In Finland, as well as all over the globe, great weight is put on the possibilities of large data collections and ‘big data’ for generating economic growth, enhancing medical research, and boosting health and wellbeing in totally new ways. This massive data gathering and usage is justified by the moral principle of improving health. The imperative of health thus legitimizes data collection, new infrastructures and innovation policy. It is also supported by the rhetoric of health promotion. New arrangements in health research and innovations in the health sector are justified, as they produce health, while the moral principle of health also obligates individual persons to pursue healthy lifestyles and become healthy citizens. I examine how, in this context of Finnish data-driven medicine, arguments related to privacy and autonomy become silenced when contrasted with the moral principle of health.

This article aims to do two things. First, it argues that moralization of health occurs not only at the practical level of individual healthcare choices and health states, but also at the conceptual level of health itself. This is most evident in cases where the concept of health is presumed to possess the property of “overridingness” when compared to competing values and norms, that is, when it is treated as taking precedence over other values and norms it may come into conflict with. Second, the article makes a case for being critically skeptical of specific deployments of the concept of health when it has been moralized in this way. In such cases, what typically results is that some other personal value/norm, or set of values/norms, held by the individual is treated as intrinsically at odds with the concept of health, which is presumed, uncritically, to be superior, often because it is taken to be free-standing and self-justifying. Yet, a growing body of evidence-based research suggests that the role played by dimensions of personal meaningfulness in the quality of individuals’ overall health is quite underappreciated. It is useful to think of these dimensions of personal meaning and significance as representing the individual’s values. Thus, taking these data more seriously ought to lead to a reevaluation of the moralization of health at the conceptual level. In the first place, it is not obvious that if the concept of health runs afoul of other values/norms held by an individual, the latter should automatically yield. In the second place, they suggest that other values/norms held by an individual are not necessarily intrinsically opposed to the concept of health, but in fact may go a good distance in support of it.

This article examines the moralistic language and arguments used in relation to genetics. The focus is on three practices: (1) the claims that there is a duty to know about one’s own genetic makeup, (2) assertions that genetic information should be used to inform reproductive decisions, and (3) the proposition that there are moral reasons to participate in biobank research. With these three, the author contends that there are equally good, if not better, arguments to challenge them from a Millian perspective. Furthermore, especially in the current political climate, there is a need to respect people’s privacy concerns.

Moralism in bioethics and elsewhere means going beyond accepted moral principles, either by exaggerating good ethical concerns, by applying them to areas where they do not belong, or simply by assuming anything else than concrete physical or mental harm as normative guides. This paper explores the conceptual background of moralism especially in the consequentialist tradition, presents cases of allegedly bad moralism in the light of this exploration, introduces six approaches to justice, and argues that these approaches question our prevailing views on the goodness and badness of moralism in its various forms.

Child sexual abuse is a global problem with significant emotional, psychological, and financial implications to victims, perpetrators, and society. Most child sexual abuse prevention programs target young children or those who have already engaged in abusive behavior, in order to prevent further offending. There are numerous secondary prevention programs targeting individuals at-risk of various health conditions in an effort to reduce the likelihood they will go on to experience a particular illness or disease. Considerable research exists regarding the risk factors for engaging in child sexual abuse and more specifically the factors contributing to reoffense. We argue that engaging in secondary prevention programs for people with pedophilia, in order to prevent child sexual abuse, is an ethically responsible and necessary practice. Secondary prevention programs with this focus are reviewed, along with the implications of mandatory reporting in doing this work.

A country’s healthcare system—the protection and healing of some its weakest people, its sick and injured—could be considered to be one of the most definitive expressions of its national morality. In recent decades, Ireland has experienced profound cultural changes; from a mostly monocultural and religious society to a multi-ethnic one, where secular ideas predominate. Economically, it is largely neoliberal, with one of the world’s most open economies, and one of its lowest corporate tax rates; though there is also a welfare state. Its healthcare system has reflected these cultural changes. The system has evolved, gradually, from being run almost exclusively by religious groups, to becoming essentially secular in nature (though religious groups are still involved at the ownership level). Overall, the system is run according to the two competing secular ideologies which currently predominate; it is a two-tier system, with a mix of a neoliberally oriented (though government subsidized) private system, and a public system. The latter has been starved of resources in recent decades; so to achieve good, or at times adequate healthcare, it is almost essential to have private health insurance (which about half of the population have).

This two-tier system has led to significant concerns and occasional scandals; for example, patients dying while on waiting lists for public treatment, who could have been treated and possibly saved if they had health insurance. A purely ethical approach to healthcare—with the aim of healing the sick—has been mixed with competing motives, such as the desire for profit in the private sector, or for short term savings and box-ticking in the public system. Thus, good healthcare practice and best moral practice are being undermined by competing agendas.

In this article, I describe and reflect ethically on the Irish healthcare system, and how it has evolved to its current state. I also discuss how dysfunction in the healthcare system, leading to the death of a pregnant woman, Savita Halappanavar, was a major factor in a constitutional ban on abortion being overturned.

In a recent article in this journal, Steve Clarke (2017) identifies two different bases for conscience-based refusals in healthcare: (1) all-things-considered moral judgments, and (2) the dictates of conscience. He argues that these two bases have distinct roles in justifying conscientious objection. However, accepting that there are these two bases, I argue that both are not able to justify conscientious objection. In particular, I argue that the second basis of the dictates of conscience cannot justify conscience-based refusal in a healthcare context. Even if someone objects in a healthcare context on the basis of the dictates of her conscience, and even if we can explain why she objects with reference to the dictates of her conscience, her objection will only be justified if she makes a judgment.

Aaron Ancell and Walter Sinnott-Armstrong (A&SA) propose a pragmatic approach to problems arising from conscientious objections in healthcare. Their primary focus is on private healthcare systems like that in the United States. A&SA defend three claims: (i) many conscientious objections in healthcare are morally permissible and should be lawful, (ii) conscientious objections that involve invidious discrimination are morally impermissible, but (iii) even invidiously-discriminatory conscientious objections should not always be unlawful, as there is a better way to protect patient rights. Pursuant to (iii), A&SA propose a framework that legally allows discriminatory conscientious objections, but that shifts the financial costs associated with such objections from patients to the clinics that employ doctors who discriminate against patients. Though their proposal is controversial, it has attractive features, and merits further discussion. In this paper, I remain neutral on the third claim A&SA advance in support of their proposal, but point out a problem with the two first claims. In the light of my criticisms, I propose to modify their proposal so that costs are shifted to clinics in a broader range of cases.

The author considers the role of narratives, specifically end-of-life narratives, in medical education. After addressing the role of indexing and other neurological explanations for the validity of narratives in the classroom, she focuses on one recent memoir that explores the medical experience of an ALS patient. The advantages of using narratives, including the understanding of the patients’ perspective and the development of empathy, are two important reasons to adopt this approach.

It is commonplace to observe that science often outstrips the ability of society to monitor, supervise and regulate it. A recent challenge in this regard concerns Learning Healthcare Systems, an initiative to collect data and test hypotheses across clinical settings, and therefore to a larger degree than before. Some argue that the line between research and clinical practice is becoming blurred, and that existing regulation seems to obstruct low risk research. They propose the creation of a new ethical framework for Learning Healthcare Systems, to speed up research. This paper opposes that view, and argues that Learning Healthcare Systems do not blur or remove the line between research and practice, and will not result in a single set of regulations for all kinds of biomedical research. The authors suggest that a large proportion of Learning Healthcare System activities resemble public health surveillance to a significant extent. Therefore, they propose that these activities should be organized in accordance with the same ethical principles as public health surveillance, specifically that Learning Healthcare Systems should rest on the principles of comprehensiveness, transparency, and public accountability.

Anthony is a fourth-year medical student, currently on service during an away surgery rotation. He is rounding with a first-year intern, Dr. Lovett, and the attending, Dr. Todd. They stop outside the room of Mr. Turpin, a 54-year-old male who has recently had a toe amputation due to uncontrolled diabetes mellitus. His chart lists him as a drug-seeker managed for chronic pain. As such, his analgesics are being closely monitored. Before entering the room, Dr. Lovett mentions that the patient had been irritated the night prior, complaining of uncontrolled pain, and upset at staff for refusing increased pain medication. Dr. Todd knows this, remarking that Mr. Turpin has a history of being a “difficult patient.”