This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each of these (...) reasons and we show that none of these stand up to scrutiny, and that some are based on a misunderstanding of the nature and purposes of this stage of treatment and of the circumstances in which it is usually prescribed. Moreover, accepting these claims at face value could have serious negative implications, not just for gender diverse youth, but for many other minors and families and in a much broader range of healthcare settings. (shrink)

BackgroundThe areas of Research Ethics (RE) and Research Integrity (RI) are rapidly evolving. Cases of research misconduct, other transgressions related to RE and RI, and forms of ethically questionable behaviors have been frequently published. The objective of this scoping review was to collect RE and RI cases, analyze their main characteristics, and discuss how these cases are represented in the scientific literature.MethodsThe search included cases involving a violation of, or misbehavior, poor judgment, or detrimental research practice in relation to a (...) normative framework. A search was conducted in PubMed, Web of Science, SCOPUS, JSTOR, Ovid, and Science Direct in March 2018, without language or date restriction. Data relating to the articles and the cases were extracted from case descriptions.ResultsA total of 14,719 records were identified, and 388 items were included in the qualitative synthesis. The papers contained 500 case descriptions. After applying the eligibility criteria, 238 cases were included in the analysis. In the case analysis, fabrication and falsification were the most frequently tagged violations (44.9%). The non-adherence to pertinent laws and regulations, such as lack of informed consent and REC approval, was the second most frequently tagged violation (15.7%), followed by patient safety issues (11.1%) and plagiarism (6.9%). 80.8% of cases were from the Medical and Health Sciences, 11.5% from the Natural Sciences, 4.3% from Social Sciences, 2.1% from Engineering and Technology, and 1.3% from Humanities. Paper retraction was the most prevalent sanction (45.4%), followed by exclusion from funding applications (35.5%).ConclusionsCase descriptions found in academic journals are dominated by discussions regarding prominent cases and are mainly published in the news section of journals. Our results show that there is an overrepresentation of biomedical research cases over other scientific fields compared to its proportion in scientific publications. The cases mostly involve fabrication, falsification, and patient safety issues. This finding could have a significant impact on the academic representation of misbehaviors. The predominance of fabrication and falsification cases might diverge the attention of the academic community from relevant but less visible violations, and from recently emerging forms of misbehaviors. (shrink)

Smajdor argues that “recognition” is the solution to the “reifying attitude” that results from “the urge to protect ‘vulnerable’ people through exclusion from research”. Drawing on theories of reification, we argue that it is the concepts of autonomy and vulnerability themselves that have been reified, resulting in the impoverishment of approaches to autonomy at law and in research ethics. Overcoming such reification demands a deeper consideration of the grounds on which vulnerable individuals are owed recognition and thereby the forms such (...) recognition should take. Smajdor argues for a recognition that appeals to autonomy and that manifests in providing vulnerable individuals with the opportunity to assent. The problem is that this kind of recognition is dependent on a more fundamental kind. It is this second form of recognition that would need to do the heavy lifting for assent-based frameworks to avoid the same problems we find with consent. (shrink)

This article introduces the notion of ‘routinisation’ into discussions of informed consent. It is argued that the routinisation of informed consent poses a threat to the protection of the personal autonomy of a patient through the negotiation of informed consent. On the basis of a large survey, we provide evidence of the routinisation of informed consent in various types of interaction on the internet; among these, the routinisation of consent to the exchange of health related information. We also provide evidence (...) that the extent of the routinisation of informed consent is dependent on the character of the information exchanged, and we uncover a range of causes of routinisation. Finally, the article discusses possible ways of countering the problem of routinisation of informed consent. (shrink)

In a recent article in the Journal of Medical Ethics, Neil Manson sets out to show that the meta-consent model of informed consent is not the solution to perennial debate on the ethics of biobank participation. In this response, we shall argue that Manson’s considerations on the costs of a meta-consent model are incomplete and therefore misleading; his view that a model of broad consent passes a threshold of moral acceptability rests on an analogy that misconstrues how biobank research is (...) actually conducted and a model of meta-consent is more in tune with the nature of biobank research and enables autonomous choice. (shrink)

The health care systems are fairly similar in theScandinavian countries. The exact details vary, but inall three countries the system is almost exclusivelypublicly funded through taxation, and most (or all)hospitals are also publicly owned and managed. Thecountries also have a fairly strong primary caresector (even though it varies between the countries),with family physicians to various degrees acting asgatekeepers to specialist services. In Denmark most ofthe GP services are free. For the patient in Norwayand Sweden there are out-of-pocket co-payments for GPconsultations, (...) with upper limits, but consultations forchildren are free. Hospital treatment is free inDenmark while the other countries use a system without-of-pocket co-payment. There is a very strongpublic commitment to access to high quality healthcare for all. Solidarity and equality form theideological basis for the Scandinavian welfare state.Means testing, for instance, has been widely rejectedin the Scandinavian countries on the grounds thatpublic services should not stigmatise any particulargroup. Solidarity also means devoting specialconsideration to the needs of those who have lesschance than others of making their voices heard orexercising their rights. Issues of limited access arenow, however, challenging the thinking about a healthcare system based on solidarity. (shrink)

It has been argued that organs should be treated as individual tradable property like other material possessions and assets, on the basis that this would promote individual freedom and increase efficiency in addressing the shortage of organs for transplantation. If organs are to be treated as property, should they be inheritable? This paper seeks to contribute to the idea of organs as inheritable property by providing a defence of a default of the family of a dead person as inheritors of (...) transplantable organs. In the course of discussion, various succession rules for organs and their justifications will be suggested. We then consider two objections to organs as inheritable property. Our intention here is to provoke further thought on whether ownership of one's body parts should be assimilated to property ownership. (shrink)

Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While (...) ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a ‘see-saw’ model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes. (shrink)

This book contains a sustained defense of the Quality Adjusted Life Years (QALY) approach to resource allocation in health care. According to this approach resources should be allocated in such a way that the number of QALYs gained is maximized. The authors place this approach within a broader preference Utilitarian framework and argue that it is a special case of consequentialism specifically relevant to the health care field. The first two chapters of the book give a basic introduction to the (...) health care economic aspects of QALYs and a basic introduction to the purpose of ethical reasoning. The three subsequent chapters form the core of the book and contain a systematic defense of the QALY approach against all the main criticisms that have been put forward in the literature. The final chapter contains the results of a survey of the attitudes and reasoning of the Australian public with regard to resource allocation. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

In his recent book The Foundation of Bioethics , H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "a (...) persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises. Keywords: medical ethics, persons, autonomy CiteULike Connotea Del.icio.us What's this? (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

Clinical information about patients is increasingly being stored in electronic form and has therefore become more easily shareable. Data are collected as part of clinical care but have multiple other potential uses in relation to health system planning, audit and research. The use of clinical information for these secondary uses is controversial, and the ability to safeguard personal and sensitive data under current practices is contested.In this study, we investigate the attitudes of a representative sample of the Danish population towards (...) transfer of clinical data from their general practice for secondary use. We specifically study: patients’ trust in different types of healthcare professionals, their interest in being asked about secondary use of data and their willingness to dispense from a requirement of informed consent based on their trust in healthcare professionals.We find that adult Danes are positive towards research that use patient data, and they generally trust general practitioners, hospitals and researchers to treat their data confidentially.Nevertheless, they feel that they have a right to control the use of their data, only 7.3% disagreeing, and that the data belong to them, only 14.0% disagreeing. Answers to further questions about the relation between trust, information and consent show that although trust modifies the wish for information and consent, there is still a strong view that the patient should control the use of data. We find no differences between those who have frequent contact with the healthcare system and those who do not. (shrink)

This chapter contains sections titled: History Specific Features of Medical Ethics Recent Developments References and Further Reading.

The prelims comprise: Introduction The Doctrine of Informed Consent I will make you an offer you cannot refuse! Consenting to an Unknown Future Consenting for Future Generations Research without Consent? Conclusion.

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and (...) products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren (...) Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

This new study provides a thorough analysis of the ethical reasoning of doctors and nurses. Based on extensive interviews, Soren Holm's work demonstrates how qualitative research methods can be used to study ethical reasoning, and that the results of such studies are important for normative ethics, that is, the analysis of how health care professionals ought to act.

This chapter examines Soren Kierkegaard's views and relationship with the Church, explaining that while Kierkegaard was a frequent churchgoer, he also considered the Church a corrupt and disgraceful business enterprise. It discusses Kierkegaard's criticism on the development of the Church as an institution and analyses various aspects of his ecclesiastical conception of the Church. The chapter also considers Kierkegaard's own experiences in writing and delivering sermons.

A competent and philosophically subtle study of S. K.'s notion of the relation of Christianity and history. The relation of time and eternity, of "sacred history" and ordinary history and the problem of contemporaneity in the Fragments, the Postscript and Training in Christianity are brought into focus through S. K.'s doctrine of the incarnation. This Holm interprets as "fictionalist"; "it is valid to believe that this man is God... as if it were so, although his empirical appearance can never (...) reveal it." --F. M. S. (shrink)

Over the course of the twentieth century, nationalistic approaches to the obstacles of racism in the United States have increasingly come to be seen as the more revolutionary of the various forms of anti-racist struggle. This paper explores several historical instances of Black Nationalism and seeks to demonstrate that, despite the many points on which they might diverge, they share in common a tendency to naturalize and embrace the category of race as a basis for political struggle, and that they (...) therefore constitute an ideologically accommodating and hence essentially regressive approach to the questions of race and racism. It is suggested that a critique of the modern category of race and a political practice aimed at its denaturalization will be a necessary aspect of any attempt to overcome racial oppression and inequality. (shrink)

Deceased organ donation is widely considered as a case of easy rescue―that is, a case in which A may bestow considerable benefits on B while incurring negligent costs herself. Yet, the policy implications of this observation remain unclear. Drawing on Christopher H. Wellman’s samaritan account of political obligations, the paper develops a case for a so-called opt-out system, i.e., a scheme in which people are defaulted into being donors. The proposal’s key idea is that we may arrange people’s options in (...) specific ways for the sake of others. (shrink)

Sharon Street vertritt einen Humeanischen Konstruktivismus in der Metaethik, nach dem die normativen Gründe einer Akteurin von dem System ihrer eigenen normativen Urteile abhängen. Ein normatives Urteil ist nach Street genau dann wahr, wenn es zu der ideal kohärenten Menge der normativen Urteile gehört, die die Akteurin im Überlegungsgleichgewicht hätte. In diesem Aufsatz wird die Frage diskutiert, wie diese Konzeption von Normativität mit einer Konzeption von Moral verbunden werden kann. Eine Möglichkeit hierfür besteht darin, an einer engen Verbindung von Normativität (...) und Moral festzuhalten. In diesem Fall muss die Wahrheit moralischer Sätze jedoch auf eine ähnliche Art als akteursrelativ verstanden werden, wie Street die Wahrheit normativer Sätze versteht. Eine zweite Möglichkeit besteht darin, an einem absolutistischen Verständnis moralischer Sätze festzuhalten. Dann wären nach Streets Konzeption von Normativität jedoch Fälle denkbar, in denen eine Akteurin keinen normativen Grund hat, moralisch zu handeln. Beide theoretische Optionen scheinen kontraintuitive Implikationen zu haben, die z.B. mit der Möglichkeit moralischen Tadels oder der Vorstellung der Kategorizität moralischer Sätze zusammenhängen. Aufbauend auf Überlegungen von Street, Bernard Williams und David Lewis wird jedoch dafür argumentiert, dass insbesondere die zweite der genannten Optionen nicht so sehr von einem herkömmlichen Moralverständnis abweicht, wie es zunächst erscheint. (shrink)

Philosophy and science employ abstract hypothetical scenarios- thought experiments - to illustrate, defend, and dispute theoretical claims. Since thought experiments furnish no new empirical observations, the method prompts two epistemological questions: whether anything may be learnt from the merely hypothetical, and, if so, how. Various sceptical arguments against the use of thought experiments in philosophy are discussed and criticized. The thesis that thought experiments in science provide a priori knowledge through non-sensory grasping of abstract entities is discussed and rejected. The (...) thesis that thought experimentation consists in manipulations of mental models is examined and found to be of limited epistemological relevance. It is argued that thought experiments are associated with characteristic arguments in a manner similar to ordinary experiments. It is further argued that thought experiments function in the same way as experiments in general: by providing premises for their associated arguments. Like other experiments, a thought experiment is successful when the premises it provides are true. This holds both for philosophical and scientific thought experiments. An argument schema is proposed and shown to be a formal analogue to that associated with ordinary experiments; similar in being subject to epistemological holism; but differing in being modal: in employing statements about possibility and necessity. The evaluation of thought experiments thus depends on how modal statements may be justified. Intuition and conceivability are discussed as sources of modal justification and found problematic. Instead it is suggested that evaluation proceed by accommodation of the statements describing the experiment's hypothetical scenario. The method of accommodation is developed and applied to five influential thought experiments in philosophy: the brain in a vat; Putnam's Twin Earth; Burge's arthritis example; Searle's Chinese Room; and Newcomb's problem. Its application shows some of these to be failed, others to be successful only relative to controversial philosophical doctrines. (shrink)

The article examines the role of natural kinds in semantic theorizing, which has largely been conducted in isolation from relevant work in science, metaphysics, and philosophy of science. We argue that the Kripke–Putnam account of natural kind terms, despite recent claims to the contrary, depends on a certain metaphysics of natural kinds; that the metaphysics usually assumed—micro-essentialism—is untenable even in a ‘placeholder’ version; and that the currently popular homeostatic property cluster theory of natural kinds is correct only to an extent (...) that fails to vindicate the Kripke–Putnam account. This undermines the metasemantics required for anti-descriptivist semantics. _1_ Introduction _2_ From Semantics to Metaphysics _3_ Metaphysics, Part I: The Demise of Micro-essentialism _3.1_ Original micro-essentialism _3.2_ Placeholder essentialism _4_ Metaphysics, Part II: Homeostatic Property Cluster Theory _5_ Prospects for Natural Kind Term Semantics. (shrink)

Philosophical interest in thought experiments has grown over the last couple of decades. Several positions have emerged, defined largely by their differing responses to a perceived epistemological challenge: how do thought experiments yield justified belief revision, even in science, when they provide no new empirical data? Attitudes towards this supposed explanandum differ. Many philosophers accept that it poses a genuine puzzle and hence seek to provide a substantive explanation. Others reject or deflate the epistemic claims made for thought experiments.In this (...) paper I present a model for many thought experiments in philosophy and science. The model doesn't assume that thought experiments in fact manage to achieve epistemic justifi cation, but it allows us to see how they aspire to do so. It also emphasises both the parallels and the discrepancies between thought experiments and ordinary scientific experiments. (shrink)

The Cambridge Companion to Philosophical Methodology offers clear and comprehensive coverage of the main methodological debates and approaches within philosophy. The chapters in this volume approach the question of how to do philosophy from a wide range of perspectives, including conceptual analysis, critical theory, deconstruction, experimental philosophy, hermeneutics, Kantianism, methodological naturalism, phenomenology, and pragmatism. They explore general conceptions of philosophy, centred on the question of what the point of philosophising might be; the method of conceptual analysis and its recent naturalistic (...) critics and competitors; perspectives from continental philosophy; and also a variety of methodological views that belong neither to the mainstream of analytic philosophy, nor to continental philosophy as commonly conceived. Together they will enable readers to grasp an unusually wide range of approaches to methodological debates in philosophy. (shrink)

The main topic of this essay is symbolic mathematics or the method of symbolic construction, which I trace to the end of the sixteenth century when Franciscus Vieta invented the algebraic symbolism and started to use the word ‘symbolic’ in the relevant, non-ontological sense. This approach has played an important role for many of the great inventions in modern mathematics such as the introduction of the decimal place-value system of numeration, Descartes’ analytic geometry, and Leibniz’s infinitesimal calculus. It was also (...) central for the rigorization movement in mathematics in the late nineteenth century, as well as for the mathematics of modern physics in the 20th century.However, the nature of symbolic mathematics has been concealed and confused due to the strong influence of the heritage from the Euclidean and Aristotelian traditions. This essay sheds some light on what has been concealed by approaching some of the crucial issues from a historical perspective. Furthermore, I argue that the conception of modern mathematics as symbolic mathematics was essential to Wittgenstein’s approach to the foundations and nature of mathematics. This connection between Wittgenstein’s thought and symbolic mathematics provides the resources for countering the still prevalent view that he defended an uttrely idiosyncratic conception, disconnected from the progress of serious science. Instead, his project can be seen as clarifying ideas that have been crucial to the development of mathematics since early modernity. (shrink)