Volume 24, Issue 12, December 2024, Page 87-88.

We concur with Baum and colleagues (2009) on the importance of pandemic planners taking explicit steps to employ public engagement methodologies. Thus far, as Baum and colleagues note, there have b...

The health care systems are fairly similar in theScandinavian countries. The exact details vary, but inall three countries the system is almost exclusivelypublicly funded through taxation, and most (or all)hospitals are also publicly owned and managed. Thecountries also have a fairly strong primary caresector (even though it varies between the countries),with family physicians to various degrees acting asgatekeepers to specialist services. In Denmark most ofthe GP services are free. For the patient in Norwayand Sweden there are out-of-pocket co-payments for GPconsultations, (...) with upper limits, but consultations forchildren are free. Hospital treatment is free inDenmark while the other countries use a system without-of-pocket co-payment. There is a very strongpublic commitment to access to high quality healthcare for all. Solidarity and equality form theideological basis for the Scandinavian welfare state.Means testing, for instance, has been widely rejectedin the Scandinavian countries on the grounds thatpublic services should not stigmatise any particulargroup. Solidarity also means devoting specialconsideration to the needs of those who have lesschance than others of making their voices heard orexercising their rights. Issues of limited access arenow, however, challenging the thinking about a healthcare system based on solidarity. (shrink)

The prelims comprise: Introduction The Doctrine of Informed Consent I will make you an offer you cannot refuse! Consenting to an Unknown Future Consenting for Future Generations Research without Consent? Conclusion.

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine (...) aimed at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine (...) aimed at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

In his recent book The Foundation of Bioethics , H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "a (...) persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises. Keywords: medical ethics, persons, autonomy CiteULike Connotea Del.icio.us What's this? (shrink)

Clinical information about patients is increasingly being stored in electronic form and has therefore become more easily shareable. Data are collected as part of clinical care but have multiple other potential uses in relation to health system planning, audit and research. The use of clinical information for these secondary uses is controversial, and the ability to safeguard personal and sensitive data under current practices is contested.In this study, we investigate the attitudes of a representative sample of the Danish population towards (...) transfer of clinical data from their general practice for secondary use. We specifically study: patients’ trust in different types of healthcare professionals, their interest in being asked about secondary use of data and their willingness to dispense from a requirement of informed consent based on their trust in healthcare professionals.We find that adult Danes are positive towards research that use patient data, and they generally trust general practitioners, hospitals and researchers to treat their data confidentially.Nevertheless, they feel that they have a right to control the use of their data, only 7.3% disagreeing, and that the data belong to them, only 14.0% disagreeing. Answers to further questions about the relation between trust, information and consent show that although trust modifies the wish for information and consent, there is still a strong view that the patient should control the use of data. We find no differences between those who have frequent contact with the healthcare system and those who do not. (shrink)

Smajdor argues that “recognition” is the solution to the “reifying attitude” that results from “the urge to protect ‘vulnerable’ people through exclusion from research”. Drawing on theories of reification, we argue that it is the concepts of autonomy and vulnerability themselves that have been reified, resulting in the impoverishment of approaches to autonomy at law and in research ethics. Overcoming such reification demands a deeper consideration of the grounds on which vulnerable individuals are owed recognition and thereby the forms (...) such recognition should take. Smajdor argues for a recognition that appeals to autonomy and that manifests in providing vulnerable individuals with the opportunity to assent. The problem is that this kind of recognition is dependent on a more fundamental kind. It is this second form of recognition that would need to do the heavy lifting for assent-based frameworks to avoid the same problems we find with consent. (shrink)

This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each of these (...) reasons and we show that none of these stand up to scrutiny, and that some are based on a misunderstanding of the nature and purposes of this stage of treatment and of the circumstances in which it is usually prescribed. Moreover, accepting these claims at face value could have serious negative implications, not just for gender diverse youth, but for many other minors and families and in a much broader range of healthcare settings. (shrink)

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and (...) products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and (...) Soren Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

It has been argued that organs should be treated as individual tradable property like other material possessions and assets, on the basis that this would promote individual freedom and increase efficiency in addressing the shortage of organs for transplantation. If organs are to be treated as property, should they be inheritable? This paper seeks to contribute to the idea of organs as inheritable property by providing a defence of a default of the family of a dead person as inheritors of (...) transplantable organs. In the course of discussion, various succession rules for organs and their justifications will be suggested. We then consider two objections to organs as inheritable property. Our intention here is to provoke further thought on whether ownership of one's body parts should be assimilated to property ownership. (shrink)

Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While (...) ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a ‘see-saw’ model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes. (shrink)

This new study provides a thorough analysis of the ethical reasoning of doctors and nurses. Based on extensive interviews, Soren Holm's work demonstrates how qualitative research methods can be used to study ethical reasoning, and that the results of such studies are important for normative ethics, that is, the analysis of how health care professionals ought to act.

BackgroundThe areas of Research Ethics (RE) and Research Integrity (RI) are rapidly evolving. Cases of research misconduct, other transgressions related to RE and RI, and forms of ethically questionable behaviors have been frequently published. The objective of this scoping review was to collect RE and RI cases, analyze their main characteristics, and discuss how these cases are represented in the scientific literature.MethodsThe search included cases involving a violation of, or misbehavior, poor judgment, or detrimental research practice in relation to (...) a normative framework. A search was conducted in PubMed, Web of Science, SCOPUS, JSTOR, Ovid, and Science Direct in March 2018, without language or date restriction. Data relating to the articles and the cases were extracted from case descriptions.ResultsA total of 14,719 records were identified, and 388 items were included in the qualitative synthesis. The papers contained 500 case descriptions. After applying the eligibility criteria, 238 cases were included in the analysis. In the case analysis, fabrication and falsification were the most frequently tagged violations (44.9%). The non-adherence to pertinent laws and regulations, such as lack of informed consent and REC approval, was the second most frequently tagged violation (15.7%), followed by patient safety issues (11.1%) and plagiarism (6.9%). 80.8% of cases were from the Medical and Health Sciences, 11.5% from the Natural Sciences, 4.3% from Social Sciences, 2.1% from Engineering and Technology, and 1.3% from Humanities. Paper retraction was the most prevalent sanction (45.4%), followed by exclusion from funding applications (35.5%).ConclusionsCase descriptions found in academic journals are dominated by discussions regarding prominent cases and are mainly published in the news section of journals. Our results show that there is an overrepresentation of biomedical research cases over other scientific fields compared to its proportion in scientific publications. The cases mostly involve fabrication, falsification, and patient safety issues. This finding could have a significant impact on the academic representation of misbehaviors. The predominance of fabrication and falsification cases might diverge the attention of the academic community from relevant but less visible violations, and from recently emerging forms of misbehaviors. (shrink)

The fields of medical ethics, bioethics, and women's studies have experienced unprecedented growth in the last forty years. Along with the rapid pace of development in medicine and biology, and changes in social expectations, moral quandaries about the body and social practices involving it have multiplied. Philosophers are uniquely situated to attempt to clarify and resolves these questions. Yet the subdiscipline of bioethics still in large part reflects mainstream scholars' lack of interest in gender as a category (...) of analysis. This volume aims to show how a feminist perspective advances bioethics. The author uncover inconsistencies in traditional arguments and argue for the importance of hitherto ignored factors in decision-making. The essays include theory and very specific examples that demonstrate the glaring inadequacy of mainstream bioethics, where gender bias is still often to be found, along with general lack of attention to women's concerns. (shrink)

Volume 24, Issue 12, December 2024, Page 71-73.

Malm and colleagues (2008) consider (and reject) five arguments putatively justifying the idea that healthcare workers (HCWs) have a duty to treat (DTT) during a pandemic. We do not have sufficient...

In lieu of an abstract, here is a brief excerpt of the content:Critical Issues in Future Environmental EthicsHolmes Rolston III (bio)1. Sustainable development vs. sustainable biosphere. The question is whether to prioritize development within environmental constraints, or whether to prioritize a sustainable biosphere and work out a suitable economy within that priority. Sustainable development, likely to remain the favored model, is also likely to prove an umbrella concept that requires little but superficial agreement, bringing a constant illusion of [End Page (...) 139] consensus and glossing over deeper problems with a rhetorically engaging word. Everybody co-opts the idea and justifies their desired developments. Sustainability will prove to be a "metafix" that will unite everybody including industrialists, subsistence farmers, fair-wage social workers, riverkeepers, wildlife lovers, economists, and politicians—all of whom wish to have their cake and eat it too.2. In tension with this, a "sustainable biosphere" model demands a baseline quality of environment, with the economy worked out "within" such quality of life in a quality environment (clean air, water, stable soils, attractive residential landscapes, forests, mountains, rivers, rural lands, parks, wildlands, wildlife, renewable resources). Development is desired, but even more, society must learn to live within the carrying capacity of its landscapes. The fundamental flaw in "sustainable development" is that it sees the Earth as a resource only.3. Global warming. Global warming is a threat of the greatest magnitude, involving an unprecedented convergence of complexities, natural and technological uncertainties, global and local interactions, and difficult scientific, ethical, political, and social choices. There are cross-cultural issues, intergenerational issues, distributional issues, concerns about merit, justice, benevolence, and about voluntary and involuntary risk. There is a long lag time from decades to hundreds of years. Surely but gradually, local "goods" cumulate into global "bads". There are opportunities for denial, procrastination, self-deception, hypocrisy, free-riding, cheating, and corruption. Individual and national self-interests are at odds with collective global interests. This is the "tragedy of the commons" now taken at the pitch.4. Biodiversity. Charismatic megafauna is likely to disappear, except in pockets. Conservation plans will increasingly need to incorporate local communities and governments in developing nations which are too unstable (if not corrupt) to insure long-range conservation. Fauna and flora generally are likely to become increasingly depauperate, due to development, pollution, ignorance, and disinterest outside of native-range industrial, medical, and agricultural resource benefits. The planet is likely to become less diverse, warmer, increasingly trashy, and weedy.5. Escalating populations, escalating consumption, maldistribution. [End Page 140] These are three main global problems (drivingfor instance, global warming and depauperate fauna and flora). Global capitalism has no intrinsic capacities to solve these problems. A major problem is that products and capital move freely across national boundaries, but labor cannot, resulting in exploitation of cheaper labor. In addition to the human misfortunes produced by this system, such exploited peoples will progressively degrade their environments. As a result, both rich and poor will jeopardize both sustainability and conservation.6. The "enough" problem. Humans have long been driven by desires to increase security and wealth. Humans have Pleistocene appetites for salt, sugar, fat, sex, and to maximize our short-term security for self and kin, and perhaps tribe. Without such concerns, people did not make it through winter. So humans always want more in order to make us more secure—more pay, bigger houses, better health, more preferences satisfied, more comfort, economic and national security. For all of human history, we have been pushing back limits.7. Especially in the West, we have lived with a deep-seated belief that life will get better, that one should hope for abundance, and work toward obtaining it. In the West we have built this into our concept of human rights—a right to self-development, to self-realization. But such an egalitarian ethic scales everybody up and drives an unsustainable world.8. Humans are not well equipped to deal with the sorts of global level problems we now face. The classical institutions—family, village, tribe, nation, agriculture, industry, law, and medicine—have shorter horizons. Humans have no evolutionary ability to deal with long-range problems on world scales. Many biologists think we are incapable of doing this at the ranges now demanded. A... (shrink)

Some very bad old arguments need removing from NICE’s latest reportLet me begin this editorial by reassuring readers that the journal does not hold any deep seated grudge against the National Institute for Health and Clinical Excellence . However, because the pronouncements of NICE are of great importance to the future of health care in England, and to a lesser extent in the other nations of the United Kingdom, and because NICE is often held up as a model for other (...) countries to follow we feel that we have to comment when these pronouncements are less than ethically excellent. And in 2005 NICE just happened to have a particularly bad year with regard to the cogency of its ethical arguments, and this flow of bad argument extended right to the end of the year.In December 2005 NICE published a report with the title Social Value Judgments—Principles for the Development of NICE Guidance, which considered whether social background, age, or lifestyle choices should ever influence NICE guidance concerning the health care provided by the National Health Service .1 This report was endorsed by the NICE board and its guidelines are binding on all panels developing specific NICE guidance.Here I want to focus on three areas of this report: The relevance of self inflicted conditions The relevance of socioeconomic status The relevance of stigmaI will not comment on NICE’s methodology in coming to these conclusions, since that is the subject of a paper by John McMillan and colleagues, which is published in this issue of the journal.2With regard to self inflicted conditions NICE has now bound itself to the following principle:PRINCIPLE 10Principle 10 states that:"NICE and its advisory bodies should avoid denying care to patients with conditions that are, or may be, self … ". (shrink)

The Future of Human Reproduction brings together new work, by an international group of contributors from various fields and perspectives, on ethical, social, and legal issues raised by recent advances in reproductive technology. These advances have put us in a position to choose what kindsof children and parents there should be; the aim of the essays is to illuminate how we should deal with these possibilities for choice. Topics discussed include gender and race selection, genetic engineering, fertility treatment, ovarian (...) tissue transfer, and post-menopausal pregnancy. The centralfocus of the volume is the interface between reproductive choice and public regulation. (shrink)

This paper seeks to analyze the construction of ethics in sexuality research in which qualitative methods are employed in the field of social sciences. Analyses are based on a bibliographic review of current discussions on research methods of queer theory and on the authors' own experiences of past research on sexuality. The article offers a theoretical perspective on the ways ethnography and in‐depth interviews become methods that can rely on a consensual method and create a politics of intimacy (...) between the researchers and research participants. The politics of intimacy may contribute to the production of a politically engaged knowledge while escaping from the moral matrix that usually governs the relationship between researchers and research participants. It is argued here that the researcher's sexed and gendered body matters for fieldwork; that the consensual method among participants may be employed in sexuality research as a fruitful tool; and that the relationships created among researchers and participants can pose a challenge to predetermined ethical guidelines in research. As a result, discussions problematize the existence of a politics of intimacy in sexuality research that is characterized by ethical relations among research participants. (shrink)

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme Ethics at the centre of global and local challenges. For much of the history of the Journal of Business Ethics, ethics was seen within the academy as a (...) peripheral aspect of business. However, in recent years, the stakes have risen dramatically, with global and local worlds destabilized by financial crisis, climate change, internet technologies and artificial intelligence, and global health crises. The authors of these commentaries address these grand challenges by placing business ethics at their centre. What if all grand challenges were framed as grand ethical challenges? Tanusree Jain, Arno Kourula and Suhaib Riaz posit that an ethical lens allows for a humble response, in which those with greater capacity take greater responsibility but remain inclusive and cognizant of different voices and experiences. Focussing on business ethics in connection to the grand challenge of environmental emergencies, Steffen Böhm introduces the deceptively simple yet radical position that business is nature, and nature is business. His quick but profound side-step from arguments against human–nature dualism to an ontological undoing of the business–nature dichotomy should have all business ethics scholars rethinking their “business and society” assumptions. Also, singularly concerned with the climate emergency, Boudewijn de Bruin posits a scenario where, 40 years from now, our field will be evaluated by its ability to have helped humanity emerge from this emergency. He contends that Milieudefensie v. Royal Dutch Shell illustrates how human rights take centre stage in climate change litigation, and how business ethics enters the courtroom. From a consumer ethics perspective, Deirdre Shaw, Michal Carrington and Louise Hassan argue that ecologically sustainable and socially just marketplace systems demand cultural change, a reconsideration of future interpretations of “consumer society”, a challenge to the dominant “growth logic” and stimulation of alternative ways to address our consumption needs. Still concerned with global issues, but turning attention to social inequalities, Nelarine Cornelius links the capability approach to global and corporate governance, arguing that CA will continue to lie at the foundation of human development policy, and, increasingly, CSR and corporate governance. Continuing debate on the grand challenges associated with justice and equality, Laurence Romani identifies a significant shift in the centrality of business ethics in debates on managing differences, positing that dialogue between diversity management and international management can ground future debate in business ethics. Finally, the essay concludes with a commentary by Charlotte Karam and Michelle Greenwood on the possibilities of feminist-inspired theories, methods, and positionality for many spheres of business ethics, not least stakeholder theory, to broaden and deepen its capacity for nuance, responsiveness, and transformation. In the words of our commentators, grand challenges must be addressed urgently, and the Journal of Business Ethics should be at the forefront of tackling them. (shrink)

With a few notable exceptions disability studies has not taken account of intersexuality, and it is principally through the lenses of feminist and queer-theory oriented ethical discussions but not through ‘straight’ bioethics that modes valuing intersex difference have been proposed. Meanwhile, the medical presupposition that intersex characteristics are inherently disabling to social viability remains the taken-for-granted truth from which clinical practice proceeds. In this paper I argue against bioethical perspectives that justify extensive and invasive pre- and post-natal medical interference (...) to eradicate intersex. I argue instead that to constitute the necessary conditions for the recognition of the intersexed child as a person, a life valid in its own right, clinicians must refrain from aggressive interference. Clinical specialists presuppose that intersexed children will be socially disabled and unrecognizable as persons; frustrated by the general failure of traditional interventions to assign a sex, clinicians are now pursuing prenatal technologies, including selective termination, to erase intersex. (shrink)

Nursing as normative praxisThe purpose of this paper is twofold. First, it introduces a variety of concepts of ‘praxis’, and argues in support of those which reflect the normative dimension of the critical social perspective. This begins with the Aristotelian concept, and moves through a variety of sources, including Hannah Arendt and Paulo Freire, but focuses primarily, and uniquely in the nursing literature, upon the work of the Yugoslavian ‘praxis Marxists’. Second, specific ways of conceiving nursing as praxis are (...) outlined, including political, aesthetic and ethical forms which have immediate import for nurses. The paper concludes with brief suggestions as to how these ways of conceiving praxis may be used by nurses to develop a more intimate and productive understanding of their own practices. (shrink)

What does it mean for algorithmic classifications to be fair to different socially salient groups? According to classification parity criteria, what is required is equality across groups with respect to some performance measure such as error rates. Critics of classification parity object that classification parity entails that achieving fairness may require us to choose an algorithm that makes no group better off and some groups worse off than an alternative. In this article, I interpret the problem of algorithmic fairness as (...) a case concerning the ethics of the distribution of algorithmic classifications across groups (as opposed to, e.g., the fairness of data collection). I begin with a short introduction of algorithmic fairness as a problem discussed in machine learning. I then show how the criticism raised against classification parity is a form of leveling down objection, and I interpret the egalitarianism of classification parity as deontic egalitarianism. I then discuss a challenge to this interpretation and suggest a revision. Finally, I examine how my interpretation provides proponents of classification parity with a response to the leveling down criticism and how it relates to a recent suggestion to evaluate fairness for automated decision-making systems based on risk and welfare considerations from behind a veil of ignorance. (shrink)

Tom Shakespeare’s book Disability rights and wrongs is very rich and interesting and ought to be compulsory reading for anyone interested in the relation between disability and medical ethics.1In my short contribution to this symposium on the book, I will focus on a particular aspect of his discussion of prenatal diagnosis and termination of pregnancy.In chapter 6 of Disability rights and wrongs, a chapter entitled Questioning prenatal diagnosis, the author discusses a wide range of issues concerning the relation between (...) disability and prenatal diagnosis. One of the arguments he discusses is the so-called “expressivist objection” to prenatal diagnosis—that is, the claim that prenatal diagnosis expresses a discriminatory or negative attitude towards people with disability. After having analysed the expressivist objection, Shakespeare, in line with a range of other authors, concludes that the argument is not sound: Nor should we interpret a decision to have a test or a termination as expressing disrespect or discrimination towards disabled people.1Is it thus time now to lay the expressivist objection to rest? In the following, I will suggest that it may be too early to completely dismiss the objection, partially because it is often misrepresented by its opponents, who argue against implausibly strong versions of the objection.THE OBJECTION UNFOLDEDWhat does the expressivist objection essentially claim? The core of the claim is, as described above, that prenatal diagnosis and termination of pregnancy expresses certain attitudes towards disabled people. What is taken to express these attitudes may be the social practice of prenatal diagnosis and termination of pregnancy either …. (shrink)

Several authors have argued that contractualism faces a dilemma when it comes to justifying risks generated by socially valuable activities. At the heart of the matter is the question of whether contractualists should adopt an ex post or an ex ante perspective when assessing whether an action or policy is justifiable to each person. In this paper I argue for the modest conclusion that ex post contractualism is a live option notwithstanding recent criticisms raised by proponents of the ex ante (...) perspective. I then consider how an ex post contractualist can best respond to the problem that it seems to prohibit a range of intuitively permissible and socially valuable activities. (shrink)

THE GREAT SPIRIT OR THE LITTLE GHOSTS? ON THE LEGITIMIZING NARRATIVES OF CAPITALISMBoltanski and Chiapello’s The New Spirit of Capitalism is a monumental work that diagnoses the nature of contemporary network capitalism and gives a compelling statement of a new ideology that sustains and legitimizes capitalism as an economic system. This paper, however, aims to raise a number of objections to Boltanski and Chiapello’s approach. It questions partly whether the ideology they identify is actually capable of legitimizing contemporary capitalism, partly (...) whether it may not be more constructive to abandon the search for one ‘spirit of capitalism’ in favor of identifying a system of different ideologies that all serve as legitimizing narratives. The paper identifies business ethics as one such ideology and argues that it actually outperforms the one identified by Boltanski and Chiapello according to the criteria defined by the authors themselves. Finally, it is argued that the different ideologies, despite their discrepancies, share one defining characteristic: They are all incapable of making a case for capitalism as an economic system that guarantees the contemporary workforce social security, and that reflects the reality of capitalist society today. (shrink)

This chapter contains sections titled: History Specific Features of Medical Ethics Recent Developments References and Further Reading.

The focus of this paper is an analysis and discussion of what kind of empirical evidence bodies that advise on or set public policy in the area of reproduction and reproductive technologies are looking for when developing new advice or policy, but the analysis has implications for other areas of ‘bioethics policy making’ as well. The paper outlines some important differences between policy making and philosophical analysis, provides an account of ‘policy relevance’ and discusses ways in which evidence may be (...) misused in policy making. The scope of the paper is, for the most part restricted to considerations of empirical evidence of a social scientific nature. (shrink)

A number of papers have appeared recently arguing for the conclusion that it is ethically acceptable to infect healthy volunteers with severe acute respiratory syndrome coronavirus 2 as part of research projects aimed at developing COVID-19 vaccines or treatments. This position has also been endorsed in a statement by a working group for the WHO. The papers generally argue that controlled human infection is ethically acceptable if the risks to participants are low and therefore acceptable, the scientific quality of the (...) research is high, the research has high social value, participants give full informed consent, and there is fair selection of participants. All five conditions are necessary premises in the overall argument that such research is ethically acceptable. The arguments concerning risk and informed consent have already been critically discussed in the literature. This paper therefore looks specifically at the arguments relating to condition 3 ‘high social value’ and condition 5 ‘fair selection of participants’ and shows that whereas they may be valid, they are not sound. It is highly unlikely that the conditions that are necessary for ethical CHI trials to take place will be fulfilled. Most, if not all, CHI trials will thus be well intentioned but unethical. (shrink)

Valuing wildlands is complex. (1) In a philosophically oriented analysis, I distinguish seven meaning levels of value, individual preference, market price, individual good, social preference, social good, organismic, and ecosystemic, and itemize twelve types of value carried by wildlands, economic, life support, recreational, scientific, genetic diversity, aesthetic, cultural syrubolization, historical, characterbuilding, therapeutic, religious, and intrinsic. (2) I criticize contingent valuation efforts to price these values. (3) I then propose an axiological model, which interrelates the multiple levels and types (...) of value, and some principles for wildland management policy. (shrink)

A student's future as a knowledge worker (one who "thinks for a living" with the task of problem solving) is the starting point of this book. With this in mind, the book combines a review of philosophical positions and problems with practical examples and perspectives gained from everyday challenges faced by knowledge workers in their businesses and organizations. Through the use of summative chapters, highlighted key concepts, questions for reflection, and illustrative examples on how to work with the theories presented, (...) the book provides a clear and accessible introduction to this challenging subject. Philosophy of Science primarily addresses students studying language, communication, marketing, economics, and management. However, the survey of the theoretical schools of thought - as well as the discussions on research ethics and the role of research in society - will be equally relevant for other students in the humanities and the natural and social sciences. (shrink)

Norman Daniels' and James Sabin's theory of “accountability for reasonableness” (A4R) is a much discussed account of due process for decision-making on health care priority setting. Central to the theory is the acceptance that people may justifiably disagree on what reasons it is relevant to consider when priorities are made, but that there is a core set of reasons, that all centre on fairness, on which there will be no disagreement. A4R is designed as an institutional decision process which (...) will ensure that only those reasons which everybody will agree are relevant and appropriate form part of decision-making. The argument which we will put forward in this paper questions whether it is a simple matter to delineate the core set of reasons and claims that it is a potential problem in A4R that it does not provide an indication of the exact content of this process. The paper first briefly outlines the content of A4R. It is argued that disagreement on what services should be high priorities cannot be resolved solely with a reference to “due process.” In order to retain consistency over time, decision-makers are required to agree and articulate what reasons qualify as relevant and how conflicting reasons are to be balanced in the course of the process. The second and main part of the paper then considers how the reason of “solidarity” can be handled within the A4R framework, and it is shown that deciding whether solidarity should be admitted to the core set of allowable reasons is not a simple matter. (shrink)

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency‐based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades—often summarized under the catchword neoliberalism—and with it the emergence of managerial models for Human Resource Management (HRM) (...) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency‐based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally. (shrink)

Human enhancement technologies raise serious ethical questions about health practices no longer content simply to treat disease, but which now also propose to “optimize” human beings’ physical, cognitive and psychological abilities. These technologies call for a reassessment of our relationship to health, the human body and the body's organic, identity and social functions. In nursing, such considerations are in their infancy. In this paper, we argue for the relevance of critical phenomenology as a way to better understand the ethical (...) issues related to human enhancement technologies (HET). In so doing, we seek to problematize HET and assess their influence on the future development of nursing science and practice. It is difficult to anticipate the concrete effects of HET, we suggest, because these practices reconfigure the meaning of normativity and disorient our conventional ethical landscape. In this context, we argue that the later work of Martin Heidegger and Michel Foucault invites a critical perspective into how techno‐scientific discourses modify our relationship to care, to health and to our own social and corporeal identities. Despite the traditional philosophical opposition between phenomenology and critical theory, we maintain that a hybrid critical phenomenological approach opens new ways to assess the integration of technology and practice. Our analysis understands HET as a process of “hybridization” between technological objects and human subjects. Critical phenomenology thus effectively questions anthropocentric definitions of technology, challenges the dichotomy between curative treatment and enhancement and, finally, prompts valuable reflection on the implications of HET for nursing theory and practice. (shrink)

Research into personal health data holds great potential not only for improved treatment but also for economic growth. In these years many countries are developing policies aimed at facilitating such research often under the banner of ‘big data’. A central point of debate is whether the secondary use of health data requires informed consent if the data is anonymised. In 2013 the Danish Minister of Health established a new register collecting data about all ritual male childhood circumcisions in Denmark. The (...) main purpose of the register was to enable future research into the consequences of ritual circumcision. This article is a study into the case of the Danish Circumcision Registry. We show that such a registry may lead to various forms of harm such as 1) overreaching social pressure, 2) stigmatization, 3) medicalization of a religious practice, 4) discrimination, and 5) polarised research, and that a person may therefore have a strong and legitimate interest in deciding whether or not such data should be collected and/or used in research. This casts doubt on the claim that the requirement of informed consent could and should be waived for all types of secondary research into registries. We finally sketch a new model of informed consent – Meta consent – aimed at striking a balance between the interests in promoting research and at the same time protecting the individual. Research participants may have a strong and legitimate interest in deciding whether or not their data should be collected and used for registry-based research whether or not their data is anonymised. (shrink)

Morality and society in moral philosophy are rarely brought into direct contact, at least not at a fundamental level of justification. David Copp develops an account of practical and moral rationality that could constitute a radical change. According to Copp moral theory has tobe ‘society-centered’ rather than focussing on the individual. This article is devoted to the moral content and structural features of a socially centered moral theory, and along those lines to its critical assessment. Concluding, it will seek to (...) present an argument why moral philosophy ought not place society at the centre of its view. (shrink)

This book contains a sustained defense of the Quality Adjusted Life Years (QALY) approach to resource allocation in health care. According to this approach resources should be allocated in such a way that the number of QALYs gained is maximized. The authors place this approach within a broader preference Utilitarian framework and argue that it is a special case of consequentialism specifically relevant to the health care field. The first two chapters of the book give a basic introduction to the (...) health care economic aspects of QALYs and a basic introduction to the purpose of ethical reasoning. The three subsequent chapters form the core of the book and contain a systematic defense of the QALY approach against all the main criticisms that have been put forward in the literature. The final chapter contains the results of a survey of the attitudes and reasoning of the Australian public with regard to resource allocation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:CALL FOR PROPOSALS TRAUMA AND HEALING 12TH EAST-WEST PHILOSOPHER’S CONFERENCE MAY 24-31, 2024 The 12th East-West Philosopher’s Conference will explore the many dimensions of trauma and healing. While trauma can be physical, it can also be psychological, social, political, economic, and cultural—encompassing the immediate effects of global pandemics, the ongoing impacts of ethnic and gender bias, the intergenerational legacies of colonization and geopolitical strife, and the planetary ramifications (...) of anthropogenic climate disruption. Ours is an era in which differences of histories, cultures, and identities are engaged as sources of insight, but also one of retrenchment—a period of relational appreciation, but also one of schism. The global scientific community’s response to the COVID-19 pandemic was a stunning example of human potential for empathetic collaboration in the face of global personal and public health trauma. Yet, the economic trauma of the pandemic has resulted in crumbling international alliances, deepening trade wars, and an unfortunate collective reinvestment in zero-sum endgame framings of geopolitics against which there is no vaccination and through which the terms of healing have become delinked from the restoration of global wholeness. These traumas do not stop shaping our lives when the immediate danger comes to an end. Traumatic pain remains stored in the memories of peoples and individuals, it populates their imagination and shapes horizons of possibility. Thus a philosophical exploration of trauma and healing is not only diagnostic of current problems but also a form of genealogy. We invite participants to reflect upon the relational complexity of both trauma and healing, critically and historically engaging concrete occurrences of trauma while also drawing out theoretical insights regarding healing that strengthens and empowers and resists the forms of personal and social amnesia that make the repetition of trauma so tragically common. Of special interest are panels and papers that explore the trauma and healing at all scales from the interpersonal, to the relational traumas experienced by nations at war and cultures in conflict, thus addressing the interplay of the private and public spheres, of ethics and economics, of the human and the natural sciences, and among disciplines, classes, genders, and generations. Panel and paper proposals are encouraged that explore trauma and healing during the ongoing COVID-19 pandemic, the trauma of refugees, displaced and colonized peoples, trauma and healing in personal relationships, climate change as a form of trauma to the planet and its people, trauma and healing related to issues of gender and sexuality, and how philosophers of all traditions, ancient and modern, cross-culturally deal with trauma and healing. KEYNOTE PRESENTERS: Jin Y. Park, Chair of Philosophy and Religion at American University, Washington DC, “Translating Violence.” Ato Quayson, Jean G. and Morris M. Doyle Professor of Interdisciplinary Studies at Stanford University, CA, “The Ethnography of the Private Sphere: Trauma, Domesticity, and Healing in the Work of Toni Morrison.” We invite proposals for individual papers and panels. Please submit a 250-300 word abstract to the Conference organizers via: ewpc2024@gmail.com. Submission Timeline: November 1, 2023 Notifications of acceptance for abstracts and panel proposals received by November 1 will be sent out by December 15, 2023. We have established an early submission timeline to facilitate faculty applying to their own institutions for travel funding. Abstracts received after November 1, 2023, will be vetted as received, taking into consideration the late submission. The absolute deadline for abstract submissions is March 15, 2024. After this, we will not be able to accommodate additional proposals. Final Papers Due: April 15, 2024 CONFERENCE REGISTRATION AND LOGISTICS: Hosted in keeping with the Hawaiian Islands’ spirit of aloha, breakfast and lunch will be provided for all registered presenters, as well as an opening reception and final dinner. The Conference does not provide lodging or travel support, but economical lodgings of various kinds are readily available in Honolulu. ABOUT THE EAST-WEST PHILOSOPHER’S CONFERENCE: The East-West Philosophers’ Conference series is the premier forum for convening philosophers from across the academy who are committed to cross-cultural inquiry. The Conference is the oldest continuous international gathering in Hawai‘i and has been a model of productive collaboration between the University of Hawai‘i at... (shrink)

This article introduces the notion of ‘routinisation’ into discussions of informed consent. It is argued that the routinisation of informed consent poses a threat to the protection of the personal autonomy of a patient through the negotiation of informed consent. On the basis of a large survey, we provide evidence of the routinisation of informed consent in various types of interaction on the internet; among these, the routinisation of consent to the exchange of health related information. We also provide evidence (...) that the extent of the routinisation of informed consent is dependent on the character of the information exchanged, and we uncover a range of causes of routinisation. Finally, the article discusses possible ways of countering the problem of routinisation of informed consent. (shrink)

In a recent article in theJournal of Medical Ethics,Neil Manson sets out to show that the meta-consent model of informed consent is not the solution to perennial debate on the ethics of biobank participation. In this response, we shall argue that (i) Manson’s considerations on the costs of a meta-consent model are incomplete and therefore misleading; (ii) his view that a model of broad consent passes a threshold of moral acceptability rests on an analogy that misconstrues how biobank (...) research is actually conducted and (iii) a model of meta-consent is more in tune with the nature of biobank research and enables autonomous choice. (shrink)

This article is an attempt to give arguments for bringing aesthetics back into praxis. Often aesthetics is understood as something coming out of individual designers' or architects' creative talents. We challenge such a view by introducing an understanding of aesthetics as an aspect of praxis. The article builds on observations of a design project for a community centre in a Danish village. We argue that aesthetics is a result of struggles by participants in praxis, where aesthetic, material, functional, ethical, (...) political, and economic aspects are formed by each other in a dialectic process. The struggles are found in the client's reasons for starting the process, in the design and construction process and the use of the results. This means that descriptions of the aesthetics of buildings should incorporate relevant discussions and struggles of the design, construction and use of the building. It also means that the key to a fruitful ongoing collaborative process producing good aesthetic comes from managing together the many aspects of praxis in an open way. (shrink)

With growing awareness of a crisis in pollinator health, the practice of urban hobbyist beekeeping has grown in Canada with practitioners arguing that this activity can help to foster healthier honey bees and more mindful beekeeping practices. However, urban hobbyist beekeepers have been critiqued for encouraging improper beekeeping practices and over-saturation of honey bees in cities. Drawing on a multispecies ethnography based in London, Ontario and Toronto, including participant observation with the Toronto Beekeeping Collective and the London Urban Beekeeping Collective (...) and interviews with 26 urban beekeepers, I argue that urban hobbyist beekeepers develop a sensuous and embodied relationship with honey bees that typifies playful work. By integrating participant perspectives with social reproduction theory, I demonstrate that the playful work of urban hobbyist beekeeping allows practitioners to engage with non-human nature outside of the constraints of capitalist labour regimes, enabling the expression of delight, enchantment, and curiosity. This relationship between beekeepers and honey bees encourages the development of bee-centred practices in which the preferences and physiological needs of the bees are consciously put ahead of the needs of the beekeeper. The possibility for honey bee flourishing is increased significantly when bee-centred beekeeping is coupled with integrated pest management. (shrink)

In July 1993, the Scottish Highlands Centre for Human Caring sponsored a conference with the title Exploring the Spirituality in Caring. The papers given at the conference and included in this volume are offered as a contribution to the debate that must take place in nursing and in the wider context of health care provision. Ann Bradshaw's paper puts the debate in context arguing that nursing is fundamentally a loving response to the human being created in the image of (...) God. (shrink)