In the ethics literature, concern about financial compensation has largely focused on the question of how payment could distort research participants’ perception of risk. Such concern about “undue inducement” has particularly occupied institutional review boards (IRBs) and has often led to conservative judgments about how much financial compensation participants can be offered in exchange for their participation in research. Increasingly, bioethics scholars have argued that such approaches to financial compensation in research could exploit participants, on one hand, or create a barrier to their enrollment, on the other. Despite the vast literature on financial compensation for research, there has been substantially less attention to the potential risk that such payment may pose to research participants. The current system of taxing research compensation is one important example of the financial risks to research participants that warrants more analysis and legislative action.

In his widely anthologized article on the therapy-enhancement distinction, Resnik argues that, from a moral point of view, the claim that something is not health related cannot be a dispositive argument against the permissibility of enhancements. He further states how the permissibility of an intervention will depend on considerations like the intention for its use and the likely consequences that will ensue, and whether these violate any moral standards. Within this framework, in this paper I first argue that enhancements may be morally permissible on autonomy grounds (its political conception); and secondly, that this permissibility does not dissolve a moral distinction between therapies and enhancements, with the reason being that there is still a difference between something being generally permissible (i.e., therapies) and something being conditionally permissible (i.e., enhancements). But that is not all that is important for a moral therapy-enhancement distinction. I also argue that the distinction — apart from being about “permissibility” (at the level of regulation of individual use) — is also about regarding justice more broadly (at the level of what is owed to individuals). What captures the moral distinction more fully is that therapies are, generally speaking, not only morally permissible but also owed to persons (due to being enablers of social cooperation and competition), whereas, at this stage, enhancements can only be morally permissible. I demonstrate the appeal of this view by considering its stability and usefulness across specialized bioethical contexts and across various kinds of enhancements and show that its practical value for policy lies in its legitimizing / anticipatory and prioritizing functions.

Shields and colleagues raise a concern for bias against low-income families when reporting suspected intentional scald burns. This is a plausible theory, and the development of Child Abuse Pediatrics as a specialty has likely helped reduce bias because they take the sociodemographic factors into account and are keenly aware of housing problems such as water heaters that are not regulated. Bringing their expertise to burn units will help reduce bias, and efforts should focus on public policy changes as described by the authors, but also on parental education to reduce the overall incidence of burn injuries in children.