conditions will often hold.
Many countries are now implementing human papillomavirus vaccination. There is disagreement about... more Many countries are now implementing human papillomavirus vaccination. There is disagreement about who should receive the vaccine. Some propose vaccinating both boys and girls in order to achieve the largest possible public health impact. Others regard this approach as too costly and claim that only girls should be vaccinated. We question the assumption that decisions about human papillomavirus vaccination policy should rely solely on estimates of overall benefits and costs. There are important social justice aspects that also need to be considered. Policy makers should consider how to best protect individuals who will remain unvaccinated through no fault of their own. This is especially important if these individuals are already disadvantaged in other ways and if vaccinating other people increases their risk of infection.
A common argument in favor of using reprogenetic technologies to enhance children goes like this:... more A common argument in favor of using reprogenetic technologies to enhance children goes like this: parents have always aimed at enhancing their children through upbringing and education, so why not use new tools to accomplish the same goal? But reprogenetics differs significantly from good childrearing and education, in its means, if not its ends.
The decision to terminate a clinical trial earlier than planned is often described as ethically p... more The decision to terminate a clinical trial earlier than planned is often described as ethically problematic, but it is rarely systematically analyzed as an ethical issue in its own right. This paper provides an overview of the main ethical considerations at stake in such decisions and of the main tensions between these considerations. Arguments about informed consent and the impact of early stopping on research and society are explored. We devote particular attention to a familiar conflict that arises with special urgency when early data suggest that the experimental treatment is superior. Should the trial be stopped so that participants in the control group will not be allocated a seemingly inferior treatment, or should it continue in pursuit of evidence conclusive enough to improve the care of future patients? We scrutinize three ways to address this problem. Rather than dissolving the tension, they represent different trade-offs between the respective welfare interests of subjects and future patients.
Human papillomavirus (HPV) infection is the world’s most common sexually transmitted infection. I... more Human papillomavirus (HPV) infection is the world’s most common sexually transmitted infection. It is a prerequisite for cervical cancer, the second most common cause of death in cancer among women worldwide, and is also believed to cause other anogenital and head and neck cancers. Vaccines that protect against the most common cancer-causing HPV types have recently become available, and different countries have taken different approaches to implementing vaccination. This paper examines the ethics of alternative HPV vaccination strategies. It devotes particular attention to the major arguments for and against one strategy: voluntary, publicly funded vaccination for all adolescent boys and girls. This approach seems attractive because it would protect more people against cervical cancer and other HPV-related cancers than less inclusive alternatives, without the sacrifice of autonomy that a comparably broad compulsory programme would require. Also, the herd immunity that it would likely generate would protect those who remain unvaccinated, a major advantage from a justice perspective. However, there is a possibility that a HPV vaccination programme targeting all adolescents of both sexes is not considered sufficiently cost-effective. Also, it might pose more difficulties for achieving informed consent than comparable vaccination programmes against other diseases. Ultimately, society’s choice of HPV vaccination strategy requires careful consideration not only of the values at stake but also of available and emerging scientific evidence.
The term exploitation is notoriously hard to define. Yet it is frequently invoked to frame moral ... more The term exploitation is notoriously hard to define. Yet it is frequently invoked to frame moral concerns about clinical research. Recently, a group of influential authors have proposed a so-called “non-exploitation framework” for the ethics of randomized controlled trials that appears to address these concerns. In this paper, I challenge one basic assumption of that framework: the idea that non-exploitation in research requires participants to be protected from excessive risks, understood as risks that are not outweighed by the benefits that the research is expected to lead to. Drawing on examples of exploitation in other contexts, I show that this idea has highly counterintuitive implications. I conclude that the non-exploitation framework obscures concerns about exploitation in biomedical research rather than clarifying them.
The influence of pervasive cultural norms on people’s actions constitutes a longstanding problem ... more The influence of pervasive cultural norms on people’s actions constitutes a longstanding problem for autonomy theory. On the one hand, such norms often seem to elude the kind of reflection that autonomous agency requires. On the other hand, they are hardly entirely beyond the pale of autonomy: people do sometimes reflect critically on them and resist them. This paper draws on phenomenological accounts of embodiment in order to reconcile these observations. We suggest that pervasive cultural norms exert a strong and elusive, but occasionally resistible, influence because they are incorporated – they operate on the largely pre-reflective bodily level of human existence. As an illustration we discuss parental decisions about surgery for children born with unclear sex, decisions permeated by deeply entrenched norms about sexual difference and genital appearance.
En replik till Marcus Agnafors artikel "En rimlig samvetsklausul" (Tidskrift för politisk filosof... more En replik till Marcus Agnafors artikel "En rimlig samvetsklausul" (Tidskrift för politisk filosofi, förhandspublikation). I repliken argumenterar jag för att även en modest samvetsklausul av det slag som Agnafors förespråkar skulle försvåra kvinnors tillgång till abortvård och därigenom lägga betydande bördor på de berörda kvinnorna. Detta underminerar Agnafors försök att stödja klausulen på den liberala tanken att staten på ett opartiskt sätt bör underlätta medborgarnas strävan efter ett gott liv.
Correspondence in response to David Shaw's article "The right to participate in high-risk researc... more Correspondence in response to David Shaw's article "The right to participate in high-risk research," Lancet 2014; 383: 1009-1011
Georgetown University Home. Back to the future: Habermas's The Future of Human Nature [l... more Georgetown University Home. Back to the future: Habermas's The Future of Human Nature [letters and reply]. DigitalGeorgetown Repository. ...
Commentary on Julian Koplin, Assessing the likely harms to kidney vendors in regulated organ mark... more Commentary on Julian Koplin, Assessing the likely harms to kidney vendors in regulated organ markets. American Journal of Bioethics 2014;14(10): 7-18.
Recent technological progresses have made technological modifications of human beings a real poss... more Recent technological progresses have made technological modifications of human beings a real possibility. Many normal traits may be artificially enhanced. Sooner or latter, individuals will have the possibility to exchange their healthy limbs and organs for better artificial ones and transplantations of human brains into artificial carriers are already under study. Therefore, socio-ethical issues related to human enhancement have started to be seriously considered by scholars around the world. While such a technological revolution concerns the society as a whole, debates addressing the socio-ethical issues related to human enhancement have mainly been restricted to academics. Lay people are largely unaware of the discussions. The objective of this book is to inform lay people of the already existing and potential future possibilities to enhance humans through emerging technologies as well as the socio-ethical issues that are already raised by such technological modifications. This book constitutes a first step to encourage democratic and interdisciplinary involvement and discussion about some of the socio-ethical issues related to the technological modifications of human beings. Enjoy your journey through the augmented world ! http://future-human.life
This book is the outcome of a research project at the Centre
for Studies in Practical Knowledge,... more This book is the outcome of a research project at the Centre
for Studies in Practical Knowledge, Södertörn University,
funded by the Baltic Sea Foundation. The main participants
of the project were one philosopher—Fredrik Svenaeus—
one historian—Ulla Ekström von Essen—and three ethnologists—
Martin Gunnarson, Susanne Lundin and Markus
Idvall—from Södertörn University and Lund University,
but we also benefitted from the help and advice of medical
researchers and physicians from the Karolinska Institutet
—Annika Tibell and C. G. Groth—and many other scholars
from Sweden and abroad, especially from the Baltic Sea Region.
You will find some of our collaborators represented
as authors in this volume, but most of them are not on the
list of participants, since they, for ethical reasons, have to
remain anonymous. The persons in question have helped
us with information about and access to practices which are
precarious objects of study—organ transplantation and organ
trade—subjects that are highly sensitive and often hard
to speak about for the people involved. We want to thank
the health care personnel, patients and other persons, who
have generously offered us their time without any other
return than to be able to support the growth of knowledge
and reflection in this field. We hope that this book and other
outcomes of our research project, such as articles in journals
and newspapers, and presentations at conferences and
meetings with the public, will help to build sound political
judgement and policies on organ, tissue and cell donation.
The rules and procedures of organ, tissue and cell transfer
are, indeed, vital, not only in the sense that they concern
who will live and who will die, but also in the sense that
the decisions in question determine how we are to view the
moral essence of human relationships as such. What duties
do we owe to each other regarding the giving away of what is
most intimately ours: our bodies and the organs, tissues and
cells they consist of? And what limits should we set regarding
procuring and transferring the “things” in question?
Uploads
for Studies in Practical Knowledge, Södertörn University,
funded by the Baltic Sea Foundation. The main participants
of the project were one philosopher—Fredrik Svenaeus—
one historian—Ulla Ekström von Essen—and three ethnologists—
Martin Gunnarson, Susanne Lundin and Markus
Idvall—from Södertörn University and Lund University,
but we also benefitted from the help and advice of medical
researchers and physicians from the Karolinska Institutet
—Annika Tibell and C. G. Groth—and many other scholars
from Sweden and abroad, especially from the Baltic Sea Region.
You will find some of our collaborators represented
as authors in this volume, but most of them are not on the
list of participants, since they, for ethical reasons, have to
remain anonymous. The persons in question have helped
us with information about and access to practices which are
precarious objects of study—organ transplantation and organ
trade—subjects that are highly sensitive and often hard
to speak about for the people involved. We want to thank
the health care personnel, patients and other persons, who
have generously offered us their time without any other
return than to be able to support the growth of knowledge
and reflection in this field. We hope that this book and other
outcomes of our research project, such as articles in journals
and newspapers, and presentations at conferences and
meetings with the public, will help to build sound political
judgement and policies on organ, tissue and cell donation.
The rules and procedures of organ, tissue and cell transfer
are, indeed, vital, not only in the sense that they concern
who will live and who will die, but also in the sense that
the decisions in question determine how we are to view the
moral essence of human relationships as such. What duties
do we owe to each other regarding the giving away of what is
most intimately ours: our bodies and the organs, tissues and
cells they consist of? And what limits should we set regarding
procuring and transferring the “things” in question?