Ulysses Contracts in psychiatric care: helping patients to protect themselves from spiralling.

This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment (time 2), they may still be less competent than they were when they signed the Ulysses Contract (time 1). As such, even if competent at time 1 and time 2, there can still be a disparity between the levels of competence at each time. Second, Ulysses Contracts are important to protect people's most meaningful concerns. Third, on the approach defended, the restrictions to people's liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis (the claim that allowing harm is as bad as doing harm), this is still consistent with the claim that, in particular cases, it can be as wrong to allow a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary.

Climate Change and Professional Responsibility: A Declaration of Helsinki for Engineers.

In this paper, we argue that the professional engineering institutions ought to develop a Declaration of Climate Action. Climate change is a serious global problem, and the majority of greenhouse gas emissions come from industries that are enabled by engineers and represented by the engineering professional institutions. If the professional institutions take seriously the claim that a profession should be self-regulating, with codes of ethics that go beyond mere obedience to the law, and if they take their own ethical codes seriously, recognising their responsibility to the public and to future generations (and also recognising a duty of "responsible leadership"), the professional institutions ought to develop a declaration for engineers, addressing climate change. Our argument here is largely inspired by the history of the Declaration of Helsinki. The Declaration of Helsinki was created by the medical profession for the profession, and it held physicians to a higher standard of ethical conduct than was found in the legal framework of individual countries. Although it was not originally a legal document, the influence of the Declaration can be seen in the fact that it is now enshrined in law in a number of different countries. Thus, we argue that the engineering profession could, and should, play a significant role in the abatement of climate change by making changes within the profession. If the engineering profession sets strict standards for professional engineers, with sanctions for those who refuse to comply, this could have a significant impact in relation to our efforts to develop a coordinated response to climate change.

Cake or death? Ending confusions about asymmetries between consent and refusal.

In this paper, I will argue that much of the debate concerning asymmetries between consent and refusal (eg, in a case in which an adolescent is granted a right to consent to treatment, but not a right to refuse treatment) is confused. My aim in this paper is to highlight nuances and ambiguities, and to emphasise the fact that we are not just addressing a puzzle about one asymmetry between consent and refusal. I will show that there are a number of relevant asymmetries, not just the asymmetry of competence. And even if we focus specifically on the asymmetry of competence, we need to recognise that 'asymmetry of competence' is ambiguous. By clarifying these issues, my aim is to end the confusion that is common in this debate, allowing us to make progress on an issue that has previously been considered puzzling.

Ambiguities and Asymmetries in Consent and Refusal: Reply to Manson.

John Harris claims that is it 'palpable nonsense' to suggest that 'a child (or anyone) might competently consent to a treatment but not be competent to refuse it.' In 'Transitional Paternalism: How Shared Normative Powers Give Rise to the Asymmetry of Adolescent Consent and Refusal' Neil Manson aims to explain away the apparent oddness of this asymmetry of consent and refusal, by appealing to the idea of shared normative powers, presenting joint bank accounts as an example. In this article, I will argue that Manson's account fails to explain away the oddness. Rather, I will argue that there are ambiguities to which Manson has not paid sufficient attention. In fact, as odd as it may sound, I argue that Manson actually agrees with Harris (at least in relation to the asymmetry of competence). He fails to recognize that he agrees with Harris because he is not careful enough to distinguish between different asymmetries, which I have labelled the asymmetries of choice, permissibility and competence.

Questioning the significance of the non-identity problem in applied ethics: a reply to Tony Hope.

In this paper I reply to Tony Hope's response to my non-identity paper, aiming to clarify the nature of my objections, and also to address, briefly, Hope's suggestion that the implications of my view are that any book written for a lay audience ought to seek to present a 'balanced overview'. Essentially, I suggest that there may be a pro tanto consideration in favour of such an approach, but this would only be one consideration, to be weighed against competing considerations.

Questioning the significance of the non-identity problem in applied ethics.

Authors such as Tony Hope and Julian Savulescu appeal to Derek Parfit's non-identity problem in relation to particular questions in applied ethics, and particularly in reproductive ethics. They argue that the non-identity problem shows that an individual cannot be harmed by being brought into existence, and therefore, we cannot say that the individual is harmed if, for example, we select an embryo in order to have a deaf child. Thus, they argue that an appeal to the non-identity problem blocks (or significantly reduces the force of) objections in a number of cases. I argue that these discussions often give the impression that this is a clear conclusion, shared by most philosophers, and largely beyond dispute. This is particularly significant because these discussions are often in journals or books with an interdisciplinary readership. My concern is that they give the impression of stating: 'philosophers have studied this issue, and this is the conclusion they have reached. Now I will emphasise the implications for medical ethics'. I argue that, far from being the consensus view, the view presented by Hope and Savulescu is rejected by many, including Parfit himself.

Delaying obsolescence.

This paper argues that those who emphasise that designers and engineers need to plan for obsolescence are too conservative. Rather, in addition to planning for obsolescence, designers and engineers should also think carefully about what they could do in order delay obsolescence. They should so this by thinking about the design itself, thinking of ways in which products could be useful and appealing for longer before becoming obsolete, as well thinking about the wider context in terms of the marketing of products, and also the social and legal. The paper also considers objections that these suggestions are unrealistically idealistic, failing to recognise the economic realities. I respond to these objections appealing to research in advertising, psychology, cognitive linguistics, philosophy, history, and economics, as well as drawing on the Statement of Ethical Principles developed by the Royal Academy of Engineering and the Engineering Council.

Organ sales: exploitative at any price?

In many cases, claims that a transaction is exploitative will focus on the details of the transaction, such as the price paid or conditions. For example, in a claim that a worker is exploited, the grounds for the claim are usually that the pay is not sufficient or the working conditions too dangerous. In some cases, however, the claim that a transaction is exploitative is not seen to rely on these finer details. Many, for example, claim that organ sales would be exploitative, in a way that doesn't seem to depend on the details. This article considers, but ultimately rejects, a number of arguments which could be used to defend this sort of claim.

Organ sales needn't be exploitative (but it matters if they are).

This paper considers two arguments that are common in the literature on organ sales. First, organ sales are exploitative and therefore should not be permitted. Second, it doesn't matter whether organ sales are exploitative or not; the only thing that matters is that we do what is in the interests of those who need to be protected. In this paper, I argue that both of these arguments are too simplistic. My intention, however, is not to argue for or against organ sales. My conclusion, rather, is simply that we cannot hope to address the issue of organ sales if we lack a good understanding of exploitation. We should not attempt to answer the question of whether or not organ sales should be banned on the grounds that they are exploitative without acknowledging and addressing the nuances involved in understanding exploitation.

Moral theories in teaching applied ethics.

It is argued, in this paper, that moral theories should not be discussed extensively when teaching applied ethics. First, it is argued that, students are either presented with a large amount of information regarding the various subtle distinctions and the nuances of the theory and, as a result, the students simply fail to take it in or, alternatively, the students are presented with a simplified caricature of the theory, in which case the students may understand the information they are given, but what they have understood is of little or no value because it is merely a caricature of a theory. Second, there is a methodological problem with appealing to moral theories to solve particular issues in applied ethics. An analogy with science is appealed to. In physics there is a hope that we could discover a unified theory of everything. But this is, of course, a hugely ambitious project, and much harder than, for example, finding a theory of motion. If the physicist wants to understand motion, he should try to do so directly. We would think he was particularly misguided if he thought that, to answer this question, he first needed to construct a unified theory of everything.