Two clusters of essays in this issue of The Journal of Medicine and Philosophy provide a critical gaze through which to explore central moral, phenomenological, ontological, and political concerns regarding human moral agency and personal responsibility. The first cluster challenges common assumptions in bioethics regarding the voluntariness of human actions. The second set turns the debate towards morally responsible choice within the requirements of distributive justice. The force of their collective analysis leaves us with a well-founded basis critically to approach (...) any account of bioethics or health policy that is insufficiently attentive to the central challenges of human freedom and responsible free choice. (shrink)

Which harms and benefits should be viewed as relevant when considering whether to launch cyber-measures? In this article, we consider this question, which matters because it is central to determining whether cyber-measures should be launched. Several just war theorists hold a version of what we call the ‘Restrictive View’, according to which there are restrictions on the sorts of harms and benefits that should be included in proportionality assessments about the justifiability of going to war (whether cyber or kinetic). We (...) discuss two such views – the Just Cause Restrictive View and Rights-based Restrictive View – and find both wanting. By contrast, we defend what we call the ‘Permissive View’. This holds that all potential goods and bads should be included in proportionality decisions about cyber-measures, even those that appear to be trivial, and where the various harms and benefits are given different weights, according to their agent-relative and agent-neutral features. We argue further that accepting the Permissive View has broader implications for the ethical frameworks governing cyberwar, both in terms of whether cyberattack provide just cause for coercive responses, including kinetic warfare and cyber-responses, and whether cyber-measures should be governed by just war theory or a new theory for cyber-operations. (shrink)

Across eight experiments (N = 2310), we studied whether people would prioritize rescuing individuals who may be thought to contribute more to society. We found that participants were generally dismissive of general rules that prioritize more socially beneficial individuals, such as doctors instead of unemployed people. By contrast, participants were more supportive of one-off decisions to save the life of a more socially beneficial individual, even when such cases were the same as those covered by the rule. This generality effect (...) occurred robustly even when controlling for various factors. It occurred when the decision-maker was the same in both cases, when the pairs of people differing in the extent of their indirect social utility was varied, when the scenarios were varied, when the participant samples came from different countries, and when the general rule only covered cases that are exactly the same as the situation described in the one-off condition. The effect occurred even when the general rule was introduced via a concrete precedent case. Participants' tendency to be more supportive of the one-off proposal than the general rule was significantly reduced when they evaluated the two proposals jointly as opposed to separately. Finally, the effect also occurred in sacrificial moral dilemmas, a general phenomenon occurring in multiple moral contexts. We discuss possible explanations of the effect, including concerns about negative consequences of the rule and a deontological aversion against making difficult trade-off decisions unless they are absolutely necessary. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)