We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...) daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

ABSTRACT Legislation recently adopted by the United States Congress provides producers of pandemic vaccines with near‐total immunity from civil lawsuits without making individuals injured by those vaccines eligible for compensation through the Vaccine Injury Compensation Program. The unusual decision not to provide an alternative mechanism for compensation is indicative of a broader problem of inconsistency in the American approach to vaccine‐injury compensation policy. Compensation policies have tended to reflect political pressures and economic considerations more than any cognizable set of principles. (...) This article identifies a set of ethical principles bearing on the circumstances in which vaccine injuries should be compensated, both inside and outside public health emergencies. A series of possible bases for compensation rules, some grounded in utilitarianism and some nonconsequentialist, are discussed and evaluated. Principles of fairness and reasonableness are found to constitute the strongest bases. An ethically defensible compensation policy grounded in these principles would make a compensation fund available to all individuals with severe injuries and to individuals with less‐severe injuries whenever the vaccination was required by law or professional duty. (shrink)

Legislation recently adopted by the United States Congress provides producers of pandemic vaccines with near‐total immunity from civil lawsuits without making individuals injured by those vaccines eligible for compensation through the Vaccine Injury Compensation Program. The unusual decision not to provide an alternative mechanism for compensation is indicative of a broader problem of inconsistency in the American approach to vaccine‐injury compensation policy. Compensation policies have tended to reflect political pressures and economic considerations more than any cognizable set of principles. This (...) article identifies a set of ethical principles bearing on the circumstances in which vaccine injuries should be compensated, both inside and outside public health emergencies. A series of possible bases for compensation rules, some grounded in utilitarianism and some nonconsequentialist, are discussed and evaluated. Principles of fairness and reasonableness are found to constitute the strongest bases. An ethically defensible compensation policy grounded in these principles would make a compensation fund available to all individuals with severe injuries and to individuals with less‐severe injuries whenever the vaccination was required by law or professional duty. (shrink)

The last of five commentaries on “Bloomberg's Health Legacy: Urban Innovator or Meddling Nanny?” from the September‐October 2013.

The United States is in its fifth year of what is now widely referred to as “the new medical malpractice crisis.” Although some professional liability insurers have begun to report improvements in their overall financial margins, there are few signs that the trend toward higher costs is reversing itself - particularly for doctors and hospitals. In 2003-2004, the presidential election and tort reform proposals in Congress brought heightened public attention to the need for some type of policy intervention to ease (...) the effects of the crisis.The darling of tort reformers at both the federal and state levels has been legislation to limit, or “cap,” damages awarded to plaintiffs in malpractice cases. Health care provider groups, liability insurers, and the Bush Administration have all seized on the example of California's MICRA law, which since 1975 has capped noneconomic damages in malpractice cases at a flat $250,000, as the path to financial recovery. (shrink)

The United States is in its fifth year of what is now widely referred to as “the new medical malpractice crisis.” Although some professional liability insurers have begun to report improvements in their overall financial margins, there are few signs that the trend toward higher costs is reversing itself - particularly for doctors and hospitals. In 2003-2004, the presidential election and tort reform proposals in Congress brought heightened public attention to the need for some type of policy intervention to ease (...) the effects of the crisis.The darling of tort reformers at both the federal and state levels has been legislation to limit, or “cap,” damages awarded to plaintiffs in malpractice cases. Health care provider groups, liability insurers, and the Bush Administration have all seized on the example of California's MICRA law, which since 1975 has capped noneconomic damages in malpractice cases at a flat $250,000, as the path to financial recovery. (shrink)

The use of brain imaging technology as a common tool of research has spawned concern and debate over how investigators should respond to incidental fndings discovered in the course of research. In this article, we argue that investigators have an obligation to respond to incidental fndings in view of their entering into a professional relationship with research participants in which they are granted privileged access to private information with potential relevance to participants' health. We discuss the scope and limits of (...) this professional obligation to respond to incidental fndings, bearing in mind that the relationship between investigators and research participants differs fundamentally from the doctor-patient relationship. (shrink)

It has become increasingly difficult for individuals to exercise meaningful control over the personal data they disclose to companies or to understand and track the ways in which that data is exchanged and used. These developments have led to an emerging consensus that existing privacy and data protection laws offer individuals insufficient protections against harms stemming from current data practices. However, an effective and ethically justified way forward remains elusive. To inform policy in this area, we propose the Ethical Data (...) Practices framework. The framework outlines six principles relevant to the collection and use of personal data—minimizing harm, fairly distributing benefits and burdens, respecting autonomy, transparency, accountability, and inclusion—and translates these principles into action-guiding practical imperatives for companies that process personal data. In addition to informing policy, the practical imperatives can be voluntarily adopted by companies to promote ethical data practices. (shrink)

Improving how health care providers respond to medical injury requires an understanding of patients’ experiences. Although many injured patients strongly desire to be heard, research rarely involves them. Institutional review boards worry about harming participants by asking them to revisit traumatic events, and hospital staff worry about provoking lawsuits. Institutions’ reluctance to approve this type of research has slowed progress toward responses to injuries that are better able to meet patients’ needs. In 2015–2016, we were able to surmount these challenges (...) and interview 92 injured patients and families in the USA and New Zealand. This article explores whether the ethical and medico‐legal concerns are, in fact, well‐founded. Consistent with research about trauma‐research‐related distress, our participants’ accounts indicate that the pervasive fears about retraumatization are unfounded. Our experience also suggests that because being heard is an important (but often unmet) need for injured patients, talking provides psychological benefits and may decrease rather than increase the impetus to sue. Our article makes recommendations to institutional review boards and researchers. The benefits to responsibly conducted research with injured patients outweigh the risks to participants and institutions. (shrink)

This manuscript uses competitive college football as a lens into the complexities of decision-making amid the Covid-19 pandemic. Pulling together what is known about the decision-makers, the decision-making processes, the social and political context, the risks and benefits, and the underlying obligations of institutions to these athletes, we conduct an ethical analysis of the decisions surrounding the 2020 fall football season. Based on this ethical analysis, we provide key recommendations to improve similar decision processes moving forward.

California has focused on health equity in the state’s COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California’s 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier’s test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must (...) meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans. (shrink)

The conflicts of interest that may arise in relationships between academic researchers and industry continue to prompt controversy. The bulk of attention has focused on financial aspects of these relationships, but conflicts may also arise in the legal obligations that faculty acquire through consulting contracts. However, oversight of faculty members' consulting agreements is far less vigorous than for financial conflicts, creating the potential for faculty to knowingly or unwittingly contract away important rights and freedoms. Increased regulation could prevent this, but (...) it is unclear what forms of oversight universities view as feasible and effective. In this article, we report on a Delphi study to evaluate several approaches for oversight of consulting agreements by medical schools. The panel was comprised of 11 senior administrators with responsibility for oversight of faculty consulting relationships. We found broad agreement among panelists regarding the importance of institutional oversight to protect universities' interests. There was strong support for two specific approaches: providing educational resources to faculty and submitting consulting agreements for institutional review. Notwithstanding the complexities of asserting authority to regulate private consulting agreements between faculty members and companies, medical school administrators reached consensus that several approaches to improving institutional oversight are feasible and useful. (shrink)

Street’s “Darwinian Dilemma” is a well-known epistemological objection to moral realism. In this paper, I argue that “third-factor” replies to this argument on behalf of the moral realist, as popularized by Enoch :413–438, 2010, Taking morality seriously: a defense of robust realism, Oxford University Press, Oxford, 2011), Skarsaune :229–243, 2011) and Wielenberg :441–464, 2010, Robust ethics: the metaphysics and epistemology of godless normative realism, Oxford University Press, Oxford, 2014), cannot succeed. This is because they are instances of the illegitimate form (...) of reasoning known as “bootstrapping.” The phenomenon of bootstrapping has been discussed in detail, most notably by Vogel :602–623, 2000) and Cohen :309–329, 2002), in a different context as an objection to reliabilism and related theories of knowledge. I introduce four different characterizations of the error of bootstrapping from the epistemic literature in order to argue that the form of reasoning exemplified by third-factor replies would be deemed illegitimate by every one of them. I conclude that the moral realist should abandon third-factor replies, or else suggest a novel diagnosis for what goes wrong in bootstrapping cases that does not apply equally to the realist’s form of argument. However, I am not optimistic about the prospects for this latter strategy. (shrink)

Are epistemic reasons merely a species of instrumental practical reasons, making epistemic rationality a specialized form of instrumental practical rationality? Or are epistemic reasons importantly different in kind? Despite the attractions of the former view, Kelly (2003) argues quite compellingly that epistemic rationality cannot be merely a matter of taking effective means to one’s epistemic ends. I argue here that Kelly’s objections can be sidestepped if we understand epistemic reasons as instrumental reasons that arise in light of the aims held (...) by social collectives of which we are members, rather than being fixed by our own individual goals. This social version of epistemic instrumentalism would not be subject to counterexamples that point to the failure of individual people to possess desires or goals that would account for all of the epistemic reasons we find it natural to attribute to them. I conclude by comparing the proposed view to the alternative version of instrumentalism defended by Kornblith (1993). I argue that the social view I sketch here has one noteworthy advantage. It better accounts for the intuitive distinctness of our practical and epistemic reasons for belief in cases where flouting epistemic norms would better help us to achieve our own individual goals. (shrink)

The author argues that well-known forms of relativism are unable to accommodate, at once, a set of three highly intuitive theses about the distinctive character of moral reasons. Yet the author argues it is possible to formulate a novel form of normative relativism that has the power to accommodate these claims. The proposed view combines the relativist idea that the normative facts are attitude-dependent with the insight that there are non-human agents to which it makes sense to attribute the kinds (...) of attitudes that give rise to normative reasons. Societies, too, can possess reasons to pursue their aims. What distinguishes moral reasons from reasons of practical rationality is that the former apply directly to societies in virtue of aims held by each society as a group, while the latter apply directly to persons in light of their own individual interests. (shrink)

This is the first collection to bring together well-known scholars writing from feminist perspectives within critical discourse analysis. The theoretical structure of CDA is illustrated with empirical research in Eastern and Western Europe, New Zealand, Asia, South America and the US, demonstrating the complex workings of power and ideology in discourse in sustaining particular gender(ed) orders. These studies deal with texts and talk in domains ranging from parliamentary settings, news and advertising media, the classroom, community literacy programs and the workplace.

Could an entire society count as an agent in its own right? I argue here that it could. While previous defenders of group agency have focused primarily on groups such as states and corporations that exhibit a great deal of formalized internal structure, less attention has been devoted to more loosely structured social groups. I focus on defending the claims that societies can have ends or goals and that they engage in end-directed behavior. I defend this view by responding to (...) three potential objections. The first is the allegation that the attribution of ends to societies would be redundant, given that the properties of any group will supervene upon the properties of the group’s individual human members. The second is the charge that societies are not genuine agents engaged in end-directed actions because their behavior is not under their own direct control. The third is the concern that while it may be useful to speak of societies ‘as if’ they were agents, this does not indicate that societies really act in pursuit of ends. I draw upon a functionalist approach from the philosophy of mind to argue that all three objections can be addressed by the defender of social agency. (shrink)

The article provides a critical analysis of a postfeminist identity that is emergent in a set of beauty advertisements, called ‘entitled femininity’. Three major discursive themes are identified, which are constitutive of this postfeminist feminine identity: 1) ‘It’s about me!’ focuses on pampering and pleasuring the self; 2) ‘Celebrating femininity’ reclaims and rejoices in feminine stereotypes; and 3) ‘Girling women’ encourages a youthful disposition in women of all ages. The article shows that entitled femininity occupies an ambivalent discursive space, which (...) celebrates as well as repudiates feminism, and re-installs normative gendered stereotypes. The ambivalence, it is argued, contributes to fostering a culture of post-critique, which numbs resistance and deflects criticism. For all its appearances to be pro-women, feminine entitlement based squarely on an entitlement to consume offers a rather limited and problematic vision of femininity and gender equality. (shrink)

In a recent BioEssays paper [W. F. Martin, BioEssays 2017, 39, 1700115], William Martin sharply criticizes evolutionary interpretations that involve lateral gene transfer into eukaryotic genomes. Most published examples of LGTs in eukaryotes, he suggests, are in fact contaminants, ancestral genes that have been lost from other extant lineages, or the result of artefactual phylogenetic inferences. Martin argues that, except for transfers that occurred from endosymbiotic organelles, eukaryote LGT is insignificant. Here, in reviewing this field, we seek to correct some (...) of the misconceptions presented therein with regard to the evidence for LGT in eukaryotes. A recent paper dismisses claims of lateral gene transfer into eukaryotic genomes. We counter the arguments made in that paper and discuss the extensive evidence for LGT in eukaryotes. (shrink)

Over the past few decades, public anxiety about how people interact with science has spawned cycles of discourse across a wide range of media, public and private initiatives, and substantial research endeavors. National and international STEM (science, technology, engineering, and math) education initiatives and research have addressed how students interact with science and pursue careers in STEM fields. Researchers concerned with adult interaction with science have focused on factors that influence how citizens gather and interpret scientific knowledge and form positions (...) on scientific issues, applications, and/or policy in a politicized democratic milieu. Building from research on how the public interacts with science in and outside of formal education, this study focuses on attitudes toward science among students in 4th, 7th, and 10th grades and their parents. Little research to date has paired the STEM experiences of adults with their children. We find that the extent to which parents are positively oriented toward science significantly shapes their children’s attitudes toward science. Furthermore, between 7th and 10th grades, students with parents holding positive orientations toward science are more likely to sustain positive attitudes toward science. Since the foundation for most adults’ interactions with science develops in the K-12 environment, we demonstrate that the foundation, as expressed in adulthood, may directly affect the ways the next generation of students interacts with science. We offer insights into the importance of developing student learning into the social scientific research on public understanding of science and how important scientific issues of today interplay with society. (shrink)

A lexicon of Hebrew terms and their Romance equivalents from Maimónides’ treatise on logic and philosophy, al-Maqālah fi-ṣināʻat al-manṭiq, circulated in Hebrew aljamiado among Jews and conversos immersed in 15th-century humanism. This lexicon is one of several texts included in a manuscript which also includes literary works by converso authors such as Alfonso de la Torre’s Visión deleytable and Alfonso de Cartagena’s translation of sentenciae by Seneca, as well as three other philosophical lexicons. This collection of texts recorded in MS (...) Parma 2666 reveals that 15th-century Jews and/or conversos –the only people capable of reading the Hebrew aljamiado– read and interpreted De la Torre’s Visión in the context of the Judeo-Arabic philosophical tradition, which is also the basis for Maimónides’ Manṭiq, available in Hebrew and Latin translations. In this article I examine how the philosophic vocabulary developed in al-Manṭiq, accessible in Romance in the lexicons in MS Parma 2666, reflects the Maimonidean epistemology as it survived and developed among 15th-century Jewish and converso readers of the Visión deleytable. (shrink)

Trust is a key component in delivering quality and respectful care within health care systems. However, a growing lack of confidence in health care, particularly among specific subgroups of the population in the United States, could further widen health disparities. In this essay, we explore one approach to building trust and reaching diverse communities to promote health: engaging community‐based organizations (CBOs) as trusted community messengers. We present case studies of partnerships in health promotion, community education, and outreach that showcase how (...) CBOs’ programs build and leverage trust in health care systems through their workforce, services, and engagement with the community. (shrink)

In this paper, we consider the composition of an optimal portfolio made of two dependent risky assets. The investor is first assumed to be a risk-averse expected utility maximizer, and we recover the existing conditions under which all these investors hold at least some percentage of their portfolio in one of the assets. Then, we assume that the decision maker is not only risk-averse, but also prudent and we obtain new minimum demand conditions as well as intuitively appealing interpretations for (...) them. Finally, we consider the general case of investor’s preferences exhibiting risk apportionment of any order and we derive the corresponding minimum demand conditions. As a byproduct, we obtain conditions such that an investor holds either a positive quantity of one of the assets or a proportion greater than 50 %. (shrink)

This article adopts the combined perspectives of critical discourse studies and (critical) intersectionality studies to examine efforts at movement-building by Pink Dot SG, an LGBTQ group, which has developed within the illiberal geopolitical space of Singapore. The term ‘intersectionalisation’ is introduced to refer to a reflexive meta-discursive strategy which mobilizes the intersectionality of social identities (such as gender, sexuality, race, class, generation, and nationality) to advance particular sociopolitical objectives. The article illustrates three ways intersectionalisation operates in Pink Dot’s official videos: (...) (i) to create solidarities within the LGBTQ community; (ii) to advocate for the LGBTQ community by straight allies, and (iii) to forge alliances dialogically between queer and straight communities in Singapore. The analysis of the videos shows that interactions between various assemblages of intersectional identities of privilege and marginality are brought to the fore in building the social movement, and how its discourse navigates a terrain of complicated power dynamics. (shrink)