Bioethics

22 Part V: Resource Allocation

23 Introduction 45 In a Pandemic, Should We Save Younger Lives? YES – Peter Singer NO – Lucy Winkett YES NO YES NO 46 The Value of Life I The Moral Significance of Age 47 Bubbles under the Wallpaper Bubbles under the Wallpaper A Rights‐Based Approach? Randomness to the Rescue? Conclusion References 48 Rescuing Lives 49 Should Alcoholics Compete Equally for Liver Transplantation? Should Patients with ARESLD Receive Transplants? Objections to Proposal Reasons Patients with ARESLD Should Have a Lower Priority on Transplant Waiting Lists Should Any Alcoholics Be Considered for Transplantation? Need for Further Research Comment References

24 Part VI: Obtaining Organs

25 Introduction 50 Organ Donation and Retrieval 51 The Case for Allowing Kidney Sales References 52 Ethical Issues in the Supply and Demand of Kidneys Brief Background: The Status Quo Systems of Kidney Procurement Anti‐Market Considerations The Integrity of the Body Policy 53 The Survival Lottery

26 Part VII: Ethical Issues in Research

27 Introduction

28 Experimentation with Humans 54 Belmont Report A Boundaries between Practice and Research B Basic Ethical Principles C Applications 55 Scientific Research is a Moral Duty Do No Harm Fairness The Moral Imperative for Research Do Universal Moral Principles Deny This Claim? Is There an Enforceable Obligation to Participate in Research? Mandatory Contribution to Public Goods Benefit Sharing A New Principle of Research Ethics On Whom Does the Obligation to Participate in Research Fall? Me and My Kind Children and the Incompetent Inducements to Participate in Research Conclusion References 56 Participation in Biomedical Research is an Imperfect Moral Duty The Principle of Beneficence The Principle of Fairness Conclusions References 57 Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries Asking the Wrong Research Question Inadequate Analysis of Data from ACTG 076 and Other Sources Defining Placebo as the Standard of Care in Developing Countries Justifying Placebo‐Controlled Trials by Claiming They Are More Rapid Toward a Single International Standard of Ethical Research References 58 We’re Trying to Help Our Sickest People, Not Exploit Them 59 Pandemic EthicsThe Case for Risky Research 1 The Principle of Risk Parity References

29 Experimentation with Animals 60 Duties towards Animals 61 A Utilitarian View 62 The Harmful, Nontherapeutic Use of Animals in Research is Morally Wrong Methods Some Distracting Issues not Discussed in Detail Some Objections: “Animal Experimentation is Morally Permissible Because …” A Positive, Cumulative Case in Defense of Animals References 63 The Use of Nonhuman Animals in Biomedical Research Arguments Against the Use of Animals in Scientific Research Ethics of Animal Research The Moral Status of Animals Rejecting the Extremes of the Spectrum Equal Consideration of Equal Interests Human Ability to Challenge Nature and Suffering is Unique Utilitarian Considerations What About Marginal Cases? Human Relationships Are Unique: The Human Family Assuming Responsibility and Stewardship Conclusion References 64 Ethical Issues When Modelling Brain Disorders in Non‐Human Primates Introduction Trends in Disease Modelling Post‐CRISPR Methodological Starting Point Conclusion References

30 Academic Freedom and Research 65 On Liberty Chapter II: Of The Liberty of Thought and Discussion 66 Should Some Knowledge Be Forbidden? 1 Introduction 2 A Case Study: The Right to Equality versus the Right to Freedom of Research 3 Past Precedents 4 The Third Precedent 5 Conclusion References 67 Academic Freedom and RaceYou Ought Not to Believe What You Think May Be True 1 An Intelligible Hypothesis 2 Not Believing What You Think May Be True 3 Not Discussing What Some Think To Be True 4 Not Using Science to Investigate the Truth 5 From Advice to Sanctions 6 The Dead Hand of Ignorance 7 The Appeal to Paradigms of Irrationality 8 Compromises 9 The Bright Light of Knowledge 10 Armageddon 11 Some History and Rhetoric References Further Reading

31 Part VIII: Public Health Issues

32 Introduction 68 Ethics and Infectious Disease I Distribution of Research Resources II The Ethical Importance of Infectious Disease III Why the Neglect? Conclusion 69 XDR‐TB in South Africa The Threat to Regional and Global Health The True Extent of the Problem Factors Fuelling the Outbreak Factors That Could Undermine Efforts to Tackle the Outbreak Is There a Role for Involuntary Detention? Conclusion References 70 Clinical Ethics During the Covid‐19 PandemicMissing the Trees for the Forest Introduction Clinical Ethics Challenges Arising in the Care of Covid‐19 Patients Clinical Ethics Considerations in the Care of “Non‐Covid‐19” Patients Moral Distress of Healthcare Providers References 71 The Moral Obligation to be Vaccinated:Utilitarianism, Contractualism, and Collective Easy Rescue Introduction From Collective to Individual Responsibility The Utilitarian Approach: Group Beneficence and Imperceptible Contributions The Deontological Approach Duty of Easy Rescue and Fairness: A Further Argument for an Individual Moral Obligation to be Vaccinated Conclusion References 72 Taking Responsibility for Responsibility Responsibility for Health The Social Determinants of Health Taking Responsibility for Responsibility References

33 Part IX: Ethical Issues in the Practice of Healthcare

34 Introduction

35 When do Doctors have a Duty to Treat? 73 What Healthcare Professionals Owe Us Introduction What Healthcare Professionals Owe Us Neoliberalism and the Fetishisation of ‘Efficiency’ Implications for Healthcare Professionals’ Obligations Conclusion References 74 Conscientious Objection in Health Care Introduction What is Conscientious Objection? Assessing Approaches to Conscientious Objection in Health Care Conscientious Objection vs. Obstruction Conclusion 75 Conscientious Objection in Medicine Introduction Conscience – What Is It, and Does It Matter? Conscience Claims – Should They be Reasonable and Genuine? Conscience and Professionalism Voluntariness and Monopoly Equality of Opportunity Diversity Equal Citizenship Peaceful Co‐existence Conclusion References

36 Confidentiality 76 Confidentiality in Medicine Two Aspects of Medical Confidentiality The Role of Confidentiality in Medicine Possible Solutions to the Confidentiality Problem Afterthought: Confidentiality and Indiscretion Conclusion 77 A Defense of Unqualified Medical Confidentiality The Case of the Infected Spouse Clearing the Ground: What Professional Obligations Are Not The Concept of a Professional Obligation The Duty to Diminish Risks to Third Parties A Defense of Unqualified Confidentiality Concluding Remarks References

37 Truth-Telling 78 On a Supposed Right to Lie from Altruistic Motives 79 Should Doctors Tell the Truth? 80 On Telling Patients the Truth

38 Informed Consent and Patient Autonomy 81 On Liberty 82 From Schloendorff v. NewYork Hospital 83 Informed Consent The Historical Foundations of Informed Consent The Concept of Informed Consent Current Challenges to Informed Consent Conclusion 84 The Doctor–Patient Relationship in Different Cultures “Physicians Treat Patients Badly” Similarities and Differences Conceptions of Autonomy: East and West Truth‐Telling 85 Transgender Children and the Right to Transition 1 Introduction 2 Gender Dysphoria and Treatment for Transgender Youth 3 Psychological Harm and Epistemic Barriers 4 The Physical Risks 5 Justifying Intervention 6 Spreading the Word and the Role of Schools 7 Objections and How to Answer Them 8 Review and Concluding Remarks References 86 Amputees by Choice 87 Rational Desires and the Limitation of Life‐Sustaining Treatment The President’s Commission Report Part I.What is Autonomy? Part III. Limitations of Treatment of Incompetent Patients Limitation of Treatment of Competent Patients Two Objections Conclusion