Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classifi ed into four categories: treating people equally, favouring the worst-off , maximising total benefi ts, and promoting and rewarding social usefulness. No single principle is suffi cient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system-the complete lives system-which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.

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Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.Informed consent is a basic ethical requirement for most research involving competent adult subjects.

The prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support that important public good. Consequently, we all have a duty to participate. The current social norm is that people participate only if they have a good reason to do so. The public goods argument implies that people should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making our society significantly healthier and longer-lived.We defend the obligation view. We do so not to make a philosophical point, but to stimulate support for a major cultural shift in the way physicians, researchers, patients, and society at large think about participation in research. The Standard ViewAccording to the standard view, participation in research is akin to giving blood or donating to charity. [1][2][3][4][5] Participation that benefits society is supererogatory -while participants who put themselves at risk or inconvenience deserve praise, people who refuse to participate in research are not acting wrongly or unethically.

This article considers two philosophical questions about coercion and mental disorders: (1) an analytical question, Le., what is meant by the concept of coercion? (2) a normative question, i.e., what justifies the use of coercion? The article distinguishes between coercion from other forms of power such as inducement, persuasion, and authority. It then considers a range of arguments for the paternalistic use of coercion for the benefit of mentally disordered persons and the use of coercion to restrain mentally disordered dangerous persons.This article rests on the assumption that there is something to be said for an academic division of labour, that empirical research in mental health and the law can benefit from conceptual clarification and the analysis of normative arguments. In this article I distinguish between two importantly different sorts of questions that we can ask about coercion and then offer some answers to those questions in broad strokes. SOME BASIC DISTINCTIONS Analysis and JustificationAt the broadest level, there are two philosophical questions about coercion: (a) what constitutes or counts as coercion? (b) what justifies the use of coercion? To exemplify, consider two questions about the use of kidneys for transplants. Whether poor people who sell their kidneys are coerced by their circumstances to do so (as many have argued) is a type (a) problem. By contrast, whether (as fewer have argued) the state is justified in coercively removing kidneys from healthy persons in order to save others is a type (b) problem. For the purpose of this discussion, let us refer to type (a) questions as analytical questions and to type (b) questions as justification questions. Whether mental disorders can themselves be thought of as constituting intrapsychic coercion is an analytical question. Whether we are morally permitted to coercively impose therapy on mentally disordered persons (where it is uncontroversial that the therapies are coercive) is a justification question.

Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

This chapter argues that the fundamental question in many contexts is not whether a person gives valid consent, but whether the consent transaction is morally transformative—and that the answers to those questions are not always identical. The chapter begins by examining the logic of consent transactions, and describes some of the ways in which consent can be morally transformative. It examines the values that underlie consent transactions, and argues that consent transactions serve to protect and promote the consenter's wellbeing (or interests) as well as autonomy. It also argues that consent transactions serve both to protect the consenter's negative autonomy or control over herself and, quite crucially, to serve her positive autonomy by facilitating mutually beneficial and altruistic interactions with others. The chapter considers the “ontology” of consent and the criteria of moral transformation (CMT). It is argued that the fair transaction model (FT) of consent transactions provides a better account of moral transformation. Two applications of FT are presented.

Payment to recruit research subjects is a common practice but raises ethical concerns relating to the potential for coercion or undue influence. We conducted the first national study of IRB members and human subjects protection professionals to explore attitudes as to whether and why payment of research participants constitutes coercion or undue influence. Upon critical evaluation of the cogency of ethical concerns regarding payment, as reflected in our survey results, we found expansive or inconsistent views about coercion and undue influence that may interfere with valuable research. In particular, respondents appear to believe that coercion and undue influence lie on a continuum; by contrast, we argue that they are wholly distinct: whereas undue influence is a cognitive distortion relating to assessment of risks and benefits, coercion is a threat of harm. Because payment is an offer, rather than a threat, payment is never coercive.