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Contemporary population ethics is dominated by views that aggregate by summing, whether of well-being or of some construct based on well-being. In contrast, average well-being is generally considered axiologically irrelevant. To many of us, however, the number of future people does not seem important, as long as it is sufficient to enable rich and varied life experiences, and as long as the population continues throughout time. It therefore seems relatively plausible to aggregate future well-being by averaging. In particular, it seems plausible to value high average well-being at any particular time, and to do so for all future times. I present a time-sensitive version of the Average View that underpins such axiological intuitions. I also address a series of issues and objections that confront such a view.

Recently, it has been argued by several scholars that we have moral reasons to limit our procreation due to the harmful environmental consequences it entails. These calls for procreative restraint are typically made in relation to other lifestyle choices, such as minimizing driving and air travel. In such comparisons, it is assumed that the environmental impact of procreation encompasses the lifetime consumption of the child created, and potentially that of further descendants. After an overview of these arguments, I go on to provide an examination of the main benefits of procreation, in relation to those of consumption, i.e., other lifestyle choices. My normative assumption is that benefits hold moral relevance, alongside harms. Procreation may benefit procreators and may provide more collective benefits. Some benefits tend to preempt the environmental impact associated with procreation. I conclude that the benefits of procreation are substantial and typically greater than those of consumption.

Inborn errors of immunity (IEI) are a group of over 450 genetically distinct conditions associated with significant morbidity and mortality, for which early diagnosis and treatment improve outcomes. Newborn screening for severe combined immunodeficiency (SCID) is currently underway in several countries, utilising a DNA-based technique to quantify T cell receptor excision circles (TREC) and kappa-deleting recombination excision circles (KREC). This strategy will only identify those infants with an IEI associated with T and/or B cell lymphopenia. Other severe forms of IEI will not be detected. Up-front, first-tier genomic-based newborn screening has been proposed as a potential approach by which to concurrently screen infants for hundreds of monogenic diseases at birth. Given the clinical, phenotypic and genetic heterogeneity of IEI, a next-generation sequencing-based newborn screening approach would be suitable. There are, however, several ethical, legal and social issues which must be evaluated in detail prior to adopting a genomic-based newborn screening approach, and these are discussed herein in the context of IEI.

Fishbowl Panel at Humlab/Zoom., TAIGA - Trasndiciplinary AI, Umeå university

To an ever-greater extent, we spend our lives in an online environment designed by corporations. These corporations have an interest in shaping not only our purchasing behavior, but also our focus of attention and engagement and to some extent our worldview and identity. As a means to this end, they collect and trade in personal information. One important method of behavioral influence employed to advance these purposes is default-setting - the design of a product or a situation such that one option out of several seems natural to accept, because it is the path of least resistance. Default-setting is a non-rational influence, often imperceptible, yet effective. To protect users from defaults that are manipulative and harmful, individually and collectively, societies should require minimal quality standards. Just as some products are overall too harmful or too poor to be legally marketed, other products have default settings that are too harmful or too poor to be acceptable. In particular, defaults should minimize inadvertent consumption, should minimize the collection of personal data, and when providing information should be truthful. In addition, opt-out costs should be minimal in order to empower users who prefer alternative options., AI, Democracy and Self-Determination

One central role of the American Federal Drug Administration (FDA) is to provide research-based health information and advice to professionals and public. Regarding vaping, the FDA currently emphasizes its possible harms rather than its relatively low risks compared to smoking, for any individual user. Larisa Svirsky, Dana Howard and Micah L Berman defend this uncompromising strategy by invoking the uncertain long-term public health outcomes of vaping and pointing to the many roles of the FDA. I agree that there are empirical uncertainties and multiple roles. I also mention some ethical uncertainties. However, I propose that the FDA in its role as advisor should, given these uncertainties, communicate individual health risks truthfully and straightforwardly, and that such communication does not conflict with its other roles.

The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers.

Advances in genetic diagnostics lead to more patients being diagnosed with hereditary conditions. These findings are often relevant to patients' relatives. For example, the success of targeted cancer prevention is dependent on effective disclosure to relatives at risk. Without clear information, individuals cannot take advantage of predictive testing and preventive measures. Against this background, we argue that healthcare professionals have a duty to make actionable genetic information available to their patients' at-risk relatives. We do not try to settle the difficult question of how this duty should be balanced against other duties, such as the duty of confidentiality and a possible duty not to know one's genetic predisposition. Instead, we argue for the importance of recognising a general responsibility towards at-risk relatives, to be discharged as well as possible within the limits set by conflicting duties and practical considerations. According to a traditional and still dominant perspective, it is the patient's duty to inform his or her relatives, while healthcare professionals are only obliged to support their patients in discharging this duty. We argue that this perspective is a mistake and an anomaly. Healthcare professionals do not have a duty to ensure that their patients promote the health of third parties. It is often effective and desirable to engage patients in disseminating information to their relatives. However, healthcare professionals should not thereby deflect their own moral responsibility., Institute of Medical Ethics Section: Original research

I denna artikel kontrasteras två olika liberala perspektiv på frihetsbegränsningars moraliska och politiska rättfärdigande. Enligt det första perspektivet har vi skäl att dels främja människors rika möjligheter, dels respektera deras vilja i frågor som rör dem själva. Båda dessa värden kan vägas mot andra värden. Enligt det andra perspektivet är frihetsbegränsningar principiellt otillåtna om och endast om de drabbar vuxna beslutsförmögna personer för dessas egen skull, oavsett andra värden. Båda perspektiven är direkt tillämpbara i enkla situationer där en persons frihet begränsas för hennes egen skull och inga andra värden påverkas. I situationer där andra värden påverkas, vilket är det vanliga, bör det senare perspektivet modifieras så att det riktas mot skäl snarare än mot handlingar. I situationer där många människors frihet minskas både för deras egen och andras skull, som vid restriktioner under en pandemi, är det senare perspektivet mycket svårt att tillämpa och väcker frågor som dess förespråkare inte har besvarat.

The traditional liberal view on conflicts between care for wellbeing and respect for choice and desire is that we should look to degrees of competence and voluntariness to determine which moral imperative should take priority. This view has likely influenced the common view that children’s choices should be considered only to the extent that this promotes their future autonomy and helps us determine their best interests. I reject both the general traditional liberal view and its application to children. Competence and voluntariness, as well as maturity, are at best proxies for what really matters, which is wellbeing, choice and desire. We typically have reason to respect children’s choices, irrespective of any further positive consequences. If we should more often make children do what they do not want to do, this is mainly because, though we should care about respecting their choices, we should care even more about their wellbeing and future autonomy.

In this comment on Kenneth Iserson’s article, ”Do You Believe in Magic? Shove, Don’t Nudge: Advising Patients at the Bedside,” I discuss the definition of and the moral evaluation of nudging. I propose that using persuasive descriptions and intentionally building trust in patients by one’s demeanor is a form of nudging. I argue that nudging is not necessarily morally problematic, but that it can be controlling and can limit liberty, despite proponents’ claims to the contrary. I agree with Iserson that clinicians should give their patients explicit advice, but add that they should ideally also be aware of the more subtle psychological effects of advice giving.

In this article, I challenge the widespread presumption that a child should have exactly two parents. I consider the pros and cons of various numbers of parents for the people most directly affected – the children themselves and their parents. The number of parents, as well as the ratio of parents to children, may have an impact on what resources are available, what relationships can develop between parents and children, what level of conflict can be expected in the family, as well as the costs involved in parenting and the experience of parenting a child. Indirectly, there is also an effect on who will have the opportunity to be a parent, as well as on wider social issues that I mention but do not discuss. Having considered all these factors, I conclude that there is some reason to believe that three or more parents is usually better than one or two, especially if children are to have siblings, which is typically beneficial. However, these reasons are not strong enough to support a general presumption in favor of any particular number. We should therefore jettison the two‐parent presumption and make different numbers of parents more socially accepted as well as legally possible.

Debates on the nature and justifiability of paternalism typically focus only on adults, sometimes presuming without argument that paternalism towards children is a non-issue or obviously justified. Debates on the moral and political status of children, in turn, rarely connect with the rich literature on paternalism. This chapter attempts to bridge this gap by exploring how issues that arise in the general debate on paternalism are relevant also for the benevolent interference with children. I survey and discuss various views and argue for my own: that paternalism towards children is in most respects like paternalism towards adults and stands in the same need of justification, though such justification is more often forthcoming both because children are typically less prudent than adults and so benefit more from interference, and because, in some respects, interference is less harmful to them.

In many or most instances of paternalism, more than one person acts paternalistically, or more than one person is treated paternalistically. This chapter discusses some complications that arise in such group cases, which are largely ignored in the conceptual debate. First, a group of people who together perform an action may do so for different reasons, which makes it more challenging to determine whether the action is paternalistic. This gives us some reason not to pin the property of being paternalistic on actions, since we may alternatively pin it on reasons for actions and allow that these differ between members in the group. Second, the prevention of harmful consensual interactions is sometimes paternalism towards both or all involved, but only if all benefit from interference with themselves rather than with other members in the group, or if all want the harm or risk (more or less) for its own sake. Third, interrelations between three components of paternalism - interference, benvolence and consent - gives us reason to allow that an action can be paternalistic towards some but not others of those affected. This makes it even more difficult, and less relevant, to determine whether or not actions are paternalistic.

While paternalism has been a long-standing philosophical issue, it has recently received renewed attention among scholars and the general public. The Routledge Handbook of the Philosophy of Paternalism is an outstanding reference source to the key topics, problems and debates in this exciting subject and is the first collection of its kind. Comprising twenty-seven chapters by a team of international contributors the handbook is divided into five parts: • What is Paternalism? • Paternalism and Ethical Theory • Paternalism and Political Philosophy • Paternalism without Coercion • Paternalism in Practice Within these sections central debates, issues and questions are examined, including: how should paternalism be defined or characterized? How is paternalism related to such moral notions as rights, well-being, and autonomy? When is paternalism morally objectionable? What are the legitimate limits of government benevolence? To what extent should medical practice be paternalistic? The Routledge Handbook of the Philosophy of Paternalism is essential reading for students and researchers in applied ethics and political philosophy. The handbook will also be very useful for those in related fields, such as law, medicine, sociology and political science.

While paternalism has been a long-standing philosophical issue, it has recently received renewed attention among scholars and the general public. The Routledge Handbook of the Philosophy of Paternalism is an outstanding reference source to the key topics, problems and debates in this exciting subject and is the first collection of its kind. Comprising twenty-seven chapters by a team of international contributors the handbook is divided into five parts: • What is Paternalism? • Paternalism and Ethical Theory • Paternalism and Political Philosophy • Paternalism without Coercion • Paternalism in Practice Within these sections central debates, issues and questions are examined, including: how should paternalism be defined or characterized? How is paternalism related to such moral notions as rights, well-being, and autonomy? When is paternalism morally objectionable? What are the legitimate limits of government benevolence? To what extent should medical practice be paternalistic? The Routledge Handbook of the Philosophy of Paternalism is essential reading for students and researchers in applied ethics and political philosophy. The handbook will also be very useful for those in related fields, such as law, medicine, sociology and political science.