There is ongoing controversy surrounding what ethical weight, if any, should be given to parents’ reasons in the setting of disagreement about a child’s treatment. Parents often readily explain their decisions without prompting. Yet this is not always the case. Some parents do not want to disclose their reasons, while others may struggle to articulate their reasoning. The question of whether parents have an obligation to share their reasons in pediatric decision-making has received limited attention in the bioethics literature. In this paper, we examine these tensions, aiming to clarify the stakes of reason-seeking and reason-giving practices in pediatrics. First, we briefly summarize prevailing views of parental obligations in philosophical and legal theories of the parental role. Second, we present two strong positions on whether parents have an obligation to share their reasons in pediatric decision-making and consider the implications of each. Third, we propose a more nuanced position that recognizes a pro tanto parental obligation. We offer six guiding considerations (disagreement, capacity concerns, parental discretion/harm to the child, complexity, preference sensitivity, and the burden of enacting the decision on others) and three relational features of decision-making that determine the presence and strength of a parental obligation to give reasons. By mapping the contours of parental reason-giving obligations, we seek to establish a stronger ethical foundation for exploration of the parental role and reasons in treatment disagreements.
This essay examines a prominent claim in abortion ethics: that bodily autonomy alone suffices to justify abortion even if the fetus is granted the moral status of a person. Instead of revisiting Thomson’s violinist, it introduces a comparator offered less as a direct analogy to pregnancy than as a stress test of—and possible counterexample to—that claim. It imagines conjoined twin sisters, one temporarily dependent on the other’s body, though a safe separation allowing both to survive is expected within months. The supporting twin’s condition imposes serious but non-catastrophic demands; immediate separation would free her at once but kill her sister. The case combines attached, asymmetric dependence with substantial burden and an impending safe separation. In that setting, the familiar autonomy-based framing of the act as withdrawal of bodily support rather than direct lethal intervention begins to look strained. Engaging Thomson, Boonin, Effron, the English decision In re A, and philosophical and clinical-ethical literature on conjoined-twin separation, the essay argues that where immediate release can be achieved only by advancing a death that need not occur at all, bodily autonomy alone no longer seems sufficient. Resisting that conclusion requires either some further premise (about intention, means, development, or personhood) or willingness to accept the high philosophical cost of claiming that autonomy alone may justify bringing about the death of a dependent person who could survive if one waited.
In this paper, I argue for an expansion of moral concern in bioethics beyond sentience-based and status-based frameworks. Drawing on Lukács' and Honneth's work on reification, I show that even where the sentience, species membership, or moral status of an entity is unknown, there are compelling ethical reasons to be concerned about the creation, manipulation, and use of such entities. I reconceive reification not just as a social pathology but as a moral vice: a disordered, objectifying mode of perception. Understood in this way, reification provides a flexible normative framework that applies across a wide range of entities, including humans, non-human animals, plants, ecosystems, and even inanimate objects. This vice-based approach helps explain why certain modes of interaction are ethically flawed regardless of the moral status of the entity in question. This facilitates a more inclusive ethical sensibility suited to emerging biotechnologies and the ecological challenges that pose an increasingly complex challenge for bioethics.
Safer supply is a medical form of harm reduction in which a patient is prescribed a drug to which they are addicted. Despite ample high-quality evidence that it is a safe and effective last-line treatment for severe, treatment-refractory substance use disorders, safer supply is not widely used or advocated. This is likely due in part to ethical concerns, but I contend that safer supply is ethical by both general moral standards and the professional ethical standards of healthcare. Recent defenses of various harm reduction interventions argue that they are permissible regardless of the moral quality of the drug use they facilitate. I critique those defenses and argue that safer supply is permissible by general moral standards because the medical drug use it supports is not immoral. Furthermore, safer supply does not run afoul of biomedical ethics because it is not maleficent, unhealthful, or nonconsensual. As an evidence-supported and ethically permissible practice, safer supply merits wider use and advocacy.
