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The development of social assistive robots for supporting healthcare provision faces a lack of an ethical approach that adequately addresses the normatively relevant challenges regarding its deployment. Current ethical reflection is primarily informed by an individual-centered perspective focused on robots' implications for their end-users and thereby limited to the dyadic human-robot interaction sphere. Considering that this is tightly correlated to the restricted understanding of core ethical concepts upon which reflection stands, this paper delves into the concept of freedom from a philosophical perspective to unfold its full normative breadth for a critical assessment of technological development. By bringing to the fore the political-structural dimension of freedom and, in turn, elaborating the political dimension of technology, the undertaken philosophical approach discloses freedom as a transversal ethical concept for a normative reflection on technology. Thereby, it broadens the scope of ethical attention beyond the sphere of human-robot interaction and turns attention to the so far overlooked structural dimension of human-robot relations. Drawing on conceptions of freedom as non-domination, among others, the paper approaches social assistive robotics and reexamines the terrain of relevant issues for its development. Since freedom is one major issue upon which current concerns revolve, the undertaken analysis substantially enriches the ongoing ethical discussion on social assistive robotics' implications for human freedom. In this way, this work contributes to going beyond the current individual-centered ethical perspective by laying conceptual grounds for a comprehensive ethical approach to social assistive robotics' development.

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In a bid to boost fertility levels, Iran and Japan have recently launched their own dating apps, with more countries likely to follow. The aim of this article is to consider whether state-run dating apps are morally desirable, which is a question that has not received any scholarly attention. It finds that such apps have at least two benefits that collectively, if not individually, render their introduction to be welcomed provided certain conditions are met. These benefits are that they are better placed than commercial dating apps such as Tinder, Bumble, and Badoo to (i) help people find lasting love and to (ii) protect individuals from spending too much money and/or time on online dating. Several objections are discussed and shown to be unconvincing as arguments against state-run dating apps tout court, including the objection that for states to offer their own dating apps is unduly expensive; the objection that it gives them too much power; and the objection that they should invest in creating offline opportunities for meeting potential partners instead.

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Settling the debate over conscientious refusal (CR) in liberal democracies requires us to develop a conception of the healthcare provider's moral role. Because CR claims and resulting policy changes take place in specific sociopolitical contexts with unique histories and diverse polities, the method we use for deriving the healthcare norms should itself be a democratic, context-dependent inquiry. To this end, I begin by describing some prerequisites-which I call publicity conditions-for any democratic account of healthcare norms that conflict or jibe with CR. Next, drawing on Ronald Dworkin's jurisprudence and Tom Beauchamp & James Childress's approach to bioethical reasoning, I briefly introduce one method for generating healthcare norms that is faithful to the publicity conditions and has potential to constructively, and democratically, derive important boundaries for CR. Finally, I argue that many critics of CR fail to similarly ground their accounts of healthcare norms in healthcare professionals' sociopolitical contexts, often relying instead on their own interpretation of a generally stateable healthcare norm. This leads to their misconstruing both the value judgments on which their own approaches rest and the public, political values that are often invoked in favor of CR.

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A considerable literature has emerged around the idea of using 'personal responsibility' as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as 'responsibilisation'. This discussion focuses most prominently, but not exclusively, on 'luck egalitarianism', the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two-way relationship between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the 'harshness objection') in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem.

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Research participants are afforded protections to ensure their rights and welfare are not unduly jeopardized by research activities. Yet people who do not meet the criteria for research participant status may likewise be impacted by research activities, and ethicists argue that protections should be afforded these "research bystanders." The standard rationale for extending protections to research bystanders contends that they are sufficiently like research participants that the ethical principles governing health research ought to extend to them. In this article we argue that this analogical reasoning is mistaken. Salient moral differences mean that research ethics frameworks are not fit for purpose. We defend the research bystander category by articulating a novel foundation for this new class of stakeholder. Focusing on bystanders directly impacted by publicly funded health research, we argue that bystanders are sometimes owed protections-but neither because of their similarity to research participants nor because research ethics principles should extend to them. Instead, we reframe the issue as a question of justice. Building on the work of Douglas MacKay, we argue that bystanders to publicly funded health research are owed protections as citizens of liberal states to whom the state owes duties of justice. The state has duties to protect the interests of citizens and to conduct health research. When the means by which the state fulfils the latter duty comes into conflict with the means by which it fulfils the former, the state must ensure that those impacted, including research bystanders, are afforded protections.

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In "Justice as Fairness: Political not Metaphysical," John Rawls suggests an approach to a public conception of justice that eschews any dependence on metaphysical conceptions of justice in favor of a political conception of justice. This means that if there is a metaphysical conception of justice that actually obtains, then Rawls' theory would not (and could not) be sensitive to it. Rawls himself admitted in Political Liberalism that "the political conception does without the truth." Similarly, in Law of Peoples, Rawls endorses a political conception of justice to govern the society of peoples that is not concerned with truth, but instead concerned with being sufficiently neutral so as to avoid conflict with any reasonable comprehensive doctrines. The odd result is that this neutrality excludes any conception of truth at all. Therefore, in times of crisis that demand incisive decision making based on scientific, economic or moral considerations, public reason will stall because it can contain no coherent conception of truth.

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Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the paper arrives at the following three conclusions: (1) that we have strong prioritarian reasons for special concern about the vulnerable and socially disadvantaged in reference to pandemic effects, (2) that severity of illness is an important factor in identifying the worse off in priority setting but that this must not over-ride the special priority to the socially disadvantaged and (3) that the maximisation rationale of the age-weighted view runs against the core prioritarian idea, and the age-weighted prioritarianism is thus unfitting as a prioritarian response to the COVID-19 case.

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Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis (CBA), a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences-say, for a coffee-might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon's contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges.

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Cox and Fritz state the central problem as the absence of a framework for healthcare policy decisions; but, they overlook the theoretical underpinnings of public law. In response, they propose a two-step procedure to guide fair decision-making. The first step relies on Thomas Scanlon's 'contractualism' for stakeholders to consider whether, or not, they could reasonably reject policy proposals made by others; then in the second step, John Rawls's principles of justice are applied to these proposals; a fair policy requires to pass both steps. I argue that Cox and Fritz misinterpret Rawls. His theory has two stages: first, public reason is used to generate principles of justice; second, public reason is used to interpret and apply these principles. The second stage requires that proposals are based on the principles of justice from the first stage, and these proposals have to be acceptable to reasonable persons. Thus, Rawls's theory does not need Scanlonian supplementation. Moreover, the application of Rawls's theory in Cox and Fritz's model is confusing. In any case, the problems with applying Rawlsian justice to healthcare can be located elsewhere. First, Rawls's theory would treat healthcare simply as a 'primary good' or resource. Social justice ought to, instead, consider healthcare as an opportunity, in the manner conceived by Amartya Sen. Second, Rawlsian justice rests, ultimately, on the conception of a reasonable person; until and unless the characteristics of reasonable stakeholders are clarified, any model of health justice will remain hostage to the unreasonable.

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Gender-affirming healthcare (GAH) interventions are medical or surgical interventions that aim to allow trans and non-binary people to better affirm their gender identity. It has been argued that rights to GAH must be grounded in either a right to be cured of or mitigate an illness-gender dysphoria-or in harm prevention, given the high rates of depression and suicide among trans and non-binary people. However, these grounds of a right to GAH conflict with the prevalent view among theorists, institutions and activists that trans and non-binary people do not have a mental illness and that one can be trans and entitled to GAH without being depressed or suicidal. This paper challenges the orthodoxy that a right to GAH must be grounded in either of these ways and instead argues for a right to GAH grounded in a right to live and act with integrity. The standard view, which this paper explains, is that our rights to live and act with integrity ground a right to religious accommodation in many cases such as a right to not be denied social security due to one's refusal to work a job on a holy day. This paper argues that if our rights to live and act with integrity can ground prima facie rights to religious accommodation, our rights to live and act with integrity ground prima facie rights to GAH.

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The General Medical Council renewed its guidance on consent in 2020. In this essay, I argue that the 2020 guidance does not advance on the earlier, 2008 guidance in regard to treatments that doctors are obliged to offer to patients. In both, doctors are instructed to not provide treatments that are not in the overall benefit, or clinical interests, of the patient; although, patients are absolutely entitled to decline treatment. As such, consent has two aspects, and different standards apply to each aspect. To explore this paradigm, I propose the reconceptualisation of consent as a person's freedom to achieve treatment, using Amartya Sen's approach. Sen explains that freedom has two aspects: process and opportunity. Accordingly, a patient's freedom to achieve treatment would comprise a process for the identification of proper treatment, followed by an opportunity for the patient to accept or decline this treatment. As per Sen, the opportunity aspect is to be assessed by the standard of public reason, whereas the standard for the process aspect is variable and contingent on the task at hand. I then use this reconceptualised view of consent to analyse case law. I show that senior judges have conceived the patient's opportunity to be encompassed in information, which is to be decided by public reason. On the other hand, the process aspect relies on the private reason of medical professionals. Given the nature of professionalism, this reliance is inescapable, and it is maintained in the case law that is cited in both guidances.

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While COVID-19 vaccines provide light at the end of the tunnel in a difficult time, they also bring forth the complex ethical issue of global vaccine distribution. The current unequal global distribution of vaccines is unjust towards the vulnerable living in low-income countries. A vaccine tax should be introduced to remedy this. Under such a scheme, a small fraction of the money spent by a country on vaccines for its own population would go into a fund, such as COVAX, dedicated to buying vaccines and distributing them to the world's poorest. A vaccine tax would provide a much-needed injection of funds to remedy the unequal distribution of vaccines. The tax allows for a distribution that, to a lesser degree, reflects the ability to pay and is superior to a donation-based model because it minimises the opportunity for free-riding.

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This paper presents a novel philosophical analysis of the problem of law enforcement's use of biased face recognition technology (FRT) in liberal democracies. FRT programs used by law enforcement in identifying crime suspects are substantially more error-prone on facial images depicting darker skin tones and females as compared to facial images depicting Caucasian males. This bias can lead to citizens being wrongfully investigated by police along racial and gender lines. The author develops and defends "A Liberal Argument Against Biased FRT," which concludes that law enforcement use of biased FRT is inconsistent with the classical liberal requirement that government treat all citizens equally before the law. Two objections to this argument are considered and shown to be unsound. The author concludes by suggesting that equality before the law should be preserved while the problem of machine bias ought to be resolved before FRT and other types of artificial intelligence (AI) are deployed by governments in liberal democracies.

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Philosophers now commonly reject the value free ideal for science by arguing that non-epistemic values, including personal or social values, are permissible within the core of scientific research. However, little attention has been paid to the normative political consequences of this position. This paper explores these consequences and shows how political theory is fruitful for proceeding in a world without value-neutral science. I draw attention to an oft-overlooked argument employed by proponents of the value free ideal I dub the "political legitimacy argument." This argument claims that the value-free ideal follows directly from the foundational principles of liberal democracy. If so, then the use of value-laden scientific information within democratic decision making would be illegitimate on purely political grounds. Despite highlighting this unaddressed and important argument, I show how it can be rejected. By appealing to deliberative democratic theory, I demonstrate scientific information can be value-laden and politically legitimate. The deliberative democratic account I develop is well suited for capturing the intuitions of many opponents of the value free ideal and points to a new set of questions for those interested in values in science.

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A wide range of non-pharmaceutical interventions (NPIs) have been introduced to stop or slow down the COVID-19 pandemic. Examples include school closures, environmental cleaning and disinfection, mask mandates, restrictions on freedom of assembly and lockdowns. These NPIs depend on coercion for their effectiveness, either directly or indirectly. A widely held view is that coercive policies need to be publicly justified-justified to each citizen-to be legitimate. Standardly, this is thought to entail that there is a scientific consensus on the factual propositions that are used to support the policies. In this paper, we argue that such a consensus has been lacking on the factual propositions justifying most NPIs. Consequently, they would on the standard view be illegitimate. This is regrettable since there are good reasons for granting the state the legitimate authority to enact NPIs under conditions of uncertainty. The upshot of our argument is that it is impossible to have both the standard interpretation of the permissibility of empirical claims in public justification and an effective pandemic response. We provide an alternative view that allows the state sufficient room for action while precluding the possibility of it acting without empirical support.

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In health economics, the distinction between welfarism and extra-welfarism has been employed to discuss various epistemological and normative differences between health evaluation approaches. However, a clear consensus on the definition of either welfarism, extra-welfarism, or the differences between the two sets of approaches has not emerged. I propose an alternative set of distinctions that allows for a more fine-grained categorization of health evaluation approaches. This categorization focuses on five dimensions: (1) the maximand of an evaluation approach, (2) its sensitivity toward normative concerns that defy compensation, (3) its position on which groups of individuals or collective entities act as sources of values, (4) its sensitivity to changes of mind, and (5) the inclusion of process-external values.

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BACKGROUND: Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. METHODS: A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. RESULTS: Three themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. CONCLUSIONS: Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question.

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This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a "zoonotic tax"; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption.

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This paper uses structural analogies to competing political philosophies of human society as a heuristic tool to differentiate between ecological theories and to bring out new aspects of apparently well-known classics of ecological scholarship. These two different areas of knowledge have in common that their objects are 'societies', i.e. units composed of individuals, and that contradictory and competing theories about these supra-individual units exist. The benefit of discussing ecological theories in terms of their analogies to political philosophies, in this case liberalism, democratism and conservatism, consists in the fact that political philosophies show clear differences and particularities as regards their approach to the concepts of individuality and intentional action. The method therefore helps to expose peculiarities of ecological theories that are usually considered canonical (e.g. Clements, Gleason), as well as hybrid forms (E. P. Odum), and to differentiate between two different types of theories about functional wholes. The basis of this method is the constitutional-theoretical premise that modern paradigms of socialization structure the ecological discourse.

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The COVID-19 pandemic has forced clinicians, policy-makers and the public to wrestle with stark choices about who should receive potentially life-saving interventions such as ventilators, ICU beds and dialysis machines if demand overwhelms capacity. Many allocation schemes face the question of whether to consider age. We offer two underdiscussed arguments for prioritising younger patients in allocation policies, which are grounded in prudence and fairness rather than purely in maximising benefits: prioritising one's younger self for lifesaving treatments is prudent from an individual perspective, and prioritising younger patients works to narrow health disparities by giving priority to patients at risk of dying earlier in life, who are more likely to be subject to systemic disadvantage. We then identify some confusions in recent arguments against considering age.