On the mainstream view, consciences are valuable because they promote moral unity. However, conscience, so defined, will systematically prevent moral growth that threatens unity, even when unity has formed around oppressive moral values. This motivates Carolyn McLeod's alternative 'Dynamic View' whereby consciences are valuable to the extent that they are dynamic. Consciences are dynamic when they interact with our best moral judgements to shape or 'retool' the moral values underpinning conscience, sometimes at an initial cost to unity. We modify and extend McLeod's account in two ways: (1) We object to her claim that conscience encourages its own retooling. We argue that the opposite is true - conscience creates a motivational barrier to change that moral judgement must overcome to successfully retool conscience. The task of ensuring dynamism, therefore, falls to moral judgement. (2) However, this motivational barrier enables conscience to play a valuable role that McLeod overlooks - compensating for the limitations of moral judgement. On our Balanced View, the value of conscience depends on it being sufficiently open to being shaped by our best moral judgements but inert enough to compensate for distorted moral judgements and to guide action when under cognitive load.

Libertarians are attracted to the self-ownership thesis because it seems to satisfy four important theoretical . First, the thesis treats all persons equally by assigning them the same initial set of rights. Second, the thesis gives people the strongest set of ownership rights possible. Third, it assigns persons a determinate set of rights. And, finally, it grounds the libertarian rejection of a duty to assist, benefit, or rescue others. This article argues that these four cannot be simultaneously satisfied. Specifically, it contends that the first three can be jointly satisfied only if the thesis merely gives people the right to their owned bodies in various actions (as opposed to a stronger version of the thesis that gives people permissions to do things with their bodies). However, such an interpretation of the thesis will not satisfy the final desideratum. Thus, libertarians face a tetralemma when defining the self-ownership thesis.

This article examines compulsory vaccination from the perspective of Nozick's theory of rights. It argues that the unvaccinated are a threat, even if unintended, to the rights of others. The reasons Nozick provides for when such threats may be forcibly prevented, such as the identifiability of the rights violator, general fear of the risky activity, probability of harm, and the general benefits of the activity, are examined, and it is argued that those reasons weigh in favour of prohibition of the threat and hence in favour of compulsory vaccination. It is also argued that anyone opposed to compulsory vaccination on Nozickian grounds faces a dilemma: if they reject compulsory vaccination, they also risk rejecting the very foundations of the legitimacy of the state.

The COVID-19 global pandemic has shone a light on several important ethical questions, ranging from fairness in resource allocation to the ethical justification of government mandates. In addition to these institutional issues, there are also several ethical questions that arise at the interpersonal level. This article focuses on several of these issues. In particular, I argue that, despite the insistence in public health messaging that avoiding infecting others constitutes 'saving lives', virus transmission that results in death constitutes an act of killing. Whether this killing is wrongful depends on several factors. I consider one intuitively plausible view - namely, that in many cases, killing via unintentional transmission is not wrongful, because the parties in question have implicitly waived their rights against this harm, often via reciprocal-risk imposition. I argue that this view is mistaken, but that its central insight can be better captured by identifying the appropriate standards of blame that we ought to apply during a pandemic. I conclude by showing how these conclusions can be fruitfully applied to certain institutional questions, such as helping to justify restrictive government mandates.

Nudges are often defended on the basis that they merely substitute existing influences on choice with other influences that are similar in kind; they introduce no new kind of influence into the choice situation. I motivate the view that, if this defence succeeds in establishing the moral innocuousness of typical nudges, it also establishes the moral innocuousness of an intuitively wrongful neurochemical intervention. I then consider two attempts to rebut this view and argue that both fail. I end by spelling out four stances that the proponent of the defence might adopt in response to my argument.

In this article, we aim to map out the complexities which characterise debates about the ethics of vaccine distribution, particularly those surrounding the distribution of the COVID-19 vaccine. In doing so, we distinguish three general principles which might be used to distribute goods and two ambiguities in how one might wish to spell them out. We then argue that we can understand actual debates around the COVID-19 vaccine - including those over prioritising vaccinating the most vulnerable - as reflecting disagreements over these principles. Finally, we shift our attention away from traditional discussions of distributive justice, highlighting the importance of concerns about risk imposition, special duties, and social roles in explaining debates over the COVID-19 vaccine. We conclude that the normative complexity this article highlights deepens the need for decision-making bodies to be sensitive to public input.

We explore the ethics of deliberately exposing consenting adults to SARS-CoV-2 to induce immunity to the virus ('DEI' for short). We explain what a responsible DEI program might look like. We explore a consequentialist argument for DEI according to which DEI is a viable harm-reduction strategy. Then we consider a nonconsequentialist argument for DEI that draws on the moral significance of consent. Additionally, we consider arguments for the view that DEI is unethical on the grounds that, given that large-scale DEI would be highly likely to result in some severe illnesses and deaths, DEI amounts to a form of killing. Our thesis is that incorporating a DEI program alongside the status quo 'calibrate the curve' responses could have significant advantages at the early stages of pandemics. These potential advantages mean that, at a minimum, research into DEI would have been justified early in the COVID-19 pandemic and that DEI programs should be explored as potential additions to our overall approach to emerging pandemics in the future.

Over the past few decades, Indigenous communities have successfully campaigned for greater inclusion in decision-making processes that directly affect their lands and livelihoods. As a result, two important participatory rights for Indigenous peoples have now been widely recognized: the right to consultation and the right to free, prior and informed consent (FPIC). Although these participatory rights are meant to empower the speech of these communities-to give them a proper say in the decisions that most affect them-we argue that the way these rights have been implemented and interpreted sometimes has the opposite effect, of denying them a say or 'silencing' them. In support of this conclusion we draw on feminist speech act theory to identify practices of locutionary, illocutionary, and perlocutionary group silencing that arise in the context of consultation with Indigenous communities.

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom's National Health Service, one strand of this latter response is the 'No Blame Culture', which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between someone and holding them responsible. This article argues for a 'responsibility culture', where healthcare professionals are held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of 'responsibility without blame', applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors.

I argue that there are significant moral reasons in addition to harm prevention for making vaccination against certain common infectious diseases compulsory. My argument is based on an analogy between vaccine refusal and tax evasion. First, I discuss some of the arguments for compulsory vaccination that are based on considerations of the risk of harm that the non-vaccinated would pose on others; I will suggest that the strength of such arguments is contingent upon circumstances and that in order to provide the strongest defence possible of compulsory vaccination, such arguments need to be supplemented by additional arguments. I will then offer my additional argument for compulsory vaccination: I will argue that in both cases of vaccine refusal and of tax evasion individuals fail to make their fair contribution to important social and public goods, regardless of whether each individual contribution 'makes a difference'. While fairness considerations have sometimes been used to support a moral duty to vaccinate, they have not been appealed to in order to argue for a legal duty to vaccinate. I will suggest that this is due, among other things, to a misapplication of the principle of the least restrictive alternative in public health. Finally, I will address nine possible objections to my argument.

Anonymity promotes free speech by protecting the identity of people who might otherwise face negative consequences for expressing their ideas. Wrongdoers, however, often abuse this invisibility cloak. Defenders of anonymity online emphasise its value in advancing public debate and safeguarding political dissension. Critics emphasise the need for identifiability in order to achieve accountability for wrongdoers such as trolls. The problematic tension between anonymity and identifiability online lies in the desirability of having low costs (no repercussions) for desirable speech and high costs (appropriate repercussions) for undesirable speech. If we practice either full anonymity or identifiability, we end up having either low or high costs in all online contexts and for all kinds of speech. I argue that free speech is compatible with instituting costs in the form of repercussions and penalties for controversial and unacceptable speech. Costs can minimise the risks of anonymity by providing a reasonable degree of accountability. Pseudonymity is a tool that can help us regulate those costs while furthering free speech. This article argues that, in order to redesign the Internet to better serve free speech, we should shape much of it to resemble an online masquerade.

Germline Gene Editing (GGE) has enormous potential both as a research tool and a therapeutic intervention. While other types of gene editing are relatively uncontroversial, GGE has been strongly resisted. In this article, we analyse the ethical arguments for and against pursuing GGE by allowing and funding its development. We argue there is a strong case for pursuing GGE for the prevention of disease. We then examine objections that have been raised against pursuing GGE and argue that these fail. We conclude that the moral case in favour of pursuing GGE is stronger than the case against. This suggests that pursuing GGE is morally permissible and indeed morally desirable.

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.

Many critics have suggested that international paid surrogacy is exploitative. Taking such concerns as its starting point, this article asks: (1) how defensible is the claim that international paid surrogacy is exploitative and what could be done to make it less exploitative? (2) In the light of the answer to (1), how strong is the case for prohibiting it? Exploitation could in principle be dealt with by improving surrogates' pay and conditions. However, doing so may exacerbate problems with consent. Foremost amongst these is the argument that surrogates from economically disadvantaged countries cannot validly consent because their background circumstances are coercive. Several versions of this argument are examined and I conclude that at least one has some merit. The article's overall conclusion is that while ethically there is something to be concerned about, paid surrogacy is in no worse a position than many other exploitative commercial transactions which take place against a backdrop of global inequality and constrained options, such as poorly-paid and dangerous construction work. Hence, there is little reason to single surrogacy out for special condemnation. On a policy level, the case for prohibiting international commercial surrogacy is weak, despite legitimate concerns about consent and background poverty.

The prospect of consumable meat produced in a laboratory setting without the need to raise and slaughter animals is both realistic and exciting. Not only could such meat become popular due to potential cost savings, but it also avoids many of the ethical and environmental problems with traditional meat productions. However, as with any new technology, meat is likely to face some detractors. We examine in detail three potential objections: 1) meat is disrespectful, either to nature or to animals; 2) it will reduce the number of happy animals in the world; and 3) it will open the door to cannibalism. While each objection has some attraction, we ultimately find that all can be overcome. The upshot is that meat production is generally permissible and, especially for ethical vegetarians, worth promoting.

The assessment of patients' decision-making capacity (DMC) has become an important area of clinical practice, and since it provides the gateway for a consideration of non-consensual treatment, has major ethical implications. Tests of DMC such as under the Mental Capacity Act (2005) for England and Wales aim at supporting autonomy and reducing unwarranted paternalism by being 'procedural', focusing on how the person arrived at a treatment decision. In practice, it is difficult, especially in problematic or borderline cases, to avoid a consideration of beliefs and values; that is, of the substantive content of ideas rather than simple 'cognitive' or procedural abilities. However, little attention has been paid to how beliefs and values might be assessed in the clinical context and what kind of 'objectivity' is possible. We argue that key aspects of Donald Davidson's ideas of 'Radical Interpretation' and the 'Principle of Charity' provide useful guidance as to how clinicians might approach the question of whether an apparent disturbance in a person's thinking about beliefs or values undermines their DMC. A case example is provided, and a number of implications for clinical practice are discussed.

Many believe that severe intellectual impairment, blindness or dying young amount to serious harm and disadvantage. It is also increasingly denied that it matters, from a moral point of view, whether something is biologically normal to humans. We show that these two claims are in serious tension. It is hard explain how, if we do not ascribe some deep moral significance to human nature or biological normality, we could distinguish severe intellectual impairment or blindness from the vast list of seemingly innocent ways in which we fail to have as much wellbeing as we could, such not having super-intelligence, or not living to 130. We consider a range of attempts to draw this intuitive normative distinction without appealing to normality. These, we argue, all fail. But this doesn't mean that we cannot draw this distinction or that we must, implausibly, conclude that biological normality does possess an inherent moral importance. We argue that, despite appearances, it is not biological normality but rather statistical normality that, although lacking any intrinsic moral significance, nevertheless makes an important moral difference in ways that explain and largely justify the intuitive distinction.

Several authors have suggested that we cannot fully grapple with the ethics of human enhancement unless we address neglected questions about our place in the world, questions that verge on theology but can be pursued independently of religion. A prominent example is Michael Sandel, who argues that the deepest objection to enhancement is that it expresses a Promethean drive to mastery which deprives us of openness to the unbidden and leaves us with nothing to affirm outside our own wills. Sandel's argument against enhancement has been criticized, but his claims about mastery and the unbidden, and their relation to religion, have not yet received sufficient attention. I argue that Sandel misunderstands the notions of mastery and the unbidden and their significance. Once these notions are properly understood, they have surprising implications. It turns out that the value of openness to the unbidden is not just independent of theism, as Sandel claims, but is in fact not even fully compatible with it. But in any case that value cannot support Sandel's objection to enhancement.This is because it is not enhancement but certain forms of opposition to enhancement that are most likely to express a pernicious drive to mastery.

Opponents of biomedical enhancement often claim that, even if such enhancement would benefit the enhanced, it would harm others. But this objection looks unpersuasive when the enhancement in question is a moral enhancement - an enhancement that will expectably leave the enhanced person with morally better motives than she had previously. In this article I (1) describe one type of psychological alteration that would plausibly qualify as a moral enhancement, (2) argue that we will, in the medium-term future, probably be able to induce such alterations via biomedical intervention, and (3) defend future engagement in such moral enhancements against possible objections. My aim is to present this kind of moral enhancement as a counter-example to the view that biomedical enhancement is always morally impermissible.

Many people assume that invasive research on animals is justified because of its supposed benefits and because of the supposed mental inferiority of animals. However probably most people would be unwilling to sign a living will which consigns themselves to live biomedical experimentation if they ever, through misfortune, end up with a mental capacity equivalent to a laboratory animal. The benefits would be greater by far for medical science if living will signatories were to be used, and also the mental superiority boast would no longer apply. Ultimately, it is argued that invasive biomedical experiments would be unacceptable in a democratic society whose members are philosophically self-consistent.

Elizabeth Anderson claims that the argument from marginal cases is 'the central argument' behind the claim that nonhuman animals have rights. But she thinks, along with Cora Diamond, that the argument is 'obtuse'. Two different meanings could be intended here: that the argument from marginal cases is too blunt or dull to dissect the reasons why it makes sense to say that nonhuman animals have rights or that the argument from marginal cases is insensitive regarding nonrational human beings (the marginal cases of humanity). The purpose of the present article is to argue that, despite Anderson's and Diamond's nuanced and perceptive treatments of the argument from marginal cases, this argument is not obtuse in either sense of the term.