This article analyzes the problem of complicity in wrongdoing in the case of healthcare practitioners (and in particular Roman Catholic ones) who refuse to perform abortions, but who are nonetheless required to facilitate abortions by informing their patients about this option and by referring them to a willing colleague. Although this solution is widely supported in the literature and is also widely represented in much legislation, the argument here is that it fails to both (1) safeguard the well-being of the patients, and (2) protect the moral integrity of healthcare practitioners. Finally, the article proposes a new solution to this problem that is based on a desirable ratio of conscientious objectors to non-conscientious objectors in a hospital or in a given geographic area.

How individuals tend to evaluate the combination of their own and other’s payoffs—social value orientations—is likely to be a potential target of future moral enhancers. However, the stability of cooperation in human societies has been buttressed by evolved mildly prosocial orientations. If they could be changed, would this destabilize the cooperative structure of society? We simulate a model of moral enhancement in which agents play games with each other and can enhance their orientations based on maximizing personal satisfaction. We find that given the assumption that very low payoffs lead agents to be removed from the population, there is a broadly stable prosocial attractor state. However, the balance between prosociality and individual payoff-maximization is affected by different factors. Agents maximizing their own satisfaction can produce emergent shifts in society that reduce everybody’s satisfaction. Moral enhancement considerations should take the issues of social emergence into account.

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity.

In this article, we engage in dialogue with Jonathan Pugh, Hannah Maslen, and Julian Savulescu about how to best interpret the potential impacts of deep brain stimulation on the self. We consider whether ordinary peoples’ convictions about the true self should be interpreted in essentialist or existentialist ways. Like Pugh, Maslen, and Savulescu, we argue that it is useful to understand the notion of the true self as having both essentialist and existentialist components. We also consider two ideas from existentialist philosophy—Jean-Paul Sartre and Simone de Beauvoir’s ideas about “bad faith” and “ambiguity”—to argue that there can be value to patients in regarding themselves as having a certain amount of freedom to choose what aspects of themselves should be considered representative of their true selves. Lastly, we consider the case of an anorexia nervosa patient who shifts between conflicting mind-sets. We argue that mind-sets in which it is easier for the patient and his or her family to share values can plausibly be considered to be more representative of the patient’s true self, if this promotes a well-functioning relationship between the patient and the family. However, we also argue that families are well advised to give patients room to determine what such shared values mean to them, as it can be alienating for patients if they feel that others try to impose values on them from the outside.

Paradigmatic cases of conscientious objection in medicine are those in which a physician refuses to provide a medical service or good because doing so would conflict with that physician’s personal moral or religious beliefs. Should such refusals be allowed in medicine? We argue that (1) many conscientious objections to providing certain services must be allowed because they fall within the range of freedom that physicians have to determine which services to offer in their practices; (2) at least some conscientious objections to serving particular groups of patients should be allowed because they are not invidiously discriminatory; and (3) even in cases of invidiously discriminatory conscientious objections, legally prohibiting individual physicians from refusing to serve patients on the basis of such objections is not always the best solution.

Neuroscience and neurotechnology are increasingly being employed to assess and alter cognition, emotions, and behaviors, and the knowledge and implications of neuroscience have the potential to radically affect, if not redefine, notions of what constitutes humanity, the human condition, and the “self.” Such capability renders neuroscience a compelling theme that is becoming ubiquitous in literary and cinematic fiction. Such neuro-SciFi (or “NeuroS/F”) may be seen as eidolá: a created likeness that can either accurately—or superficially, in a limited way—represent that which it depicts. Such eidolá assume discursive properties implicitly, as emotionally salient references for responding to cultural events and technological objects reminiscent of fictional portrayal; and explicitly, through characters and plots that consider the influence of neurotechnological advances from various perspectives. We argue that in this way, neuroS/F eidolá serve as allegorical discourse on sociopolitical or cultural phenomena, have power to restructure technological constructs, and thereby alter the trajectory of technological development. This fosters neuroethical responsibility for monitoring neuroS/F eidolá and the sociocultural context from which—and into which—the ideas of eidolá are projected. We propose three approaches to this: evaluating reciprocal effects of imaginary depictions on real-world neurotechnological development; tracking changing sociocultural expectations of neuroscience and its uses; and analyzing the actual process of social interpretation of neuroscience to reveal shifts in heuristics, ideas, and attitudes. Neuroethicists are further obliged to engage with other discourse actors about neuroS/F interpretations to ensure that meanings assigned to neuroscientific advances are well communicated and more fully appreciated.

This article explores some implications of the concept of transformative change for the debate about human enhancement. A transformative change is understood to be one that significantly alters the value an individual places on his or her experiences or achievements. The clearest examples of transformative change come from science fiction, but the concept can be illuminatingly applied to the enhancement debate. We argue that it helps to expose a threat from too much enhancement to many of the things that make human lives valuable. Among the things threated by enhancement are our relationships with other human beings. The potential to lose these relationships provides a compelling reason for almost all humans to reject too much enhancement.

Discussions about the ethical permissibility of pediatric cognitive enhancement frequently revolve around arguments about welfare, and often include an appeal to the child’s right to an open future. Both proponents and opponents of cognitive enhancement claim that their respective positions best serve the interests of the child by promoting an open future. This article argues that this right to an open future argument only captures some of the risks to the welfare of children, therefore requiring a broader ethical approach. Further, it suggests that a thorough moral assessment of the ends pursued is needed before concluding on the moral permissibility of cognitive enhancement in children, which ultimately hinges on the effect on the overall welfare of the child, beyond an open future.

Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I focus on the question of how clinicians ought to act: should they provide or support a course of action that is contrary to their deeply held moral beliefs? I discuss two secular examples of potential CO in intensive care, and propose that clinicians should adopt a norm of conscientious non-objection (CNO). In the face of divergent values and practice, physicians should set aside their personal moral beliefs and not object to treatment that is legally and professionally accepted and provided by their peers. Although there may be reason to permit conscientious objections in healthcare, conscientious non-objection should be encouraged, taught, and supported.

This article examines one kind of conscientious refusal: the refusal of healthcare professionals to treat sexual dysfunction in individuals with a history of sexual offending. According to what I call the orthodoxy, such refusal is invariably impermissible, whereas at least one other kind of conscientious refusal—refusal to offer abortion services—is not. I seek to put pressure on the orthodoxy by (1) motivating the view that either both kinds of conscientious refusal are permissible or neither is, and (2) critiquing two attempts to buttress it.

There are manifold intriguing issues located within largely unexplored borderlands of bioethics, future studies (including global risk analysis), and astrobiology. Human enhancement has for quite some time been among the foci of bioethical debates, but the same cannot be said about its global, transgenerational, and even cosmological consequences. In recent years, discussions of posthuman and, in general terms, postbiological civilization(s) have slowly gained a measure of academic respect, in parallel with the renewed interest in the entire field of future studies and the great strides made in understanding of the origin and evolution of life and intelligence in their widest, cosmic context. These developments promise much deeper synergic answers to questions regarding the long-term future of enhancement: how far can it go? Is human enhancement a further step toward building a true postbiological civilization? Should we actively participate and help shape this process? Is the future of humanity “typical” in the same Copernican sense as our location in space and time is typical in the galaxy, and if so, can we derive important insights about the evolutionary pathways of postbiological evolution from astrobiological and Search for ExtraTerrestrial Intelligence (SETI) studies? These and similar questions could be understood as parts of a possible unifying research program attempting to connect cultural and moral evolution with what we know and understand about their cosmological and biological counterparts.

The use of the electronic medical record (EMR) facilitates many aspects of patient care as well as clinical and outcomes research. However, our thought processes are directed differently when collecting data to be entered into a structured database compared with when collecting data to construct a narrative of the patient and his or her complaints. While recognizing that the EMR will improve overall patient care, it is worthwhile examining aspects of patient–doctor interaction that may be sacrificed.