Compensation and Limits on Harm in Animal Research.

Although researchers generally take great care to ensure that human subjects do not suffer very serious harms from their involvement in research, the situation is different for nonhuman animal subjects. Significant progress has been made in reducing unnecessary animal suffering in research, yet researchers still inflict severe pain and distress on tens of thousands of animals every year for scientific purposes. Some bioethicists, scientists, and animal welfare advocates argue for placing an upper limit on the suffering researchers may impose on animal subjects, with rare exceptions for research that promises critical social benefits. In this article, I argue against such an upper limit on harm on the grounds that researchers often can compensate animal subjects for their suffering, even severe and long-lasting suffering. If animal subjects receive adequate compensation for the harms they suffer, then there is no general limit on how much suffering researchers may impose on them for scientific purposes.

Against procreative moral rights.

Many contemporary ethical debates turn on claims about the nature and extent of our alleged procreative moral rights: moral rights to procreate or not to procreate as we choose. In this article, I argue that there are no procreative moral rights, in that generally we do not have a distinctive moral right to procreate or not to procreate as we choose. However, interference with our procreative choices usually violates our nonprocreative moral rights, such as our moral rights to bodily autonomy or to privacy. My argument presents hypothetical cases in which a state interferes with a person's procreative choices in order to promote aggregate social welfare, but this interference does not violate any of the person's nonprocreative moral rights. These cases not only undermine frequently made claims that widely recognized nonprocreative moral rights entail procreative moral rights, they also challenge the intuitively plausible claim that interference with our procreative choices as such violates our moral rights. What at first appear to be substantive moral rights are in fact a kind of illusion created by the frequent overlap of other rights, but lacking in substance beyond that overlap. While this argument against the existence of procreative moral rights has substantive implications for ongoing debates in reproductive ethics, I ultimately suggest that it is consistent with a progressive approach to reproductive justice.

Ethics of information-gathering interventions in innovative practice.

Innovative practice involves medical interventions that deviate from standard practice in significant ways. For many patients, innovative practice offers the best chance of successful treatment. Because little is known about most innovative treatments, clinicians who engage in innovative practice might consider including extra procedures, such as scans or blood draws, to gather information about the innovation. Such information-gathering interventions can yield valuable information for modifying the innovation to benefit future patients and for designing scientific studies of the innovation. However, existing guidelines do not say when or whether it is appropriate to add potentially risky information-gathering interventions for these purposes. As a result, clinicians may assume that information-gathering interventions are ethically inappropriate and should not be used in innovative practice. This assumption can lead to seriously negative consequences, such as increasing the likelihood that harmful or ineffective innovations will be adopted and creating new barriers to the development of genuinely beneficial treatments. We argue that health care institutions need to promote the responsible use of information-gathering interventions as an adjunct to innovative practice, and that these interventions are not clinical research and should not be subject to research oversight.

The Belmont Report and Innovative Practice.

One of the Belmont Report's most important contributions was the clear and serviceable distinction it drew between standard medical practice and biomedical research. A less well-known achievement of the Report was its conceptualization of innovative practice, a type of medical practice that is often mistaken for research because it is new, untested, or experimental. Although the discussion of innovative practice in Belmont is brief and somewhat cryptic, this does not reflect the significant progress its authors made in understanding innovative practice and the distinctive ethical issues it raises. This article explores the history and broader context of Belmont's conception of innovative practice, its strengths and weaknesses, and its contemporary relevance for scholars working in bioethics and health policy. While this conception of innovative practice deserves our attention, it is inherently limited in some important ways.

Innovative Practice, Clinical Research, and the Ethical Advancement of Medicine.

Innovative practice occurs when a clinician provides something new, untested, or nonstandard to a patient in the course of clinical care, rather than as part of a research study. Commentators have noted that patients engaged in innovative practice are at significant risk of suffering harm, exploitation, or autonomy violations. By creating a pathway for harmful or nonbeneficial interventions to spread within medical practice without being subjected to rigorous scientific evaluation, innovative practice poses similar risks to the wider community of patients and society as a whole. Given these concerns, how should we control and oversee innovative practice, and in particular, how should we coordinate innovative practice and clinical research? In this article, I argue that an ethical approach overseeing innovative practice must encourage the early transition to rigorous clinical research without delaying or deferring the development of beneficial innovations or violating the autonomy rights of clinicians and their patients.

Fertility, immigration, and the fight against climate change.

Several philosophers have recently argued that policies aimed at reducing human fertility are a practical and morally justifiable way to mitigate the risk of dangerous climate change. There is a powerful objection to such "population engineering" proposals: even if drastic fertility reductions are needed to prevent dangerous climate change, implementing those reductions would wreak havoc on the global economy, which would seriously undermine international antipoverty efforts. In this article, we articulate this economic objection to population engineering and show how it fails. We argue, first, that the economic objection paints an inaccurate picture of the complicated relationship between demographic change and economic growth, and second, that any untoward economic effects of fertility reduction can be mitigated with additional policies. Specifically, we argue that supplementing fertility reduction with policies that facilitate the emigration of younger people from developing nations to developed nations could allow for both global reductions in GHG emissions and continued economic stability. Further, we show that moral arguments against such unprecedented increases in immigration are unsuccessful. We conclude that population engineering is a practical and morally justifiable tool for addressing the twin evils of climate change and global poverty.