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  • Editor’s Note, September 2021
  • Quill Kukla

All five articles in this issue consider, in different ways, what it takes to respect an individual’s humanity; each one offers a broader conception of human regard than is standard in the practical ethics literature. Respectively, they explore how truth-telling (including refraining from deceiving as well as providing information), providing appropriate treatment for those with substance use disorders, enabling real reproductive choice and control, and providing meaningful access to the internet all form important parts of what it takes to treat people as fully human and to care for their well-being. All are grounded not just in abstract rights arguments, but in attention to the empirical and social conditions of flourishing and self-determination.

In “Truth and Deceit in Dementia Care: An Argument for Truthful Regard as a Morally Significant Human Bond,” Philippa Byers weaves together personal reflection, conceptual argumentation, and narrative, to make a beautifully written case for the importance of telling the truth to people with dementia in almost all circumstances. Taking people with dementia as fully human, she claims, requires holding them in ‘truthful regard’—that is, as people for whom truth matters—even as their hold on reality slips. The small white lies that are often treated as harmless when told to people with dementia are in fact deeply disrespectful, in ways that cannot be morally compensated for on utilitarian grounds, even if they produce happiness, she argues. She explores how we can tell the truth judiciously and kindly. Even if deceit is carefully considered and beneficently motivated, she concludes, it should be regarded as exceptional and ‘unsettling’, and only engaged in as a last resort.

Continuing the focus on truth-telling, D. Robert MacDougall, in “Must Consent be Informed?: Patient Rights, State Authority, and the Physician’s Legal Duties of Disclosure,” seeks a moral justification for physicians’ distinctive duties to inform patients about all their options before obtaining consent. He points out that this extended duty of disclosure is not a standard part of the duty to inform before getting consent. (To [End Page vii] use an example other than those he gives: I do not have to explain to you all the other people you could have sex with and their pros and cons before getting your consent to have sex with me!) MacDougal gives a justification for this strong duty to disclose that is grounded in Kantian political philosophy, founded in the civil rights that it would be rational to implement in a state that protects individual freedom as long as it does not intrude upon the freedom of others. Thus for MacDougal, like for Byers, our truth-telling duties are based upon our fundamental duties to treat one another as self-determining beings with full humanity, and these duties are more extensive than we typically think.

In “Can Treatment for Substance Abuse Prescribe the Same Drug as That Abused? The Case of Injectable Opioid Agonist Treatment”, Daniel Steel and Şerife Tekin ask whether prescribing the same drug that someone is abusing can conceptually count as treatment for substance use disorder, and whether such an approach can be ethical and effective. They focus on the case of iOAT for opioid use disorder, which contains the same active ingredient as heroin. They create a typology of understandings of both substance use disorder and treatment. They argue that on all but one combination of these understandings, same-substance interventions can be valid treatments, while the final combination is independently implausible. One interesting point they make along the way is that the intervention of giving iOAT is different from just taking an opioid outside of a medical context, since the contact with the health system is part of the intervention; the context of the intervention changes the intervention itself. Steel and Tekin show how our denial of same-substance treatments to those with use disorder is based on conceptual and empirical confusion and bad ideology. They argue that standards of care that took seriously how people function as agents in their full material, institutional, and social context would probably include such interventions and classify them as treatments.

The question of whether reproductive autonomy rights include...

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