Rural Bioethics: The Alaska Context.

With by far the lowest population density in the United States, myriad challenges attach to healthcare delivery in Alaska. In the "Size, Population, and (In)Accessibility" section, we characterize this geographic context, including how it is exacerbated by lack of infrastructure. In the "Distributing Healthcare" section, we turn to healthcare economics and staffing, showing how these bear on delivery-and are exacerbated by geography. In the "Health Care in Rural Alaska" section, we turn to rural care, exploring in more depth what healthcare delivery looks like outside of Alaska's major cities. This discussion continues in the "Alaska's Native Villages" section, which specifically analyzes healthcare in Alaska's indigenous villages, some of the smallest and most isolated communities in the United States. Though many of the ways we could improve Alaskan health care for Alaskan residents are limited by its unique features, the "Justice and Healthcare Delivery" and "Technology and Telemedicine" sections consider ways in which certain policies and technology-including telemedicine-could mitigate the challenges developed in previous sections.

What are applied ethics?

This paper explores the relationships that various applied ethics bear to each other, both in particular disciplines and more generally. The introductory section lays out the challenge of coming up with such an account and, drawing a parallel with the philosophy of science, offers that applied ethics may either be unified or disunified. The second section develops one simple account through which applied ethics are unified, vis-à-vis ethical theory. However, this is not taken to be a satisfying answer, for reasons explained. In the third section, specific applied ethics are explored: biomedical ethics; business ethics; environmental ethics; and neuroethics. These are chosen not to be comprehensive, but rather for their traditions or other illustrative purposes. The final section draws together the results of the preceding analysis and defends a disunity conception of applied ethics.

The coming era of nanomedicine.

This essay presents some general background on nanomedicine, particularly focusing on some of the investment that is being made in this emerging field. The bulk of the essay, however, consists of explorations of two areas in which the impacts of nanomedicine are likely to be most significant: diagnostics and medical records and treatment, including surgery and drug delivery. Each discussion includes a survey some of the ethical and social issues that are likely to arise in these applications.

Medical Error and Moral Luck.

Medical error is the third-leading cause of death in the United States, but there has been little work done on the associated conceptual and normative questions. What is medical error? Is all medical error bad? The first section of this paper surveys the dominant conception of medical error-promulgated by the Institute of Medicine-and tries to understand whether error necessarily eventuates in adverse events. The second section challenges an asymmetry in the way that we think about error: For example, the received view would allow that undertesting could comprise medical error, whereas overtesting cannot. The third section considers the concept of moral luck and how it bears on our ascriptions of medical error.

Medical immunity, international law and just war theory.

Under customary international law, the First Geneva Convention and Additional Protocol I, medical personnel are protected against intentional attack. In § 1 of this paper, we survey these legal norms and situate them within the broader international humanitarian law framework. In § 2, we explore the historical and philosophical basis of medical immunity, both of which have been underexplored in the academic literature. In § 3, we analyse these norms as applied to an attack in Afghanistan (2015) by the United States; the United States was attempting to target a Taliban command-and-control centre but inadvertently destroyed a Médecins Sans Frontières hospital instead, killing 42 people. In § 4, we consider forfeiture of medical immunity and, more sceptically, whether supreme emergency could justify infringement of non-forfeited protected status.

Germ-line genetic enhancement and Rawlsian primary goods.

Genetic interventions raise a host of moral issues and, of its various species, germ-line genetic enhancement is the most morally contentious. This paper surveys various arguments against germ-line enhancement and attempts to demonstrate their inadequacies. A positive argument is advanced in favor of certain forms of germ-line enhancements, which holds that they are morally permissible if and only if they augment Rawlsian primary goods, either directly or by facilitating their acquisition.

Telomeres and the ethics of human cloning.

In search of a potential problem with cloning, I investigate the phenomenon of telomere shortening which is caused by cell replication; clones created from somatic cells will have shortened telomeres and therefore reach a state of senescence more rapidly. While genetic intervention might fix this problem at some point in the future, I ask whether, absent technological advances, this biological phenomenon undermines the moral permissibility of cloning.

Evolutionary ethics from Darwin to Moore.

Evolutionary ethics has a long history, dating all the way back to Charles Darwin. Almost immediately after the publication of the Origin, an immense interest arose in the moral implications of Darwinism and whether the truth of Darwinism would undermine traditional ethics. Though the biological thesis was certainly exciting, nobody suspected that the impact of the Origin would be confined to the scientific arena. As one historian wrote, 'whether or not ancient populations of armadillos were transformed into the species that currently inhabit the new world was certainly a topic about which zoologists could disagree. But it was in discussing the broader implications of the theory...that tempers flared and statements were made which could transform what otherwise would have been a quiet scholarly meeting into a social scandal' (Farber 1994, 22). Some resistance to the biological thesis of Darwinism sprung from the thought that it was incompatible with traditional morality and, since one of them had to go, many thought that Darwinism should be rejected. However, some people did realize that a secular ethics was possible so, even if Darwinism did undermine traditional religious beliefs, it need not have any effects on moral thought. Before I begin my discussion of evolutionary ethics from Darwin to Moore, I would like to make some more general remarks about its development. There are three key events during this history of evolutionary ethics. First, Charles Darwin published On the Origin of the Species (Darwin 1859). Since one did not have a fully developed theory of evolution until 1859, there exists little work on evolutionary ethics until then. Shortly thereafter, Herbert Spencer (1898) penned the first systematic theory of evolutionary ethics, which was promptly attacked by T.H. Huxley (Huxley 1894). Second, at about the turn of the century, moral philosophers entered the fray and attempted to demonstrate logical errors in Spencer's work; such errors were alluded to but never fully brought to the fore by Huxley. These philosophers were the well known moralists from Cambridge: Henry Sidgwick (Sidgwick 1902, 1907) and G.E. Moore (Moore 1903), though their ideas hearkened back to David Hume (Hume 1960). These criticisms were so strong that the industry of evolutionary ethics was largely abandoned (though with some exceptions) for many years. Third, E.O. Wilson, a Harvard entomologist, published Sociobiology: The New Synthesis in 1975 (Wilson E.O. 1975), which sparked renewed interest in evolutionary ethics and offered new directions of investigation. These events suggest the following stages for the history of evolutionary ethics: development, criticism and abandonment, revival. In this paper, I shall focus on the first two stages, since those are the ones on which the philosophical merits have already been largely decided. The revival stage is still in progress and we shall eventually find out whether it was a success.