Some participants will get HIV‐infected in HIV prevention trials, despite risk reduction measures. The subsequent treatment responsibilities of sponsor‐investigators have been widely debated, especially where access to antiretroviral therapy (ART) is not available. In this paper, we explore two accounts of beneficence to establish whether they can shed light on sponsor‐investigator responsibilities. We find the notion of general beneficence helpful insofar as it clarifies that some beneficent actions will be obligatory where they can be dispensed without scuppering the trial. We (...) find the notion of specific beneficence helpful insofar as it directs investigators to attend to the needs of trial participants; however the range of interventions that could be provided remains unhelpfully broad. We then examine accounts of the investigator‐participant relationship to narrow the range of interventions that investigators should provide, concluding that health‐care, and HIV infection, are appropriate foci. We conclude that when investigators are able to meet the ART needs of their participants (e.g. referral, assisted referral or direct provision) without sacrificing trial quality, they must do so. However, there is little of this explicit direction to be found in the account of specific beneficence itself, but rather it is found in accounts of the relationship that are compatible with beneficence. (shrink)

Background South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality. Discussion This article sets out essential requirements for the lawful conduct of adolescent research in South Africa including compliance with consent requirements, (...) child protection laws, and processes for the ethical and regulatory approval of research. Summary This article outlines likely complexities for researchers and research ethics committees, including determining that trial interventions meet current risk standards for child research. Explicit recommendations are made for role-players in other jurisdictions who may also be planning such trials. This article concludes with concrete steps for implementing these important trials in South Africa and other jurisdictions, including planning for consent processes; delineating privacy rights; compiling information necessary for ethics committees to assess risks to child participants; training trial site staff to recognize when disclosures trig mandatory reporting response; networking among relevant ethics commitees; and lobbying the National Regulatory Authority for guidance. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 21-22, June 2011.

South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders’ perspectives on ethical guidance related to prevention and care in HIV vaccine trials.

Civil society organizations (CSOs) have significantly impacted on the politics of health research and the field of bioethics. In the global HIV epidemic, CSOs have served a pivotal stakeholder role. The dire need for development of new prevention technologies has raised critical challenges for the ethical engagement of community stakeholders in HIV research. This study explored the perspectives of CSO representatives involved in HIV prevention trials (HPTs) on the impact of premature trial closures on stakeholder engagement. Fourteen respondents from South (...) African and international CSOs representing activist and advocacy groups, community mobilisation initiatives, and human and legal rights groups were purposively sampled based on involvement in HPTs. Interviews were conducted from February-May 2010. Descriptive analysis was undertaken across interviews and key themes were developed inductively. CSO representatives largely described positive outcomes of recent microbicide and HIV vaccine trial terminations, particularly in South Africa, which they attributed to improvements in stakeholder engagement. Ongoing challenges to community engagement included the need for principled justifications for selective stakeholder engagement at strategic time-points, as well as the need for legitimate alternatives to CABs as mechanisms for engagement. Key issues for CSOs in relation to research were also raised. (shrink)

Civil society organizations (CSOs) have significantly impacted on the politics of health research and the field of bioethics. In the globalHIVepidemic,CSOs have served a pivotal stakeholder role. The dire need for development of new prevention technologies has raised critical challenges for the ethical engagement of community stakeholders inHIVresearch. This study explored the perspectives ofCSOrepresentatives involved inHIVprevention trials (HPTs) on the impact of premature trial closures on stakeholder engagement. Fourteen respondents fromSouthAfrican and internationalCSOs representing activist and advocacy groups, community mobilisation initiatives, (...) and human and legal rights groups were purposively sampled based on involvement inHPTs. Interviews were conducted fromFebruary‐May 2010. Descriptive analysis was undertaken across interviews and key themes were developed inductively.CSOrepresentatives largely described positive outcomes of recent microbicide andHIVvaccine trial terminations, particularly inSouthAfrica, which they attributed to improvements in stakeholder engagement. Ongoing challenges to community engagement included the need for principled justifications for selective stakeholder engagement at strategic time‐points, as well as the need for legitimate alternatives toCABs as mechanisms for engagement. Key issues forCSOs in relation to research were also raised. (shrink)

This article reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasize the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasize its contribution to the healthcare system and to current patients. Furthermore, (...) relations between research stakeholders were perceived to be somewhat fragile, making it difficult for stakeholders to achieve consensus about the social value of research, as well as on ways to maximize value. Interventions to negotiate a shared perspective on the social value of research would appear to be warranted, and the findings of this study suggest some focus areas for such intervention. (shrink)

Some participants will get HIV-infected in HIV prevention trials, despite risk reduction measures. The subsequent treatment responsibilities of sponsor-investigators have been widely debated, especially where access to antiretroviral therapy (ART) is not available. In this paper, we explore two accounts of beneficence to establish whether they can shed light on sponsor-investigator responsibilities. We find the notion of general beneficence helpful insofar as it clarifies that some beneficent actions will be obligatory where they can be dispensed without scuppering the trial. We (...) find the notion of specific beneficence helpful insofar as it directs investigators to attend to the needs of trial participants; however the range of interventions that could be provided remains unhelpfully broad. We then examine accounts of the investigator-participant relationship to narrow the range of interventions that investigators should provide, concluding that health-care, and HIV infection, are appropriate foci. We conclude that when investigators are able to meet the ART needs of their participants (e.g. referral, assisted referral or direct provision) without sacrificing trial quality, they must do so. However, there is little of this explicit direction to be found in the account of specific beneficence itself, but rather it is found in accounts of the relationship that are compatible with beneficence. (shrink)

There is little published literature on the ethical concerns of stakeholders in HIV vaccine trials. This study explored the ethical challenges identified by various stakeholders, through an open-ended, in-depth approach. While the few previous studies have been largely quantitative, respondents in this study had the opportunity to spontaneously identify the issues that they perceived to be of priority concern in the South African context. Stakeholders spontaneously identified the following as ethical priorities: informed consent, social harms, collaborative relationships between research stakeholders, (...) the participation of children and adolescents, access to treatment for participants who become infected with HIV, physical harms, fair participant and community selection, confidentiality, benefits, and payment. While there is some speculation that research in developing countries poses special ethical challenges, overall no issues were identified that have not been anticipated in international guidance, literature and popular frameworks. However, the South African context affords a distinctive gloss to these expected issues; for example, respondents were concerned that the predominant selection of black participants may perpetuate racist practices of apartheid. Stakeholders should be aware of contextual factors impacting on the implementation of ethical principles. We make a series of recommendations for South African trials, including amendments to the ethical-legal framework and research policies, and, for further research. (shrink)

Access to treatment, in HIV vaccine trials (HVTs), remains ethically controversial. In most prevention trials, including in South Africa, participants who seroconvert are referred to publicly funded programmes for treatment. This strategy is problematic when there is inadequate and uneven access to public sector antiretroviral therapy (ART) and support resources. The responsibilities, if any, of researchers, sponsors and public health authorities involved in HVTs has been hotly debated among academics, scholars, representatives of international organizations and sponsors. However, there is little (...) published on community perceptions. Recent guidance asserts that communities should make inputs into treatment and care decisions. This qualitative study explored a South African community's perceptions of who should provide what to HVT participants as well as how and why this should be done. Twenty-nine adults working at or attending five primary health care clinics in two rural areas in KwaZulu-Natal participated in in-depth interviews. Respondents expressed that researchers should ‘help participants to access’ treatment and care ‘because they are in a position to do so’ and ‘are in a relationship with’ trial participants. Respondents suggested that researchers could help by ‘facilitating referral’ until such time that participants can access care and treatment on their own. We highlight a series of implications for researchers in HVTs, including their need to be aware of prospective participants' considerable trust in and respect for researchers, the responsibility that this places on them, and the need for clear communication with communities so as not to erode community trust. (shrink)

Introduction: Platonic dramatology -- The political and philosophical problems. Using pre-Socratic philosophy to support political reform: the Athenian stranger ; Plato's Parmenides: Parmenides' critique of Socrates and Plato's critique of Parmenides ; Becoming Socrates ; Socrates interrogates his contemporaries about the noble and good -- Paradigms of philosophy. Socrates' positive teaching ; Timaeus-Critias: completing or challenging Socratic political philosophy? ; Socratic practice -- The trial and death of Socrates. The limits of human intelligence ; The Eleatic challenge ; The trial (...) and death of Socrates -- Conclusion: Why Plato made Socrates his hero. (shrink)

This landmark study examines the role played by the rediscovery of the writings of the ancient atomists, Epicurus and Lucretius, in the articulation of the major philosophical systems of the seventeenth century, and, more broadly, their influence on the evolution of natural science and moral and political philosophy. The target of sustained and trenchant philosophical criticism by Cicero, and of opprobrium by the Christian Fathers of the early Church, for its unflinching commitment to the absence of divine supervision and the (...) finitude of life, the Epicurean philosophy surfaced again in the period of the Scientific Revolution, when it displaced scholastic Aristotelianism. Both modern social contract theory and utilitarianism in ethics were grounded in its tenets. Catherine Wilson shows how the distinctive Epicurean image of the natural and social worlds took hold in philosophy, and how it is an acknowledged, and often unacknowledged presence in the writings of Descartes, Gassendi, Hobbes, Boyle, Locke, Leibniz, Berkeley. With chapters devoted to Epicurean physics and cosmology, the corpuscularian or "mechanical" philosophy, the question of the mortality of the soul, the grounds of political authority, the contested nature of the experimental philosophy, sensuality, curiosity, and the role of pleasure and utility in ethics, the author makes a persuasive case for the significance of materialism in seventeenth-century philosophy without underestimating the depth and significance of the opposition to it, and for its continued importance in the contemporary world. Lucretius's great poem, On the Nature of Things, supplies the frame of reference for this deeply-researched inquiry into the origins of modern philosophy. (shrink)

Science relies on models and idealizations that are known not to be true. Even so, science is epistemically reputable. To accommodate science, epistemology should focus on understanding rather than knowledge and should recognize that the understanding of a topic need not be factive. This requires reconfiguring the norms of epistemic acceptability. If epistemology has the resources to accommodate science, it will also have the resources to show that art too advances understanding.

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can be (...) instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

This paper reports on a survey of auditors in New Zealand which investigates the nature of the moral judgements they make on a series of problems with ethical dimensions. The framework adopted for this purpose is developed from earlier work which identifies a range of ethical principles which may be involved in business ethical decision‐making. Auditors responded to a questionnaire which posed, firstly, several questions about the context of their ethical decision‐making, and secondly, a series of vignettes elaborating problematical dilemmas (...) which required the selection of one of four possible responses. Data was analysed to determine whether or not it confirmed previous findings in suggesting a predominant ethical orientation for auditors. The results were correlated with demographic variables in order to determine whether or not age, gender, position in firm and size of employee firm were significantly correlated to ethical response. The survey results, on the whole, confirmed the ethical orientation suggested by previous findings, but there were some unexpected results in three out of the ten vignettes examined. Although some correlations were found between the demographic variables and subject responses, the evidence of this survey does not strongly suggest a consistent significant correlation. (shrink)

Corporate social responsibility is a recognised and common part of business activity. Some of the regularly cited motives behind CSR are employee morale, recruitment and retention, with employees acknowledged as a key organisational stakeholder. Despite the significance of employees in relation to CSR, relatively few studies have examined their engagement with CSR and the impediments relevant to this engagement. This exploratory case study-based research addresses this paucity of attention, drawing on one to one interviews and observation in a large UK (...) energy company. A diversity of engagement was found, ranging from employees who exhibited detachment from the CSR activities within the company, to those who were fully engaged with the CSR activities, and to others who were content with their own personal, but not organisational, engagement with CSR. A number of organisational context impediments, including poor communication, a perceived weak and low visibility of CSR culture, and lack of strategic alignment of CSR to business and personal objectives, served to explain this diversity of employee engagement. Social exchange theory is applied to help explore the volition that individual employees have towards their engagement with CSR activities, and to consider the implications of an implicit social, rather than explicit economic, contract between an organisation and its employees in their engagement with CSR. (shrink)

It has been claimed that ‘virtuous structures’ can foster moral agency in organisations. We investigate this in the context of employee involvement in corporate philanthropy, an activity whose moral status has been disputed. Employing Alasdair MacIntyre’s account of moral agency, we analyse the results of eight focus groups with employees engaged in corporate philanthropy in an employee-owned retailer, the John Lewis Partnership. Within this organisational context, Employee–Partners’ moral agency was evidenced in narrative accounts of their engagement in philanthropic activities and (...) in their disputes about the moral status of corporate philanthropy. (shrink)

The development of genomics has dramatically expanded the scope of genetic research, and collections of genetic biosamples have proliferated in countries with active genomics research programs. In this essay, we consider a particular kind of collection, national biobanks. National biobanks are often presented by advocates as an economic ‘‘resource’’ that will be used by both basic researchers and academic biologists, as well as by pharmaceutical diagnostic and clinical genomics companies. Although national biobanks have been the subject of intense interest in (...) recent social science literature, most prior work on this topic focuses either on bioethical issues related to biobanks, such as the question of informed consent, or on the possibilities for scientific citizenship that they make possible. We emphasize, by contrast, the economic aspect of biobanks, focusing specifically on the way in which national biobanks create biovalue. Our emphasis on the economic aspect of biobanks allows us to recognize the importance of what we call clinical labor—that is, the regularized, embodied work that members of the national population are expected to perform in their role as biobank participants—in the creation of biovalue through biobanks. Moreover, it allows us to understand how the technical way in which national biobanks link clinical labor to databases alters both medical and popular understandings of risk for common diseases and conditions. (shrink)

Confronting fundamentalism: the dangerous God of "control and condemn" -- 1967: What the cake said -- God-talk 101: The art that is Christianity -- The Copernican turn of Christian humanism -- Quantum theology: the symbolic character of God-talk -- Theological weirdness (1): the symbolic claim that God is a person -- Poets as theologians: the moral imagination of Christian Humanist tradition -- Moses debates with a burning bush -- I AM v. I WILL BE: translation and the authority of theologians (...) -- Theological weirdness (2): the symbolic claim that God is necessarily impersonal -- What, then, can be said about God? (shrink)

This paper examines the strategic use of corporate philanthropy in the 1990s by UK building societies faced with an intensification of societal pressure to change legal form from mutual to corporate status. While the economic case for mutuality has been made elsewhere, this paper examines the observation that community relationships were thought by management to be capable of assisting in the strategic positioning of mutual societies with regard to their legal form. By increasing charitable giving to respond to the level (...) of societal scrutiny and discussion on the issue of mutuality, this paper argues that charitable giving, as one proxy for community involvement, was used as a strategic tool to deflect calls for demutualisation, thereby preserving the existing mutual status of building societies. (shrink)

Network analysis is increasingly appreciated as a methodology in the social sciences. In recent years, it is also receiving attention among historians of science. History of economics is no exception in that researchers have begun to use network analysis to study a variety of topics, including collaborations and interactions in scientific communities, the spread of economic theories within and across fields, or the formation of new specialties in the discipline of economics. Against this backdrop, a debate is emerging about how (...) network analysis can help address questions that are pertinent to the history of economics. With this paper, we want to push this debate one step forward by offering and discussing five reasons why network analysis should have a future in the history of economics. (shrink)

In this unconventional article, Sarah Banet-Weiser, Rosalind Gill and Catherine Rottenberg conduct a three-way ‘conversation’ in which they all take turns outlining how they understand the relationship among postfeminism, popular feminism and neoliberal feminism. It begins with a short introduction, and then Ros, Sarah and Catherine each define the term they have become associated with. This is followed by another round in which they discuss the overlaps, similarities and disjunctures among the terms, and the article ends with how (...) each one understands the current mediated feminist landscape. (shrink)

Over the past 40 years a tradition of Marx interpretation has built up around a single passage concerning black slavery in an 1853 letter from Marx to Engels, in order to demonstrate that Marx’s support for emancipation was conditional on the level of ‘civilization’ attained by black slaves. I will argue that this interpretation, which attempts to prove Marx’s racist defense of slavery, is overdetermined by an inattention to historical context and a hypersensitivity to Marx’s nineteenth-century epithets. This is important (...) because the alleged anti-black racism of Marx and the place black workers occupy in his historical materialist vision of class struggle are of the utmost significance for properly conceptualizing the relationship between Marxism and black liberation. (shrink)

De Marco et al 1 argue that the standard account of medical ‘invasiveness’ (as ‘incision’ or ‘insertion’) fails to capture three aspects of its existing use, namely that invasiveness can come in degrees, often depends on features of alternative medical interventions and can be non-physical. They propose a new schematic account that suggests that medical interventions can possess ‘basic invasiveness’ (which can come in degrees and of which they suggest at least two types: physical and mental), and ‘threshold invasiveness’ which (...) can depend on the alternatives a specific intervention is being compared with. While we agree that the standard account of invasiveness fails to capture existing use and are supportive of their aim, here we express scepticism about the practical utility of De Marco et al ’s revised account. Our scepticism concerns the application of De Marco et al’s revised account in the narrow context of clinician–patient communication and deliberation about medical interventions within clinical practice, which we see as a crucial context for its use. While De Marco et al do not specify the contexts in which their revised account could be used, we assume from their discussion of treatment interventions (e.g. non-invasive prenatal testing, ventilation) and their comparison to ‘more or less invasive’ options, that at least one of the purposes in mind for …. (shrink)

The great plague in London in 1665 was the last in a series of epidemics that had begun with the Black Death in the 14th century. Plagues continued elsewhere in Europe into the 18th century, but after 1679 no cases of plague were reported in England at all. The disease seemed to have disappeared. How could that be explained? The purpose of this paper is to discover when contemporaries began to think that plague had gone for good, and why they (...) thought that had happened. The paper falls into two parts. The first concentrates on the decade of the 1720s, when plague was expected to come from Marseilles and never arrived. In the space of a few months there was fierce and concentrated public debate about a new Quarantine Act to be enforced if an epidemic developed, much of it arguing that the Act was unnecessary because plague was plainly not contagious at all. It depended wholly on local environments, and in England they had been improving ever since the Great Fire of London. The second part of the paper takes the story forward into the later 18th century, when there was no longer much dispute that plague was indeed contagious, but it was confidently supposed that England now enjoyed the double protection of further environmental improvement at home combined with effective quarantine of shipping abroad, especially in the Mediterranean. Over the century, contending explanations for plague were debated, interpretations of the past disputed and sometimes falsified, and expectations and ambitions for the future remodelled, because one epidemic threat had disappeared for good. (shrink)

The rapid growth of next-generation genetic sequencing has prompted debate about the responsibilities of researchers toward genetic incidental findings. Assuming there is a duty to disclose significant incidental findings, might there be an obligation for researchers to actively look for these findings? We present an ethical framework for analyzing whether there is a positive duty to look for genetic incidental findings. Using the ancillary care framework as a guide, we identify three main criteria that must be present to give rise (...) to an obligation to look: high benefit to participants, lack of alternative access for participants, and reasonable burden on researchers. Our analysis indicates that there is no obligation to look for incidental findings today, but during the ongoing translation of genomic analysis from research to clinical care, this obligation may arise. (shrink)

This paper examines the strategic use of corporate philanthropy in the 1990s by UK building societies faced with an intensification of societal pressure to change legal form from mutual to corporate status. While the economic case for mutuality has been made elsewhere, this paper examines the observation that community relationships were thought by management to be capable of assisting in the strategic positioning of mutual societies with regard to their legal form. By increasing charitable giving to respond to the level (...) of societal scrutiny and discussion on the issue of mutuality, this paper argues that charitable giving, as one proxy for community involvement, was used as a strategic tool to deflect calls for demutualisation, thereby preserving the existing mutual status of building societies. (shrink)

The tension between public duty and private conscience is a central theme of English history in the seventeenth century, when established authorities were questioned and violently disrupted. It has also been an important theme in the work of one of the foremost historians of the period, G.E. Aylmer. It makes, therefore, an especially appropriate subject for this volume. The contributors are leading historians, whose topics range from contemporary writings on conscience and duty to the particular problems faced by individuals and (...) groups, both Puritan and Royalist, at the center and in the localities. These scholarly and original studies throw new light on the innumberable dilemmas of conscience of seventeenth-century men and women, and together make a distinguished contribution to seventeenth-century history. (shrink)

Psychologists and philosophers have argued that the capacity for perseverance or “grit” depends both on willpower and on a kind of epistemic resilience. But can a form of hopefulness in one’s future success also constitute a source of grit? I argue that substantial practical hopefulness, as a hope to bring about a desired outcome through exercises of one’s agency, can serve as a distinctive ground for the capacity for perseverance. Gritty agents’ “practical hope” centrally involves an attention-fuelled, risk-inclined weighting of (...) two competing concerns over action: when facing the decision of whether to persevere, hopeful gritty agents prioritize the aim of choosing a course of action which might go very well over that of choosing a course of action which is very likely to go fairly well. By relying on the notion of a “risk-inclined attentional pattern” as a dimension of gritty agents’ practical hope, we can explain that form of hope’s contribution to their motivation and practical rationality, especially on a risk-weighted expected utility framework. The upshot is a more pluralistic view of the sources of grit. (shrink)

: At the center of Catherine's Malabou's study of Hegel is a defense of Hegel's relation to time and the future. While many readers, following Kojève, have taken Hegel to be announcing the end of history, Malabou finds a more supple impulse, open to the new, the unexpected. She takes as her guiding thread the concept of "plasticity," and shows how Hegel's dialectic--introducing the sculptor's art into philosophy--is motivated by the desire for transformation. Malabou is a canny and faithful (...) reader, and allows her classic "maître" to speak, if not against his own grain, at least against a tradition too attached to closure and system. Malabou's Hegel is a "plastic" thinker, not a nostalgic metaphysician. (shrink)