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.
In recent philosophical discourse, flourishing has emerged as a concept of growing importance-often linked to the field of well-being studies and explored by various and different disciplines. The article approaches flourishing not as an abstract ideal, but rather as a condition that must be understood as rooted in the lived reality of human vulnerability. More specifically, I argue that any genuine account of human flourishing must regard vulnerability- human inherent fragility and reciprocal dependence-not as an impediment, but as the very foundation from which meaningful flourishing can arise. Building on Alasdair MacIntyre's reflections-who observes that this perspective is insufficiently acknowledged in comparison to the prevailing standard of moral philosophy-I understand vulnerability as a fundamental human characteristic arising from the interconnectedness of dependence, rationality, and animality. The second part of the paper engages with phenomenological perspectives in order to establish a dialogue between this tradition and MacIntyre's framework of virtue ethics. The aim is to anchor the concept of a virtuous moral life-implicit in the notion of flourishing-in the lived, embodied experience of the individual. In this light, three fundamental categories intrinsic to human vulnerability are identified as essential compass points for understanding what must be preserved, pursued, and guaranteed even under conditions of extreme fragility. Only by attending to these dimensions-embodiment, co-existence and lived temporality-can ensure that the human environment remains habitable, and thus adequate for a disposition toward flourishing.
Social camouflaging—broadly defined as the suppression or modulation of autistic traits to conform to dominant ableist social norms—has become a dominant construct in autism research. Yet despite its empirical and cultural prominence, the concept has not undergone sustained philosophical scrutiny. This paper develops a fourfold critique. Ontologically, camouflaging lacks stability, as it fails to identify a coherent class of phenomena distinguishable from adjacent behaviours. Epistemologically, it relies on theory-laden and circular methodologies that presuppose what they purport to measure. Logically, it embeds contradictions, particularly in attributing intentional capacities to subjects diagnosed in part on the basis of impaired social reasoning. Ethically, it operates within a dual-normative framework that pathologises deviation while privileging narrow forms of autistic legibility. We argue that deconstructing camouflaging exposes its fragility and raises fundamental questions about the normative commitments underlying psychiatric classification.
Many ethicists who have opposed euthanasia have nonetheless approved of various practices which have been believed to hasten, or risk hastening, the death of terminally ill and suffering patients. For instance, they have approved of a practice which I shall call ‘end-of-life sedation,’ or ‘EOL sedation.’ This practice involves administering drugs with sedating effects to relieve suffering at the end of life. Some have believed that EOL sedation risks hastening death by suppressing respiration in certain cases. The main difference, according to these opponents of euthanasia, is that whereas euthanasia by definition involves an intention to kill, EOL sedation does not. At most, it is argued, EOL sedation foreseeably but unintentionally hastens, or risks hastening death as a byproduct of relieving the patient’s suffering while they are still alive. As such, it has been argued that EOL sedation is supported by the rule of double effect (RDE). In his paper, “The last low whispers of our dead,” Daniel P. Sulmasy raises objections to a specific form of EOL sedation called ‘palliative sedation,’ focusing especially on two variants of that practice which have been defended by Timothy Quill and colleagues. Palliative sedation involves intentionally sedating a patient as a means of relieving their suffering rather than foreseeably sedating them as a byproduct of targeting specific symptoms. Sulmasy argues that palliative sedation, so defined, is neither supported by RDE nor permissible. Here it is argued that Sulmasy’s criticisms of this practice, and of the specific variants of it which he singles out for special criticism, are unsuccessful.
By defending practical wisdom (phronesis) as a multidimensional virtue that complements the moral virtues, we offer a critique of “practical wisdom eliminativism”, with special attention to the context of medicine, arguing that the core dimensions of practical wisdom enjoy broad consensus. As the meta-virtue that demonstrates excellence in ethical decision-making, practical wisdom recognizes and employs the best means to achieve good and worthwhile ends by integrating goals, perception of context, moral virtues, deliberation, reason-guided emotion, and motivation. In medicine, practical wisdom encompasses patient-centered deliberation directed toward ends of health and flourishing that promote the patient’s good. To counter the notion that practical wisdom is a redundant concept (the eliminativist view), we provide philosophical arguments, evidence from medical practitioners, and psychometric data from a detailed empirical study of US and UK adults. Practical wisdom has survived for more than 2300 years as a unified and unifying intellectual meta-virtue that guides the moral virtues. We believe the reasons we put forward explain why phronesis should be expected to endure as a meaningful, multidimensional concept reflecting the nature of moral deliberation in response to practical challenges in life and medicine.
Care has become a key concept in the theoretical literature in nursing and various health professions. However, while there is generally an agreement on the purposes of care, the same cannot be said about the nature of care. Clarifying this point is fundamental to analyzing and understanding the conceptual and ethical presuppositions of medical science and healthcare professions and to determining what to focus on to improve the quality of care. In this sense, important help comes from the discipline of palliative care. For the first time in the debate about caring, Cicely Saunders introduced the concept of ‘total care.’ The perspective of the Hospice Movement’s founder is stimulating, even if methodologically complex, precisely because Sauders’ thought does not have an exclusively speculative character. However, her writings are deeply imbued, even if not explicitly thematized, with philosophical elements, particularly a practical philosophy that arises from experience and is fascinating precisely because it challenges the traditional thought to imagine new hermeneutic horizons. Thus, the first aim of this paper is to connect these philosophical elements and to propose a critical reconstruction, analysis, commentary, and interpretation of the concept of total care in Saunders’ writings. The second objective will be to propose a reflection on the meaning of care, clarifying its profound ethical nature as an act that discerns the best and most appropriate way of being and acting for both the patient and the doctor.
I defend conscientious objection (CO) in the medical profession by refuting the incompatibility thesis (IT). IT maintains that CO is incompatible with fulfilling the objectives and obligations of the medical profession and thus impermissible for medical professionals. To refute IT, I construct a case of conscience-based refusal in parallel with a case of profession-based refusal, such that both cases fulfill the primary objective and core obligation of the medical profession, thereby directly demonstrating the compatibility of CO with fulfilling obligations in the medical profession. I conclude that IT is false and thus that CO is permissible for medical professionals. I then defend my argument against potential objections. My argument strategy is two-fold. First, to avoid begging the question, I follow a neutral definition of CO that is compatible with IT. Second, to make the argument as logically strong as possible, I assume only minimal claims about the primary objective and core obligation of the medical profession that should be acceptable to (at least some) defenders of IT.
An enduring divide separates the biomedical account of disease from the phenomenological understanding of illness. In this article, I develop a two-level counterfactual model that treats these domains as parallel and formally comparable modes of reasoning: the Clinical Counterfactual (CC) for causal hypotheses and the Experiential Counterfactual (EC) for goal-directed patient claims. Grounded in Biostatistical Theory and operationalized through Homeostatic Property Cluster theory, the framework fixes background conditions for counterfactual assessment and anchors diagnosis in causal-mechanistic disruption rather than population averages alone. An Integration Condition evaluates coherence between levels, and an intervention is favored only if at least one admissible scenario exists in which removing the dysfunction resolves the symptom and enables the realization of the patient's valued activity. Practically, I outline a structured documentation workflow in which CCs and ECs are articulated in parallel and linked by a deviation-analysis protocol that is activated when the two levels diverge. The protocol treats disagreement as diagnostically informative, prompting focused re-examination of causal assumptions, value priorities, and evidential gaps. Conceptually, the framework avoids reducing reasons to causes. It employs counterfactual difference-making as a shared analytical language while preserving distinct explanatory roles at each level. Unlike patient-centered outcome approaches that assess values mainly post hoc, this model integrates patient goals ex ante into causal reasoning itself, with patient-reported outcomes serving as downstream validation rather than as the integrative glue. The result is a disciplined and transparent heuristic for clinical reasoning, particularly under conditions of uncertainty, contestation, and incomplete knowledge, that renders causal inferences, patient goals, and normative assumptions explicit and mutually testable.
Services dedicated to clinical ethics consultation (CEC) have rapidly proliferated through American hospital systems. One concern about this notable rate of growth is the possibility that practice has outstripped theory. In particular, it is controversial whether clinical ethicists should offer substantive recommendations as part of their practice. This article addresses the status, legitimacy, and authority of such recommendations, proceeding from the idea that they are to be treated as advisory. Taking this idea seriously and developing it through recent philosophical work on advising helps to defuse challenges to CEC as a profession and promotes a conception of CEC as a collaborative activity with a clear distribution of responsibility between ethicist and stakeholders. Moreover, moral norms for advising that exist in abstraction from particular knowledge domains can help to substantiate and clarify professional norms for CEC practice, including the loci of moral responsibility for patient outcomes, the relationship to patient advocacy, and the norm against functioning as the "ethics police."
Contemporary controlled donation after circulatory determination of death (cDCD) faces a widening epistemic gap: as resuscitative and perfusion technologies expand the ability to restore regional circulation, the inferential distance between the concept of death and bedside determinations becomes more salient. I defend organismic unity—the permanent loss of the organism’s capacity for integrated self-maintenance—as the most defensible biological criterion of death. Yet this criterion is underdeterminate at the bedside: it must be tracked by fallible proxies operating under time pressure and uncertainty. The central claim is modal: if irreversibility is constitutive of death, then protocols must distinguish biological impossibility from practical or policy-based non-intervention. In cDCD contexts, what is often operationally established is not biological irreversibility in the strongest sense but a form of prudential warrant under a normative frame of non-intervention (i.e., permanence). I develop (1) a taxonomy and protocol-facing hierarchy of irreversibility senses, (2) an analysis of what 5-min no-touch intervals can and cannot establish, and (3) a conceptual geography of normothermic regional perfusion (NRP) variants, including the thoracoabdominal hard case. From these epistemic limits I derive second-order safeguards-conservatism, transparency, independence, corrigibility, and public accountability-grounded both in deontic respect for the patient and in the dead donor rule (DDR)’s role as a trust-sustaining commitment device. I conclude that safeguarding the dead donor rule in the age of NRP requires neither metaphysical pretense nor DDR abandonment, but institutional integrity: taxonomic clarity about irreversibility, verifiable cerebral exclusion, and second-order safeguards that make uncertainty governable.
Analytical and conceptual engineering approaches converge in showing that harm should be a necessary component of the general concept of mental disorder, particularly within the Diagnostic and Statistical Manual of Mental Disorders (DSM). Nevertheless, the notion of harm in this and similar manuals remains vague and insufficiently defined. Using conceptual engineering, which refines or constructs concepts to better serve theoretical and practical aims, I develop an explication of psychiatric harm. Psychiatric harm arises when psychological inabilities obstruct the formation or pursuit of admissible conceptions of the good life. I reject definitions grounded in uncritical social consensus, rationalist exclusions, or essentialist ideals of human flourishing, and instead propose standards rooted in normative pluralism and democratic values that respect individual diversity. Finally, I indicate that this framework could be operationalised through methodologies exemplified by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF).
Every aspect of what healthcare professionals do for patients is ethically significant, so it might seem strange that, when healthcare professionals are asked if anything ethically significant has occurred, their answer frequently is: “No, there were no ethical issues here.” But this answer does not mean that nothing ethically significant occurred during their caregiving. For healthcare professionals attend to the ethical content of their caregiving so routinely, so habitually, that their doing this is rarely thought of as involving a method of ethical reflection. This essay will examine this kind of ethical reflection in detail: its main components, how it works in practice, and how to grow in doing it effectively.
The tests and procedures used to determine death must be consistent with a coherent concept of death. This concept includes the subject of death, the definition of death, the sign/criterion of death, and the methods used to diagnose death. All four levels must logically build on one another. Additionally, any concept of death must align with the generally accepted meaning of the term “death” in everyday language. Judged by these standards, the current guidelines for determining death based on neurological criteria are not convincing: brain death does not indicate the disintegration of the human organism, and intensive care keeps patients alive and does not ‘mask’ death. Furthermore, ‘permanent’ loss of organ function can never reliably indicate death. Thus, the criterion and the definition of death do not match.
