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On 20 May 2025, the World Health Organization (WHO) adopted the Pandemic Agreement at the World Health Assembly in Geneva. After nearly three years of negotiations and after failing to adopt it in 2024, this is a decisive step towards more combined efforts to address future pandemics. The final text of the treaty highlights the need for equitable access to pandemic-related health products and aims to improve the ability of international health regulators to guide countries during future pandemics. There is hope that by learning from mistakes made during the COVID-19 pandemic, the Agreement can be used to address global inequities and make globally equitable resource sharing the norm, preventing harmful practices, such as vaccine hoarding and barriers to data sharing. However, while the current Pandemic Agreement puts equitable access to surveillance, therapeutics, vaccines, and other pandemic-related products at the forefront, many important questions are yet to be answered. The authors of this paper draw attention to ethics preparedness efforts. The piece considers the importance of building the necessary infrastructure for the provision of ethical advice on health-related matters as part of the implementation phases of the WHO Pandemic Agreement to ensure that we learn from the mistakes made during the COVID-19 pandemic.

Philosophers who publish articles that make practical ethical recommendations are thereby offering advice. I consider what obligations they incur in advising. I analyse the giving of advice as a communicative act whose defining and characteristic aim is to secure acceptance of what is advised. Such advice need not be solicited or taken up. I distinguish advice from incitement and threats and specify the scope of the adviser's responsibility for others acting upon the advice. I explore how advice can be bad in how it is given and what is given. I consider, and criticise, various pleas for exemption from the responsibilities of philosophical advising: that advice was not meant; that it wouldn't make any difference anyway; and that the writing was not for those who might act on it. I examine the offering of philosophical advice to policy makers, comparing the views on this of Mary Warnock and Dan Brock. I conclude by asking practical normative philosophers to consider what they should do inasmuch as they are advising.

In cases where the best interests of the child are disputed or finely balanced, Clinical Ethics Committees (CECs) can provide a valuable source of advice to clinicians and trusts on the pertinent ethical dimensions. Recent judicial cases have criticised the lack of formalised guidance and inconsistency in the involvement of parents in CEC deliberations. In Manchester University NHS FT v Verden [2022], Arbuthnot J set out important procedural guidance as to how parental involvement in CEC deliberations might be managed. She also confirmed substantive guidance on the role of parental views in determining the child’s best interests. We agree that it is good practice to ensure that the patient voice is heard in ethics processes, but how that is achieved is controversial. Surely it is best that what matters most to a patient and their family, whether facts or values, is conveyed directly to those considering the moral issues involved, rather than via a prism of another party. The approach suggested in the Verden case has much in common with the process used by our CEC. In this article, we commend Arbuthnot J’s approach, provide an example of its effective operation and consider what it might mean for ethics processes.

BackgroundThe COVID-19 pandemic highlighted the need for clinical ethics support provision to ensure as far as possible fair decision making and to address healthcare workers’ moral distress.PurposeTo describe the availability, characteristics and role of clinical ethics support services (CESSs) in the UK during the COVID-19 pandemic.MethodA descriptive cross-sectional online survey was developed by the research team. The survey included questions on CESSs characteristics (model, types of support, guidance development, membership, parent and patient involvement) and changes in response to the pandemic. Invitations to participate were widely circulated via National Health Service institutional emails and relevant clinical ethics groups known to the research team.ResultsBetween October 2020 and June 2021, a total of 53 responses were received. In response to the pandemic, new CESSs were established, and existing provision changed. Most took the form of clinical ethics committees, groups and advisory boards, which varied in size and membership and the body of clinicians and patient populations they served. Some services provided moral distress support and educational provision for clinical staff. During the pandemic, services became more responsive to clinicians’ requests for ethics support and advice. More than half of respondents developed local guidance and around three quarters formed links with regional or other local services. Patient and/or family members’ involvement in ethics discussions is infrequent.ConclusionsThe pandemic has resulted in an expansion in the number of CESSs. Though some may disband as the pandemic eases, the reliance on CESSs during the pandemic demonstrates the need for additional research to better understand the effectiveness of their various forms, connections, guidance, services and modes of working and for better support to enhance consistency, transparency, communication with patients and availability to clinical staff.

The pace of change and, indeed, the sheer number of clinical ethics committees (not to be confused with research ethics committees) has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street Hospital for Children NHS Foundation Trust v MX, FX and X ([2020] EWHC 1958 (Fam), [21]–[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK.

This article examines what is wrong with some expressive acts, 'insults'. Their putative wrongfulness is distinguished from the causing of indirect harms, aggregated harms, contextual harms, and damaging misrepresentations. The article clarifies what insults are, making use of work by Neu and Austin, and argues that their wrongfulness cannot lie in the hurt that is caused to those at whom such acts are directed. Rather it must lie in what they seek to do, namely to denigrate the other. The causing of offence is at most evidence that an insult has been communicated; it is not independent grounds of proscription or constraint. The victim of an insult may know that she has been insulted but not accept or agree with the insult, and thereby submit to the insulter. Hence insults need not, as Waldron argues they do, occasion dignitary harms. They do not of themselves subvert their victims' equal moral status. The claim that hateful speech endorses inequality should not be conflated with a claim that such speech directly subverts equality. Thus, 'wounding words' should not unduly trouble the liberal defender of free speech either on the grounds of preventing offence or on those of avoiding dignitary harms.

This article provides a philosophical analysis of a putative right of the child to have their expressed views considered in matters that affect them. Article 12 of the United Nations Convention on the Rights of the Child 1989 is an influential and interesting statement of that right. The article shows that the child’s ‘right to a voice’ is complex. Its complexity lies in the problem of contrasting an adult’s normative power of choice with a child’s weighted views, in the various senses in which we might consider the child’s views, and in the questions of how to weight those views and how their weighting makes a practical difference in coming to a decision. In so doing we criticise other accounts that simply regard a child’s views as having consultative value. We also make better sense of how we might weight a child’s views. The philosophical issues addressed in the article carry implications for how we might understand Article 12 that are not satisfactorily identified and addressed in the voluminous literature on Article 12 within childhood studies. These issues also have implications for how we might understand the distinction between adults and children in respect of powers of personal choice. We conclude by emphasising the importance and value of the right that Article 12 seeks to formally identify.

If rape is evaluated as a serious wrong, can it also be defined as non-consensual sex (NCS)? Many do not see all instances of NCS as seriously wrongful. I argue that rape is both properly defined as NCS and properly evaluated as a serious wrong. First, I distinguish the hurtfulness of rape from its wrongfulness; secondly, I classify its harms and characterize its essential wrongfulness; thirdly, I criticize a view of rape as merely 'sex minus consent'; fourthly, I criticize mistaken attempts to discount the wrongfulness of rape for those who do not value sex; fifthly, I contrast two models for weighing interests, according to one of which rape is not seriously wrongful; finally, I sketch a defence of the view that our sexual integrity ought to be a central interest of ours.