This chapter contains sections titled: References Further reading.

One of the most controversial areas of animal research is the use of nonhuman primates for fundamental research. At the centre of the controversy is the question of whether the benefits of research outweigh the harms. We argue that the evaluation of harms and benefits is highly problematic. We describe some common procedures in neurological research using nonhuman primates and the difficulties in evaluating the harm involved. Even if the harm could be quantified, it is unlikely (...) that it could be meaningfully aggregated over different procedures, let alone different animals. A similar problem arises for evaluating benefits. It is not clear how benefits could be quantified, and even if they could be, values for different aspects of expected benefits cannot be simply added up. Sorting harms and benefits in three or four categories cannot avoid the charge of arbitrariness and runs the risk of imposing its structure on the moral decision. The metaphor of weighing or balancing harms and benefits is inappropriate for the moral decision about whether to use nonhuman primates for research. Arguing that the harms and benefits in this context are incommensurable, we suggest describing the moral consideration of harms and benefits as a coherent trade-off. Such a decision does not require commensurability. It must be well-informed about the suffering involved and the potential benefits, it must be consistent with the legal, regulatory and institutional framework within which it is made, and it must cohere with other judgments in relevant areas. (shrink)

Psychologists and philosophers who pose moral dilemmas to understand moral judgment typically specify outcomes as certain to occur in them. This contrasts with real-life moral decision-making, which is almost always infused with probabilities (e.g., the probability of a given outcome if an action is or is not taken). Seven studies examine sensitivity to the size and location of shifts in probabilities of outcomes that would result from action in moral dilemmas. We find that moral judgments differ between actions that result (...) in an equal increase in probability of harm (equal size), but have different end-states (e.g., an increase in harm probability from 25% to 50% or from 50% to 75%). This deviation from expected value is robust under separate evaluation, and increases when the comparison between shifts is made explicit under simultaneous evaluation. Consistent with the centrality of perceived harm in some models of moral judgment, perceived harm partially mediates sensitivity to location of harm probability shift. Unlike for shifts in harm probabilities, participants are insensitive to the location of shifts in probability of beneficial outcomes. They are also insensitive to the location of shifts in probability of analogous monetary losses and gains, suggesting an asymmetry between harm and benefit in moral reasoning, as well as an asymmetry between moral and monetary decision-making more broadly. Implications for normative philosophical theory and moral psychological theory, as well as practical applications, are discussed. (shrink)

Concerns have been raised around the alleged commercialisation of South African genetic material by various research institutes nationally and abroad. We consider whether the Protection of Personal Information Act in South Africa will conflict with or complement existing protections in health law and research ethics. The Act is not applicable to de‐identified samples that cannot be re‐identified but we question whether genetic samples can ever be truly de‐identified. The research participants in this matter provided consent for use of their samples (...) for research but did not consent to commercialisation by global research institutions, and neither did the researchers. We suggest that consent models incorporating broad consent as an option should include explicit discussions around benefit sharing and commercialisation. Mistrust between researchers and participants impedes scientific research and can harm relationships built up over the years between South African researchers and local communities. (shrink)

An idea is a public good. The use of an idea by one person does not hinder others to benefit from the same idea. However in order to generate new life-saving ideas, e.g. inventions in the life sciences, a huge amount of human and material resources are needed. Powerful, but highly criticized tools to speed up the rate of innovation are exclusive rights, most prominently the use of patents and plant breeders’ rights. Exclusive rights leave by nature a number of (...) people empty-handed, with starvation, stuntedness, prevalence of disease and death as preventable and quotidian consequences. To stimulate a human rights compatible use of exclusive rights a wide range of moral frameworks have been developed to condemn current praxes. Most prominent in the debate are theories building on (1) utilitarian calculations of weighing benefits with Peter Singer as a prominent advocate, (2) Pogge’s vindication of compensatory duties for institutional harms, (3) a comprehensive analysis on how the current innovation incentive system fails to secure human rights and human capabilities and lastly (4) showing how the status quo nurtures misrecognition. With help of those theories modest targets as well as a thorough restructure of the innovation incentive system can be justified. Those theories have the mammoth task of restraining well-established ideas supporting the permissibility of a reckless use of property rights that are deeply anchored in the property law discourse. Life sciences raise a range of special problems when justifying pro-poor innovation. Healthy people living in a society with a good sanitary infrastructure need far less resources to tackle health problems than people in places with a poor infrastructure. Patents that involve gene sequences (or part thereof) make inventing around impossible, making the seeking of licenses mandatory for investigators wanting to make follow-up research with the molecule. Speedy sharing of data concerning public health hazards or threats to food security are vital to maintain living standards. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 40.4 (2006) 77-88 MuseSearchJournalsThis JournalContents[Access article in PDF]The Aesthetic Appreciation of Environmental Architecture under Different Conceptions of EnvironmentAllen CarlsonIntroductionIn what is in retrospect easily recognized as one of the three or four truly groundbreaking essays in environmental aesthetics, Francis Sparshott distinguishes a number of different ways of conceptualizing our relationships to our environments. Such different conceptualizations, he argues, deeply influence the ways in which (...) we aesthetically experience both environments and the things that occupy them. 1 It follows that understanding of, and thus education about, our environmental conceptualizations are of the utmost importance to our aesthetic appreciation. In this article I follow up some of Sparshott's insights by considering the ways in which a number of rather common conceptualizations of environments relate to what is an increasingly important feature of our built environments—what is commonly referred to as "environmental architecture." In doing so, I hope to make clear how aesthetic education concerning these common conceptualizations is vital for the appreciation of not only environmental architecture but the whole of our built environment.Initially, however, some clarifications are in order. First, due to the emphasis in environmental architecture on environments in general, there is, within this area of concern, somewhat of a shift away from the idea of architecture as a fine art. Traditionally, architecture, along with painting, sculpture, poetry, and music, was regarded as one of the five founding art forms of the so-called modern system of the arts. 2 And, although architecture, given its utilitarian dimensions, has often been the poor sister of the famous five, some individuals nonetheless regard it essentially as a fine art. 3 However, given my focus on environmental architecture, I here pay equal attention to what is known as "vernacular architecture." [End Page 77]Second, the phrase "environmental architecture" refers to architecture and architectural practices that are typically promoted as "working with the environment" or as being "environmentally friendly." Such characterizations bring to mind ideas such as ecological design, sustainable development, and green architecture. They are associated with design and building practices that rely on renewable energy and materials, stress recycling and efficient use of resources, and attempt to maintain the long-term integrity of both natural and human environments. Consequently, whether exemplified in the fine art of architecture or in the vernacular, such design and building practices point initially to the ecological and, more broadly, the ethical issues associated with architecture, which are best approached within environmental ethics or traditional ethical theory. 4 Although these ethical matters are of the greatest importance, I here primarily address, as noted, aesthetic issues involved in environmental architecture.Aesthetics and Environmental ArchitectureThe aesthetics of environmental architecture, as the ethics of environmental architecture, concerns most generally the relationships between structures and their environments, and especially the environmental effects of the former on the latter. Of course, unlike ethics, which in the case of architecture considers the environmental benefits or harms brought about by design and building practices and the resultant structures, aesthetics focuses first and foremost on appearances, on that which is perceived by the senses. As is well known, the discipline takes its name from the Greek aisthetikos, meaning "of sense perception." However, to recognize that aesthetics is concerned with appearances is not necessarily to relegate it to the realm of the superficial. Even though, since the aesthetics of environmental architecture considers the relationships between structures and their environments, it initially focuses on the appearances of such relationships, it need not be restricted to questions of whether such relationships are simply "pleasing to the eye" or "pretty." Rather, the basic question in the aesthetics of environmental architecture is whether structures reside in their environments such that they appear as they should. By this I mean that they and their environments are related in such a way that the structures appear appropriate or proper within their environments. 5An emphasis on whether structures appear appropriate within their environments immediately moves the matter beyond simple appearances. This is because... (shrink)

What is the proper role of cost-benefit analysis in understanding the tort concept of negligence or reasonable care? A straightforward question, you might think. But it is a question that manages to elicit groans of exasperation from those on both sides of the controversy. For most utilitarians and adherents to law and economics, the answer is obvious: to say that people should not be negligent is to say that they should minimize the sum of the costs of accidents and the (...) costs of preventing accidents. Under the economic formulation of the famous Learned Hand test, they should take a precaution if but only if the marginal costs (or burden, B) of that precaution are less than its marginal benefits (in the form of reduced risks of injury, measured by multiplying the probability (P) of the injury times the magnitude (L) of the injury if it occurs). If B>PxL, it would be absurd to require the greater expenditure, B. For many advocates of a fairness, corrective justice, rights-based, or contractualist perspective, the opposite answer is equally obvious. Permitting a person to impose risks of harm on others merely because he would thereby obtain a benefit (or would otherwise incur a burden) greater than the discounted value of the harm he might inflict, amounts to authorizing him to dump the costs of his risky activities on innocent victims. To permit this type of sacrifice of individuals on the altar of aggregate social welfare is morally abhorrent. Both sets of criticism have important elements of truth. Neither an unqualified cost-benefit analysis nor an unqualified rights-based rejection of tradeoffs is defensible - either as a description of tort doctrine and practice or as a normative prescription. However, a qualified (sensitive) consequentialist approach can accommodate legitimate criticisms of cost-benefit analysis: the consequentialist can launder preferences, and can consider the distribution of risk both in the social welfare calculus and in determining whether to compensate. At the same time, a qualified (tough-minded) deontological approach can accommodate the legitimate need to recognize tradeoffs: the deontologist can permit intrapersonal but not interpersonal aggregation of risks and benefits, can apply the concept of threshold deontology to risky activity, and can consider individual rather than population risk. I conclude that the formulation of the Learned Hand test found in the Restatement Third of Torts is broad enough to encompass each of these qualified approaches. (shrink)

When weighing up which inhaler to prescribe, a doctor may prioritise a patient’s preferences over the expected harms from the associated carbon emissions. Parker argues that this is wrong.1 Doctors have a pro-tanto duty to switch from a high-carbon metered-dose inhaler (MDI) to a low-carbon dry-powdered inhaler (DPI)—even though this provides no direct patient benefit—unless switching would undermine trust or significantly worsen a patient’s health. He goes on to state that even if DPIs are more expensive for the National (...) Health Service (NHS) then this is justified so long as it does not ‘significantly threaten’ the NHS’ ability to protect and promote health. This may appear to be a radical proposal, challenging the ethical principles of autonomy, health entitlements and justly distributed resources. However, we will claim that it is only radical in so far as one perceives (A) patient autonomy and healthcare entitlements as existing within a vacuum, unrelated to other foundational ethics concerns and (B) the health consequences of a given healthcare budget are limited solely to the designated recipients rather than all affected parties. Here, we test the claim that our responsibility for promoting patient autonomy …. (shrink)

A majority opinion seems to have emerged in scholarly analysis of the assortment of technologies that have been given the label “synthetic biology.” According to this view, society should allow the technology to proceed and even provide it some financial support, while monitor­ing its progress and attempting to ensure that the development leads to good outcomes. The near‐consensus is captured by the U.S. Presidential Commission for the Study of Bioethical Issues in its report New Directions: The Ethics of Synthetic Biology (...) and Emerging Technologies, which arguably marked the end of a preliminary round of analysis about the ethical and policy questions raised by synthetic bi­ology. Like a number of other, earlier documents issued by various groups around the world, the re­port called attention to questions about how the technology will be used; whether it might be mis­used; what sorts of accidents might happen along the way; the economic, environmental, and social impacts of the eventual applications; whether the very idea of “synthetic biology” should be trou­bling; and how the debate over all of these ques­tions will be conducted. Also like most similar documents, however, while it called for careful monitoring and oversight of technology, it did not recommend any significant new constraints on its development and use. The commission's stance was that it would be “imprudent either to declare a moratorium on synthetic biology until all risks can be determined and mitigated, or to simply ‘let science rip,’ regardless of the likely risks.”In this report, we will take stock of the current consensus, comment on some of the major points of disagreement, and identify the next steps for the debate. In part I, we offer a brief overview of the research and applications commonly grouped together under the heading of synthetic biology, partly in order to set the stage for the rest of the discussion and partly because we want to highlight some conceptual problems that attend the very la­bel given this field. In parts II, III, and IV, we take up, respectively, three broad classes of concerns that arise in the context of synthetic biology: con­cerns about the intrinsic or inherent value of do­ing synthetic biology, concerns about the concrete harms and benefits of doing synthetic biology, and concerns about justice. Addressing these concerns requires a method for bringing the public's values to bear on policy‐making concerning emerging biotechnologies; in part V, we discuss the chal­lenges in developing such a method. (shrink)

Whereas liberals tend to emphasize harm as the decisive criterion for legitimizing criminalisation, moralists take a qualified notion of wrongfulness as sufficient even when no harm is at hand. This comment takes up Andreas von Hirsch ’s “dual element approach” requiring both harm and wrongfulness as necessary conditions for criminalisation and argues that Joel Feinberg’s account of harming as violation of moral rights is perfectly compatible with it. Subsequently, two issues from the liberalism-moralism debate on criminalisation are examined: The difficulty (...) of how to determine wrongfulness beyond the scope of harming, and the so far disregarded question of whether the democratic legislator is free within the framework of constitution to criminalise whatever conduct he wants to prevent irrespective of philosophical constraints. (shrink)

Colonies, Commerce, and Constitutional Law is a major theoretical analysis of the harmful effects of colonies on commerce and constitiutional democracy, and is one of the most important studies of colonialism written in the nineteenth century. Of the four essays collected in this voloume, three have been edited directly from the original manuscript sources. The only essay to have appeared in print, `Observations on the Restrictive and Prohibitory Commercial System', is generally regarded as an early classic statement of the beneficial (...) effects of freedom of trade. In the these pioneering essays written in 1820-2, Bentham provided a penetrating critique of colonialism from within the liberal utilitarian tradition. Applying his general principles to the case of Spain and Spanish America, he argued that any attempt by Spain to maintain dominion over her Empire, or even to maintain a claim to the dominion was fundamentally misguided. Colonies were not a source of wealth to the colonizing country, but rather led to the imposition of increased taxation. Moreover, the existence of colonies increased the amount of patronage at the disposal of Spain's rulers, and thus would facilitate the corruption of the members of the new legislative assembly and eventually lead to the restoration of the ancient despotism. Colonies were not only wasteful and expensive, but posed a threat to constitutional government itself. The should therefore be granted unconditional independence, as a prererequisite to the establishment of unrestricted commercial relations, which would produce mutual benefit to both Spain and Spanish Amarica. (shrink)

In his essay on 'Broad on Induction and Probability' (first published in 1959, reprinted in this volume), Professor G. H. von Wright writes: "If Broad's writings on induction have remained less known than some of his other contributions to philosophy . . . , one reason for this is that Broad never has published a book on the subject. It is very much to be hoped that, for the benefit of future students, Broad's chief papers on induction and probability will (...) be collected in a single volume . . . . " The present volume attempts to perform this service to future students of induction and probability. The suggestion of publishing a volume of this kind in Synthese Library was first made by Professor Donald Davidson, one of the editors of the Library, and was partly prompted by Professor von Wright's statement. In carrying out this suggestion, the editors of Synthese Library have had the generous support of Professor Broad who has among other things supplied a new Addendum to 'The Principles of Problematic Induction' and corrected a number of misprints found in the first printings of this paper. The editors gratefully acknow ledge Professor Broad's help and encouragement. A bibliography of Professor Broad's writings (up to 1959) has been compiled by Dr. C. Lewy and has appeared in P. A. Schilpp, editor, The Philosophy of C. D. Broad (The Library of Living Philosophers), pp. 833-852. (shrink)

When it comes to climate change, the greatest difficulty we face is that we do not know the likely degree of change or its cost, which means that environmental policy decisions have to be made under uncertainty. This book offers an accessible philosophical treatment of the broad range of ethical and policy challenges posed by climate change uncertainty. Drawing on both the philosophy of science and ethics, Martin Bunzl shows how tackling climate change revolves around weighing up our interests now (...) against those of future generations, which requires that we examine our assumptions about the value of present costs versus future benefits. In an engaging, conversational style, Bunzl looks at questions such as our responsibility towards non-human life, the interests of the developing and developed worlds, and how the circumstances of poverty shape the perception of risk, ultimate developing and defending a view of humanity and its place in the world that makes sense of our duty to Nature without treating it as a rights bearer. This book will be of interest to students and scholars of environmental studies, philosophy, politics and sociology as well as policy makers. (shrink)

Artificial intelligence is set to transform healthcare. Key ethical issues to emerge with this transformation encompass the accountability and transparency of the decisions made by AI-based systems, the potential for group harms arising from algorithmic bias and the professional roles and integrity of clinicians. These concerns must be balanced against the imperatives of generating public benefit with more efficient healthcare systems from the vastly higher and accurate computational power of AI. In weighing up these issues, this paper applies the (...) deliberative balancing approach of the Ethics Framework for Big Data in Health and Research. The analysis applies relevant values identified from the framework to demonstrate how decision-makers can draw on them to develop and implement AI-assisted support systems into healthcare and clinical practice ethically and responsibly. Please refer to Xafis et al. in this special issue of the Asian Bioethics Review for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end of this paper. (shrink)

This book has been defined around three important issues: the first sheds light on how people, in various philosophical, religious, and political contexts, understand the natural environment, and how the relationship between the environment and the body is perceived; the second focuses on the perceptions that a particular natural environment is good or bad for human health and examines the reasons behind such characterizations ; the third examines the promotion, in history, of specific practices to take advantage of the health (...) benefits, or avoid the harm, caused by certain environments and also efforts made to change environments supposed to be harmful to human health. The feeling and/or the observation that the natural environment can have effects on human health have been, and are still commonly shared throughout the world. This led us to raise the issue of the links observed and believed to exist between human beings and the natural environment in a broad chronological and geographical framework. In this investigation, we bring the reader from ancient and late imperial China to the medieval Arab world up to medieval, modern, and contemporary Europe. This book does not examine these relationships through the prism of the knowledge of our modern contemporary European experience, which, still too often, leads to the feeling of totally different worlds. Rather, it questions protagonists who, in different times and in different places, have reflected, on their own terms, on the links between environment and health and tries to obtain a better understanding of why these links took the form they did in these precise contexts. This book targets an academic readership as well as an “informed audience”, for whom present issues of environment and health can be nourished by the reflections of the past. (shrink)

ABSTRACT Suppose that, for every possible event and person who would exist whether or not the event were to occur, there is a well-being level that the person would occupy if the event were to occur, and a well-being level that the person would occupy if the event were not to occur. Do facts about such connections between events and well-being levels always suffice to determine whether an event would harm or benefit a person? Many seemingly attractive accounts of harm (...) and benefit entail an affirmative answer to this question, including the widely held Counterfactual Comparative Account (CCA). In this paper, however, we argue that all such accounts will be unsuccessful. (shrink)

This book is the result of a three-year study undertaken by a multidisciplinary working party of the Institute of Medical Ethic (UK). The group was chaired by a moral theologian, and its members included biological and ethological scientists, toxicologists, physicians, veterinary surgeons, an expert in alternatives to animal use, officers of animal welfare organizations, a Home Office Inspector, philosophers, and a lawyer. Coming from these different backgrounds, and holding a diversity of moral views, the members produced the agreed report as (...) a result of detailed and rigorous discussions. The book sets out facts about animal experiments and about animal abilities to experience pain, distress and anxiety. There is a detailed examination of the moral claims related to the benefits likely to accrue from animal research, and of strategies for weighing these benefits against the harm caused to animals, in order to decide whether particular research projects ought or ought not to proceed. This leads to consideration of the statutory and non-statutory controls which safeguard standards in such research. The final section explores a variety of philosophical arguments about the use of animals in research, and offers a philosophical justification for the Working Party's more practical conclusions. Written in clear, nontechnical language, this book is accessible to lay people as well as to scientists. It is the first such document to emerge from a meeting of people with such widely differing views on this highly controversial subject, and represents a major contribution towards informing and raising the quality of contemporary debate. The book is unique in drawing together material and ideas never before found in one volume. It will interest a broad spectrum of readers, from ethicists and animal rights advocates to scientific researchers and laboratory administrators, along with general readers concerned about this compelling issue. (shrink)

The Racial and Religious Hatred Act 2006 represents a significant development in UK law. It extends the offence of incitement to racial hatred set out in the Public Order Act 1986 to make it also an offence to stir up hatred against persons on religious grounds. As the most celebrated liberal thinker of the nineteenth century, J.S. Mill might be expected to offer some lessons about the possible dangers of this sort of legislation. A Millian response to the 2006 (...) Act is developed here by first applying Mill’s famous defence of free speech to the Lords amendments to the Racial and Religious Hatred Bill 2005 and then by looking at potential cases in which even freedom of expression loses its immunity when this is necessary to prevent harm to others. Three versions of the harm‐prevention justification for liberty‐limiting restrictions are assessed and it is argued that the most promising version is the claim that it may be permissible to punish incitement to racial and religious hatred not so much because it is itself a kind of harm but by virtue of the acts of discrimination, violence and injustice that are more likely to occur within a climate of hatred. Ultimately, however, this rationale must be weighed against what is, for Mill, the special value of free speech and may in the end justify intervention in only the most acute cases. (shrink)

It is common to interpret Rawls's maximin theory of justice as egalitarian. Compared to utilitarian theories, this may be true. However, in special cases practices that distribute resources so as to benefit the worst off actually increase the inequality between the worst off and some who are better off. In these cases the Rawlsian maximin parts company with what is here called true egalitarianism. A policy question requiring a distinction between maximin and "true egalitarian" allocations has arisen in the (...) arena of organ transplantation. This case is examined here as a venue for differentiating maximin and true egalitarian theories. Directed donation is the name given to donations of organs restricted to a particular social group. For example, the family of a member of the Ku Klux Klan donated his organs on the provision that they go only to members of the Caucasian race. While such donations appear to be discriminatory, if certain plausible assumptions are made, they satisfy the maximin criterion. They selectively advantage the recipient of the organs without harming anyone. Moreover, everyone who is lower on the waiting list is advantaged by moving up on the waiting list. This paper examines how maximin and more truly egalitarian theories handle this case arguing that, to the extent that directed donation is unethical, the best account of that conclusion is that an egalitarian principle of justice is to be preferred to the maximin. (shrink)

The author offers a defense for elective death on utilitarian grounds, but one that is presented specifically from the perspective of someone who: 1) faces a potentially terminal illness and diminishing quality of life; 2) views death as nothing more than a return to prenatal nonbeing; and 3) maintains common humanist ethical commitments. The argument, then, is uniquely situated and limited in scope, rooted both in the particulars of his recent experience with a rheumatic autoimmune illness and non-Hodgkin’s lymphoma (...) as well as in a worldview shaped largely by emerging narratives in the sciences. Drawing upon the work of J.S. Mill and P. Singer, the author begins by assuming that one is generally free to act on a preference for nonbeing so long as others are not unduly harmed or thwarted in pursuing their own aims as a result. But a humanist, he suggests, ideally ought to press beyond this minimum criterion and do one’s best to maximize eudaimonia by carefully weighing how elective death would likely affect others to whom one is currently obligated in significant ways. The focus of one’s ethical reasoning, then, should remain on maximizing well-being and minimizing harm, not on creating a logical flawless and internally coherent defense that may satisfy a set of abstract or universally applicable criteria drawn up by others in an effort to define precisely what might render a given suicide “rational” or “morally permissible.”. (shrink)

This contribution deals with the issue of the professional autonomy ofthe medical doctor. Worldwide, the physician's autonomy is guaranteedand limited, first of all, by Codes of Medical Ethics. InItaly, the latest version of the national Code of MedicalEthics (Code 1998) was published in 1998 by the Federation ofprovincial Medical Associations (FnomCeO). The Code 1998acknowledges the physician's autonomy regarding the scheduling, thechoice and application of diagnostic and therapeutic means, within theprinciples of professional responsibility. This responsibility has tomake reference to the following (...) fundamental ethical principles:(1) the protection of human life; (2) the protection of thephysical and psychological health of the human being; (3) therelief from pain; (4) the respect for the freedom and the dignityof the human person, without discrimination; (5) an up-to-datescientific qualification (Art. 5). The authors underline that autonomyis an anthropological – and consequently ethical –characteristic of the human person. Different positions on autonomy inbioethics (individualistic, evolutionistic, utilitarian andpersonalistic models) are explained. The relation between theprofessional autonomy of the physician and the autonomy of the patientand of colleagues is discussed. In fact, the medical doctor isobliged: (1) to respect the fundamental rights of the person,first of all his/her life; (2) to ensure the continuity of thecare, even if he can only relieve the patient's suffering; (3) tomaintain, except under certain circumstances, professional secrecy andconfidentiality regarding patients and their medical records. Moreover,the physician cannot deny the patient correct and appropriateinformation. He/she should not perform any diagnostic or therapeuticactivity without the informed consent of the patient and the medicaldoctor must give up medical treatment in case of documented refusal ofthe individual. Furthermore, the medical doctor has the right to raiseconscientious objections if he/she is requested to perform medicalactions that are contrary to his/her conscience or medical opinion,unless this attitude would seriously and immediately harm the patient.Regarding the relationships with colleagues, the physician is obliged tosolidarity, mutual respect, and care of sick colleagues. Finally, theauthors discuss the Italian legislation affecting the physician'sprofessional autonomy: (1) the SSN health care Acts; (2) theso-called Charter for Public Health Care Services; (3) the Acts onprivacy; (4) Good Clinical Practice. (shrink)

Mitochondrial replacement therapy (MRT) utilises nuclear transfer technology to replace defective mitochondria with healthy ones and thereby minimise the risk of a mitochondrial disease passing from a mother to her child. It promises much but comes with ethical controversy, significant risk of harm and many unknowns. Forming a position on MRT requires accurate information about the current state of knowledge, and an appreciation of the ethical issues at stake. Ethical deliberations will vary depending on the framework used. There are in (...) principle objections to MRT on the grounds of direct harm to human embryos and germline genetic modification. But even without these objections MRT can be weighed in terms of the balance between risks and benefits, alternatives and uncertainties. This paper explores the evidence and lays out the relevant issues to assist such a deliberation. (shrink)

The article takes as its starting point the assumption that (a) competing accounts of moral rules should be judged by the distribution of benefits and burdens which would arise from everyone accepting these rules, and that (b) these benefits and burdens are understood in a way which has a substantial resource or freedom-based component. This starting point is compatible with contractualism and various forms of rule consequentialism, and will yield a morality in which people have significant freedoms. The (...) main claim of the article is that as a consequence of these freedoms, and because of phenomena connected with cost internalization, this morality will also impose strong constraints on harming and weak constraints on allowing harm. Thus the starting point ends up vindicating commonsense morality. (shrink)

This article addresses the question of how ‘Country of Origin Information’ reports—that is, research developed and used to support decision-making in the asylum process—can be published in an ethical manner. The article focuses on the risk that published COI reports could be misused and thereby harm the subjects of the reports and/or those involved in their development. It supports a situational approach to assessing data ethics when publishing COI reports, whereby COI service providers must weigh up the benefits and (...) harms of publication based, inter alia, on the foreseeability and probability of harm due to potential misuse of the research, the public good nature of the research, and the need to balance the rights and duties of the various actors in the asylum process, including asylum seekers themselves. Although this article focuses on the specific question of ‘how to publish COI reports in an ethical manner’, it also intends to promote further research on data ethics in the asylum process, particularly in relation to refugees, where more foundational issues should be considered. (shrink)

Sustainability is typically viewed as consisting of three forces, economic, social, and ecological, in tension with one another. In this paper, we address the dangers posed to societal sustainability. The concern being addressed is the very survival of societies where the rights of individuals, personal and collective freedoms, an independent judiciary and media, and democracy, despite its messiness, are highly valued. We argue that, as a result of various technological innovations, a range of dysfunctional impacts are threatening social and political (...) stability. For instance, robotics and automation are replacing human labor and decision-making in a range of industries; search engines, monetized through advertising, have access to, and track, our interests and preferences; social media, in connecting us to one another often know more about us than we ourselves do, enabling them to profit in ways which may not coincide with our well-being; online retailers have not only acquired the ability to track and predict our buying choices, but also they can squeeze vendors based on their outsize bargaining power; and, in general, virtual technologies have changed both the way we think and our sense of self. With the rising deployment of the Internet of Things, and developments in machine learning and artificial intelligence, the threats to individual freedoms and rights, societal cohesion and harmony, employment and economic well-being, and trust in democracy are being ratcheted up. This paper lauds the benefits and addresses the harm wrought by the high tech giants in Information and Communication Technologies. The search for rapidly growing revenues drives firms to accelerate product innovation without fully investigating the entire gamut of their impacts. As greater wealth accrues to the leaders of tech firms, inequalities within firms and societies are widening, creating social tensions and political ferment. We explore the ethical nature of the challenge employing a simple utilitarian calculus, complemented by approaches rooted in rights, justice, and the common good. Various options to address the challenges posed by ICTs are considered and evaluated. We argue that regulation may do little more than slow down the damage to society, particularly since societal values and political preferences vary internationally. Firms need to establish ethical standards, imbuing the upholders of these standards with sufficient authority, while creating a culture of morality. User involvement and activism, and shareholders’ concerns for the sustainability of societies on whose continued prosperity they depend, are imperative to humanity’s ability to decide the future direction of technology. (shrink)

Advocates of cognitive enhancement maintain that technological advances would augment autonomy indirectly by expanding the range of options available to individuals, while, in a recent article in this journal, Schaefer, Kahane, and Savulescu propose that cognitive enhancement would improve it more directly. Here, autonomy, construed in broad procedural terms, is at the fore. In contrast, when lauding the goodness of enhancement expressly, supporters’ line of argument is utilitarian, of an ideal variety. An inherent conflict results, for, within their (...) class='Hi'>utilitarian frame, the content of rational, hence autonomous, choices is quite restricted. Further, advocates do not clearly indicate their relative emphasis between the often conflicting goals of maximizing benefit and avoiding harm. In practice, their construction of harms is highly expansive, for disabilities include any constraints that “rational” people would decline if it were technically possible to do so. For advocates, this means that where enhancement measures are available, those constraints become avoidable limitations, and not to remove them is to harm. The centrality of harm-avoidance and their ideal utilitarian frame entail sociopolitical requirements that enhancement defenders disallow when trumpeting autonomy in the vein of individual choice. Advocates have thus not done enough to support the claim that their views are wholly separate from earlier eugenics. (shrink)

We weigh the presumed benefts of routinely searching all research scans for incidental fndings against its substantial risks, including false-positive and false-negative fndings, and the possibility of triggering unnecessary, costly evaluations and perhaps harmful treatments. We argue that routinely searching for IFs may not maximize benefts and minimize risks to participants.

In a recent paper Edwards, Kirchin, and Huxtable have argued that research ethics committees (RECs) are often wrongfully paternalistic in their approach to medical research. They argue that it should be left to competent potential research subjects to make judgments about the acceptability of harms and benefits relating to research, and that this is not a legitimate role for any REC. They allow an exception to their overall antipaternalism, however, in that they think RECs should have the power (...) to prohibit the use of financial inducements to recruit research subjects into trials. In this paper it is argued that these claims are unjustified and implausible. A sketch is provided of an alternative model of the role of the REC as an expert body making judgments about the acceptability of research proposals through a consensual weighing of different moral considerations. (shrink)

In his essay on 'Broad on Induction and Probability' (first published in 1959, reprinted in this volume), Professor G. H. von Wright writes: "If Broad's writings on induction have remained less known than some of his other contributions to philosophy..., one reason for this is that Broad never has published a book on the subject. It is very much to be hoped that, for the benefit of future students, Broad's chief papers on induction and probability will be collected in a (...) single volume.... " The present volume attempts to perform this service to future students of induction and probability. The suggestion of publishing a volume of this kind in Synthese Library was first made by Professor Donald Davidson, one of the editors of the Library, and was partly prompted by Professor von Wright's statement. In carrying out this suggestion, the editors of Synthese Library have had the generous support of Professor Broad who has among other things supplied a new Addendum to 'The Principles of Problematic Induction' and corrected a number of misprints found in the first printings of this paper. The editors gratefully acknow ledge Professor Broad's help and encouragement. A bibliography of Professor Broad's writings (up to 1959) has been compiled by Dr. C. Lewy and has appeared in P. A. Schilpp, editor, The Philosophy of C. D. Broad (The Library of Living Philosophers), pp. 833-852. (shrink)

The first set of case studies on animal use, this volume offers a thorough, up-to-date exploration of the moral issues related to animal welfare. Its main purpose is to examine how far it is ethically justifiable to harm animals in order to benefit mankind. An excellent introduction provides a framework for the cases and sets the background of philosophical and moral concepts underlying the subject. Sixteen original, previously unpublished essays cover controversies associated with the human use of animals in a (...) broad range of contexts, including biomedical, behavioral, and wildlife research, cosmetic safety testing, education, the food industry, commerce, and animal use as pets and in religious practices. Scientific research is accorded the closest scrutiny. The authors represent a wide range of expertise within their specialized areas of research--physiology, public policy, ethics, philosophy, law, veterinary science, and psychology. The careful analysis of each case makes it possible to elevate the discourse beyond over-simplified positions, and to demonstrate the complexity of the issues. The Human Use of Animals will be welcomed by students and faculty in law, philosophy, ethics, public policy, religion, medicine, and veterinary medicine. It will also interest activists in the animal protection movement, and members of animal protection organizations and Institutional Animal Care and Use Committees. (shrink)

First-in-human clinical trials represent a critical juncture in the translation of laboratory discoveries. However, because they involve the greatest degree of uncertainty at any point in the drug development process, their initiation is beset by a series of nettlesome ethical questions [1]: has clinical promise been sufficiently demonstrated in animals? Should trial access be restricted to patients with refractory disease? Should trials be viewed as therapeutic? Have researchers adequately minimized risks? The resolution of such ethical questions inevitably turns on claims (...) about future events like harms, therapeutic response, and clinical translation. Recurrent failures in clinical translation, like Eli Lilly's Alzheimer candidate semagacestat, highlight the severe limitations of current methods of prediction. In this case, patients in the active arm of the placebo-controlled trial had earlier onset of dementia and elevated rates of skin cancer [2]. Various authoritative accounts of human research ethics state that decision-making about risk and benefit should be careful, systematic, and non-arbitrary [3]–[5]. Yet, these sources provide little guidance about what kinds of evidence stakeholders should use to ensure their estimates of such events ground responsible ethical decisions. In this article, we suggest that investigators, oversight bodies, and sponsors often base their predictions on a flawed and inappropriately narrow preclinical evidence base. (shrink)

Sport categorization is often justified by benefits such as increased fairness or inclusion. Taking inspiration from John Rawls, Sigmund Loland’s fair equality of opportunity principle in sport (FEOPs) is a tool for determining whether the existence of an inequality ethically justifies the institution of a new category in any given sport. It is an elegant ethical normative framework, but since FEOPs does not account explicitly for athlete safety (i.e. athlete physical and mental wellbeing), we are left in an ethically (...) dubious situation where the risk of harm associated with a categorization regime might in fact prove to be greater than the risk of harm present within the sport before its introduction. To address this critical gap, I propose the ‘scales of ignorance’ ethical normative framework to weigh the relative risk of harm within a sport, crucially inserting athlete safety into the discourse surrounding ethical justification for categorization in sport. The current paper is the first explicit formulation of assessment and ethical justification of risk of harm in the familiar logic of FEOPs. The scales of ignorance framework can also be used independently of Loland’s approach. Two new concepts are also proposed: ‘insidious risk of harm’ and ‘pernicious risk of harm’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.1 (2001) 91-112 [Access article in PDF] Scope Note 40 Animals in Research and Education: Ethical Issues Laura Jane Bishop and Anita Lonnes Nolen Scientific enquiry is inexorably tied to animal experimentation in the popular imagination and human history. Many, if not most, of the spectacular innovations in the medical understanding and treatment of today's human maladies have been based on research using animals. (...) However, the use of animals in research and experimentation has been debated, defended, and protested by both individuals and organizations at various levels. Responses range from personal lifestyle decisions and fervent philosophical treatises to strident arguments, violent demonstrations, and direct action. The continuum of attitudes about animals and the human relationship with animals spans the range between those who support no regulation of the human use of animals and those who advocate absolute animal liberation from all human use (see II, Orlans 1993, p. 22). History The first recorded experimentation on animals occurred in ancient Rome, but not until the Renaissance did scholars begin serious study of how the body works. Leonardo da Vinci (1452-1519) and other artists and anatomists pursued anatomical investigations of muscle and bone structure. William Harvey (1578-1657) discovered the circulation of the blood via his experiments on live deer. During this period, much live animal experimentation both in England and France was based on the view of French philosopher René Descartes (1596-1650) that animals are incapable of feeling pain. Jeremy Bentham (1748-1832), the English utilitarian philosopher, thought otherwise. In his "Introduction to the Principles of Morals and Legislation" in 1789, Bentham declared, "The question is not, can they reason? Nor, can they talk? But can they suffer? Despite Bentham and others, the belief that animals could not perceive pain persisted in many quarters into the twentieth century. Nineteenth century French physiologist Claude Bernard [End Page 91] (1813-1878)-and his teacher, François Magendie (1783-1855)-conducted wide-ranging animal experiments including surgery, use of drugs, and removal of body parts from many species. Bernard argued that while no amount of benefit could justify any harm to human research subjects, even extreme harm and pain for animal research subjects could be justified by the potential benefit to human beings. Although he did use anesthetics in his work after their discovery in 1847, even Bernard's later work was controversial because of the numbers of animals used and the repetitive nature of his research. The experiments of Magendie and Bernard both laid the foundations for animal experimentation as a practice for scientific advance and contributed in large measure to the emergence of the anti-vivisection movement. Public protests over animal experiments conducted in France and the fear that these might come to England led to the passage of the first law controlling animal experimentation, the "1876 Cruelty to Animals Act" in England. This history and the dynamic tension between scientific inquiry and public concern set the stage for the activism and scholarship of the twentieth century.Since the 1960s, the amount of attention, activism, and scholarship related to animal use has increased at a rapid pace. The modern animal protection movement, led by the Australian philosopher Peter Singer in his book, Animal Liberation (II, 1975), based its advocacy on animals' ability to experience pain and suffering (Bentham's argument). Singer's book and other investigations into animal research, such as LIFE magazine's photojournalism piece on pet theft, animal cruelty, and animal experimentation (Concentration Camps for Dogs. LIFE (4 February 1966), pp. 22-29), brought the use of animals in research, testing, and education to the attention of the general public. Activists, advocates, laypersons, scientists, lawmakers, and animals themselves, have created the interesting, complicated, and complex history of animal rights and animal welfare over the last several decades. Current Statistics Worldwide, approximately 35 million animals are used in research each year; the United States alone uses 12 million animals annually--more than any other country. In 1998, the official number of research animals recorded in the United States was 1... (shrink)

The counterfactual comparative account of harm and benefit has several virtues, but it also faces serious problems. I argue that CCA is incompatible with the prudential and moral relevance of harm and benefit. Some possible ways to revise or restrict CCA, in order to avoid this conclusion, are discussed and found wanting. Finally, I try to show that appealing to the context-sensitivity of counterfactuals, or to the alleged contrastive nature of harm and benefit, does not provide a solution.

Socrates' attitude towards falsehood is quite puzzling in the Republic. Although Socrates is clearly committed to truth, at several points he discusses the benefits of falsehood. This occurs most notably in Book 3 with the "noble lie" (414d-415c) and most disturbingly in Book 5 with the "rigged sexual lottery" (459d-460c). This raises the question: What kinds of falsehoods does Socrates think are beneficial, and what kinds of falsehoods does he think are harmful? And more broadly: What can this (...) tell us about the relationship between ethics and epistemology? The key to answering these questions lies in an obscure and paradoxical passage in Book II; at 382a-d Socrates distinguishes between "true falsehoods" and "impure lies." True falsehoods are always bad, but impure lies are sometimes beneficial. Despite Socrates' insistence that he is not saying anything deep, his distinction is far from straightforward. Nevertheless, in order to determine why some falsehoods are beneficial and why some are always harmful, we must understand what exactly true falsehoods are and how they differ from impure lies. In this paper, I argue that true falsehoods are a restricted class of false beliefs about ethics; they are false beliefs about how one should live and what one should pursue. I refer to these beliefs as "normative commitments." False normative commitments are always pernicious because they create and sustain psychological disharmony. Unlike true falsehoods, impure lies can be about anything. Nevertheless, they are only beneficial when they help produce and sustain true normative commitments. I argue that the upshot of this is that practical concerns have a kind of primacy over theoretical concerns. (shrink)

Much of the contemporary debate about the propriety of non-therapeutic circumcision of male infants and boys revolves around the question of risks vs. benefits. With its headline conclusion that the benefits outweigh the risks, the current circumcision policy of the American Academy of Pediatrics [AAP] (released 2012) is a typical instance of this line of thought. Since the AAP states that it cannot assess the true incidence of complications, however, critics have pointed out that this conclusion is unwarranted. (...) In this paper it is argued that the AAP’s conclusion is untenable not only for empirical reasons related to lack of data, but also for logical and conceptual reasons: the concept of risk employed—risk of surgical complications—is too narrow to be useful in the circumcision debate. Complications are not the only harms of circumcision: the AAP and other parties debating the pros and cons of circumcision should conceptualize their analysis more broadly as risk of harm vs. prospect of benefit, thereby factoring in the value of the foreskin to the individual and the physical and ethical harms of removing it from a non-consenting child. (shrink)

In this paper, we put forward two novel arguments against the counterfactual comparative account (CCA) of harm and benefit. In both arguments, the central theme is that CCA conflicts with plausible judgements about benefit and prudence.

In the ‘Concluding note’ to An Introduction to the Principles of Morals and Legislation, added in January 1789 to the original 1780 text, Bentham addresses highly theoretical questions in jurisprudence: ‘What is a law? What are the different parts of a law?’ He then demonstrates that only an imperative theory of legislation can provide adequate answers and provide the means to establish a precise nomenclature of legal phenomena. These broad questions sum up the work conducted in the manuscripts (...) Of the Limits of the Penal Branch of Jurisprudence, which remained at that time unpublished. After such abstract matter, Bentham concludes on a much lighter note: Leaning on his elbow, in an attitude of profound and solemn meditation, ‘What a multitude of things there are’,, ‘in a minuet?’ – May we now add? – and in a law. (shrink)

In the ‘Concluding note’ to An Introduction to the Principles of Morals and Legislation, added in January 1789 to the original 1780 text, Bentham addresses highly theoretical questions in jurisprudence: ‘What is a law? What are the different parts of a law?’ He then demonstrates that only an imperative theory of legislation can provide adequate answers and provide the means to establish a precise nomenclature of legal phenomena. These broad questions sum up the work conducted in the manuscripts (...) Of the Limits of the Penal Branch of Jurisprudence, which remained at that time unpublished. After such abstract matter, Bentham concludes on a much lighter note: Leaning on his elbow, in an attitude of profound and solemn meditation, ‘What a multitude of things there are’,, ‘in a minuet?’ – May we now add? – and in a law. (shrink)

Many have argued that that it is morally wrong to benefit from an agent's culpable wronging of a third party. This thought has formed the basis of some arguments that agents can have duties to make up for wrongful acts by others that they could not have stopped, or that occurred before they were born. For example, it has been argued that those who benefited from slavery, colonialism and other shameful events in their nation's history should surrender those benefits, (...) their equivalent value, or provide other forms of redress. Some have also argued that it is morally wrong to benefit from unjust situations caused by third parties even where there is no culpable element. These ideas have potential to be a principle of redress for harms that are caused by the working of very complex systems, such as the global climate system. Geoengineering, the intentional manipulation of the global climate, is a new development in climate science and policy — and one which raises many normative challenges. This article focuses on one specific challenge. The global climate is very complex and there is a real possibility that the best available science will not be able to account for all the consequences of deploying a geoengineering technique. Therefore, any governance regime that allows deployment will have to consider how to organise compensation or redress for any adverse impacts that could not have been predicted at the time of deployment. This article proposes that, with some modification, the principle that agents should surrender benefits that have accrued to them from using geoengineering techniques, can be a good basis for such a scheme. (shrink)

An axiom of medical research ethics is that a protocol is moral only if it has a “favorable risk-benefit ratio”. This axiom is usually interpreted in the following way: a medical research protocol is moral only if it has a positive expected value -- that is, if it is likely to do more good (to both subjects and society) than harm. I argue that, thus interpreted, the axiom has two problems. First, it is unusable, because it requires us to know (...) more about the potential outcomes of research than we ever could. Second, it is false, because it conflicts with the so-called “soft paternalist” principles of liberal democracy. In place of this flawed rule I propose a new way of making risk-benefit assessments, one that does comport with the principles of liberalism. I argue that a protocol is moral only if it would be entered into by competent subjects who are informed about the protocol. The new rule this eschews all pseudo-utilitarian calculation about the protocol’s likely harms and benefits. (shrink)

Rapid developments in science and technology have resulted in novel discoveries, leading to new questions particularly related to human values and ethics. Every discovery and technology has positive and negative implications and affects human lives either directly or indirectly, involving all walks of life. Bioethical discourse in Malaysia must consider the multiracial and multireligious background of Malaysia and especially the Islamic view as the majority of Malaysians are Muslims and Islam is the religion of the federation. This article discusses several (...) selected bioethical issues in Malaysia by studying the application of maṣlaḥah (the public good) and mafsadah (evil and harms) in Malaysian Islamic rulings (fatwas). This article uses the critical interpretation approach, as this is an ethical, interpretive, textual, and contextual analysis. In a situation when there is a conflict between maṣlaḥah and avoidance of mafsadah, it is preferred to attempt to address both needs. However, if maṣlaḥah and avoidance of mafsadah are mutually exclusive, the decision to choose must be made by weighing (tarjīḥ) and choosing the one which is superior. The maṣlaḥah and mafsadah concepts play vital and significant roles in bioethical discourse to realize human essential interests, namely faith, life, lineage, intellect, and property, thus achieving maqāṣid al-sharīʿah (the ultimate goal of sharia). This concept helps in guiding bioethical discussions, especially in determining the priority between achieving benefits and avoiding harms. The application of this concept will also assist Malaysian authorities in formulating appropriate rulings, especially bioethical issues related to Malaysian Muslims’ lives. (shrink)

Proponents of permitting living kidney sales often argue as follows. Many jobs involve significant risks; people are and should be free to take these risks in exchange for money; the risks involved in giving up a kidney are no greater than the risks involved in acceptable hazardous jobs; so people should be free to give up a kidney for money, too. This paper examines this frequently invoked but rarely analysed analogy. Two objections are raised. First, it is far from clear (...) that kidney sales and dangerous jobs involve comparable risks on an appropriately broad comparison. Second, and more importantly, even if they do involve comparable risks it does not follow that kidney sales must be permitted because dangerous jobs are. The analogy assumes that kidney sales are banned for paternalistic reasons. But there may be other, non-paternalistic reasons for the ban. And paternalists, too, can consistently defend the ban even if kidney sales are no riskier than occupations that they find acceptable. Soft paternalists may want to protect would-be vendors from harms that they have not voluntarily chosen. Egalitarian hard paternalists may want to protect already badly off vendors from further worsening their situation. For neither species of paternalist is the size of the risk prevented decisive. I conclude that the analogy with dangerous jobs, while rhetorically powerful, pulls little real argumentative weight. Future debates on living kidney sales should therefore proceed without it. (shrink)

Life insurance settlements, or life settlements, are life insurance policies owned by investor-beneficiaries on the lives of unrelated individuals. With life settlements, investors make substantial payments to the insured individuals upon purchasing such policies, pay any remaining premius, and collect the death benefits upon the demise of the insured individuals. Transactions involving life settlements seem poised to become a major source of profits for investment banks, comparable in dollar amount to subprime mortgages. With life settlements, the insured individuals suffer (...) no immediate harm, and the sale of a policy an individual owns is permissible under current law. Nevertheless, moral questions can be posed about the social values expressed by these practices, the effect of these practices on the virtue of charity, and the overall loss of social utility that will result from life settlements. We consider life settlements from utilitarian and libertarian perspectives, and then consider the effects of life settlements on social values and on individual character. On balance, we favor legislative changes in insurance and tax laws to discourage life settlements, and argue that certain forms of life settlements should be banned outright. (shrink)

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of (...) time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. (shrink)

Traditional moral explorations of sexual violation are dyadic: they focus on the relationship between the perpetrator and the victim, considered in relative isolation. We argue that the moral texture of sexual violation and its fallout only shows up once we see acts of sexual violation as acts that occur within an ecosystem. An ecosystem is made up of dwellers and an environment embedded in a broad, thick, interdependent, and relatively stable web of norms, practices, environments, material and institutional structures. We (...) argue that many of the important and interesting harms wrought by sexual violation can only be understood as ecological harms. To illustrate this, we focus on sexual violations that occur within a specific type of ecosystem, namely an academic department with a graduate program. We examine the possible damaging effects of sexual violation on the ecology of a department. We also consider what makes an ecosystem resilient and relatively able to self-repair, and how sexual violation within an ecosystem may weaken its self-repairing resources. We show that looking at sexual violation through this ecological lens lets us identify harms that are otherwise obscured or difficult to locate. (shrink)

In this article, responding to assertions that the principle of double effect has no place in legal analysis, I explore the overlap between double effect and negligence analysis. In both, questions of culpability arise in situations where a person acts with no intent to cause harm but where reasonable foreseeability of unintended harm exists. Under both analyses, the determination of whether such conduct is permissible involves a reasonability test that balances that foreseeable harm against the good intended by the actor's (...) conduct. In both, absent a finding that the foreseeable harm is unreasonable in light of that intended good, no liability will be imposed upon the actor. Even conceding, however, such general similarity between double effect and negligence analysis - disagreement over the proper interpretation of the reasonability criterion at play in negligence poses an additional challenge for the attempt to correlate negligence with double effect. Economic efficiency interpretations of negligence, for example, purportedly based on the Learned Hand Formula and the RESTATEMENT (SECOND) OF THE LAW OF TORTS, propose that culpability depends upon a utilitarian balancing of good effects of conduct (utility) versus its harmful foreseeable consequences (magnitude of risk of injury). Based on such an interpretation of negligence, however, contrasts between actors' states of mind, and normative differences between kinds of goods and harms, ultimately fade into the background and become irrelevant as essential conditions for properly assessing liability. This article elaborates and defends the view that double effect analysis lies at the heart of negligence theory. Part I elucidates in more detail the principle of double effect and describes its prima facie operation in negligence analysis. Part II considers and rejects the economic efficiency interpretation that has been offered as a theory of negligence, overcoming the challenge that such an interpretation presents for the effort to locate double effect analysis in the law. Part III illustrates and confirms the overlap between double effect and negligence by consideration of a series of case applications. The Article proposes that the weighing of conflicting values in double effect analysis and negligence is not achieved - as proposed by law and economics theory with respect to negligence - by imposing a consequentialist-utilitarian reduction of all value to a single concept of good and eliminating the relevance of traditional state of mind distinctions between intention and foreseeability. Instead, each mode of analysis recognizes that distinct culpability determinations flow naturally and plausibly from an appreciation of the traditional legal distinctions made between various types of goods and harms, and upon whether such goods and harms come about as result of an actor's intention or mere foreseeability. Keywords: Double effect, negligence, intention, foreseeability, choice, law and economics, utilitarianism, consequentialism, weighing of values. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well (...) as economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

Health checks identify disease in people without symptoms. They may be offered by the government through population screenings and by other providers to individual users as ‘personal health checks’. Health check providers’ perspective of ‘good’ health checks may further the debate on the ethical evaluation and possible regulation of these personal health checks. In 2015, we interviewed twenty Dutch health check providers on criteria for ‘good’ health checks, and the role these criteria play in their practices. Providers unanimously formulate a (...) number of minimal criteria: Checks must focus on treatable/preventable disease; Tests must be reliable and clinically valid; Participation must be informed and voluntary; Checks should provide more benefits than harms; Governmental screenings should be cost-effective. Aspirational criteria mentioned were: Follow-up care should be provided; Providers should be skilled and experienced professionals that put the benefit of users first; Providers should take time and attention. Some criteria were contested: People should be free to test on any disease; Health checks should only be performed in people at high risk for disease that are likely to implement health advice; Follow up care of privately funded tests should not drain on collective resources. Providers do not always fulfil their own criteria. Their reasons reveal conflicts between criteria, conflicts between criteria and other ethical values, and point to components in the organisation of health care that hinder an ethical provision of health checks. Moreover, providers consider informed consent a criterion that is hard to establish in practice. According to providers, personal health checks should meet the same criteria as population screenings, with the exception of cost-effectiveness. Providers do not always fulfil their own criteria. Results indicate that in thinking about the ethics of health checks potential conflicts between criteria and underlying values should be explicated, guidance in weighing of criteria should be provided and the larger context should be taken into account: other actors than providers need to take up responsibility, and ideally benefits and harms of health checks should be weighed against other measures targeting disease. (shrink)

In this issue of the Hastings Center Report, Amulya Mandava, Joseph Millum, and Benjamin E. Berkman revisit an old conundrum—whether to disclose incidental findings of misattributed parentage—in light of new developments in genomic sequencing that will make that conundrum both more complex and more common. While the authors’ defense of nondisclosure as the appropriate default action in genomic research aligns with prior thinking and practice, their exploration of philosophical foundations is refreshingly rigorous and developed. The final product of their analysis—an (...) applied taxonomy of the types of harms and benefits that can result from disclosure of misattributed parentage—is an important contribution to the literature on this subject and worthy of serious consideration by genomic researchers and bioethicists alike. Despite these virtues, I am struck by the authors’ deference to the traditional assumption that disclosure ethics can be adequately understood and appreciated within a purely consequentialist framework. (shrink)