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)
Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.
Many recent definitions of lying are based on the notion of what is said. This paper argues that says-based definitions of lying cannot account for lies involving non-literal speech, such as metaphor, hyperbole, loose use or irony. It proposes that lies should instead be defined in terms of assertion, where what is asserted need not coincide with what is said. And it points to possible implications this outcome might have for the ethics of lying.
It is widely held that all lies are assertions: the traditional definition of lying entails that, in order to lie, speakers have to assert something they believe to be false. It is also widely held that assertion contrasts with presupposition and, in particular, that one cannot assert something by presupposing it. Together, these views imply that speakers cannot lie with presuppositions—a view that Andreas Stokke has recently explicitly defended. The aim of this paper is to argue that speakers can lie (...) with presuppositions, and to discuss some of the implications this outcome has for current research on lying, assertion and presupposition. (shrink)
Pictures are notably absent from the current debate about how to define lying. Theorists in this debate tend to focus on linguistic means of communication and do not consider the possibility of lying with photographs, drawings and other kinds of pictures. The aim of this paper is to show that such a narrow focus is misguided: there is a strong case to be made for the possibility of lying with pictures and this possibility allows for insights concerning the question of (...) how lying should be defined. (shrink)
1. The opinions expressed are the author's own. They do not reflect any position or policy of the National Institutes of Health, Public Health Service, Department of Health and Human Services, or any of the authors affiliated organizations.
Intentionalism is the view that demonstratives, gradable adjectives, quantifiers, modals and other context‐sensitive expressions are intention‐sensitive: their semantic value on a given use is fixed by speaker intentions. The first aim of this paper is to defend Intentionalism against three recent objections, according to which speakers at least sometimes do not have suitable intentions when using supposedly intention‐sensitive expressions. Its second aim is to thereby shed light on the so far little‐explored question of which kinds of intentions can be semantically (...) relevant. (shrink)
I propose a new argument for the existence of God. God is defined as a conscious being that is the first cause of reality. In its simplified initial form, the argument has two premises: all possible truths are knowable, and it is impossible to know that the proposition that God does not exist is true. From and it follows that the proposition that God exists is necessarily true. After introducing the argument in its crude initial form and laying out the (...) core intuitions behind its premises, I point to two difficulties that this simplified version faces. I then go on to show how the argument can be revised to handle these difficulties. I defend the revised argument from various objections. (shrink)
In Emanuel Adler's distinctive constructivist approach to international relations theory, international practices evolve in tandem with collective knowledge of the material and social worlds. This book - comprising a selection of his journal publications, a new introduction and three previously unpublished articles - points IR constructivism in a novel direction, characterized as 'communitarian'. Adler's synthesis does not herald the end of the nation-state; nor does it suggest that agency is unimportant in international life. Rather, it argues that what mediates (...) between individual and state agency and social structures are communities of practice, which are the wellspring and repositories of collective meanings and social practices. The concept of communities of practice casts new light on epistemic communities and security communities, helping to explain why certain ideas congeal into human practices and others do not, and which social mechanisms can facilitate the emergence of normatively better communities. (shrink)
All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the (...) trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classiﬁed into four categories: treating people equally, favouring the worst-oﬀ, maximising total beneﬁts, and promoting and rewarding social usefulness. No single principle is suﬃcient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and (...) disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)
We argue that charging people to participate in research is likely to undermine the fundamental ethical bases of clinical research, especially the principles of social value, scientific validity, and fair subject selection.
The recent TeGenero phase I trial of a novel monoclonal antibody in healthy volunteers produced a drastic inflammatory reaction in participants receiving the experimental agent. Commentators on the ethics of the research have focused considerable attention on the role of financial considerations: the for-profit status of the biotechnology company and Contract Research Organization responsible respectively for sponsoring and conducting the trial and the amount of monetary compensation to participants. We argue that these financial considerations are largely irrelevant and distort ethical (...) appraisal of this tragic research. Except for administering the antibody to all 6 participants nearly simultaneously, the trial appears to fulfill all of the critical ethical requirements for clinical research?social value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for enrolled participants. (shrink)
The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)
The standard Kratzerian analysis of modal auxiliaries, such as ‘may’ and ‘can’, takes them to be univocal and context-sensitive. Our first aim is to argue for an alternative view, on which such expressions are polysemous. Our second aim is to thereby shed light on the distinction between semantic context-sensitivity and polysemy. To achieve these aims, we examine the mechanisms of polysemy and context-sensitivity and provide criteria with which they can be held apart. We apply the criteria to modal auxiliaries and (...) show that the default hypothesis should be that they are polysemous, and not merely context-sensitive. We then respond to arguments against modal ambiguity. Finally, we show why modal polysemy has significant philosophical implications. (shrink)
The understanding of appropriate ethical protections for participants of biomedical research has not been static. It has evolved over time, with the evolution of biomedical research as well as social values. Since World War II, there have been four major paradigms of research and research oversight operative in the United States. These paradigms incorporate different values and provide different approaches to research oversight and the protection of research participants.
The aim of this paper is to show that tests for semantic context-sensitivity are of no help in the debate between semantic contextualists and minimalists. Two kinds of context-sensitivity tests are discussed: Cappelen & Lepore's says-that tests and Cappelen & Hawthorne's agreement-based tests. It is shown that Cappelen & Lepore's tests are unreliable because they are based on unstable data. Then it is argued that although the data of Cappelen & Hawthorne's tests is more reliable, contextualists and minimalists alike can (...) explain this data. The paper ends by pointing to ways in which the debate might be moved forward without context-sensitivity tests. (shrink)
In his 2012 book God in the Age of Science? A Critique of Religious Reason Herman Philipse argues that all known deductive versions of the cosmological argument are untenable. His strategy is to propose a few objections to two classical deductive cosmological arguments. The first argument is from the impossibility of there being contingent entities that are the sufficient cause for the existence of a contingent entity. The second argument is from the impossibility of there being an infinite causal regress. (...) In this article I argue that Philipse’s attempt to write off all deductive cosmological arguments fails. (shrink)
The debate about justice and health care has occurred largely at a remove from the institutions it concerns; it has been about our most general moral principles, and about what things we value. This debate has foundered. But if the debate is turned in another direction, toward some moral principles that are widely accepted within those institutions, and toward principles that have to do with control over allocation decisions rather than with actually how to make those decisions, agreement may be (...) nearer at hand. (shrink)
Suppose a meeting had been called among chief medical officers, chief administrative officers, and other leaders from a range of health-related institutions in this country. The question posed for this meeting was simple but unusual: Arethestructuresofourorganizations,systems,andinstitutionsethical? Though it was a question reminiscent for a few of the focus some time before on whether the conduct of individuals in their organization was ethical, this question seemed more demanding. Is it reasonable to consider structures or arrangements as ethical or not; or in (...) other words, is ethics an applicable attribute of organizations? And if it is reasonable to speak of an ethics of organizations, by what method might one discern any kind of an answer? And what of the informal connections that link different organizations … how can they be evaluated? (shrink)
Although for the last 50 years, ethicists dealing with human experimentation have focused primarily on the need to protect individual research subjects and vulnerable groups, biomedical research, especially in genetics, now requires the establishment of standards for the protection of communities. We have developed such a strategy, based on five steps. (i) Identification of community characteristics relevant to the biomedical research setting, (ii) delineation of a typology of different types of communities using these characteristics, (iii) determination of the range of (...) possible community protections, (iv) creation of connections between particular protections and one or more community characteristics necessary for its implementation, and (v) synthesis of community characteristics and possible protections to define protections appropriate for each type of community. Depending on the particular community, consent and consultation, consultation alone, or no added protections may be required for research. (shrink)
During the WHO-GloPID COVID-19 Global Research and Innovation Forum meeting held in Geneva on the 11th and 12th of February 2020 a number of different ethical concepts were used. This paper briefly states what a number of these concepts mean and how they might be applied to discussions about research during the COVID-19 pandemic and related outbreaks. This paper does not seek to be exhaustive and other ethical concepts are, of course, relevant and important.
This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)
The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens (...) they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)