The concept of vulnerability is deployed in bioethics to, amongst other things, identify and remedy harms to participants in research, yet although nonhuman animals in experimentation seem intuitively to be vulnerable, this concept and its attendant protections are rarely applied to research animals. I want to argue, however, that this concept is applicable to nonhuman animals and that a new taxonomy of vulnerability developed in the context of human bioethics can be applied to research animals. This taxonomy does useful explanatory (...) work, helping to pinpoint the limitations of the 3Rs/welfare approach currently adopted in the context of animal experimentation. On this account, the 3Rs/welfare approach fails to deliver for nonhuman animals in experimentation because it effectively addresses only one element of their vulnerability (inherent) and paradoxically through the institution of Animal Ethics Committees intended to protect experimental animals in fact generates new vulnerabilities that exacerbate their already precarious situation. (shrink)

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund (...) access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. (shrink)

In this paper we propose a new way of conceptualizing animals in experimentation – the animal-as-patient. Construing and treating animals as patients offers a way of successfully addressing some of the entrenched epistemological and ethical problems within a practice of animal experimentation directed to human clinical benefit. This approach is grounded in an epistemological insight and builds on work with so-called ‘pet models’. It relies upon the occurrence and characterization of analogous human and nonhuman animal diseases, where, if certain criteria (...) of homology and mechanism are met, the animal simultaneously becomes a patient and a spontaneous model of the human disease. (shrink)

Using an approach developed in the context of human bioethics, we argue that chimpanzees in research can be regarded as vulnerable subjects. This vulnerability is primarily due to communication barriers and situational factors—confinement and dependency—that make chimpanzees particularly susceptible to risks of harm and exploitation in experimental settings. In human research, individuals who are deemed vulnerable are accorded special protections. Using conceptual and moral resources developed in the context of research with vulnerable humans, we show how chimpanzees warrant additional safeguards (...) against harm and exploitation paralleling those for human subjects. These safeguards should include empowering third parties to act as surrogate decision makers for chimpanzees, ensuring participant “assent,” and avoiding recruitment of animal subjects based merely on convenience. (shrink)

Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery.

In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard remedies for conflicts of interest are transparency and recusal, (...) which are unlikely to address this conflict, in part because of unconscious bias. Alternative systemic measures may be more effective, but these require changes in the culture of surgery and accurate identification of surgical innovation. (shrink)

The standard view of Kant’s retributivism, as well as its more recent reworking in the ‘limited’ or ‘partial’ retributivist reading are, it is argued here, inadequate accounts of Kant on punishment. In the case of the former, the view is too limited and superficial, and in the latter it is simply inaccurate as an interpretation of Kant. Instead, this paper argues that a more sophisticated and accurate rendering of Kant on punishment can be obtained by looking to his construction of (...) the concept of justice. In so doing, not only is a superior account of Kant furnished, but also one up to the task of resolving the vexed issue of justifying legal punishment. (shrink)

This article examines strategies used by human rights advocates to lobby for policy at intergovernmental organizations. We suggest that the literatures’ central questions are about how best to organize, connect, and communicate, which are usually seen through theory on transnational advocacy networks and framing. We add that these questions should be seen as gendered, given the continued male dominance within diplomatic corps. With unusual access to their strategy, we conduct a case study of one advocate’s successful campaign to get the (...) United Nations to adopt a country-specific resolution. Like others, we found this campaigning relies upon the use of networks to overcome formal obstacles to access, human rights language to frame the problem, analysis of tally sheets of member states’ voting, and in-person lobbying. We also point out strategies key to their success that are not usually noticed by scholars, such as the gendered dynamics that get advocates in the door. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

Though it involves significant harms and is a widespread and entrenched practice, legal punishment lacks a sure philosophical footing. In spite of frequent attempts by utilitarians, retributivists and so called "mixed solution" advocates the problem of justifying punishment remains. This book aims to redress this shortcoming by turning to the German thinkers Kant and Hegel and their idealism to fashion punishment's justification. In the case of Kant this is achieved by developing his construction of justice, while for Hegel it involves (...) taking seriously his theory of recognition and aspects of his logic. In applying ideas from this tradition to a contemporary problem, this book will appeal to both those interested in Kant and Hegel scholarship and its recent resurgence, as well as to students of jurisprudence. (shrink)

The public can influence animal welfare law and regulation. However what constitutes ‘the public’ is not a straightforward matter. A variety of different publics have an interest in animal use and this has implications for the governance of animal welfare. This article presents an ethnographic content analysis of how the concept of a public is mobilized in animal welfare journals from 2003 to 2012. The study was undertaken to explore how experts in the discipline define and regard the role of (...) the public in determining animal welfare standards. Analysis indicates that experts in animal welfare constitute different types of citizen and consumer publics around specific types of animal use, framed by different theories of value. These results suggest a need for greater clarity about the roles and responsibilities of experts and publics in animal welfare reform processes. Clearly citizens and consumers can both contribute to promoting higher welfare standards, but an over-reliance on market mechanisms and consumer behaviour to assign value is beset by moral hazards, foremost being the risk of disarticulating the concept of animal welfare from the public good. (shrink)

Studies with captive fowl have revealed that they possess greater cognitive capacities than previously thought. We now know that fowl have sophisticated cognitive and communicative skills, which had hitherto been associated only with certain primates. Several theories have been advanced to explain the evolution of such complex behavior. Central to these theories is the enlargement of the brain in species with greater mental capacities. Fowl present us with a conundrum, however, because they show the behaviors anticipated by the theories but (...) do not have the expected changes in the brain. Consequently fowl present two challenges of interest to us here. One is a scientific challenge to explain their remarkable capabilities. The other is an ethical challenge regarding our treatment of animals with higher cognitive skills. (shrink)