One of the most prominent strands in contemporary work on the virtues consists in the attempt to develop a distinctive—and compelling—account of practical reason on the basis of Aristotle’s ethics. In response to this project, several eminent critics have argued that the Aristotelian account encourages a dismissive attitude toward moral disagreement. Given the importance of developing a mature response to disagreement, the criticism is devastating if true. I examine this line of criticism closely, first elucidating the features of the Aristotelian (...) account that motivate it, and then identifying two further features of the account that the criticism overlooks. These further features show the criticism to be entirely unwarranted. Once these features are acknowledged, a more promising line of criticism suggests itself—namely, that the Aristotelian account does too little to help us to resolve disputes—but that line of objection will have to be carried out on quite different grounds. (shrink)

ABSTRACT Glen Pettigrove wishes to accommodate the thought that exemplary instances of love, forgiveness and ambition need not be strictly proportional to the value present in their objects and that agents who are excellent may value the same things somewhat differently from one another or differently over time. To make room for these attractive ideas, he sketches an approach according to which (i) the virtuous agent’s particular modus operandi constitutes an important locus of value and (ii) the value of virtue (...) is sui generis. I note that the principle of universalizability threatens his project. I sketch a way to reject this principle that agrees with the thesis that an agent’s modus operandi may be an important locus of value but puts pressure on the thesis that the value of virtue is sui generis. I question whether Pettigrove needs the second thesis. (shrink)

Australasian Journal of Philosophy, Volume 89, Issue 3, Page 557-559, September 2011.

In order to fulfill ABET requirements, Northern Arizona University’s Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to “grey” or multiple possible solution technical problems. To identify (...) and solve these problems, the engineering design process is used. Ethical problems are also “grey” problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue. (shrink)

ABSTRACT Abduction as a method for sociological explanation is increasingly gaining interest, but questions remain as to what exactly it is and how it differs from other methods of inquiry. This paper compares abduction as conceived in Peircean pragmatism with the critical realist concept of retroduction. I argue that abduction in the Peircean sense and retroduction in the critical realist sense refer to different, but complementary, modes of inference. Abductive conclusions provide the starting point for retroductive inferences; the latter inform (...) the tenability of the former. Together, abduction and retroduction contribute to theoretical explanation. (shrink)

With evidence of vaccine hesitancy in several jurisdictions, the option of making COVID-19 vaccination mandatory requires consideration. In this paper I argue that it would be ethical to make the COVID-19 vaccination mandatory for older people who are at highest risk of severe disease, but if this were to occur, and while there is limited knowledge of the disease and vaccines, there are not likely to be sufficient grounds to mandate vaccination for those at lower risk. Mandating vaccination for those (...) at high risk of severe disease is justified on the basis of the harm principle, as there is evidence that this would remove the grave public health threat of COVID-19. The risk–benefit profile of vaccination is also more clearly in the interests of those at highest risk, so mandatory vaccination entails a less severe cost to them. Therefore, a selective mandate would create fairness in the distribution of risks. The level of coercion imposed by a mandate would need to be proportionate, and it is likely that multiple approaches will be needed to increase vaccine uptake. However, a selective mandate for COVID-19 vaccines is likely to be an ethical choice and should be considered by policy-makers. (shrink)

I mention this story also as the best method I can advise any person to take in such a case, especially if he be one that makes conscience of his duty, and would be directed what to do in it, namely, that he should keep his eye upon the particular providences which occur at that time, and look upon them complexly, as they regard one another, and as all together regard the question before him: and then, I think, he may (...) safely take them for intimations from Heaven of what is his unquestioned duty to do in such a case; I mean as to going away from or staying in the place where we dwell, when visited with an infectious distemper.Daniel Defoe's fictional narrator H.F. introduces his account of the 1665 plague with the... (shrink)

A number of recent studies have revealed correspondences between song- and language-related neural structures, pathways, and gene expression in humans and songbirds. Analyses of vocal learning, song structure, and the distribution of song elements have similarly revealed a remarkable number of shared characteristics with human speech. This article reviews recent developments in the understanding of these issues with reference to the phonological phenomena observed in human language. This investigation suggests that birds possess a host of abilities necessary for human phonological (...) computation, as evidenced by behavioral, neuroanatomical, and molecular genetic studies. Vocal-learning birds therefore present an excellent model for studying some areas of human phonology, though differences in the primitives of song and language as well as the absence of a human-like morphosyntax make human phonology differ from birdsong phonology in crucial ways. (shrink)

We propose an account of dynamic predicates which draws on the notion of force, eliminating reference to events in the linguistic semantics. We treat dynamic predicates as predicates of forces, represented as functions from an initial situation to a final situation that occurs ceteris paribus, that is, if nothing external intervenes. The possibility that opposing forces might intervene to prevent the transition to a given final situation leads us to a novel analysis of non-culminating accomplishment predicates in a variety of (...) languages, including the English progressive. We then apply the force-theoretic framework to the composition of basic Vendlerian eventuality types within a lexical-decomposition syntax. The difference between predicates of forces and predicates of situations is argued to underlie the dynamic/stative contrast, and also to allow for a formal treatment of the difference between be and stay. Consequences for the relationship between language and cognition are discussed. (shrink)

Both autistic adults and families of autistic children rely heavily on blogs and other digital platforms to create community and gain experiential knowledge about autism, but research on autism blogs has failed to distinguish between the perspectives of autistic adults and neurotypical parent bloggers. Furthermore, intersections in the experiences of BIPOC autistics are rarely examined. Using a content analysis with a feminist Critical Disability Studies lens, I explore six autism parent blogs from diverse demographics: a white neurotypical father, a white (...) autistic mother in an interracial relationship, a white neurotypical mother, an Indigenous autistic trans father, a Black autistic nonbinary mother, and a Black neurotypical mother. I examine the attitudes of these bloggers to get a sampling of their opinions on autism, how they parent autistic children, and how their social location, specifically race, impacts their experiences. More intersectional research needs to be done to boost the perspectives of BIPOC autistics and the expertise of autistic parents. (shrink)

It is often assumed that adaptation — a temporary change in sensitivity to a perceptual dimension following exposure to that dimension — is a litmus test for what is and is not a “primary visual attribute”. Thus, papers purporting to find evidence of number adaptation motivate a claim of great philosophical significance: That number is something that can be seen in much the way that canonical visual features, like color, contrast, size, and speed, can. Fifteen years after its reported discovery, (...) number adaptation’s existence seems to be nearly undisputed, with dozens of papers documenting support for the phenomenon. The aim of this paper is to offer a counterweight — to critically assess the evidence for and against number adaptation. After surveying the many reasons for thinking that number adaptation exists, we introduce several lesser-known reasons to be skeptical. We then advance an alternative account — the old news hypothesis — which can accommodate previously published findings while explaining various (otherwise unexplained) anomalies in the existing literature. Next, we describe the results of eight pre-registered experiments which pit our novel old news hypothesis against the received number adaptation hypothesis. Collectively, the results of these experiments undermine the number adaptation hypothesis on several fronts, whilst consistently supporting the old news hypothesis. More broadly our work raises questions about the status of adaptation itself as a means of discerning what is and is not a visual attribute. (shrink)

This article challenges what is now the orthodoxy concerning the heritage of Bourdieu (1930–2002): namely, the judgement that his distinctive sociological innovation has been his theory of social reproduction, and that he has failed to provide a necessary theory of social change. Yet Bourdieu consistently claimed to offer a theory of social transformation as well as accounting for continuities of power. Indeed, he provides two substantive keys for an understanding of historical transformation—first, a theory of prophets (religious or secular) as (...) the authors of heresies or “symbolic revolutions” that dispel current doxa; second, a theory of the “corporatism of the universal”: the role of intellectuals or other educated professionals in pursuit of social justice and other universalistic goals. Moreover, Bourdieu fuses his theories of “symbolic revolutions” with a materialist analysis of their social preconditions, including a fresh account of social crises. Crises—war, famine, recession, and especially the intensified precarity of the educated—have, for him, a profound impact, both within differentiated fields and across fields. Conflicts that become effectivelysynchronizedacross fields acquire great resonance within the wider field of power, particularly due to hysteresis or “maladjusted habitus.” Indeed, the appearance of crises, together with new prophetic heresies, leads the subordinate classes to question the taken-for-granted order of things and to orchestrate their resistance. Alongside his corpus of published writings, this article draws widely on Bourdieu’s posthumously published lectures. These cast a distinctive new light on how his well-known conceptual instruments can aid us in the study of historical change. They also expand on how social science itself might be used to facilitate progressive social movements. (shrink)

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and (...) a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

Many nonhuman animals produce facial expressions which sometimes bear clear resemblance to the facial expressions seen in humans. An understanding of this evolutionary continuity between species, and how this relates to social and ecological variables, can help elucidate the meaning, function, and evolution of facial expression. This aim, however, requires researchers to overcome the theoretical and methodological differences in how human and nonhuman facial expressions are approached. Here, we review the literature relating to nonhuman facial expressions and suggest future directions (...) that could facilitate a better understanding of facial expression within an evolutionary context. (shrink)

Anglicanism's relationship with its Reformation heritage represents a tension. It looks to the Reformation as the movement from which an English Church, independent of papal authority, was inaugurated. At the same time, it refuses to be labelled as a “church of the Reformation”, pointing to its continuity with a much longer history of Christian practice in Britain. The growth of the Anglican Communion and current controversies over church order, the interpretation of scripture and the exercise of authority make Anglican identity (...) difficult to define. Identity would once have been sought in liturgy, but the view that liturgy completely enshrines Anglican doctrine has been convincingly put to rest by scholarship since the 1970s. This paper argues that the liturgical legacy of the Reformation offers categories that can help to form possible approaches to the current crisis of Anglican identity. (shrink)

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through “herd immunity,” which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to (...) increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination. In addition, it has raised the possibility of banning unvaccinated children from childcare centres. This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices. (shrink)

This article considers whether there is a specific demand for migrant domestic workers in the UK, or for workers with particular characteristics that in theory could be met by citizens. It discusses how immigration status can make it easier not only to recruit domestic workers, but also to retain them. `Foreignness' may also make the management of the employment relation easier with employers anxious to discover a coincidence of interest with the worker. Employers are not only looking for generic `foreignness' (...) however, but typically also seek particular nationalities or ethnicities of worker, which can raise difficulties for agencies who are not allowed to discriminate on the basis of `race'. (shrink)

Published data show that new HIV prevention strategies including treatment‐as‐prevention and pre‐exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV‐based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment‐as‐prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment‐as‐prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment‐as‐prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV‐based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

This article undertakes a critical analysis of the work of Gisèle Sapiro, with reference to sociology of literature. From 1999 (Sapiro, 2014a), Sapiro has developed the Bourdieusian research tradition, amplifying especially Bourdieu’s theory of crisis. Focusing on the antagonisms between literary “prophets” and “priests”, she has drawn on a rich sample of 184 writers to elucidate the struggles inherent in World War II between writers from different field positions and literary habitus. Further, her historical analyses of the ethical commitments of (...) nineteenth century writers via a fresh microsociology of literary trials (Sapiro, 2011) has reminded us of the importance of popular poets in articulating the suffering of the subordinate classes. Her most recent book (Sapiro, 2018) has expanded on her earlier themes, whilst identifying the recuperation of certain 1930s’ fascist worldviews within contemporary literature. This article notes that there is a telling divergence between Bourdieu and Sapiro on the issue of interests behind disinterestedness, exemplified in the case of Zola. On this issue, Sapiro’s reading (Sapiro, 2011) is found convincing. Finally, the dialectic of avant-garde consecration and routinisation is questioned as a universal structure. It is suggested that certain avant-garde – the Harlem Renaissance, for example – did not undergo swift consecration or routinisation, although this contention deserves greater research. The paper concludes by showing that Sapiro’s conception of writers’ responsibility owes its origins less to Sartre than to the Durkheimian/ Bourdieusian notion of the expertise of the “specific intellectual”. It welcomes Sapiro’s concern for literature as a potential force for social change. (shrink)

This study investigated cheating behaviours, contributing factors, and strategies to enhance the integrity of assessment in an online learning context. The researchers conducted an analysis of the literature on students’ motivation to cheat in online modules and noted that there is limited research on the specific reasons why students cheat in online learning contexts. To contribute to this knowledge gap, this study set out to understand cheating in two English modules with first-year second language students, in an open distance and (...) e-learning institution in South Africa. The purpose of this study is (1) to investigate why students cheat in their online assessments, (2) to explore the contributing factors of cheating behaviours, and (3) to determine strategies to minimise cheating. Using qualitative methods such as focus group discussions with students, evaluation questions with markers, and one-on-one interviews with lecturers, the study found that cheating is a significant issue in distance education, with students admitting to various forms of cheating in online assessments. Using the social cognitive theory of moral disengagement, the study found that cognitive mechanisms motivate students to engage in unethical behaviour such as cheating. The study recommends implementing an interactive module design, lecturer training on student support, and stringent academic integrity policies to minimise cheating. There is a need for studies that explore the impact of cheating and the effectiveness of different strategies for minimising cheating and enhancing integrity in online assessment. (shrink)

In this paper, I discuss critical realists’ and contemporary sociological pragmatists’ approaches to conceptualizing social mechanisms, which, on my reading, each involve some ambiguities or confusions. I sketch some corrections and clarifications that bring into view ways pragmatism and critical realism might inform each other in a constructive fashion on the question of what social mechanisms are. Finally, I suggest a concept of social mechanisms that is compatible with both critical realist and pragmatist insights, as a starting point from which (...) to launch further conversation. (shrink)

In this paper I attempt a new reading of the passage found in 1 Timothy 2.8-15, to try to show how it might be read by women today. The difficulties of reading such patriarchal texts from the canon of biblical literature are not trivialized or overlooked, and are addressed by a selective survey of how this passage has been read in different contexts through the history of interpretation. The resulting reading neither removes this problematic material from the canon, nor denies (...) the oppressive uses it has been put to in keeping women out of positions of power in various church communities. (shrink)

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses’ opinions of the content and function of codes and their use in nursing practice. A total of 49 focus (...) groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be ‘paper tigers’ with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice. (shrink)

In the Transcendental Aesthetic (TA), Kant is typically held to make negative assertations about “things in themselves,” namely that they are not spatial or temporal. These negative assertions stand behind the “neglected alternative” problem for Kant’s transcendental idealism. According to this problem, Kant may be entitled to assert that spatio-temporality is a subjective element of our cognition, but he cannot rule out that it may also be a feature of the objective world. In this paper, I show in a new (...) way how Kant’s view (focusing on his conclusions about space) is not subject to this objection, by showing that he does not make the denial about mind-independent reality that he is typically held to make. The argument develops consequences of a new reading of Kant’s expression “an sich selbst” (‘in itself’; ‘in themselves’). I argue that “an sich selbst” or “per se” has a special, judgment-level role, so that this expression does not form new noun-terms adjectivally. It follows that the conceptual unit of Kant’s “Conclusions” in the TA is simply “things” (Dinge), since “things in themselves” is not a nominal expression; Kant adopts the Wolffian ontological use of “thing” as the basic kind-term for any existent. The arguments that things per se are not in space are arguments that space cannot be a necessary property or relations of things as a kind. I show that this does not involve the positive claim about mind-independent reality that inspires the neglected alternative objection. (shrink)

In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against placebo. (...) But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)

The topic of epistemic injustice in global health ethics is complex, important and vast. While presenting as nuanced and complete a picture of the challenge as we possibly could, we were acutely aware of our positionality and how it gave us a certain viewpoint that would need to be expanded by others with different positions and experiences. We were, therefore, delighted to receive the collected commentaries by Atuire,1 Abimbola,2 Frimpong-Mansoh,3 Nyamnjoh and Ewuoso,4 Tangwa,5 Ambrogi et al.6 We would like to (...) thank these authors for furthering our account by raising questions, pointing out gaps or complementing our analysis. The points raised by these authors—and many points that will undoubtedly be raised by others in future—should be critically engaged with as we collectively define and work towards a more epistemically just global health ethics. Specifically, two points stand out. First, Frimpong-Mansoh accurately diagnoses our ambiguity about being drawn into debates about relativism in bioethics. We …. (shrink)

The visual system adapts to a wide range of visual features, from lower-level features like color and motion to higher-level features like causality and, perhaps, number. According to some, adaptation is a strictly perceptual phenomenon, such that the presence of adaptation licenses the claim that a feature is truly perceptual in nature. Given the theoretical importance of claims about adaptation, then, it is important to understand exactly when the visual system does and does not exhibit adaptation. Here, we take as (...) a case study one specific kind of adaptation: visual adaptation to size. Supported by evidence from four experiments, we argue that, despite robust effects of size adaptation in the lab, (1) size adaptation effects are phenomenologically underwhelming (in some cases, hardly appreciable at all), (2) some effects of size adaptation appear contradictory, and difficult to explain given current theories of size adaptation, and (3) prior studies on size adaptation may have failed to isolate size as the adapted dimension. Ultimately, we argue that while there is evidence to license the claim that size adaptation is genuine, size adaptation is a puzzling and poorly understood phenomenon. (shrink)

Carens's discussion of the work-related rights of irregular migrants fails to consider the differentiated employment rights of legal temporary migrants, permanent residents, and citizens.

Community engagement (CE) is gaining prominence in global health research. A number of ethical goals–spanning the instrumental, intrinsic, and transformative–have been ascribed to CE in global health research. This paper draws attention to an additional transformative value that CE is not typically linked to but that seems very relevant: solidarity. Both are concerned with building relationships and connecting parties that are distant from one another. This paper first argues that furthering solidarity should be recognized as another ethical goal for CE (...) in global health research. It contends that, over time, CE can build the bases of solidaristic relationships—moral imagination, recognition, understanding, empathy—between researchers and community members. Applying concepts from existing accounts of solidarity, the paper develops preliminary ideas about who should be engaged and how to advance solidarity. The proposed approach is compared to current CE practice in global health research. Finally, the paper briefly considers how solidaristic CE could affect how global health research is performed. (shrink)

This book brings together research on the topic of causation from experts in the fields of linguistics, philosophy, and psychology. It draws on data from a wide range of languages and seeks to arrive at a more sophisticated understanding of how causal concepts are expressed in causal meanings, and how those meanings are organized into structures.

The development of the Islamic world -- The education of Averroes -- Philosophy and Islam -- Law and medicine -- Remembering Averroes.

The Golden Age of Islam -- Avicenna's early life -- On the prince's court -- Prince of physicians -- A short life with width -- Chief of the wise.

Al-Kindi is believed by many scholars to be the first Islamic philosopher. At a time when Europe was plunged into the Dark Ages, the Islamic world was experiencing an important time of cultural growth and scientific advancement. While many considered Muslim students of ancient Greek philosophers to be infidels, al-Kindi was able to master the scholarship while interpreting it through his Muslim faith. His conclusions always supported the teachings of Islam, but the methods that he drew upon to reach these (...) conclusions were rooted in science, math, and principles accepted by many other cultures and faiths. (shrink)

Is there more to Buddhism than sitting in silent meditation? Is modern Buddhism relevant to the problems of daily life? Does it empower individuals to transform their lives? Or has Buddhism become too detached, so still and quiet that the Buddha has fallen asleep? Waking the Buddha tells the story of the Soka Gakkai International, the largest, most dynamic Buddhist movement in the world today--and one that is waking up and shaking up Buddhism so it can truly work in ordinary (...) people's lives. Drawing on his long personal experience as a Buddhist teacher, journalist, and editor, Clark Strand offers broad insight into how and why the Soka Gakkai, with its commitment to social justice and its egalitarian approach, has become a role model, not only for other schools of Buddhism, but for other religions as well. Readers will be inspired by the struggles and triumphs of the Soka Gakkai's three founding presidents--individuals who staked their lives on the teachings of the Lotus Sutra and the extraordinary power of those teachings to help people become happy. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

The principle of providing post-trial access for research participants to successful products of that research is widely accepted and has been enshrined in various declarations and guidelines. While recent ethical guidelines recognise that the responsibility to provide post-trial access extends to sponsors, regulators and government bodies as well as to researchers, it is the researchers who have the direct duty of care to participants. Researchers may thus need to act as advocates for trial participants, especially where government bodies, sponsors, and (...) regulatory bodies have complex interests vested in decisions about whether or not new interventions are made available, how, and to whom. This paper provides an empirical account of post-trial access in the context of HIV prevention research. It describes both access to the successful products of research and the provision antiretroviral drugs for trial participants who acquire HIV. First, we provide evidence that, in the current system, there is considerable variation in the duration and timeliness of access. We then argue that by analysing the difficulties faced by researchers to this point, and their efforts to meet this obligation, much can be learned about how to secure post-trial access in HIV biomedical preventions trials. While researchers alone have a limited obligation, their advocacy on behalf of trial participants may be necessary to call the other parties to account. (shrink)