The "neuromoral" medical explanatory model of antisocial or inadequately prosocial behavior posits a biological cause for what advocates judge to be immoral activity. Proponents of this model hold that immoral behavior i...The "neuromoral" medical explanatory model of antisocial or inadequately prosocial behavior posits a biological cause for what advocates judge to be immoral activity. Proponents of this model hold that immoral behavior is the result of a dysfunction in a network of neural circuits primarily located in the frontal lobes, believed to be the "neurobiological seat" of ethical choice. Advocates encourage medical treatments, such as transcranial direct current stimulation of the prefrontal cortex, to correct brain functional impairments that presumably cause aggressive, risk-affirming, antisocial, or non-empathetic behavior. Assuming therapy successfully modifies patient behavior toward higher levels of empathy and prosocial activity, while reducing risky or aggressive behavior, such an outcome, given these background assumptions, would constitute medical treatment for immoral behavior-plausibly, a form of "moral enhancement." As I argue, however, neurobiological claims to have found the source of moral decision-making are ambiguous and unjustified or, at least, overstated. Consequently, assertions regarding neurological treatment as moral enhancement should be approached with skepticism.
J Med Philos
· 2026 Jun · PMID 42287730
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Zygotes are persisting organisms. That is, zygotes are organisms and most born human beings are identical to the zygotes from which they originated. I defend these claims against recent critiques. Chunghyoung Lee, for ex...Zygotes are persisting organisms. That is, zygotes are organisms and most born human beings are identical to the zygotes from which they originated. I defend these claims against recent critiques. Chunghyoung Lee, for example, argues that for any zygote, z, z may develop into one of several, numerically distinct infants. If so, then for any infant, that infant is not identical to the zygote from which he or she originated. If Lee is correct, then zygotes are like gametes, which may give rise to mature human beings, but cease to exist along the way. This, Lee claims, suggests that zygotes are not organisms. I respond that Lee (like many others) confuses zygotic parts with whole zygotes. The error lies in identifying zygotes (and embryos) with their inner contents alone. Zygotes are more than their internal parts, however, just as the reader is more than their heart, lungs, and kidneys. To advance these claims, I defend a version of "zona-essentialism," which maintains that the zona pellucida-the membrane surrounding zygotes and early embryos-is essential to their identity during early stages of life. By distinguishing between zygotic parts and whole zygotes, I show that Lee's (and others') arguments fail to establish that zygotes are not organisms. I conclude by discussing practical implications for finding that zygotes are human organisms. Clinicians and researchers must embrace reality: individual human beings are routinely killed in the name of scientific advancement and reproductive autonomy. Failure to acknowledge this-e.g., by using euphemisms to obscure the truth-is problematic.
J Med Philos
· 2026 May · PMID 42168778
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With rapid advances in gene editing technology, the ethics of genetic enhancement has emerged as a prominent issue attracting scholarly attention. Many scholars express concern that genetic enhancement facilitated by gen...With rapid advances in gene editing technology, the ethics of genetic enhancement has emerged as a prominent issue attracting scholarly attention. Many scholars express concern that genetic enhancement facilitated by gene editing may infringe on human dignity. Bioethicists remain divided on whether genetic enhancement violates human dignity and how effectively to safeguard it during the application of this technology. Confucian ethics offers a profound exploration of human dignity and can serve as a critical lens for assessing whether genetic enhancement technology compromises human dignity. This article explores the ethical implications of human genetic enhancement by reinterpreting the dual dimensions of the Confucian concept of dignity and its associated moral requirements. The Confucian perspective on dignity provides a valuable and unique approach to addressing ethical challenges in genetic enhancement technology.
J Med Philos
· 2026 May · PMID 42168771
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In this paper, we examine the governance of fertility services and situate our analysis in the broader context of reproductive ageing. Most countries restrict access to these services in reference to the age of people (e...In this paper, we examine the governance of fertility services and situate our analysis in the broader context of reproductive ageing. Most countries restrict access to these services in reference to the age of people (especially women) who are unable to conceive and the causes of such inability. Despite the popularity of this approach, we argue that age- and cause-based restrictions actively rely on, and hence perpetuate, the constraints that hinder the realization of reproductive aspirations. To motivate this view, we provide an overview of the demographic trends that have reconfigured women's reproductive lifecourse. We then argue that the criteria governing access to publicly funded services are anachronistic, as they alienate policy from citizens' circumstances. In closing, we question the legitimacy of a reproductive governance that perpetuates existing inequality of opportunity, and propose the following changes: (1) de-responsibilizing (in)fertility; (2) reconsidering restrictions; (3) recognizing reproductive aspirations as a public good.
J Med Philos
· 2026 May · PMID 42105357
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Genetic moral enhancement (GME) aims to morally improve a person by using genetic technology. This paper discusses what kinds of GMEs are morally acceptable (or unacceptable) based on Mencius' theory of human nature. Fir...Genetic moral enhancement (GME) aims to morally improve a person by using genetic technology. This paper discusses what kinds of GMEs are morally acceptable (or unacceptable) based on Mencius' theory of human nature. First, I argue that one kind of GME aimed at improving empathic concern to be more inclined to help others can be defended by Mencius' view of the heart-mind of pity and compassion (ceyinzhixin, ). Second, I show that one kind of GMEs would be morally unacceptable for Mencius based on the Confucian view of love with distinction (aiyouchadeng, ). This approach to GME attempts to modify the biological mechanisms underlying empathy, enabling individuals to "feel and experience" others' pain or harm as if it were their own, thereby making them more inclined to help others.
MacKay D, Cadigan RJ, Juengst E
… +2 more, Robinson A, Walker RL
J Med Philos
· 2026 Apr · PMID 41955300
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National and international agencies and organizations are currently considering which ethical principles should inform the governance and use of heritable and non-heritable human genome editing. In this paper, we conside...National and international agencies and organizations are currently considering which ethical principles should inform the governance and use of heritable and non-heritable human genome editing. In this paper, we consider the prevalence principle, according to which heritable and non-heritable genome editing in humans is permissible if and only if it involves the conversion of variants to ones expected to produce traits that are prevalent in the relevant population. This principle thus permits genome editing targeting variants responsible for disease and disability but prohibits genetic enhancement. We consider whether the prevalence principle is supported by considerations of egalitarian justice, as its proponents claim. We argue that it is not and that prominent theories of egalitarian justice instead offer different approaches to genome editing governance. We identify four egalitarian principles policymakers should consider when crafting anticipatory guidance for heritable and non-heritable genome editing.
J Med Philos
· 2026 Mar · PMID 41863289
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Patients living with chronic pain often report experiencing invalidation from healthcare practitioners. Epistemic injustices, that is, the disqualification of a person as a knower, have been used to study medical encount...Patients living with chronic pain often report experiencing invalidation from healthcare practitioners. Epistemic injustices, that is, the disqualification of a person as a knower, have been used to study medical encounters and chronic pain invalidation. However, these studies are largely theoretical and tend to reproduce epistemic injustices by not giving a voice to the people directly impacted by these injustices. This research is focused on enhancing our understanding of the consequences of epistemic injustice in health care. We conducted seventeen qualitative narrative interviews with people living with chronic pain in the province of Québec, Canada. The results support many consequences that were already identified in the theoretical literature, including the impact on patients' interaction with the healthcare system, but also less-discussed consequences, including the impact of epistemic injustices on patients' agency. We discuss emancipation and resistance strategies to epistemic injustices, as well as the implications of the results for health equity.
J Med Philos
· 2026 Mar · PMID 41863284
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In this article, I argue that patients' testimonial knowledge is assessed with a default evidentialist approach. I primarily support this claim by drawing from work on physicians' accounts of assessing the trustworthines...In this article, I argue that patients' testimonial knowledge is assessed with a default evidentialist approach. I primarily support this claim by drawing from work on physicians' accounts of assessing the trustworthiness of patients' testimony. Furthermore, I explicate a three-tiered evidence-ranking approach within these physician accounts and detail how it resembles existing hierarchical evidence-ranking frameworks in medicine. I then discuss the role that aperspectival objectivity plays in this evidentialist approach and highlight some tensions that emerge. Next, I identify some practical, epistemic, and ethical consequences of said evidentialist approach and end on potential strategies for mitigating the potential negative consequences. The account I detail ultimately reveals much of the epistemic complexity surrounding patients' testimonial knowledge as a kind of evidence.
J Med Philos
· 2026 Mar · PMID 41849226
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Precision medicine impacts virtually all medical specializations, including psychiatry. Although precision psychiatry, in general, is a flourishing area of research and debate, psychotherapy as one pillar of psychiatry r...Precision medicine impacts virtually all medical specializations, including psychiatry. Although precision psychiatry, in general, is a flourishing area of research and debate, psychotherapy as one pillar of psychiatry receives little attention. Theoretical discussions about precision psychotherapy are rare; research on precision in psychotherapy is just evolving. In this paper, we provide a conceptualization of precision psychotherapy providing a common idea of what should be understood as precision in the context of psychotherapy and what kind of psychotherapy research is considered to contribute to the aims of precision psychotherapy.
J Med Philos
· 2026 Mar · PMID 41830554
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Gene therapies for severe genetic disease are often highly expensive. In deciding whether or when to provide them, one ethical consideration is the benefit of treatment relative to cost. Another and separate consideratio...Gene therapies for severe genetic disease are often highly expensive. In deciding whether or when to provide them, one ethical consideration is the benefit of treatment relative to cost. Another and separate consideration is concern for medical need and the desire to benefit those who are worse off. The latter is a prioritarian concern. But how should we apply prioritarianism to decisions about gene therapy, particularly since such treatments might affect which individuals come into existence? That question is the main aim of this paper. I focus on a particular version of prioritarianism articulated and defended by Derek Parfit. My primary aim is to explore how, if we were to adopt such an account, we should interpret and practically apply this in medical ethics. In doing so, I assess how it fits with other elements of Parfit's philosophy. I defend a new "time-relative" version of priority.
Lippert-Rasmussen K, Hvid VL, Midtgaard SF
… +1 more, Andersen DB
J Med Philos
· 2026 Mar · PMID 41824779
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One important objection to vaccination policies involving nudging or coercive measures such as restrictions on unvaccinated people's access to public spaces is that they are paternalistic. This objection is weaker than i...One important objection to vaccination policies involving nudging or coercive measures such as restrictions on unvaccinated people's access to public spaces is that they are paternalistic. This objection is weaker than is often assumed. We defend this claim by (1) introducing a novel distinction between individual and collective paternalism; (2) showing that, across a range of circumstances, vaccination programs involve collective, not individual, paternalism; and (3) arguing that collective paternalism is not wrong for the reasons that, arguably, individual paternalism is.
J Med Philos
· 2026 Mar · PMID 41812141
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Biohacking love-that is, using drugs either to enhance or diminish lust, attraction, and/or attachment-is currently feasible (although imperfectly so). It is likely that in the future, scientists will develop drugs that...Biohacking love-that is, using drugs either to enhance or diminish lust, attraction, and/or attachment-is currently feasible (although imperfectly so). It is likely that in the future, scientists will develop drugs that target lust, attraction, and attachment more accurately than anything currently available, thereby opening up possibilities for people to use such drugs to leave or remain in a relationship. Several scholars have recently argued for the desirability and moral permissibility of using such love drugs. However, we argue that it is most often morally impermissible to use love drugs as interventions in relationships. In particular, we argue that using love drugs is most often incompatible with adhering to the norms of relationships, such as the moral requirement that people in relationships relate to each other virtuously.
J Med Philos
· 2026 Apr · PMID 41805800
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Anti-psychiatrists contend that psychiatric practice is fundamentally misguided: it inappropriately medicalises difference by equating it with illness, resultantly forcing unwarranted "treatment" on the "mentally ill." I...Anti-psychiatrists contend that psychiatric practice is fundamentally misguided: it inappropriately medicalises difference by equating it with illness, resultantly forcing unwarranted "treatment" on the "mentally ill." I explain why the most popular realist accounts of mental illness-naturalism, constructivism, and hybridism-are typically considered vulnerable to this moral problem. Then, I introduce "the phenomenological account" that promises to avoid it. The phenomenological account equates mental health with the being-body experiential mode, which is conducive to the flow experiences empirically demonstrated as constitutively necessary for subjective well-being. Mental illness, meanwhile, is equated with entrapment in the having-a-body mode. This precludes flow and, as such, subjective well-being. I explain why the phenomenological account is better placed to resolve the moral problem than its peers, thus providing a proof of principle demonstration of its potential to rebut the anti-psychiatry argument across the board. Finally, I defend the phenomenological account from three common objections.
The assumption that the justifiability of scientific belief depends exclusively on the relevant facts is a widely accepted orthodoxy both inside and outside of the scientific establishment. Drawing on the pragmatic and m...The assumption that the justifiability of scientific belief depends exclusively on the relevant facts is a widely accepted orthodoxy both inside and outside of the scientific establishment. Drawing on the pragmatic and moral encroachment thesis in epistemology, this article challenges that assumption by showing that practical and moral considerations affect the justifiability of our beliefs regarding the safety of COVID-19 vaccines. In particular, I show that a proper consideration of the practical and moral costs of committing to the belief that COVID-19 vaccines are safe enough for a general vaccine mandate requires COVID-19 vaccines to meet a higher-than-current evidentiary standard of safety. Furthermore, I show that a reassessment of existing COVID-19 vaccines against a higher evidentiary standard of safety would entail a wider scope of medical exemptions and remedial duties. Beyond the case of COVID-19 vaccines, this argument has important general implications for how scientific beliefs should be assessed.
Proponents of transhumanism argue for the use of medical technologies to transform human nature into something better. Those who are opposed to taking steps in the direction of transhumanism sometimes do so on the basis...Proponents of transhumanism argue for the use of medical technologies to transform human nature into something better. Those who are opposed to taking steps in the direction of transhumanism sometimes do so on the basis of an obligation to preserve human nature. But how exactly are we to know what constitutes the human essence that demands protection? Kass's appeal to "the wisdom of repugnance" too easily lends itself to the defense of irrational bias. Although Nussbaum is strongly opposed to Kass's appeal to emotions as a source of reliable ethical intuitions, her capabilities approach to justice provides the foundation for an ethical appeal to a notion of human essence that allows one to avoid mere bias and can be employed to determine limits to the transformation of humanity.
J Med Philos
· 2026 Feb · PMID 41729186
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This essay presents arguments against legalizing medically assisted suicide (MAS) or voluntary active euthanasia (VAE) in Islamic regions. MAS and VAE should be determined by particular regions based on their respective...This essay presents arguments against legalizing medically assisted suicide (MAS) or voluntary active euthanasia (VAE) in Islamic regions. MAS and VAE should be determined by particular regions based on their respective mainstream moral cultures. Taking the Islamic regions of Bangladesh as examples, the essay argues that MAS or VAE should not be legalized in such regions because it would contradict the Islamic classical moral convictions, authentic interpretations, and relevant bioethical codes that prioritize saving human lives and providing quality palliative care rather than MAS or VAE for patients. The essay also provides practical ethical justifications for why the implementation of a non-legalization policy does not disregard non-Muslims in these regions, including secular liberals who may not align with the predominant Islamic moral culture concerning MAS and VAE.
J Med Philos
· 2026 Jun · PMID 41729185
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Human beings and their microbiomes are interrelated. Now what is the nature of their relation? In this paper, I claim that human beings have microbiomes as parts of themselves. In other words, rather than merely being ca...Human beings and their microbiomes are interrelated. Now what is the nature of their relation? In this paper, I claim that human beings have microbiomes as parts of themselves. In other words, rather than merely being casually associated with human beings, those microbiomes that reside in/on/around people are constituent parts of human beings. I argue this by reference to organismal homeostasis as understood as a systems-level phenomenon. To support my argument, I provide a survey of contemporary scientific literature surrounding the composition, location, structure, and function of the human microbiome(s). Finally, I cash out this finding by developing the idea of the "constitutive publicity" of the human organism. By this I mean that the human organism is not a "private" entity that then finds itself in the world, but rather that it is constantly created, suffused by, and contributing to the "public" world.
J Med Philos
· 2026 Jun · PMID 41729181
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In this article I argue for an Aristotelian hylomorphic view of bodily parthood on which parthood turns on functionality: something is part of a human being's body just in case it functions in the right way for the sake...In this article I argue for an Aristotelian hylomorphic view of bodily parthood on which parthood turns on functionality: something is part of a human being's body just in case it functions in the right way for the sake of that person; that is, its functioning aims at the flourishing of the particular human's biological life. Thus, perhaps counterintuitively, some things can stand in the body part relation without being composed of human cells-say, transplanted non-human organs or prosthetic appendages. I argue that there is evidence that some functions of the human body are relational: body parts can perform social functions. If these social or relational functions are genuine functions of the human body, then parts that may not appear to be functioning are. I argue that this could have ethical implications for delineating surgeries that are "functional" versus "aesthetic" (and perhaps necessary versus elective), and implications for human enhancement.
The practice of force-feeding dangerously malnourished patients with anorexia nervosa (AN) raises a puzzle for clinical ethics. Force-feeding AN patients may seem justified to save their lives and to help them recover fr...The practice of force-feeding dangerously malnourished patients with anorexia nervosa (AN) raises a puzzle for clinical ethics. Force-feeding AN patients may seem justified to save their lives and to help them recover from a debilitating pathological condition. Yet, clinical ethics seems committed to a robust anti-paternalism principle, on which it is normally wrong to force treatment on decisionally capacitated patients for their own good. Some AN patients do retain decisional capacity, at least by standard criteria. Thus, routinely force-feeding AN patients seems to constitute an unjustifiable exception to a well-established principle of clinical decision-making. Call this the moral puzzle of AN. I examine three attempts to solve the puzzle and argue that, individually or taken together, they cannot justify force-feeding those AN patients for whom this intervention would be potentially effective at enabling recovery. I conclude that no such justification is currently available. A solution to the moral puzzle of AN may come from a reevaluation of the anti-paternalism principle, a deeper clinical understanding of the psychology of AN, or even a novel reconceptualization of decisional capacity.
J Med Philos
· 2026 Jun · PMID 41520189
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This project explores what it means to be a 'biofixture': a medical implant, transplant, or therapy that is morally analogous to a native body part. A motivating case is provided wherein a decision to deactivate a ventri...This project explores what it means to be a 'biofixture': a medical implant, transplant, or therapy that is morally analogous to a native body part. A motivating case is provided wherein a decision to deactivate a ventricular assist device (VAD) provokes discomfort in medical providers. Taking as a starting point a previous project where a similar case of provider discomfort around pacemaker deactivation led to the conclusion that pacemakers are biofixtures, an argument is made that VADs are likewise biofixtures, the deactivation of which would be more morally analogous to active euthanasia than to standard cases of withdrawal of life support. To this end, criteria for biofixture status are developed, motivated, and applied to VADs and other cardiopulmonary therapies. Clinical entailments of this account of biofixture status are considered and further avenues of research for better understanding the nature and moral import of biofixtures are proposed.