A biography of the Spanish-born Jewish philosopher, rabbi, and physician of the Middle Ages who spent a good deal of his life in Egypt and whose works influenced the thinking of Jews, Christians, and Moslems.

In this article, we outline a novel approach to understanding the role of responsibility in health promotion. Efforts to tackle chronic disease have led to an emphasis on personal responsibility and the identification of ways in which people can ‘take responsibility’ for their health by avoiding risk factors such as smoking and over-eating. We argue that the extent to which agents can be considered responsible for their health-related behaviour is limited, and as such, state health promotion which assumes certain forms (...) of moral responsibility should be avoided. This indicates that some approaches to health promotion ought not to be employed. We suggest, however, that another form of responsibility might be more appropriately identified. This is based on the claim that agents have prudential reasons to maintain their health, in order to pursue those things which make their lives go well—i.e. that maintenance of a certain level of health is rational for many agents, given their pleasures and plans. On this basis, we propose that agents have a self-regarding prudential responsibility to maintain their health. We outline the implications of a prudential responsibility approach to health promotion. (shrink)

Thomas Reid thought of himself as a critic of the representative theory of perception, of what he called the ‘theory of ideas’ or ‘the ideal theory’.2 He had no kind words for that theory: “The theory of ideas, like the Trojan horse, had a specious appearance both of innocence and beauty; but if those philosophers had known that it carried in its belly death and destruction to all science and common sense, they would not have broken down their walls to (...) give it admittance.”3 Many have supposed that his opposition to the representative theory was grounded in his direct realism.4 A direct realist theory of perception holds that perception of external objects is not mediated by any mental entity whose intrinsic character licenses a move from the mental entity to the external object presented in perception. Reid himself, in an oration of 1759, delivered at graduation ceremonies over which he presided as regent and professor of philosophy at King’s College in Aberdeen, said that he did not “understand what need there is of an intermediate object for thought about something to be possible.”5 Hence, if Reid was not a direct realist, philosophers and historians would have to ask whether and to what degree Reid was what he thought himself to be. (shrink)

The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...) immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people’s civil liberties. We make tentative recommendations for the ethical introduction of immunity passports. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...) what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

Subject perspectives : the missing element in research ethics -- Personal knowledge and study participation -- The everyday ethics of human research -- The hidden world of subjects : rule-breaking in clinical trials -- Participants as partners in genetic research -- Terminally ill patients and the right to try experimental drugs -- Embedded ethics in developing country research -- Research subjects as literary subjects -- How to hear subjects.

Human beings with diminished decision-making capacities are usually thought to require greater protections from the potential harms of research than fully autonomous persons. Animal subjects of research receive lesser protections than any human beings regardless of decision-making capacity. Paradoxically, however, it is precisely animals’ lack of some characteristic human capacities that is commonly invoked to justify using them for human purposes. In other words, for humans lesser capacities correspond to greater protections but for animals the opposite is true. Without explicit (...) justification, it is not clear why or whether this should be the case. Ethics regulations guiding human subject research include principles such as respect for persons—and related duties—that are required as a matter of justice while regulations guiding animal subject research attend only to highly circumscribed considerations of welfare. Further, the regulations guiding research on animals discount any consideration of animal welfare relative to comparable human welfare. This paper explores two of the most promising justifications for these differences␣between the two sets of regulations. The first potential justification points to lesser moral status for animals on the basis of their lesser capacities. The second potential justification relies on a claim about the permissibility of moral partiality as␣found in common morality. While neither potential justification is sufficient to justify the regulatory difference as it stands, there is possible common ground between supporters of some regulatory difference and those rejecting the current difference. (shrink)

The Principle of Procreative Beneficence claims that we have a moral obligation, where choice is possible, to choose to create the best child we can. The existence of this moral obligation has been proposed by John Harris and Julian Savulescu and has proved controversial on many levels, not least that it is eugenics, asking us to produce the best children we can, not for the sake of that child's welfare, but in order to make a better society. These are strong (...) claims that require robust justification that can be open to scrutiny and debate. This article argues that robust justifications are currently lacking in the work of Savulescu and Harris. The justifications provided for their conclusions about this obligation to have the best child possible rely heavily on Derek Parfit's Non-Identity Problem and the intuitive response this provokes in many of us. Unfortunately Harris and Savulescu do not embrace the entirety of the Non-Identity Problem and the puzzle that it presents. The Non-Identity Problem actually provides a refutation of PPB. In order to establish PPB as a credible and defendable principle, Harris and Savulescu need to find what has eluded Parfit and many others: a solution to the Non-Identity Problem and thus an overturning of the refutation it provides for PPB. While Harris and Savulescu do hint at possible but highly problematic solutions to the Non-Identity Problem, these are not developed or defended. As a result their controversial is left supported by little more than intuition. (shrink)

The revised Common Rule adopts the reasonable person standard to guide research disclosure. Some members of the research community contend that the standard is confusing and ill-suited to the research oversight system. Yet the revised rule is not as radical as it might seem. During the 1970s, judges started using the standard to evaluate negligence claims brought by injured patients who said doctors had failed to obtain informed consent to the harmful procedures. In its influential Belmont Report, the National Commission (...) recommended application of a “reasonable volunteer standard” to guide IRBs evaluating research disclosures. Evidence also suggests that IRBs often invoke the reasonable person standard in deliberations about consent forms. But past application of the standard has been informal and uneven. Robust application of the reasonable person standard will require researchers and IRBs to learn more about what ordinary people want and need to know about the studies they are invited to join. Input from people with personal experience as study participants could be particularly useful to this effort. (shrink)

Translational science is a 21st century mission. Government officials and industry leaders are making huge investments in an attempt to transform more basic science discoveries into therapeutic applications. Scientists and policymakers express great excitement about the medical advances that could come with the current bench-to-bedside campaign.A key step in translational science is the move from animal and other preclinical studies to initial human testing. Researchers ability to predict human effects is limited, and first-in-human tests present significant uncertainty. Participants in this (...) form of research face risks and can experience serious, even lethal, harm. Well-known incidents involving Jolee Mohr and Jesse Gelsinger, as well as subjects in the 2006 study of the investigational agent TGN1412, show the dangers that can arise in early human research.The bench-to-bedside campaign will need many volunteers to participate in early human testing. Investigators and regulators must not allow the policy enthusiasm for translational science to overshadow the commitment to protect human subjects. Participants in exploratory research are diverse and as a group lack characteristics usually associated with vulnerable populations, such as impaired decisional ability or economic or educational disadvantage. (shrink)

The term “therapeutic misconception” was coined in 1982 by Paul Appelbaum, Loren Roth, and Charles Lidz. Appelbaum and his colleagues interviewed participants in several psychiatric studies, including a drug trial with a placebo control arm. Appelbaum's group found that many people were unaware of the differences between participating in a study and receiving treatment in the clinical setting. Rather than understanding these differences, study participants tended to believe that therapy and research were governed by the same primary goal: to advance (...) the individual patient's best interests. Appelbaum's group labeled this mistaken belief the therapeutic misconception. (shrink)

In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and Care (...) Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children. (shrink)

Most patients suffering from progressive dementia have thoughts, emotions, perspectives, and perceptions of a world of experience. Decisions about life‐sustaining treatment should incorporate a principled approach to evaluating what life is like for these patients.

Scientific explanations are widely recognized to have instrumental value by helping scientists make predictions and control their environment. In this paper I raise, and provide a first analysis of, the question whether explanatory proofs in mathematics have analogous instrumental value. I first identify an important goal in mathematical practice: reusing resources from existing proofs to solve new problems. I then consider the more specific question: do explanatory proofs have instrumental value by promoting reuse of the resources they contain? In general, (...) I argue that the answer to this question is “no” and demonstrate this in detail for the theory of mathematical explanation developed by Marc Lange. (shrink)

We can understand objectivity, in the broadest sense of the term, as epistemic accountability to the real. Since at least the 1986 publication of Sandra Harding’s The Science Question in Feminism, so-called standpoint epistemologists have sought to build an understanding of such objectivity that does not essentially anchor it to a dislocated, ‘view from nowhere’ stance on the part of the judging subject. Instead, these theorists have argued that a proper understanding of objectivity must recognize that different agential standpoints offer (...) different access to objective truths, with some standpoints holding better epistemic potential than others. As Harding puts it, standpoint epistemology calls for “a critical evaluation of which social situations tend to generate the most objective knowledge claims” so as to identify those standpoints that “produce empirically more accurate descriptions and theoretically richer explanations” (1991, 142, 149). Which standpoints enable the most objectivity with respect to a particular inquiry is, for the standpoint theorists, always an empirical at least as much as a conceptual question; it requires attention to the actual, material relationship between knowers, knowledge practices, and objects known. Standpoint epistemology was developed primarily by self-identiªed feminist epistemologists. Virtually all developments of standpoint episte-. (shrink)

van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation (...) to VE; and third, the significant risk of perpetuating under-recognised harms associated with unwanted or unconsented VE. I argue that opt-out consent cannot be ethically justified for VE. Its use would result in further weakening of consent practices, circumvention of individuals’ autonomy, and greater harm for women and birthing people. At the outset, it is important to recognise that the authors do not claim that their approach should be applied to VE, merely that their discussion may have relevance to consent for other interventions beyond episiotomy ‘where consent is also frequently lacking, and which are under-researched’, including VE.1 Nonetheless, it is easy to assume that episiotomy and VE are sufficiently similar that their analysis might be transferred wholesale. I disagree. There are similarities: both interventions are performed on ‘the most intimate and socially sensitive body parts’1; …. (shrink)

There is an obvious affinity between virtue ethics and particularism. Both stress the complexify of the moral life, the inadequacy of rule-following as a guide to moral deliberation, and the importance of judgement in discerning the morally relevant features of particular situations. Yet it remains an open question how deep the affinity goes. I argue that the radical form of particularism defended by Jonathan Dancy has surprisingly strong implications for virtue ethics. Adopting such a view would require the virtue theorist (...) either to adopt an unattractive model of moral motivation or to embrace a fairly strong version of the unity of the virtues. (shrink)

Bernard Reginster has argued that in "Nietzsche's terminology, 'experimentation [Versuch]' is a paradigmatic exercise of curiosity."1 According to Reginster, the kind of curiosity in question, as far as Nietzsche's concept of the free spirit is concerned, is not the state of knowing or of being certain of the truth of some proposition, but is rather a matter of the activity or process of truth seeking and of inquiry.2 My own view is very similar: I have argued that experimentalism is a (...) form of virtue for Nietzsche.3 Specifically, as I have suggested, Nietzsche employs experimentalism in two main ways: as a strategy for philosophical engagement, for example through his use of diverse writing styles and authorial... (shrink)

The year 2014 brought a new development in the bioethics “laboratory of the states.” Five states adopted “right to try” laws intended to promote terminally ill patients' access to investigational drugs. Many more state legislatures are now considering such laws. The campaign for right to try laws is the latest move in an ongoing effort to give seriously ill patients access to drugs whose safety and effectiveness remain largely unknown. Although scientists and policy‐makers oppose the right to try approach, it (...) has proven quite popular among state legislators and the public. (shrink)

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation. One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. (...) I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable. (shrink)

It's not unusual to hear someone say, ‘I'd rather be dead than have Alzheimer's’. In ‘Alzheimer Disease and Preemptive Suicide’,1 Dena Davis explains why this is a reasonable position. People taking this position will welcome the discovery of biomarkers permitting very early AD diagnosis, Davis suggests, for this will enable more of them to end their lives while they remain motivated and able to do so. At the same time, Davis observes, people would have less reason to resort to the (...) drastic remedy of pre-emptive suicide if they had absolute authority over the medical treatment they received as patients with dementia; but the threat of pre-emptive suicide is not, in my view, a sufficient reason to grant competent individuals that authority.If preclinical diagnosis of AD becomes possible, some pre-emptive suicides will probably occur. There would be no ethical or practical way to ban such suicides, and it would be silly to try. Clinicians will undoubtedly try to discourage people seeking biomarker information in furtherance of a suicide plan, but savvy individuals will simply conceal their true motivation for having the tests. The real problem for people intent on self-destruction is that biomarkers are unlikely to deliver a clear suicide signal.First, as Davis notes, work on biomarkers remains in the research stage. No one yet knows whether biomarker tests will prove accurate enough to warrant clinical use. Second, even clinically accepted biomarker tests will generate imperfect information about future disease. Biomarkers may produce more accurate estimates of a person's risk of developing AD, but like all predictive tests, they will also yield false positive and negative results. The …. (shrink)

In this issue, Paul Menzel and M. Colette Chandler‐Cramer propose a novel advance directive. Besides giving competent people the opportunity to refuse future life‐prolonging medical interventions, they say, advance directives should give people the opportunity to refuse ordinary food and water if they later experience severe dementia.This proposal is both appealing and unsettling. It is appealing because it offers some relief to people seeking to avoid the prolonged decline and extreme incapacity they have witnessed in relatives and friends with advanced (...) dementia. But does it sufficiently protect patients? Menzel and Chandler‐Cramer want to empower competent persons to impose potential discomfort and distress on a later self who cannot understand the reasons for that choice. In this situation, the price of respecting autonomy is paid by a frail incapacitated patient who has no idea why food and water are no longer offered to her. (shrink)

Much of the public debate over laboratory animal use has focused on either the scientist's demand for absolute freedom of inquiry, or the abolitionist's demand for an end to animal use in science. Yet many recent proposals for reform seek instead to balance the interests of laboratory animals in avoiding harm against the interests of research beneficiaries in continued animal use. This essay is an analysis of the intermediate reform positions and their underlying ethical principles. Keywords: animal research, animal experimentation, (...) ethics CiteULike Connotea Del.icio.us What's this? (shrink)

Abstract:I raise several concerns with Earp and colleagues' analysis of enhancement through neurochemical modulation of love as a key issue in contemporary neuroethics. These include: (i) strengthening their deflation of medicalization concerns by showing how the objection that love should be left outside of the scope of medicine would directly undermine the goal of medicine; (ii) developing stronger analysis of the social and political concerns relevant to neurochemical modulation of love, by exploring and suggesting possible counters to ways in which (...) 'wellbeing' may be used as a tool of oppression; (iii) providing reasons to support a broad need for ecological investigation of, and indeed ecological education concerning, neurotechnology; (iv) suggesting ways in which philosophy, and the humanities more broadly, remain directly relevant to responding effectively to issues in contemporary neuroethics. (shrink)

It is observed that in ordinary everyday causal explanations often just one causal factor is mentioned. One causal factor carries the explanatory burden, even if there are several causal factors that are responsible for the event to be explained. This paper deals with the question of how to account for this explanatory selection. I argue for a pragmatic stance towards explanation, that we must attend to the question–answer situation as a whole and the context of the explanation. The context of (...) an explanation includes the inquirer's and the explainer's beliefs and presuppositions relevant for the explanation-seeking question, and these are encoded in a reference class. Furthermore I argue that the explanation-giving answer contains an implicit counterfactual claim, the explanation-giving counterfactual. The solution to the problem of explanatory selection is to be found in the presuppositions encoded by the reference class and the eg-counterfactual. In short we select as explanatory that factor which, together with the presupposition encoded in the reference class we believe will make the eg-counterfactual true. (shrink)

Approaches to supporting autonomy in medicine need to be able to support complex and sensitive decision-making, incorporating reflection on the patient's values and goals. This should involve deliberation in partnership between physician and patient, allowing the patient to take responsibility for her decision. Nowhere is this truer than in decisions around pregnancy and Caesarean section where maternal autonomy can seem to directly conflict with foetal interests. Medical and societal expectations and norms such as the expectations of a ‘mother’, constraints of (...) making decisions in an emergency, and the role of technology in viewing the foetus as a separate patient and surgery as a guarantor of results can all act to limit a woman's autonomy. In considering decisions about Caesarean section, maternal interests in bodily integrity can be dismissed as being less important than the foetus's own interests and the mother's duties to it, despite the inherent risks and impacts of such a major surgical procedure... (shrink)

Studies with humans have failed to produce evidence that any direct causal relation exists between the asymmetry of one function in an individual and the asymmetry of a different function in that individual. Without such evidence, factors external to an individual's nervous system, such as social interactions, may play crucial roles in explaining the directions of all asymmetries at all levels.

Is a woman ever morally obligated to forgo an abortion for the sake of the man who has impregnated her? In “Fathers and Fetuses,” George Harris contends that in some situations women are so obligated. Harris argues that a woman who lies to her partner about her desire to have children, becomes pregnant, and then decides to abort, will, if she acts on this decision, violate her partner’s autonomy and harm him in so far as she will harm his fetus. (...) To avoid these wrongs, a woman must therefore carry this fetus to term. I argue that this conclusion depends on a principle for which Harris offers no argument, namely that the conditions under which a fetus is to be considered a man’s are the same conditions under which a fetus is to be considered a woman’s. Evaluating this principle andconsidering related cases leads to important conclusions about a parent’s relationship with the fetus. Specifically, I challenge the notion that we should ever consider a fetus ‘his’ or even ‘hers.’. (shrink)

Volume 24, Issue 8, August 2024, Page 37-40.

Traditionally reproduction, gestation and childbirth have all been regarded as being primarily a woman's domain. As natural reproduction occurs inside a woman's body, respect for autonomy and bodily integrity requires the pregnant woman to have the conclusive say over the fate of the embryo/fetus growing within her. Thus traditionally the ethics and law of reproduction is dominated by the importance of respecting women's reproductive choices. This paper argues that emerging technologies demand a radical rethink of ethics and law in the (...) area of reproduction. The creation and storing of embryos outside of a woman's body and maintaining a pregnancy in a brain dead woman's body and future possibilities such as ectogenesis and male pregnancy raise important issues that cannot simply be answered by appealing to the rights of women to control their bodies. There are those who argue that when reproduction or reproductive products exist outside of a woman's body each gamete donor should have an equal say over the fate of the embryo/fetus. Others, however, argue that giving an equal say to gamete donors in practice usually means allowing the male donor to veto the reproductive enterprise and this is unacceptable. As a result it has been suggested that women should be favoured when it comes to such reproductive choices. This paper examines both sides of this debate in order to answer the fundamental ethical and policy question: 'Is there any reason why women should necessarily retain control over reproduction rather than simply over their own bodies?'. (shrink)

Book reviewed in this article: To Do No Harm: DES and the Dilemmas of Modern Medicine. By Roberta J. Apfel and Susan M. Fisher.

This paper explores the integration of environmental concern into the workplace by combining insights from the literature on governmentality with work that focuses on the role of emotion in organisational contexts. I build on work by Hargreaves (2008) and Butler (2010) to show that environmental concern is an emerging form of workplace governance which acts by and through the emotions and which intersects with pre-existing forms of power in surprising and complex ways. I conclude by reflecting on some additional theoretical (...) approaches which may offer some tools for developing forms of workplace governance that are more socially and environmentally sustainable. (shrink)