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This is a time when overpopulation is a growing problem. It seems that there is

This is a time when overpopulation is a growing problem. It seems that there is no slowing down of procreation even though people are aware of the problem. At the rate it is going I see that it will result in Authorities having to take drastic action to sustain the human race. Any decision they make will be unfair in some way. I wonder whether it would be right to stop trying to cure terminal illnesses such as Cancer and AIDS (as they seem an unbias/fair population control system). On the one hand it would be better for the future of mankind and yet it seems unjust to let people die when we can help them. Where does this issue stand with ethics? as it seems both moral and immoral.

Letting terminally ill people die will do little to slow population growth because the vast majority of these people are not going to have (additional) children anyway. But there are other solutions that would actually work.

You write that there seems to be no slowing of procreation. This is quite false. Total fertility rates (average number of children per woman) have fallen spectacularly since 1955 ... but only in countries and regions where poverty has been meaningfully reduced. For example, the TFR of East Asia fell from 5.42 to 1.72 (below the rate of reproduction) -- and East Asia is the most populous region on Earth. So this is highly significant. There were large drops also in Portugal, Australia, Botswana, Italy, and so on. Where poverty persists, on the other hand, so do high TFRs. Many African states are good examples of this. Niger's TFR has increased from 6.86 to 7.15, and other high-poverty countries (Mali, Senegal, Equatorial Guinea) are not far behind. The evidence is overwhelming, and the lesson is clear: ensure that people have some social security, so they need not depend in their old age on having surviving children; ensure that infant mortality is low, so people need not get lots of children to ensure that a few will survive; ensure that women have good educational and employment opportunities so that they have important social roles other than that of bearing and raising children.

Letting terminally ill people die will do little to slow population growth because the vast majority of these people are not going to have (additional) children anyway. But there are other solutions that would actually work. You write that there seems to be no slowing of procreation. This is quite false. Total fertility rates (average number of children per woman) have fallen spectacularly since 1955 ... but only in countries and regions where poverty has been meaningfully reduced. For example, the TFR of East Asia fell from 5.42 to 1.72 (below the rate of reproduction) -- and East Asia is the most populous region on Earth. So this is highly significant. There were large drops also in Portugal, Australia, Botswana, Italy, and so on. Where poverty persists, on the other hand, so do high TFRs. Many African states are good examples of this. Niger's TFR has increased from 6.86 to 7.15, and other high-poverty countries (Mali, Senegal, Equatorial Guinea) are not far behind. The evidence is overwhelming,...

There was a debate recently about organ donation, and one group of people

There was a debate recently about organ donation, and one group of people adamantly opposed the notion of making organ donation mandatory or even opt-out, because, and I quote, "They're my organs and nobody else gets to decide what to do with them." Considering organ donation only ever occurs when a person is deceased and no longer has any use for the organs, how is ownership of organs even relevant to the discussion? Why shouldn't it be acceptable to make organ donation opt-out, or even mandatory?

The claim that a deceased person has no use for her organs, that the integrity of her body after her death is of no importance to her, is a claim that many dispute, typically in the context of some religious beliefs or others. It seems best for the state to avoid policies that some citizens find offensive on the basis of religious beliefs which the state is in no position to refute. Fortunately, we can avoid such policies in this case: by making organ donations opt-out, as you suggest, we'd have all the organs we might need.

The reason against this which you cite ("They're my organs and nobody else gets to decide what to do with them") is not a good reason against the opt-out solution. Yes, they are her organs and she alone gets to decide what to do with them -- but we still need to have a fall-back default for those cases in which a person dies without leaving clear instructions. Here any default society might settle upon is in the same boat, e.g. subject to the objection that it may not be what the deceased would have wanted when she was still alive. Still, society needs to set up some default and may then democratically select and implement any default so long as it is widely publicized and can easily be overruled by the person while she is still alive. In this democratic process, I for one would argue for the opt-out solution because it would bring huge benefits to people in need of organs.

The claim that a deceased person has no use for her organs, that the integrity of her body after her death is of no importance to her, is a claim that many dispute, typically in the context of some religious beliefs or others. It seems best for the state to avoid policies that some citizens find offensive on the basis of religious beliefs which the state is in no position to refute. Fortunately, we can avoid such policies in this case: by making organ donations opt-out, as you suggest, we'd have all the organs we might need. The reason against this which you cite ("They're my organs and nobody else gets to decide what to do with them") is not a good reason against the opt-out solution. Yes, they are her organs and she alone gets to decide what to do with them -- but we still need to have a fall-back default for those cases in which a person dies without leaving clear instructions. Here any default society might settle upon is in the same boat, e.g. subject to the objection that it may not be...

I am now taking a medication once a month to manage a symptom of a slow-growing

I am now taking a medication once a month to manage a symptom of a slow-growing cancer that I have. I just started Medicare last year and see by my statements that the cancer center charges my Medicare an enormous sum of money for this treatment and my oncologist says that there is not a generic equivalent that can be administered this way. Is it ethical for them to charge this sum (over $10,000) for an injection and is it morally "acceptable" for me to take this, at great cost to my fellow taxpayers?

It is very good of you to pay attention to these costs borne by others -- most people don't. Given the amount involved ($120,000 per annum), I think you should make an effort to find out more. Your oncologist says that no generic drug "can be administered this way" -- well, is there a compelling reason why it should be so administered, or would you be equally well off with the generic product administered in some other way? It is quite possible that your oncologist makes a lot more money from giving you the expensive medication rather than the cheaper one, so explore the question on the internet and perhaps also ring Medicare to get their opinion. If we all pay attention in this way, then it will be much harder for pharmaceutical companies and medical providers to overcharge the system we all pay for.

If the expensive drug you are taking really is the only way to manage the symptom in question, then I would expect this symptom to be serious enough to justify this lavish reimbursement. But perhaps the symptom isn't very bad and the treatment is reimbursed only because of some corporate lobbying? If so, you might well forego the treatment and even question more generally its use in cases such as yours. On the other hand, if the treatment makes you feel and function much better, then you are surely entitled to it. You should then not feel bad about the cost you are imposing on the rest of us, for the roles might easily have been reversed with you contributing to the cost of relieving my severe cancer symptoms. If the treatment helps you substantially, I for one am willing to help pay for it (and so are, I daresay, most others).

Is it unethical to charge $10,000 for an injection? I cannot answer this from the facts you provide. I am sure that the marginal cost of producing the fluid injected is a tiny fraction of $10,000. But then it may have been very expensive to develop and test this treatment, in which case the price tag might be justifiable. Or the price tag may be the result of lobbying and corruption, in which case it would not be justifiable. Again, you might spend a little time on finding out more.

It is very good of you to pay attention to these costs borne by others -- most people don't. Given the amount involved ($120,000 per annum), I think you should make an effort to find out more. Your oncologist says that no generic drug "can be administered this way" -- well, is there a compelling reason why it should be so administered, or would you be equally well off with the generic product administered in some other way? It is quite possible that your oncologist makes a lot more money from giving you the expensive medication rather than the cheaper one, so explore the question on the internet and perhaps also ring Medicare to get their opinion. If we all pay attention in this way, then it will be much harder for pharmaceutical companies and medical providers to overcharge the system we all pay for. If the expensive drug you are taking really is the only way to manage the symptom in question, then I would expect this symptom to be serious enough to justify this lavish reimbursement. But perhaps...

The following dilemma has arisen in my work as a health professional. I suppose

The following dilemma has arisen in my work as a health professional. I suppose it is more of an ethical conundrum than anything else. Imagine the following scenario: Someone is seeking help because they believe they may be at high risk of developing condition X. Our assessment suggests that they are in fact at high risk of developing condition X. Part of the reason they are high risk is BECAUSE they are worried they may develop condition X. As you can imagine informing the person of the results of their assessment can actually lead to that high risk person developing condition X. Health professionals have a clear duty to respect autonomy (including telling people the truth), balanced with a duty not to cause harm, and a duty to do good. Bearing this in mind, what should we tell the clients about the results of their assessment? NOTE: They would still be at high risk of developing condition X if we didn't assess or treat them. What we appear to do currently is assess them, but when communicating...

This is an interesting problem, very crisply stated. Variants of it occur in other life contexts as well. Thus truthful reporting of information can be counterproductive, for example, in the work of Human Rights Watch or Amnesty International in situations where such information may undermine the reputation of a political party or faction that, all things considered, is better than its rivals. This case is different from yours in that the responsibility for being truthful is primarily to third parties: to those who rely on the NGO to report the whole truth and nothing but the truth about the various governments, parties, or factions and their conduct.

In your case, where the responsibility is basically to the patient, the practice you and your colleagues have developed seems entirely right to me. Maybe your slight doubts about this practice can be mitigated by a brief further thought about autonomy. Contrary to what you suggest, I do not think that respecting autonomy requires being entirely candid. Rather, respecting autonomy requires deferring to the patient's judgments about how she ought to be treated and what she should be told. If she wants health professionals to be entirely candid with her -- and many patients do want this and will tell you so -- then respecting autonomy means being entirely candid. But in the absence of such an insistence on hearing the whole truth, you can make your own judgment about what the patient would want. (Directly asking her how much honesty she wants is tricky because it deprives her of what may be for her the best option: being uncertain about how honest you are with her while trusting that you will make decisions about what to tell her in a way that you judge is best for her.) And you may well conclude -- correctly -- that the patient is scared and would rather be firmly reassured than hear the full litany of risks and disclaimers.

When a patient really presses you for the truth, then you can -- in addition to the obfuscations you mention in your last two sentences -- also say truthfully that the condition does have an important psychological component and is most likely (ambiguity intended) to remain latent if one worries about it as little as possible.

This is an interesting problem, very crisply stated. Variants of it occur in other life contexts as well. Thus truthful reporting of information can be counterproductive, for example, in the work of Human Rights Watch or Amnesty International in situations where such information may undermine the reputation of a political party or faction that, all things considered, is better than its rivals. This case is different from yours in that the responsibility for being truthful is primarily to third parties: to those who rely on the NGO to report the whole truth and nothing but the truth about the various governments, parties, or factions and their conduct. In your case, where the responsibility is basically to the patient, the practice you and your colleagues have developed seems entirely right to me. Maybe your slight doubts about this practice can be mitigated by a brief further thought about autonomy. Contrary to what you suggest, I do not think that respecting autonomy requires being entirely candid....

Some friends and I have been debating the question of state mandated vaccination

Some friends and I have been debating the question of state mandated vaccination. There are actually several different pieces to this. First, forcing someone to undergo a medical procedure seems to be a major violation of their individual rights. Or is it? Second, there are always risks with any medical procedure, including vaccination. Does the value to the group of controlling infectious disease trump the right of the individual to free choice of risk? Some people might prefer the risk of disease. Third, what about parental responsibility? How far does the state have the right to force medical procedures on minors, against the parent's objections? Thanks for your help!

Vaccinations protect the vaccinated person. But they also protect others (who would come into contact with the vaccinated person if she were to be infected) and the population at large (as the disease has less of a chance to spread if there a fewer usable carriers).

Given this situation, a classic collective action problem can arise. The cost and risk of getting vaccinated are mine alone, while much of the benefit is dispersed. So it is quite possible that it is better for each not to get vaccinated (regardless of what others do) even while it is also better for all that all get vaccinated than that none do. (In numbers: Suppose the cost and risk of getting vaccinated is 6 and the benefit to oneself is 3 and the benefit of another person getting vaccinated in a 101-person community is 0.05. Then, if all get vaccinated, everyone gains: 3 + 100*0.05 - 6 = +2. But each can reason this way: The first term is +3, the second is whatever it is independently of what I do, and the third term is -6. So I will lose 3 if I get vaccinated, whatever others do.) The sad outcome is that no one will choose to get the vaccination.

What can be done to overcome the problem? We can reciprocally agree to get the vaccination. But if this reciprocal agreement is voluntary (a "coalition of the willing"), then any individual has reason not to join for the reason canvassed above. So the only way to overcome the collective action problem is by agreeing, through a democratic decision, to enforce the vaccination on all . In that democratic vote, the two possible outcomes are yes (all are forced to get vaccinated and everyone is better off) or no (no one is forced and none or very few get vaccinated).

The best justification for allowing such votes with consequent coercion here is, in my view, that they offer the only way of overcoming the collective action problem. Letting people's individual rights be decisive here would frustrate the point of these rights: our protecting our interests. We fail to do this when we get stuck in a collective action problem.

About your second point. Yes, there are risks. Some may die as a consequence of getting vaccinated (albeit fewer than would have died without the vaccination program). How do we justify the program to them? We can say that the vacination was beneficial to them ex ante, that everyone's risk of premature death was diminished by the vaccination program (relative to its non-existence).

But there is a problem. Some may be known to be especially likely to die from being vaccinated. (For them the cost and risk may be 9 in the above numerical example, say, so they would be better off without the vaccination program.) I think these people should have the option to exempt themselves. Fortunately, they are generally only a few, and their non-vaccination therefore has little impact on the benefit the others achieve.

Your third question poses no special difficulty. If it's OK democratically to overrule the expressed preference of an adult with regard to her own body in this case, then it should be alright to override her preference with regard to her child's body in the same case. We can say to her that it is better for all children, including hers, that they all are compelled to get vaccinated than that their parents have discretion (and thus predictably veto the vaccination of their children). It's in the best interest of the children that we do not allow any parent to do what's in the interest of her own child.

Vaccinations protect the vaccinated person. But they also protect others (who would come into contact with the vaccinated person if she were to be infected) and the population at large (as the disease has less of a chance to spread if there a fewer usable carriers). Given this situation, a classic collective action problem can arise. The cost and risk of getting vaccinated are mine alone, while much of the benefit is dispersed. So it is quite possible that it is better for each not to get vaccinated (regardless of what others do) even while it is also better for all that all get vaccinated than that none do. (In numbers: Suppose the cost and risk of getting vaccinated is 6 and the benefit to oneself is 3 and the benefit of another person getting vaccinated in a 101-person community is 0.05. Then, if all get vaccinated, everyone gains: 3 + 100*0.05 - 6 = +2. But each can reason this way: The first term is +3, the second is whatever it is independently of what I do, and the third term is -6. So I will...

I am a baseball coach/manager. In my stepson's baseball league, another team

I am a baseball coach/manager. In my stepson's baseball league, another team has a child (these are pony league players - 13 & 14) who has some arm problems. I know he has had an MRI (know the MRI tech) and also that his doctor instructed him never to pitch again. The coach and parents are aware of this too - yet the coach still pitches him in games. Other parents discuss this problem, yet no one seems willing to step up and do something about this. Since I know the story, would it be ethical if I anonymously informed the league? There may be a potential liability issue at stake here too. This kid is going to ruin his arm before he gets to high school. I am also trying to balance the confidentiality of the medical relationship vs. the kid's welfare. Should I even be considering this?

I agree with Thomas Pogge's remarks, but I also have a couple of cents to add.

First, consider very seriously and act in light of the fact that your information comes to you second hand (from a lab tech and not the child's physician or parent)--unless, of course you are the MRI technician. Second hand reports are notoriously inaccurate, and so I suggest proceeding with caution and when you act qualifying your comments with the acknowledgment that your information may be inaccurate. The tech may be exaggerating the physician's instructions or otherwise distorting them.

Secondly, it's worth pointing up front that (again unless you are the technician) that it was probably unethical for the technician to have given you medical information about the boy. Medical information is by law, custom, and moral principle extremely private material. The technician's poor conduct in providing you with medical information about the child further calls his or her credibility into question.

Thirdly, while I think Dr. Pogge is correct that the best first route is through the technician--or, better, directly through the physician--if that route doesn't achieve results that satisfy you, you should consider speaking with the parent. Your having this knowledge does give you a moral burden, I'm afraid. Your being a coach/manager magnifies that burden. If you find speaking to the parent uncomfortable or unsatisfying, you may consider informing the league. Now, the parent may deny that a physician has given the child such an instruction--at which point you will likely have no way of proving your claim, and the parents' claim will rightfully trump yours. Remember you will be reporting to the league third hand and, anyway, who is one to believe, the tech or the parent or you? If you somehow have access to hard evidence (and I mean really hard evidence, as overriding a parent is no small matter), you may wish to discuss the matter with a social worker.

He will ruin his arm -- that's a major burden for a child who loves sports. The goal of saving his arm seems a lot more important than the other considerations you mention. But perhaps you don't actually have to make this choice. Instead of informing the league, you might just talk to the MRI technician (who already knows that you know, and is responsible for your knowing, the boy's condition). Urge the technician to tell the doctor that the boy is being pitched by his coach and that his parents apparently approve of this. (The technician can say that this information comes from someone else without saying that this someone else -- you -- knows about the severity of the boy's injury.) The doctor can then decide what to do -- e.g., telephone the boy and/or the parents or write them a stern letter, and, if all else fails, communicate her or his concerns to the league. The doctor best understands the boy's condition and can speak about it with the greatest authority.

Is it ethical for surgeons to use economic considerations when setting their

Is it ethical for surgeons to use economic considerations when setting their fees? For example, is it ethical for a surgeon who is known to have better results for a certain operation to charge more than a surgeon who has worse results? Likewise is it ethical for a surgeon who has a scarce skill in a region to charge exorbitant fees for that skill simply because it would be unaffordable for most patients to travel to another region to attend another surgeon?

It may also matter what sort of operation we are talking about. If this is cosmetic surgery (beautifying belly buttons, say), then the service does seem quite similar to other commodities (face cream), and the reasons against the surgeon's charging what she will seem quite weak.

As we move to the other end of the spectrum -- to operations that are a matter of life and death -- Peter Fosl's points become ever more compelling. Such operations should not be rationed on the basis of wealth: A medically important operation that is routinely available to the wealthy should also be available, in roughly the same quality, to the poor. Call this the medical equity principle (MEP).

It does not follow from the MEP (here comes my second point) that it is unethical for the best surgeons to charge more. Societies that have organized themselves around the MEP need to have enough high-quality doctors to take care of the medical needs of all. To attract people into the profession of surgeon, and to entice them to become really good surgeons, such a MEP society may arrange itself so that the income of surgeons reflects their level of skill. Why should not a top surgeon who lives in a MEP society take the high remuneration available to her just as other surgeons with her outstanding skills are also doing in this society?

G. A. Cohen gives a reason against her doing this. See e.g. If You're and Egalitarian How Come You are so Rich?. But this reason applies to all highly-paid professionals. It is quite different from the ones Peter Fosl advances, which seem to me to be as inapplicable to a MEP society as they are to cosmetic surgery.

Our society -- not to speak of the world at large -- is very far from realizing MEP. Millions are spent on small improvements and extensions of the lives of the affluent even while poor uninsured Americans lack access to important medical services and millions of child deaths abroad could be avoided each year at the cost of a few Dollars per case.

These grotesque violations of MEP are a very grave injustice, in my view. An important aspect of your questions is then how one ought to behave in a context of grave injustice. By demanding from every patient what the market will bear for a medically important operation, a highly skilled surgeon would be both contributing to and taking advantage of a grave injustice: She would be contributing to the unjust segregation of patients by wealth, and she would be taking advantage of the fact that the social context is one in which patients must bid for top-flight medical treatment. What such a surgeon should plausibly do is to earn her living by charging the affluent what the market will bear and then giving equally good service to poor people for what they can comfortably afford (which may sometimes be $0).

Last point. It is not only top surgeons who, in an unjust social context, have responsibilities to shield people from grievous effects of injustice. Affluent citizens should understand that, if our society were just and thus in reasonable compliance with MEP, then people like themselves would have lower net incomes (as more of the social product would be spent on ensuring that all have access to important medical care). Understanding this, affluent citizens should not just pocket the fruits of injustice, but should spend some of their wealth on supporting political reforms or on protecting the victims of injustice. We all should help put access to medical care on the political agenda this primary season and help elect politicians who are firmly committed to moving this country and the world closer to MEP compliance.

It may also matter what sort of operation we are talking about. If this is cosmetic surgery (beautifying belly buttons, say), then the service does seem quite similar to other commodities (face cream), and the reasons against the surgeon's charging what she will seem quite weak. As we move to the other end of the spectrum -- to operations that are a matter of life and death -- Peter Fosl's points become ever more compelling. Such operations should not be rationed on the basis of wealth: A medically important operation that is routinely available to the wealthy should also be available, in roughly the same quality, to the poor. Call this the medical equity principle (MEP). It does not follow from the MEP (here comes my second point) that it is unethical for the best surgeons to charge more. Societies that have organized themselves around the MEP need to have enough high-quality doctors to take care of the medical needs of all. To attract people into the profession of surgeon, and to entice them...

Is it ethical for a surgeon to perform an operation on his own mother?

Is it ethical for a surgeon to perform an operation on his own mother? Especially when it may involve the finding of a cancer?

Doctors try to avoid such situations, and, I think, for good reason. They add extra stress to what is already a difficult task -- stress for the surgeon and also stress for the patient. Such extra stress, in turn, is likely to diminish the prospects for success. And a surgeon who performs a major operation on his mother may then be acting unethically by not giving his patient the best chances of a successful outcome. If so, he should step aside, even if his mother would prefer to be operated by him.

But what if some surgeon is, and is known by his mother to be, especially cool and unemotional, thus adding no stress to the proceedings? Or what if he is much better than the other available surgeons so that his greater skill more than makes up for the extra stress? In such cases, I would think, there's nothing unethical about him doing the operation himself -- provided, of course, his mother agrees. So, as I see it, performing a surgical operation on a loved one is not unethical as such, it is unethical -- often -- only because of its likely impact on the chances for success.

To see whether this makes sense, you can consider a more homely example. Imagine your spouse has a life-threatening accident and needs to be driven to the next emergency room at once. It's probably a bad idea for you to do the driving -- you would probably not be at your best. If so, you ought not to endanger your spouse's life, and your own, by insisting on being the driver -- provided there's another good driver available who is much less affected by the emergency. But if the only other available driver is your neighbor's son, one month into his L-sticker, then you may be the better bet and your doing the driving is then beyond ethical reproach.

Doctors try to avoid such situations, and, I think, for good reason. They add extra stress to what is already a difficult task -- stress for the surgeon and also stress for the patient. Such extra stress, in turn, is likely to diminish the prospects for success. And a surgeon who performs a major operation on his mother may then be acting unethically by not giving his patient the best chances of a successful outcome. If so, he should step aside, even if his mother would prefer to be operated by him. But what if some surgeon is, and is known by his mother to be, especially cool and unemotional, thus adding no stress to the proceedings? Or what if he is much better than the other available surgeons so that his greater skill more than makes up for the extra stress? In such cases, I would think, there's nothing unethical about him doing the operation himself -- provided, of course, his mother agrees. So, as I see it, performing a surgical operation on a loved one is not unethical as such, it is...

Imagine I am a scientist working for a pharmaceutical company and I spend 25

Imagine I am a scientist working for a pharmaceutical company and I spend 25 years working on a drug that will cure a disease. I patent my work, but the patent only lasts for 8 years. In that time, the pharmaceutical company sells the drug at a high price but uses most of its profits to fund more research. After 8 years, anyone can replicate my drug. Why should I allow generic brands, in that 8 years, to make my drug? I know many more people would have access to it if I did, but at least when my company is in control of it there are quality controls and secondly, my work is not only funding more research but is something I invested a great portion of my life in. Is it fair to argue for generic drugs in that case?

Your reasoning appeals to a false dichotomy. You assume that either we give monopoly pricing powers to inventors and thereby effectively deny access to recent drugs to poor patients or we allow generic companies to compete and thereby effective deprive inventors of their rewards and of funds for new research ventures. But there are further options.

One would be to allow generic companies to compete immediately (thereby reducing the price of a new medicine to near the marginal cost of production) and then to reward inventors in another way, for example with a reward (out of public funds) proportioned to the impact of their invention on the global disease burden. All patients would benefit for much cheaper access to recent drugs, and taxpayers would pay a little more. Millions of lives would be saved through this innovation -- not merely because poor patients get access to cutting-edge drugs, but also because biotech and pharma companies would gain an incentive to research remedies for the diseases that predominantly affect the poor.

So, while I agree with you that inventors should be rewarded -- for fairness to them and also for encouraging and enabling new research ventures -- and also agree that the quality of pharmaceuticals (whoever produces them) must be strictly maintained, I don't see how any of this needs to come (as it now does) at the expense of poor patients.

Your reasoning appeals to a false dichotomy. You assume that either we give monopoly pricing powers to inventors and thereby effectively deny access to recent drugs to poor patients or we allow generic companies to compete and thereby effective deprive inventors of their rewards and of funds for new research ventures. But there are further options. One would be to allow generic companies to compete immediately (thereby reducing the price of a new medicine to near the marginal cost of production) and then to reward inventors in another way, for example with a reward (out of public funds) proportioned to the impact of their invention on the global disease burden. All patients would benefit for much cheaper access to recent drugs, and taxpayers would pay a little more. Millions of lives would be saved through this innovation -- not merely because poor patients get access to cutting-edge drugs, but also because biotech and pharma companies would gain an incentive to research remedies for the...

Do patients have an absolute moral right to the confidentiality of their medical

Do patients have an absolute moral right to the confidentiality of their medical records?

An absolute right is presumably one that cannot be outweighed, forfeited, and/or alienated. (Such a right can still be waived -- e.g., by allowing your doctor to show your medical records to someone you nominate.) Let's look at these three issues with regard to the assumed moral right to the confidentiality of one's medical records.

It seems evident that this right can be outweighed. Suppose, for example, that a society faces a serious risk of a pandemic involving a life-threatening and highly virulent pathogen (ebola, avian flu). May such a society require doctors to notify the authorities of any positive diagnosis so as quickly to isolate the patient and prevent contagion? With potentially millions of lives at stake, any right to confidentiality must surely give way.

Less confidently, I would also think that the right in question can be forfeited, at least in part. Here is a possible case. Suppose the right is not outweighed by the danger to a single person. So, even where AIDS is still a deadly disease, an AIDS patient has a right that his doctor not tell his sexual partner of his condition even when she (the doctor) has good reason to believe that her patient is having unprotected intercourse with his partner. This sub-right could, I think, be forfeited, for instance by malicious intent. What if the patient allows his doctor to tell his relatives but not his lover of his condition because "I really don't want my lover to survive me"? Or what if the patient tells his doctor that he plans to begin a sexual relationship with someone he envies so as to ruin this person's life? In such cases, I would think, the doctor should be morally (and legally) free to warn the intended victim if she cannot persuade the patient to desist.

I am uncertain about whether a moral right to the confidentiality of one's medical records might be alienable. By alienating this right, its bearer would not merely waive it on one occasion (by allowing the doctor to share medical information about him with a third party), but would give this right away, in whole or in part, for a period or forever. A film star, for instance, might then sell to a magazine the right to full and indefinite access to all her present and future medical records (or some more limited right to medical records -- concerning her pregancy status for the next 48 months, say). Should such contracts be enforceable? Or should the moral right be conceived so that it cannot be alienated in this way? I am inclined to the latter view, but a confident answer would surely require a lot of thought.

In conclusion. A moral right to confidentiality of one's medical records may well be inalienable, but it cannot plausibly be conceived as one that can never be outweighed or forfeited.

An absolute right is presumably one that cannot be outweighed, forfeited, and/or alienated. (Such a right can still be waived -- e.g., by allowing your doctor to show your medical records to someone you nominate.) Let's look at these three issues with regard to the assumed moral right to the confidentiality of one's medical records. It seems evident that this right can be outweighed. Suppose, for example, that a society faces a serious risk of a pandemic involving a life-threatening and highly virulent pathogen (ebola, avian flu). May such a society require doctors to notify the authorities of any positive diagnosis so as quickly to isolate the patient and prevent contagion? With potentially millions of lives at stake, any right to confidentiality must surely give way. Less confidently, I would also think that the right in question can be forfeited, at least in part. Here is a possible case. Suppose the right is not outweighed by the danger to a single person. So, even where AIDS is still a...

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