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Evidence suggests that psychedelics bring about their therapeutic outcomes in part through the subjective or qualitative effects they engender and how the individual interprets the resulting experiences. However, psychedelics are contraindicated for individuals who have been diagnosed with certain mental illnesses, on the grounds that these subjective effects may be disturbing or otherwise counter-therapeutic. Substantial resources are therefore currently being devoted to creating psychedelic substances that produce many of the same biological changes as psychedelics, but without their characteristic subjective effects. In this article, we consider ethical issues arising from the prospect of such potential “nonsubjective” psychedelics. We are broadly supportive of efforts to produce such substances for both scientific and clinical reasons. However, we argue that such nonsubjective psychedelics should be reserved for those special cases in which the subjective effects of psychedelics are specifically contraindicated, whereas classic psychedelics that affect subjective experience should be considered the default and standard of care. After reviewing evidence regarding the subjective effects of psychedelics, we raise a number of ethical concerns around the prospect of withholding such typically positive, meaningful, and therapeutic experiences from most patients.

Introduction To improve the rigor of science, experimental evidence for scientific claims ideally needs to be replicated repeatedly with comparable analyses and new data to increase the collective confidence in the veracity of those claims. Large replication projects in psychology and cancer biology have evaluated the replicability of their fields but no collaborative effort has been undertaken in sports and exercise science. We propose to undertake such an effort here. As this is the first large replication project in this field, there is no agreed-upon protocol for selecting studies to replicate. Criticism of previous selection protocols include claims they were non-randomised and non-representative. Any selection protocol in sports and exercise science must be representative to provide an accurate estimate of replicability of the field. Our aim is to produce a protocol for selecting studies to replicate for inclusion in a large replication project in sports and exercise science. Methods The proposed selection protocol uses multiple inclusion and exclusion criteria for replication study selection, including: the year of publication and citation rankings, research disciplines, study types, the research question and key dependent variable, study methods and feasibility. Studies selected for replication will be stratified into pools based on instrumentation and expertise required, and will then be allocated to volunteer laboratories for replication. Replication outcomes will be assessed using a multiple inferential strategy and descriptive information will be reported regarding the final number of included and excluded studies, and original author responses to requests for raw data.

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision.

There is little debate regarding the acceptability of providing medical care to restore physical or mental health that has deteriorated below what is considered typical due to disease or disorder (i.e., providing “treatment”—for example, administering psychostimulant medication to sustain attention in the case of attention deficit disorder). When asked whether a healthy individual may undergo the same intervention for the purpose of enhancing their capacities (i.e., “enhancement”— for example, use of a psychostimulant as a “study drug”), people often express greater hesitation. Building on prior research in moral philosophy and cognitive science, in this work, we ask why people draw a moral distinction between treatment and enhancement. In two experiments, we provide evidence that the accessibility of health-related interventions determines their perceived descriptive or statistical normality (Experiment 1), and that gains in descriptive normality for such interventions weaken the moral distinction between treatment and enhancement (Experiment 2). In short, our findings suggest that the tendency to draw a moral distinction between treatment and enhancement is driven, in part, by assumptions about descriptive abnormality; and raise the possibility that normalizing novel biomedical interventions by promoting access could undermine people’s selective opposition toward enhancement, rendering it morally comparable to treatment.

Phrases like "true love" and "true happiness" are familiar ones. Yet it's unclear what they mean. Moreover, it seems that only some emotions are normally described as "true." For instance, people don't normally talk about "true grumpiness." This study investigates ordinary intuitions about which emotions can be "true."

This entry summarizes an emerging subdiscipline of both empirical bioethics and experimental philosophy (“x-phi”) which has variously been referred to as experimental philosophical bioethics, experimental bioethics, or simply “bioxphi” (Earp et al. 2020a, b; Lewis 2020; Mihailov et al. 2021a). Like empirical bioethics, bioxphi uses data-driven research methods to capture what various stakeholders think (feel, judge, etc.) about moral issues of relevance to bioethics. However, like its other parent discipline of x-phi, bioxphi tends to favor experiment-based designs drawn from the cognitive sciences (Knobe 2016) – including psychology, neuroscience, and behavioral economics – to tease out why and how stakeholders think as they do.

Historically, empirical research in bioethics has drawn on methods developed within the social sciences, including qualitative interviews, focus groups, ethnographic studies, and opinion surveys, t...

If you grade enough papers, you will find some consistent pitfalls, especially in the writing of students who are coming to philosophy for the first time. I wrote up the following tips a couple of years ago when I was a teaching assistant for an introductory philosophy class at Yale led by Daniel Greco called ‘Problems in Philosophy’. The tips were intended, then, for college students, many of them right out of high school, and most of whom had never written a philosophy paper before. So the focus is on clarity and mastering the basics. With that in mind, I hope you will find these tips helpful for teaching or writing in philosophy (or any other relevant field or discipline).

Frederick (2021, see the preceding article) offers a critique of my writing tips aimed at undergraduate students coming to philosophy – and in many cases, essay writing – for the first time (Earp, 2021, in this volume) Frederick claims that most of my tips are good tips but characterizes two of them as bad tips, as follows: Bad tip 1. Be very careful about making any universal claims (involving words such as ‘every’, ‘never’, ‘always’). Such a claim can be refuted by just a single counterexample. Do not leave yourself open to such refutation. Make a universal claim only if you are sure that there are no counterexamples.Bad tip 2. Pick a smaller, more narrow thesis and argue for it thoroughly rather than a more ambitious thesis for which you argue less thoroughly.

There is an ongoing public debate about sex, gender and identity that is often quite heated. This is an edited transcript of an informal lecture I recorded in 2019 to serve as a friendly guide to these complex issues. It represents my best attempt, not to score political points for any particular side, but to give an introductory map of the territory so that you can think for yourself, investigate further, and reach your own conclusions about such controversial questions as ‘What does mean to be a man or a woman?’

According to the World Health Organization (WHO), customary female genital modification practices common in parts of Africa, South and Southeast Asia, and the Middle East are inherently patriarchal: they reflect deep-rooted inequality between the sexes characterized by male dominance and constitute an extreme form of discrimination against women. However, scholars have noted that while many societies have genital modification rites only for boys, with no equivalent rite for girls, the inverse does not hold. Rather, almost all societies that practice ritual female genital modification also practice ritual male genital modification, often for comparable reasons on children of similar ages, with the female rites led by women and the male rites led by men. In contrast, then, to the situation for boys in various cultures, girls are not singled out for genital modification on account of their sex or gender; nor do the social meanings of the female rites necessarily reflect a lower status. In some cases, the women’s rite serves to promote female within-sex bonding and network building—as the men’s rite typically does for males—thereby counterbalancing gendered asymmetries in political power and weakening male dominance in certain spheres. In such cases, and to that extent, the female rites can be described as counter-patriarchal. Selective efforts to discourage female genital modifications may thus inadvertently undermine women-centered communal networks while leaving male bonding rites intact. Scholars and activists should not rely on misleading generalizations from the WHO about the relationship between genital cutting and the social positioning of women as compared to men. To illustrate the complexity of this relationship, we compare patterns of practice across contemporary societies while also highlighting anthropological data regarding pre-industrial societies. Regarding the latter, we find no association between the presence of a female initiation rite and a key aspect of patriarchy as it is classically understood, namely, social endorsement of a gendered double-standard regarding premarital sexual activity. We situate this finding within the broader literature and discuss potential implications.

A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Not...

Testimony from hundreds of medical students and numerous physicians and scholars suggests that unconsented intimate exams (UIEs) are unlikely to be rare, isolated incidents. However, much is unknown about the frequency of these exams and the circumstances in which they take place. The Community Bioethics Forum, founded and chaired by one of the authors of this commentary, is a consultative group of diverse community members who provide insights on law and policy to policy-makers and medical associations. Connecticut legislators asked the CBF to provide their views on proposed "explicit consent" legislation, and during those discussions, concerning narratives emerged about members' (and their loved ones') personal experiences with UIEs. To gain greater clarity on the demographic patterns and frequency of UIEs, we conducted the first national survey on UIEs. Data from this survey suggest that UIEs may occur under a broader range of circumstances than addressed by most law and policy. The survey resulted in nearly the exact same rate of affirmative responses between males and females in answer to whether they had received a UIE within the past five years. The survey results also showed evidence of racial disparity. Additional research is needed to understand the nature of UIEs.

Copyright © The Author(s) 2022. This paper argues that there exists a collective epistemic state of ‘Broad Medical Uncertainty’ (BMU) regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about the benefit / harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a ‘Corrective Response’. We then consider some objections to this position (the ‘Anti-Corrective Response’), including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing. This research was funded in part by the Wellcome Trust [Grant number WT203132/Z/16/Z]. This project/publication was made possible through the support of a grant from The Honesty Project at Wake Forest University and the John Templeton Foundation. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of The Honesty Project, Wake Forest University, or the John Templeton Foundation [Grant number 61842 PI: Brown] .

In our recent article, together with more than 60 of our colleagues, we outlined a proposal for drug policy reform consisting of four specific yet interrelated strategies: (1) de jure decriminalization of all psychoactive substances currently deemed illicit for personal use or possession (so-called “recreational” drugs), accompanied by harm reduction policies and initiatives akin to the Portugal model; (2) expunging criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs (and releasing those serving time for these offenses), while delivering retroactive ameliorative relief; (3) the ultimate legalization and careful regulation of currently illicit drugs; and (4) the delivery of a new “Marshall Plan” focused on community-building initiatives, expanded harm reduction programs, and social and health care support efforts (Earp et al. 2021). We were gratified to see so many thoughtful commentaries on our proposal, and we respond to them in part in this reply.

Campaigns to circumcise millions of boys and men to reduce HIV transmission are being conducted throughout eastern and southern Africa, recommended by the World Health Organization and implemented by the United States government and Western NGOs. In the United States, proposals to mass-circumcise African and African American men are longstanding, and have historically relied on racist beliefs and stereotypes. The present campaigns were started in haste, without adequate contextual research, and the manner in which they have been carried out implies troubling assumptions about culture, health, and sexuality in Africa, as well as a failure to properly consider the economic determinants of HIV prevalence. This critical appraisal examines the history and politics of these circumcision campaigns while highlighting the relevance of race and colonialism. It argues that the "circumcision solution" to African HIV epidemics has more to do with cultural imperialism than with sound health policy, and concludes that African communities need a means of robust representation within the regime.

Moralistic punishment is common in humans and functions to discourage perceived moral transgressions. Research in neuroeconomics suggests that moralistic punishment behavior is associated with activity in neural systems involved in detecting norm violations and in value-based decision-making. Separately, research in philosophy and social psychology highlights different moral expectations for girls/women and boys/men. Here, we synthesize these perspectives to propose a framework for investigating gender disparities in punishment. We propose such disparities may arise through multiple channels, including (1) differences in how the neural salience network responds to perceived norm violations, with stronger responses when women (versus men) violate feminine-coded norms, and when men (versus women) violate masculine-coded norms; and (2) differences in how the neural valuation network tracks the value of punishment decisions, with stronger responses when punishing gender-specific norm violations. We review literature on gendered moral expectations and neural mechanisms underlying moralistic punishment, and suggest hypotheses for future research.

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that (1) the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; (2) there are additional equity-based reasons to offer OPS to non-binary adults as a group; and (3) the ethical defensibility of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results.

Purpose of Review To summarize and critically evaluate the moral principles invoked in support of zero tolerance laws and policies for medically unnecessary female genital cutting (FGC). Recent Findings Most of the moral reasons that are typically invoked to justify such laws and policies appear to lead to a dilemma. Either these reasons entail that several common Western practices that are widely regarded to be morally permissible and are currently treated as legal—such as intersex “normalization” surgery, female genital “cosmetic” surgery performed on adolescent girls, or infant male circumcision—are in fact morally impermissible and should be discouraged if not legally forbidden; or the reasons are being applied in a biased and prejudicial manner that is itself unethical, as well as inconsistent with Western constitutional requirements of equal treatment of individuals before the law. Summary In the recent literature, only one principle has been defended that appears capable of justifying a zero tolerance stance toward medically unnecessary FGC without relying on, exhibiting, or perpetuating unjust cultural or moral double standards. This principle holds that, in countries whose ethicolegal traditions are shaped by a foundational concern for individual rights, respect for bodily integrity, and personal autonomy over sexual boundaries, all non-consenting persons have an inviolable moral right against any medically unnecessary (or medically deferrable) interference with their genitals or other private anatomy. In such countries, therefore, all non-consenting persons, regardless of age, race, ethnicity, parental religion, assigned sex, gender identity, or other individual or group-based features, should be protected from medically unnecessary genital cutting, regardless of the severity of the cutting or the expected level of benefit or harm.

Wilson and Zaki describe a “Novel Clitoral Reconstruction and Coverage With Sensate Labial Flaps” as a “potential remedy” for women who have undergone female genital mutilation/cutting (FGM/C).1 We would like to discuss some scientific and ethical issues in relation to clitoral reconstruction (CR) surgery, touching on sociocultural, political, interpersonal, and psychological factors involved in promoting psychosexual health of women and girls with FGM/C.

We are immensely grateful to Joshua Knobe for his dedication to this project, as well as his support, guidance, and invaluable comments and suggestions during the writing process. We also gratefully acknowledge the respective contributions of the two anonymous reviewers, and we wish to thank Katelyn MacDougald for doing such a stellar job editing the manuscript as well as Kristien Hens and Andreas De Block for inviting us to contribute to this special issue., This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments.

Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state—something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services.

FGM/C type IIIb in a 16-month old girl from Mali (a, b), admitted with acute retention of urine and acute renal failure, Mali.

Please note that when WHO refers to labia minora and majora such terms are now replaced by inner and outer labia.

Informed consent is essential to ensuring a trauma-informed, survivor-centered, ethical process that respects the (developing) autonomy of a patient.

Labial and Clitoral adhesion. Examples of convergence of inner labia under the glans and intersection with clitoral hood.