Given the sordid history of injustices linking genetics to race and ethnicity, considerations of justice are central to ensuring the responsible development of precision medicine programmes around the world. While considerations of justice may be in tension with other areas of concern, such as scientific value or privacy, there are also tensions between different aspects of justice. This paper focuses on three particular aspects of justice relevant to this precision medicine: social justice, distributive justice and human rights. We describe the (...) implications of each for the use of race and ethnicity in precision medicine, and also how they intersect and potentially conflict with each another. By attending to these intersections, we aim to enrich and add nuance to debates over how best to proceed with precision medicine initiatives. (shrink)

The collection and disposal of rubbish and waste and the maintenance of a decent standard of hygiene was as much a problem for ancient city authorities as for modern town councils. The responsibility for the removal of waste would often be dependent upon the nature of the rubbish and the facilities which city authorities offered. Thus early in the fourth century B.C. the agoranomic law from Piraeus prohibited individuals from piling earth and other waste on the streets and compelled the (...) offender to remove it. The astynomic law from Pergamon, which probably dates originally to the Hellenistic period, similarly forbade the dumping or piling up of earth or the mixing of mortar on the streets of the city. As one of Demosthenes' speeches indicates, the effect of dumping rubbish indiscriminately was to raise the level of the road surface, which consequently restricted access and endangered adjacent property. Excavation of a triangular hieron to the south west of the agora at Athens further illustrates the results of dumping. Here it was found that, between the construction of the hieron in the late fifth century B.C. and the beginning of the fourth century B.C, the road surface on its northern side rose more than half a metre and covered the lower part of the wall of the hieron and its boundary marker. The accumulated fill included a deep layer of marble chips, which had been dumped in the area by marble workers. The laws from Piraeus and Pergamon were thus designed to keep streets passable, protect adjacent buildings, and safeguard pedestrians. (shrink)

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

Schulman (Entropy 7(4):221–233, 2005) has argued that Boltzmann’s intuition, that the psychological arrow of time is necessarily aligned with the thermodynamic arrow, is correct. Schulman gives an explicit physical mechanism for this connection, based on the brain being representable as a computer, together with certain thermodynamic properties of computational processes. Hawking (Physical Origins of Time Asymmetry, Cambridge University Press, Cambridge, 1994) presents similar, if briefer, arguments. The purpose of this paper is to critically examine the support for the link between (...) thermodynamics and an arrow of time for computers. The principal arguments put forward by Schulman and Hawking will be shown to fail. It will be shown that any computational process that can take place in an entropy increasing universe, can equally take place in an entropy decreasing universe. This conclusion does not automatically imply a psychological arrow can run counter to the thermodynamic arrow. Some alternative possible explanations for the alignment of the two arrows will be briefly discussed. (shrink)

Background We aimed to examine the ethical concerns Singaporeans have about sharing health-data for precision medicine and identify suggestions for governance strategies. Just as Asian genomes are under-represented in PM, the views of Asian populations about the risks and benefits of data sharing are under-represented in prior attitudinal research. Methods We conducted seven focus groups with 62 participants in Singapore from May to July 2019. They were conducted in three languages and analysed with qualitative content and thematic analysis. Results Four (...) key themes emerged: nuanced understandings of data security and data sensitivity; trade-offs between data protection and research benefits; trust in the public and private sectors; and governance and control options. Participants were aware of the inherent risks associated with data sharing for research. Participants expressed conditional support for data sharing, including genomic sequence data and information contained within electronic medical records. This support included sharing data with researchers from universities and healthcare institutions, both in Singapore and overseas. Support was conditional on the perceived social value of the research and appropriate de-identification and data security processes. Participants suggested that a data sharing oversight body would help strengthen public trust and comfort in data research for PM in Singapore. Conclusion Maintenance of public trust in data security systems and governance regimes can enhance participation in PM and data sharing for research. Contrary to themes in much prior research, participants demonstrated a sophisticated understanding of the inherent risks of data sharing, analysed trade-offs between risks and potential benefits of PM, and often adopted an international perspective. (shrink)

The following suggestions for the interpretation of Parmenides and Melissus can be grouped for convenience about one problem. This is the problem whether, as Aristotle thought and as most commentators still assume, Parmenides wrote his poem in the broad tradition of Ionian and Italian cosmology. The details of Aristotle's interpretation have been challenged over and again, but those who agree with his general assumptions take comfort from some or all of the following major arguments. First, the cosmogony which formed the (...) last part of Parmenides' poem is expressly claimed by the goddess who expounds it to have some measure of truth or reliability in its own right, and indeed the very greatest measure possible for such an attempt. Second, the earlier arguments of the goddess prepare the ground for such a cosmogony in two ways. For in the first place these arguments themselves start from assumptions derived from earlier cosmologists, and are concerned merely to work out the implications of this traditional material. And, in the second place, they end by establishing the existence of a spherical universe: the framework of the physical world can be secured by logic even if the subsequent introduction of sensible qualities or ‘powers’ into this world marks some decline in logical rigour. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of 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. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

The following suggestions for the interpretation of Parmenides and Melissus can be grouped for convenience about one problem. This is the problem whether, as Aristotle thought and as most commentators still assume, Parmenides wrote his poem in the broad tradition of Ionian and Italian cosmology. The details of Aristotle's interpretation have been challenged over and again, but those who agree with his general assumptions take comfort from some or all of the following major arguments. First, the cosmogony which formed the (...) last part of Parmenides' poem is expressly claimed by the goddess who expounds it to have some measure of truth or reliability in its own right, and indeed the very greatest measure possible for such an attempt. Second, the earlier arguments of the goddess prepare the ground for such a cosmogony in two ways. For in the first place these arguments themselves start from assumptions derived from earlier cosmologists, and are concerned merely to work out the implications of this traditional material. And, in the second place, they end by establishing the existence of a spherical universe: the framework of the physical world can be secured by logic even if the subsequent introduction of sensible qualities or ‘powers’ into this world marks some decline in logical rigour. (shrink)

It is now nearly axiomatic among Platonic scholars that the Timaeus and its unfinished sequel the Critias belong to the last stage of Plato's writings. The Laws is generally held to be wholly or partly a later production. So, by many, is the Philebus, but that is all. Perhaps the privileged status of the Timaeus in the Middle Ages helped to fix the conviction that it embodies Plato's maturest theories.

The “happiness agenda” is a worldwide movement that claims that happiness is the highest good, happiness can be measured, and public policy should promote happiness. Against Happiness is a thorough and powerful critique of this program, revealing the flaws of its concept of happiness and advocating a renewed focus on equality and justice. Written by an interdisciplinary team of authors, this book provides both theoretical and empirical analysis of the limitations of the happiness agenda. The authors emphasize that this movement (...) draws on a parochial, Western-centric philosophical basis and demographic sample. They show that happiness defined as subjective satisfaction or a surplus of positive emotions bears little resemblance to the richer and more nuanced concepts of the good life found in many world traditions. Cross-cultural philosophy, comparative theology, and social and cultural psychology all teach that cultures and subcultures vary in how much value they place on life satisfaction or feeling happy. Furthermore, the ideas promoted by the happiness agenda can compete with rights, justice, sustainability, and equality—and even conceal racial and gender injustice. Against Happiness argues that a better way forward requires integration of cross-cultural philosophical, ethical, and political thought with critical social science. Ultimately, the authors contend, happiness should be a secondary goal—worth pursuing only if it is contingent on the demands of justice. (shrink)

Some statements couched in the present tense have no reference to time. They are, if you like, grammatically tensed but logically tenseless. Mathematical statements such as ‘twice two is four’ or ‘there is a prime number between 125 and 128’ are of this sort. So is the statement I have just made. To ask in good faith whether there is still the prime number there used to be between 125 and 128 would be to show that one did not understand (...) the use of such statements, and so would any attempt to answer the question. It is tempting to take another step and talk of such timeless statements as statements about timeless entities. If the number 4 neither continues nor ceases to be twice two this is, surely, because the number 4 has no history of any kind, not even the being a day older today than yesterday. Other timeless statements might shake our confidence in this inference: ‘clocks are devices for measuring time’ is a timeless statement, but it is not about a class of timeless clocks. But, given a preoccupation with a favoured set of examples and a stage of thought at which men did not distinguish the properties of statements from the properties of the things they are about, we can expect timeless entities to appear as the natural proxies of timeless statements. (shrink)

Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in generating public benefits from precision medicine initiatives, it is (...) important to understand what the concerns are and how they might be mitigated. This study reports outcomes of a deliberative method of citizen engagement in Singapore that asked whether sharing precision medicine data with private industry would be permissible, and if so, under what circumstances. Findings from this citizens’ jury suggest sharing with industry would be permissible under certain conditions that are set out in nine recommendations. Implications of the recommendations and their underlying assumptions for policy decision makers are discussed. This study aligns with prior international studies which found conditional acceptance for data sharing with private industry, a public benefit requirement, specific reluctance to share with insurance companies and an emphasis on accountability and transparency to demonstrate trustworthiness. However, our results differ from prior studies in that opt-in consent did not dominate the deliberations as jurors were able to set it aside as an assumed prerequisite for participation in a precision medicine programme. (shrink)

G. E. L. Owen; VIII*—Aristotelian Pleasures, Proceedings of the Aristotelian Society, Volume 72, Issue 1, 1 June 1972, Pages 135–152, https://doi.org/10.1093/ar.