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“The Mitochondrial Replacement ‘Therapy’ Myth,” Bioethics (Early View December 2016)
ABSTRACT: This article argues that two forms of mitochondrial replacement therapy, maternal spindle transfer (MST) and pro-nuclear transfer (PNT), are not therapies at all because they do not treat children who are on their way in coming into existence. Rather, these technologies merely create healthy children where none was inevitable. Even if creating healthy lives has some value, it is not to be mistaken with the medical value of a cure or therapy. The article addresses a recent Bioethics article, “Mitochondrial Replacement: Ethics and Identity,” by Wrigley, Wilkinson, and Appleby, who argue that PNT is morally favorable to MST due to the Non-Identity Problem. Wrigley et al. claim that PNT, since it occurs post-conception, preserves the identity of the resulting child, whereas MST, since it occurs pre-conception, is an identity-altering technique. As such, a child born with mitochondrial disease could complain that her parents failed to use PNT, but not MST. The present article argues that the authors are mistaken: both MST and PNT are identity-affecting techniques. But this is of little matter, for we should be cautious in drawing any moral conclusions from the application of the Non-Identity Problem to cases. The article then argues that the authors are mistaken in inferring that PNT is a type of embryonic cure or therapy for children with mitochondrial disease. The article cautions against the mistaken life-saving rhetoric that is common in bioethics discussions of MRTs.

“For Dog’s Sake, Adopt!,” in Pets and People: The Ethics of Our Relationships with Companion Animals, edited by Christine Overall, Oxford University Press, 2017.
ABSTRACT: I investigate the claim that people should adopt their animal companions from rescue organizations rather than from breeders, using recent arguments for a duty to adopt children (rather than procreate) as a starting point. The underlying rationale for the claim is the same: adopting saves an existing life that would otherwise be in peril, where creating does not answer to the same important needs. I show how the animal adoption claim is even more compelling on several fronts. For instance, it is strengthened by the wrong of contributing to breeder practices. But what can be said on the other side? I discuss possible motivations for choosing to buy one’s animal companion from a breeder rather than adopt and show that these do not constitute justifications for doing so.

Doug Mackay and Tina Rulli,* “The Duty to Rescue and Investigators’ Obligations,” Kennedy Institute of Ethics Journal Vol. 27, no. 1, 2017.
ABSTRACT: We examine current applications of the moral duty to rescue to justify clinical investigators’ duties of ancillary care and standard of care to subjects in resource-poor settings. These applications fail to explain why investigators possess obligations to research participants, in particular, and not to people in need, in general. Further, these applications fail to recognize the normative significance of the institutional role of the investigators. We offer a positive account of the duty to rescue for investigators as institutional agents, with duties to populations rather than merely individuals.
(* authorship is equal)

“The Ethics of Procreation and Adoption” Philosophy Compass 11/6 (2016): 305-315.
ABSTRACT: It is widely assumed that people have a moral right to procreate. I explore recent arguments in opposition to procreation in some or all contexts. Some anti-natalist and precautionary views are concerned with the risks and harms of life that procreation imposes on non-consenting children. Others articulate concerns for third-parties— the environmental damage or opportunity costs that procreation poses to already existing people. I also explore pro-natalist arguments that favor procreation despite the risks to the children created and third parties. The best argument for procreation is the important interest people have in forming the parent-child relationship. I suggest an important under-discussed middle ground—one that avoids the criticisms of the anti-natalist, while fulfilling the best aims of procreation—viz. adoption. I summarize the argument for a duty to adopt and consider objections to it. Thoughtful people who deeply desire to become parents but do not wish to participate in the range of potential procreative harms should consider adoption as a first choice.

“What is the Value of Three-Parent IVF?” Hastings Center Report Vol. 46, Issue 4, July-August 2016: 38-47.
ABSTRACT: In 2015, the U.S. Institute of Medicine will consider the ethical and social policy implications of three-parent in-vitro fertilization, also known as mitochondrial replacement. Three-parent IVF enables women with mitochondrial disease to have genetically-related children without transmitting the disease. This article argues that investment of public resources in bringing Three-Parent IVF to clinical trials in the U.S. is unethical because of its low social value. Contra the claims of its proponents, the technology will not eradicate mitochondrial disease, nor will it save lives. Its primary value is in maintaining the mother-child genetic connection. The significance of this aim is not sufficiently urgent to warrant use of resources that come at the opportunity cost of researching treatment for actual present and future mitochondrial disease sufferers. We cannot justify our investment of social and public resources into developing this technology.

Tina Rulli and Alex Worsnip,* “IIA, Rationality, and the Individuation of Options,” Philosophical Studies (173)1, 2016: 205-221.
ABSTRACT: The independence of irrelevant alternatives (IIA) is a popular and important axiom of decision theory. It states, roughly, that one’s choice from a set of options should not be influenced by the addition or removal of further, unchosen options. Over recent debates, a number of authors have given putative counterexamples to it, involving intuitively rational agents who violate IIA. Generally speaking, however, these counterexamples do not move IIA’s proponents. Defenders of IIA propose individuating the options that the agent faces differently, so that the case no longer counts as a violation of IIA. In this paper, we examine whether this strategy succeeds. We argue that the ways of individuating options required to save IIA from the most problematic counterexamples – in particular, cases where agents violate IIA due to nonconsequentialist moral beliefs – do so only at the expense of severely compromising its central function within decision theory.
(* authorship is equal)

Tina Rulli and David Wendler, “The Duty to Take Rescue Precautions,” Journal of Applied Philosophy Vol. 33, Issue 3, 2016: 240-258.
ABSTRACT: There is much philosophical literature on the duty to rescue. Individuals who encounter and could save a person at risk of losing life or limb at relatively little cost to themselves are morally obligated to do so. Yet little has been said about the other side of the issue: what moral obligations might potential rescuees have to rescuers? Rescuees can oftentimes do very little to prevent coming to peril; yet there are cases in which rescue needs could have been reasonably avoided. In these cases, it is intuitive to think that the benefitted agents should have taken certain precautions to reduce the risk of imposing rescue burdens on others. That is, there is a duty to take rescue precautions. We argue for the duty to take rescue precautions, providing an account of the circumstances in which it arises. This novel duty might have important implications for public policy. We apply it to the situation of some of the uninsured in the United States. Given the U.S. clinician’s duty to provide emergency care to all people regardless of ability to pay, some of the uninsured have a moral duty to purchase health insurance. We defend the duty against objections, including the possibility that a right to rescue can be waived, thus undermining a duty to take rescue precautions.

“Preferring a Genetically-Related Child,” Journal of Moral Philosophy, online November 2014. Link: 17455243_4681062_text
ABSTRACT: Millions of children worldwide could benefit from adoption. One could argue that there is a pro tanto duty of prospective parents to adopt rather than create children. For the sake of argument, I assume there is such a duty and focus on a pressing objection to it: prospective parents may prefer that their children are genetically related to them. I examine reasons prospective parents have for preferring genetic children, including to preserve family resemblance, for psychological similarity, for the sake of love, to achieve a kind of immortality, for the genetic connection itself, and to experience pregnancy. I argue that, with a possible exception, these reasons cannot ground a moral permission to create children against a duty to adopt, even assuming that we do have some leeway to favor our own interests for more than their objective weight.

“The Unique Value of Adoption,” Family Making: Contemporary Ethical Challenges, eds. Francoise Baylis and Carolyn McLeod, Oxford University Press, 2014. Link to anthology
ABSTRACT: Most people would agree that adoption is a good thing for children in need of a family. Yet adoption is often considered a second best or even last resort for parents in making their families. Against this assumption, I explore the unique value of adoption for prospective parents. I begin with a criticism of the selective focus on the value of adoption for only those people using assisted reproductive technologies. I focus on the value of adoption for all prospective parents, reflecting on non-relative, non-procreative adoptions. First, adoption can meet the important need that a child has for a family, whereas procreation creates rather than meets needs. Second, adoption provides a morally noble opportunity to extend to a stranger benefits usually withheld for one’s genetic kin. As such, adoption offers a unique possibility in which impartial concern for an other can be the starting point for a lifetime of love and care. Finally, adoptions can have transformative power over adoptive parents’ conception of family and self. In highlighting the unique value of adoption, I aim to challenge the widespread assumption that adoption has second best status to procreation. Indeed adoption can exemplify the human potential for moral compassion and impartial concern for the needs of others.

Tina Rulli and Joseph Millum, “Rescuing the Duty to Rescue,” Journal of Medical Ethics, 2014.
ABSTRACT: Clinicians and health researchers frequently encounter opportunities to rescue people. Such rescue cases can generate a moral duty to aid those in peril. As such, bioethicists have leveraged a duty to rescue for a variety of purposes. Yet, despite its broad application, the duty to rescue is under-analyzed. In this short essay we assess the state of theorizing about the duty to rescue. There are large gaps in bioethicists’ understanding of the force, scope, and justification of the two most cited duties to rescue—the individual duty of easy rescue and the institutional rule of rescue. If the duty to rescue is to help solve ethical problems, these theoretical gaps must be addressed. We identify two further duties to rescue that have received less attention—an institutional duty of easy rescue and professional duties to rescue—and propose research priorities for developing accounts of duties to rescue in bioethics.

Tina Rulli, Ezekiel Emanuel, & David Wendler. The Moral Duty to Buy Health Insurance, Journal of the American Medical Association, Vol. 308, No. 2 (July 11, 2012): 137-138.
ABSTRACT: The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty.


Of Chignell, Cuneo, and Halteman’s Philosophy Comes to Dinner, Notre Dame Philosophical Reviews, 2016

Of Judith Lichtenberg’s Distant Strangers, Notre Dame Philosophical Reviews, 2014