In recent decades, researchers have attempted to prospectively identify individuals at high risk of developing psychosis in the hope of delaying or preventing psychosis onset. These psychosis risk individuals are identified as being in an ‘At-Risk Mental State’ (ARMS) through a standardised psychometric interview. However, disclosure of ARMS status has attracted criticism due to concerns about the risk–benefit ratio of disclosure to patients. Only approximately one quarter of ARMS patients develop psychosis after three years, raising concerns (...) about the unnecessary harm associated with such ‘false-positive’ results. These harms are especially pertinent when identifying psychosis risk individuals due to potential stigma and discrimination in a young clinical population. A dearth of high-quality evidence supporting interventions for ARMS patients raises further doubts about the benefit accompanying an ARMS disclosure. Despite ongoing discussion in the bioethical literature, these concerns over the ethical justification of disclosure to ARMS patients are not directly addressed in clinical guidelines. In this paper, we aim to provide a unified disclosure strategy grounded in principle-based analysis for ARMS clinicians. After considering the ethical values at stake in ARMS disclosure, and their normative significance, we argue that full disclosure of the ARMS label is favoured in the vast majority of clinical situations due to the strong normative significance of enhancing patients' understanding. We then compare our framework with other approaches to ARMS disclosure and outline its limitations. (shrink)

Abstract The debate about the ethics of uninhabited aerial vehicles (UAVs) is failing to keep pace with the rise of the technology. Therefore, all the key players, including ethicists, lawyers, and roboticists, are keen to offer their views on the use of these drone aircraft. Some are opposed to their use, citing a range of ethical, legal and operational issues, while others argue for their ethically mandated use. B.J. Strawser fits into this latter category. He develops a principle of (...) ?unnecessary risk?, from which he argues that we have an ethical obligation to employ UAVs if we can do so without incurring a loss of capability. Strawser defends his argument against a number of potential objections, most questionably, the argument that the use of distance weaponry such as drones, against another state without distance weaponry, crosses some moral threshold that makes the combat immoral. Utilising Jeff McMahan's work on the inequality of combatants, Strawser essentially argues that there are no grounds for a ?fair fight?. However, this paper will argue that it is not so easy to overturn the doctrine of the moral equality of combatants, nor dismiss the problem with asymmetry. It will demonstrate that if the asymmetry reaches a certain level, the justification for resorting to war may be removed and some sort of policing action may remain the only option. (shrink)

There is widespread agreement that there should be a principle requiring that artificial intelligence be ‘explicable’. Microsoft, Google, the World Economic Forum, the draft AI ethics guidelines for the EU commission, etc. all include a principle for AI that falls under the umbrella of ‘explicability’. Roughly, the principle states that “for AI to promote and not constrain human autonomy, our ‘decision about who should decide’ must be informed by knowledge of how AI would act instead of us” (...) :689–707, 2018). There is a strong intuition that if an algorithm decides, for example, whether to give someone a loan, then that algorithm should be explicable. I argue here, however, that such a principle is misdirected. The property of requiring explicability should attach to a particular action or decision rather than the entity making that decision. It is the context and the potential harm resulting from decisions that drive the moral need for explicability—not the process by which decisions are reached. Related to this is the fact that AI is used for many low-risk purposes for which it would be unnecessary to require that it be explicable. A principle requiring explicability would prevent us from reaping the benefits of AI used in these situations. Finally, the explanations given by explicable AI are only fruitful if we already know which considerations are acceptable for the decision at hand. If we already have these considerations, then there is no need to use contemporary AI algorithms because standard automation would be available. In other words, a principle of explicability for AI makes the use of AI redundant. (shrink)

Subjects in studies on humans are used as a means of conducting the research and achieving whatever good would justify putting them at risk. Accordingly, consent must normally be obtained before subjects are exposed to any substantial risks to their welfare. Bystanders are also often put at risk, but they are not used as a means. Accordingly—or so I argue—consent is more often unnecessary before bystanders are exposed to similar substantial risks to their welfare.

Autonomous Weapon Systems (AWS) are artificial intelligence systems that can make and act on decisions concerning the termination of enemy soldiers and installations without direct intervention from a human being. In this article, I provide the positive moral case for the development and use of supervised and fully autonomous weapons that can reliably adhere to the laws of war. Two strong, prima facie obligations make up the positive case. First, we have a strong moral reason to deploy AWS (in an (...) otherwise just war) because such systems decrease the psychological and moral risk of soldiers and would-be soldiers. Drones protect against lethal risk, AWS protect against psychological and moral risk in addition to lethal risk. Second, we have a prima facie obligation to develop such technologies because, once developed, we could employ forms of non-lethal warfare that would substantially reduce the risk of suffering and death for enemy combatants and civilians alike. These two arguments, covering both sides of a conflict, represent the normative hill that those in favor of a ban on autonomous weapons must overcome. Finally, I demonstrate that two recent objections to AWS fail because they misconstrue the way in which technology is used and conceptualized in modern warfare. (shrink)

Non-beneficial paediatric research is vital to improving paediatric healthcare. Nevertheless, it is also ethically controversial. By definition, subjects of such studies are unable to give consent and they are exposed to risks only for the benefit of others, without obtaining any clinical benefits which could compensate those risks. This raises ethical concern that children participating in non-beneficial research are treated instrumentally; that they are reduced to mere instruments for the benefit of science and society. But this would make the research (...) incompatible with the widely endorsed principle of the primacy of the human subject, which stipulates that the interests of the participating individual should prevail over the interests of science and society. This paper deals with this conflict. It analyses solutions to this problem developed in the literature, and shows that they are unsuccessful. Finally, it offers a new idea of how to reconcile the conduct of non-beneficial paediatric research with the PP. The paper argues for a new formula of the PP, and shows that it implies a specific non-comparative definition of the minimal risk threshold. (shrink)

The paper, written for a research handbook, critically surveys some fundamental philosophical, historical, and doctrinal issues in the crime of aggression. The two introductory sections set the theoretical issues in the context of Russia’s invasion of Ukraine, and explain the origins of criminalizing aggression under the heading of “crimes against peace.” Section 3 explores an ambiguity between aggression as first use of force and aggression as unprovoked use of force, while section 4 discusses the doctrinal distinction between acts of aggression (...) and wars of aggression. Sections 5 and 6 turn to the theory of aggression. Section 5 examines modern versus early modern just war theorists’ views of just cause. Section 6 explores various theories of what exactly makes aggressive war so evil that it belongs in the pantheon of core crimes, side by side with genocide, crimes against humanity, and other war crimes. The basic question is whether aggression is fundamentally a crime against states, a crime against human rights, or a crime against peace itself. I reject the first, statist, version, and endorse the human rights version. I examine three versions of the view that aggressive war is fundamentally about its human costs: that aggressive wars lead to atrocities (Trainin); that aggressive wars lead more generally to unjustified killings (Dannenbaum); and that aggressive wars lead to both unjustified killings by the aggressor, and to unnecessary killings that include the justified killings of aggressors’ troops by defenders (Mégret). As for crimes against peace, I argue that this theory of aggression’s evils comes in two “flavors,” one of which has justly been criticized by postcolonial writers, and one of which I think is legitimate. The former originates in Judge Pal’s famous dissenting opinion in the IMTFE, and argues that criminalizing aggression is a move by colonial powers to freeze the oppressive status quo. The more legitimate version is that in an age of catastrophically destructive weapons, the risks of escalation in armed conflict –the threat that conflicts will spiral into world wars–are simply too great in human terms. Thus, the legitimate version of “crimes against peace” is part and parcel of the human rights analysis. The final sections break new ground. Section 7 considers whether aggression is solely a leadership crime. Everyone agrees that it would be wrong to punish ordinary soldiers for the crime of aggression launched by their leaders. The questions is why, and it is not easy to answer. Examining it brings us to a contemporary dispute over which leaders can be prosecuted: only those who control or direct the aggressive policies (as per the ICC’s Rome Statute), or others as well, who “shape or influence” the policy without necessarily directing it (as the customary rule used to be formulated). I argue against any narrowing of the leadership clause. Section 8 explores the “paradox of immunity”: Under the legal principle of sovereign immunity, apex leaders are immune from prosecution in the courts of another state. But under the narrow leadership clause, only apex leaders can be prosecuted. Here I argue for a surprising conclusion: that in fact there never was a customary rule of immunity for the crime of aggression. If so, the paradox of immunity disappears. This resolution also helps cut the Gordian knot of a current debate about whether a relatively small subset of states (the EU, perhaps) can form an aggression tribunal and call it “international.”. (shrink)

Is it ethical to perform a surgery whose purpose is to make a male look like a female or a female to appear male? Is it medically appropriate? Sexual reassignment surgery (SRS) violates basic medical and ethical principles and is therefore not ethically or medically appropriate. (1) SRS mutilates a healthy, non-diseased body. To perform surgery on a healthy body involves unnecessary risks; therefore, SRS violates the principle primum non nocere, “first, do no harm.” (2) Candidates for SRS (...) may believe that they are trapped in the bodies of the wrong sex and therefore desire or, more accurately, demand SRS; however, this belief is generated by a disordered perception of self. Such a fixed, irrational belief is appropriately described as a delusion. SRS, therefore, is a “category mistake”—it offers a surgical solution for psychological problems such as a failure to accept the goodness of one’s masculinity or femininity, lack of secure attachment relationships in childhood with same-sex peers or a parent, self-rejection, untreated gender identity disorder, addiction to masturbation and fantasy, poor body image, excessive anger, and severe psychopathology in a parent. (3) SRS does not accomplish what it claims to accomplish. It does not change a person’s sex; therefore, it provides no true benefit. (4) SRS is a “permanent,” effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition. National Catholic Bioethics Quarterly 9.1 (Spring2009): 97–125. (shrink)

In Bayesian epistemology, the problem of the priors is this: How should we set our credences (or degrees of belief) in the absence of evidence? That is, how should we set our prior or initial credences, the credences with which we begin our credal life? David Lewis liked to call an agent at the beginning of her credal journey a superbaby. The problem of the priors asks for the norms that govern these superbabies. -/- The Principle of Indifference gives (...) a very restrictive answer. It demands that such an agent divide her credences equally over all possibilities. That is, according to the Principle of Indifference, only one initial credence function is permissible, namely, the uniform distribution. In this paper, we offer a novel argument for the Principle of Indifference. I call it the Argument from Accuracy. (shrink)

The article addresses the pervasive global challenge of delayed justice, emphasizing its role as a catalyst for widespread judicial reforms. The study defines international and national court approaches to reasonable trial durations by employing systematic and comparative legal methods. It delves into essential technology courts and parties use to ensure timely proceedings, categorizing associated risks and problems. The authors advocate for the multi-door courthouse system, illustrating its efficacy in reducing delays. Furthermore, the article classifies technologies facilitating reasonable trial durations, acknowledging (...) and offering solutions for the challenges they present. This research contributes to the dynamic landscape of judicial reform, offering a holistic perspective on the multifaceted aspects of timely justice. (shrink)

Volume 20, Issue 7, July 2020, Page 207-209.

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about (...) its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy, to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. (shrink)

Standard definitions of procrastination underscore the irrational nature of this habit, a critical criterion being that the procrastinating individual delays despite expecting to be worse off for the delay. However, an examination of more than 175 items in 18 procrastination scales reveals that they do not address such a forward-looking criterion. Consequently, scales run the risk of not separating maladaptive and irrational delays from other forms of delay. We propose that forward-looking considerations may not be the best way of (...) operationalizing the irrationality involved in procrastination and argue that scales should instead focus on past negative consequences of unnecessary delay. We suggest a new scale to measure such procrastination-related negative consequences and demonstrate that this scale, used separately or combined with established procrastination scales, performs better in predicting negative states and correlates to procrastination than established scales. The new scale seems to be helpful in separating trivial forms of unnecessary delay from maladaptive forms and hence represents a potentially valuable tool in research and clinical/applied efforts. (shrink)

The following text is a voice in the discussion around normative problems of innovative therapies. It particularly refers to problems related to the concept of risk and the principle of its minimization, also discussed in this issue in the article by Wojciech Załuski "On the Limits of Medical Experiment from the Perspective of Rational Choice Theory.”.

The referral is the key source of information that enables radiologists and radiographers to provide quality services. However, the frequency of suboptimal referrals is widely reported. This research reviews the literature to illuminate the challenges suboptimal referrals present to the delivery of care in radiology departments. The concept of suboptimal referral includes information, that is; missing, insufficient, inconsistent, misleading, hard to interpret or wrong. The research uses the four ethical principles ofnon-maleficence, beneficence, AutonomyandJusticeas an analytic framework.Suboptimal referrals can causeharmby hindering (...) safe contrast-media administration, proper radiation protection by justification of procedures, and compassionate patient care. Suboptimal referrals also hinder promoting patientbenefitsfrom the correct choice of imaging modality and protocol, an optimal performed examination, and an accurate radiology report. Additionally, patientautonomyis compromised from the lack of information needed to facilitate benefit–risk communication. Finally, suboptimal referrals challengejusticebased on lack of reasonable patient prioritising and the unfairness caused by unnecessary examinations.These findings illuminate how suboptimal referrals can inhibit good health and well-being for patients in relation to safety, missed opportunities, patient anxiety and dissatisfaction. The ethical challenges identified calls for solutions. Referral-decision support tools and artificial intelligence may improve referral quality, when implemented. Strategies addressing efforts of radiology professionals are inevitable, including gatekeeping, shared decision-making and inter-professional communication; thereby raising awareness of the importance of good referral quality and promoting commitment to ethical professional conduct. (shrink)

Volume 20, Issue 7, July 2020, Page 13-14.

Here we reconsider teachers’ changing subjectivities as autonomous agents whose practices acknowledge risk as an essential element in intellectual inquiry. We seek alternative descriptions to the limiting language of teachers’ current practices within the primacy of the market. We are convinced by Levinas’s claim that ethics is the first philosophy with its concomitant responsibility for the Other. This provides a valuable point of departure and our understanding of its relevance is expanded by Biesta and Todd. This perspective allows interruption (...) of the global reform ensemble with its reductionist understandings of teachers’ subjectivities within concerns for a ‘visible pedagogy’ and performativity. We illustrate how this global policy imperative is reworked in policies in the Republic of Ireland and share reflexive insights from our tutoring of teachers studying for a Master’s degree in Education. We show that teachers’ autonomy, which we understand as the capacity of teachers to facilitate risk and make ethically informed local judgements, is severely restricted by imposed standards, codes and laws to which there is tightly policed adherence. Instead we describe teachers’ practices occurring within an Invisible Pedagogy, which is not concerned with totalising and limited performativity but instead, explores risks associated with existential possibilities beyond commodification. (shrink)

'A comprehensive and important collection that includes essays by some of the leading figures in the field....Essential reading for anyone interested in risk assessment.' Professor Kristin Shrader-Frechette, University of Notre Dame 'The editors are to be congratulated for bringing together a distinguished international group of theorists to reflect on the issues. This volume will be sure to raise the level of debate while at the same time showing the importance of philosophical reflection in approaches to the problems of the (...) age.' Professor Jonathan Wolff, University College London This volume brings together top authors from the fields of risk, philosophy, social sciences and psychology to address the issue of how we should decide how far technological risks are morally acceptable or not. The underlying principles are examined, along with methodological challenges, public involvement and instruments for democratization. A strong theoretical basis is complemented by a range of case studies from some of the most contentious areas, including medical ethics and GM crops. This book is a vital new resource for researchers, students and anyone concerned that traditional approaches to risk management don't adequately address ethical considerations. (shrink)

Warfare is becoming increasingly automated, from automatic missile defense systems to micro-UAVs (WASPs) that can maneuver through urban environments with ease, and each advance brings with it ethical questions in need of resolving. Proponents of lethal autonomous weapons systems (LAWS) provide varied arguments in their favor; robots are capable of better identifying combatants and civilians, thus reducing "collateral damage"; robots need not protect themselves and so can incur more risks to protect innocents or gather more information before using deadly force; (...) robots can assess situations more quickly and do so without emotion, reducing the likelihood of fatal mistakes due to human error; and sending robots to war protects our own soldiers from harm. However, these arguments only point in favor of autonomous weapons systems, failing to demonstrate why such systems need be made *lethal*. In this paper I argue that if one grants all of the proponents' points in favor of LAWS, then, contrary to what might be expected, this leads to the conclusion that it would be both immoral and illegal to deploy *lethal* autonomous weapons, because the many features that speak in favor of them also undermine the need for them to be programmed to take lives. In particular, I argue that such systems, if lethal, would violate the moral and legal principle of necessity, which forbids the use of weapons that impose superfluous injury or unnecessary harm. I conclude by highlighting that the argument is not against autonomous weapons per se, but only against *lethal* autonomous weapons. (shrink)

Cognitive neuroscience aims to improve our understanding of aspects of human learning and performance by combining data acquired with the new brain imaging technologies with data acquired in cognitive psychology paradigms. Both neuroscience and psychology use the philosophical assumptions underpinning the natural sciences, namely the scientific method, whereby hypotheses are proposed and tested using quantitative approaches. The relevance of 'brain science' for the classroom has proved controversial with some educators, perhaps because of distrust of the applicability of so-called 'medical models' (...) to education. Nevertheless, the brain is the main organ of learning, and so a deeper understanding of the brain would appear highly relevant to education. Modern science is revealing the crucial role of biology in every aspect of human experience and performance. This does not mean that biology determines outcomes. Rather, there is a complex interplay between biology and environments. Improved knowledge about how the brain learns should assist educators in creating optimal learning environments. Neuroscience can also identify 'biomarkers' of educational risk, and provide new methodologies to test the effects of educational interventions. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

After arrival in a hospital, a man with suspected meningococcal septicaemia slips into a coma. One of his friends posts a message on the patient’s Facebook ‘wall’ informing three named contacts that the patient has meningitis and tells them to speak to a doctor. At the request of the Health Protection Unit (HPU), this message is later modified, to reduce unnecessary anxiety and to provide better guidance (Mandeville et al., 2013). Based on the harm principle and considerations of (...) reasonableness, it will be argued that in this case the HPU is justified to contact the close contacts of the patient individually (via Facebook or otherwise), and to require the enterprising ‘friend’ of the patient to post a modified message on the patient’s Facebook wall advising close contacts to contact the HPU, without naming close contacts. Generally, the internal logic of social networking sites like Facebook (sharing personal information with a broad range of ‘friends’) is contrary to the logic of health care systems (keeping breaches of confidentiality to a minimum). Social networking sites (SNS) could justifiably be used for contract tracing, provided that such use complies with the well-established norms of health care systems. (shrink)

Precautionary Principles are often said to be appropriate for decision-making in contexts of uncertainty such as climate policy. Contexts of uncertainty are contrasted to contexts of risk depending on whether we have probabilities or not. Against this view, I argue that the risk-uncertainty distinction is practically irrelevant. I start by noting that the history of the distinction between risk and uncertainty is more varied than is sometimes assumed. In order to examine the distinction, I unpack the idea (...) of having probabilities, in particular by distinguishing three interpretations of probability: objective, epistemic, and subjective probability. I then claim that if we are concerned with whether we have probabilities at all—regardless of how low their epistemic credentials are—then we almost always have probabilities for policy-making. The reason is that subjective and epistemic probability are the relevant interpretations of probability and we almost always have subjective and epistemic probabilities. In contrast, if we are only concerned with probabilities that have sufficiently high epistemic credentials, then we obviously do not always have probabilities. Climate policy, for example, would then be a case of decision-making under uncertainty. But, so I argue, we should not dismiss probabilities with low epistemic credentials. Rather, when they are the best available probabilities our decision principles should make use of them. And, since they are almost always available, the risk-uncertainty distinction remains irrelevant. (shrink)

Volume 23, Issue 3-4, November - December 2024, Page 251-263.

Ethics in sport demand not only that we respect ourselves and others, but also that we respect sport itself. But the question of respecting sport seems to create a kind of moral dilemma between the obligation to “play one’s best” by maximizing performance, and the obligation to follow rules and traditions that ban the use of ergogenic aids. It is often argued that bans on performance-enhancing substances, equipment, and training techniques are paternalistic and violate athletes’ liberty to rationally accept risks (...) in their pursuit of excellence. Against advocates for the legalization of ergogenic aids, however, I argue in this paper that such bans must be respected because they are an essential part of the nature of sport. Whether one understands sports metaphysically to be Suits’ “voluntary attempt to overcome unnecessary obstacles” or a MacIntyrean social practice, inefficiency of means is an essential component sport that demands respect from all participants. The performance principle in sport is ontologically posterior to the prescription of inefficiencies upon which sport depends, so ethical respect for sport demands that we limit the efficiencies provided by ergogenic aids. (shrink)

Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to (...) serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation. (shrink)

In this paper, we present a Capabilities -based Approach to the acceptability and the tolerability of risks posed by natural and man-made hazards. We argue that judgments about the acceptability and/or tolerability of such risks should be based on an evaluation of the likely societal impact of potential hazards, defined in terms of the expected changes in the capabilities of individuals. Capabilities refer to the functionings, or valuable doings and beings, individuals are able to achieve given available personal, material, and (...) social resources. The likely impact of a hazard on individuals’ capabilities should, we argue, be compared against two separate thresholds. The first threshold specifies the minimum level of capabilities attainment that is acceptable in principle for individuals to have in the aftermath of a hazard over any period of time. This threshold captures the level that individuals’ capabilities ideally should not fall below. A risk is acceptable if the probability that the attained capabilities will be less than the acceptable level is sufficiently small. In practice, it can be tolerable for some individuals to temporarily fall below the acceptable threshold, provided this situation of lower capabilities attainment is temporary, reversible, and the probability that capabilities will fall below a tolerability threshold is sufficiently small. This second, tolerable threshold delimits an absolute minimum level of capabilities attainment below which no individual in a society should ever fall, regardless of whether that level of capabilities attainment is temporary or reversible. In this paper, we describe and justify this Capabilities -based Approach to the acceptability and tolerability of risks. We argue that the proposed theoretical framework avoids the limitations in current approaches to acceptable risk. The proposed approach focuses the attention of risk analysts directly on what should be our primary concern when judging the acceptability and the tolerability of risks, namely, how risks impact the well-being of individuals in a society. Also, our Capabilities -based Approach offers a transparent, easily communicable way for determining the acceptability and the tolerability of risks. (shrink)

The level of communicativeness of official letters in the field of tax law leaves much to be desired. The article concerns the consequences of the application of “Language Relief” in the practice of applying tax law by the National Revenue Administration. The author calls for the principles of plain language to be introduced first in relation to acts of state law, so that officials can adapt their letters to the plain language of the law. A reversal of this order poses (...) significant risks to the protection of taxpayers’ rights since internal instructions and letter templates proposed on the NRA intranet will be used to a greater extent instead of legal acts. (shrink)

The technology required for tissue-engineering food is the same as for medical applications, and in fact is derived from it. There are major differences in the implementation of those technologies, primarily related to the enormous scale required for food production and the different economical framework. In addition, the emotional context of food tissue engineering is also more complex than for medical applications. On the other hand, the tissues that are generated do not need to integrate in the body, with less (...) risk of adverse effects in the event of incomplete functional, neuronal or humoral adaptation. The implementation of tissue engineering for food is still in its infancy. No products exist yet. It will be extremely challenging to make these products a reality for the consumer, but the reward and return in terms of value for our society will be tremendous. (shrink)

Advancement of modern agricultural biotechnology has brought various potential benefits to humankind, but at the same time ethical concerns regarding some applications such as genetically modified foods have been raised among the public. Several questions are being posed; should they utilize such applications to improve quality of their life, or should they refrain in order to save themselves from any associated risk? What are the ethical principles that can be applied to assess these applications? By using GMF as a (...) case study, this paper discusses possible answers to these questions from Islamic perspective. Such answers are based on the understanding of the Islamic concept of maslahah and mafsadah as well as the Islamic principles of priority. There is no specific GMF that has been declared as unlawful by Muslim scholars thus far. Nevertheless, they generally state that any GMF that contains unlawful substance is prohibited in Islam. Such statement can be understood since Islam puts highest priority to preserve shari’ah which prescribes the lawful and unlawful things in human life. Priorities have also been given to preserve human health and environment therefore any GMF that may inflict harm on both entities is also considered as unlawful. (shrink)

It can be argued that there is an ethical requirement to classify correctly what is known and what is unknown in decision situations, especially in the context of biomedicine when risks and benefits have to be assessed. This is because other methods for assessing potential harms and benefits, decision logics and/or ethical principles may apply depending on the kind or degree of uncertainty. However, it is necessary to identify and describe the various epistemic states of uncertainty relevant to such estimates (...) in the first place. Therefore, this paper aims to develop a category system of different epistemic states of uncertainty which, although not exclusively, is primarily intended to be applied to early clinical trials. It is formed on the basis—and various combinations—of three dimensions of uncertainty that represent certain parts of incomplete knowledge: outcome (type of event), probability (of outcome) and evaluation (assessment of outcome). Furthermore, it is argued that uncertainty can arise from three different sources (the structure of the object of research, the state of the evidence, or individual handling of the research and already existing knowledge). The categories developed are applied to actual examples from gene therapy and genome editing to illustrate that they can be helpful for a more precise definition of the respective uncertainties, especially in the context of risk–benefit assessment. The categories allow a differentiated perspective of decision-making situations from the point of view of incomplete knowledge in general, but particularly, for example, in early clinical research, and may thereby support a more acceptable ethical assessment of potential harms and benefits. (shrink)

Human civilization is moving into the digital age. Many believe that total digitalization is bringing humanity closer to the dream age of general wellbeing and happiness. However, although there is a real revolution in the knowledge and mastering of the world, the tension and conflicts within human society do not stop, and people do not feel happier. This determines the aim and the tasks of the research, which are based on the analysis of deep contradictions and conflicts existing in modern (...) society, including military conflicts, to find out the factor of consciousness in their emergence and development, as well as the role and significance of information and communication technologies in formation of positive or negative trends. The research methodology has a complex nature and is based on a philosophical and cultural analysis of the problems of the influence of digitalization on the formation of the consciousness of our contemporary, which leads to constructive or destructive directions of the development of society. To solve the specific tasks of the research, the principles of historicism, systematicity, objectivity, the connection of the historical and the logical were also used.Research results: The reasons for deep contradictions tearing modern societylie, first of all, in the material sphere. However, the possibilities of the extensive path are practically exhausted today, it is necessary to go in the direction of improving the mental sphere, to look for new ideas that could help to find new opportunities for the further development of human civilization. However, this is where one of the main conflicts of our time arises, namely: the human consciousness, which is intended for the production of constructive ideas and solutions, is often directed in the exact opposite direction, towards destruction and violence. The search for reasons and discussions on this matter have not stopped for many decades and are becoming increasingly acute.Discussion. The most contradictory human consciousness manifests itselfin the conditions of war. One of the main causes of wars and military conflicts is the deformation of people’s consciousness, the mental sphere at the local and global levels. Modern information and communication technologies create great opportunities to shape human consciousness with given properties, to direct it in one direction or another. Modern highly developed societies, where democracy reigns and the Global Network plays a huge role, seem to be the territory of freedom and pluralism. However, precisely thanks to digital technologies, the satisfaction of spiritual needs has turned into a kind of mass production, when tastes are lowered below the lowest level, and worthy things are replaced by informational surrogates.Conclusions. In order to be able to distinguish a high-quality informationproduct from a fake, veiled or outright lie, a fairly high level of intellectualdevelopment of the individual is required. It is necessary to form an own information environment, where priorities will be clearly defined, as well as curtains and mental filters will be installed, which do not allow the penetration and accumulation of unnecessary and harmful information. The triumph of man in the modern information and digital age lies in the fact that we have reached the level of a society of mass information consumption. But the tragedy is that people were not ready for such a rapid turn in the development of our civilization. There is a real risk of losing one’s humanity, turning not into spiritual beings, but into something similar to machines, homo technologicus, for whom not only higher spiritual needs disappear, but also the value of life in general. In order to avoid a negative scenario, it is necessary to seriously revise the attitude to information, to make information hygiene at all levels the norm of our life. (shrink)

Although previous studies have acknowledged the connections between gender and emotional competences, more research is needed on how gender and emotion interact to influence psychosocial risks at work. This paper addresses how gender stereotypes and emotions simultaneously act as psychosocial antecedents of organizational stress. Following the principles of psychological androgyny, we propose that a combination of communion and agency can serve as a preventive factor at work and lead to healthier responses by providing a wider range of emotional competences to (...) deal with organizational demands. Following previous methodological approaches, we include a quantitative review about scientific research on occupational health in the PsycINFO database during the period 1980–2017 from a multidimensional gender perspective that differentiates between studies addressing the topic from either sex, gender or gender identity dimensions. Finally, we propose new analytical directions to deal with psychosocial hazards at work by underscoring some of the complex ways in which gender and emotional competences influence psychosocial risks at work. (shrink)

In The Birthright Lottery, Ayelet Shachar subjects the institution of birthright citizenship to close scrutiny by applying to citizenship the historical and philosophical critique of hereditary ownership built up over four centuries of liberal and democratic theory, and proposing compelling alternatives drawn from the theory of private law to the usual modes of conveyance of membership. Nonetheless, there are some difficulties with this critique. First, the analogy between entailed property and birthright citizenship is not as illustrative as Shachar intends it (...) to be; second, the mechanism of the birthright privilege levy is insufficient for addressing structural impediments to growth; and third, the principle of ius nexi, while an important corrective to currently dominant principles of nationality, will likely have effects both unnecessary and insufficient to correct the injustices that Shachar identifies. In the end, the most significant improvements in the lives of the neediest persons on the planet are more likely advanced through conventional arguments for the lowering of barriers to the circulation of goods, labor, and capital. This shift in attention from opening borders to extending citizenship risks being a distraction from more effective means of addressing the injustices associated with global inequality.Dans son livre The Birthright Lottery, Ayelet Shachar soumet l’institution de la citoyenneté par droit de naissance à un examen rigoureux, en appliquant à la citoyenneté la critique philosophique et historique de la propriété héritée construite pendant quatre siècles de théorie démocratique libérale, et en proposant aux modes habituels d’attribution de la citoyenneté une alternative séduisante tirée de la théorie du droit privé. Néanmoins, cette critique comporte certaines difficultés. Premièrement, l’analogie entre la transmission de la propriété par l’institution de la taille et la citoyenneté par droit de naissance n’est pas aussi éclairante que le soutient Shachar ; deuxièmement, le mécanisme de la taxe sur le privilège du droit de naissance est insuffisant pour s’attaquer aux obstacles structurels à la croissance ; et troisièmement, le principe du jus nexi, bien qu’on puisse le considérer comme un important correctif du principe de nationalité actuellement dominant, aura vraisemblablement des effets à la fois non nécessaires et insuffisants pour corriger les injustices que Shachar identifie. En fin de compte, les améliorations les plus significatives dans la vie des personnes les plus démunies de la planète sont vraisemblablement mieux défendues à l’aide des arguments conventionnels en faveur d’une baisse des barrières à la circulation des biens, du travail et du capital. Ce déplacement de l’attention de l’ouverture des frontières à l’extension de la citoyenneté risque de nous distraire des moyens plus efficaces de nous attaquer aux injustices associées à l’inégalité globale. (shrink)

This paper targets an orphan topic in research ethics, namely the so called principle of the primacy of the human being, which states that the interests of the human subject should always take precedence over the interests of science and society. Although the principle occupies the central position in the majority of international ethical and legal standards for biomedical research, it has been commented in the literature mainly in passing. With a few notable exceptions, there is little in-depth (...) discussion about the meaning and role of the principle. Several authors note that the principle is vogue, ambiguous and apparently conflicting with the accepted practice of conducting non-beneficial research on individuals unable to give consent. There are opinions that it is just “a vacuous figure of speech” and should be abandoned. This paper argues that the primacy principle is far from being “a vacuous figure of speech”, rather it should be seen as a threefold concept: a fundamental interpretative rule, a procedural rule, and a substantive rule aimed at protecting research subjects from instrumental treatment and unacceptable risks. This interpretation tracks back to the principle regulatory and normative origins in the Declaration of Helsinki of 1975, but also acknowledges changes in research ethics and practice, which took place at the turn on the twentieth and twenty-first centuries. Thus, the proposed reading of the principle is not only original, but also historically grounded and normatively fruitful. It provides a fresh and ethically rich perspective on extensively debated, but still controversial problem of an upper limit of permissible risks in non-beneficial studies. (shrink)

In “Genetic Privacy, Disease Prevention, and the Principle of Rescue,” Madison Kilbride argues that patients have a duty to warn biological family members about clinically actionable adverse genetic findings. The duty does not stem from the special obligations that we may have to family members, she argues, but rather follows from the principle of rescue, which she understands as the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the (...) expected harm is serious and the cost or risk to oneself is sufficiently moderate. We doubt, however, whether the principle of rescue can ground a duty to warn in the cases Kilbride envisages, and we suggest that Kilbride may have underappreciated the role that special obligations could play in generating a duty to warn family members. (shrink)

Suppose that you have deeply personal information that you do not want to share. Further suppose that this information could help others, perhaps even saving their lives. Should you reveal the information or keep it secret? With the increasing prevalence of genetic testing, more and more people are finding themselves in this situation. Although a patient's genetic results are potentially relevant to all her biological family members, her first‐degree relatives—parents, children, and full siblings—are most likely to be affected. This is (...) especially true for genetic mutations—like those in the BRCA1 and BRCA2 genes—that are associated with a dramatically increased risk of disease. Fortunately, people are usually willing to share results with their at‐risk relatives. Occasionally, however, a patient refuses to disclose her findings to anyone outside her clinical team. Ethicists have written little on patients’ moral duties to their at‐risk relatives. Moreover, the few accounts that have been advanced are problematic. Some unnecessarily expose patients’ genetic information to relatives who are unlikely to benefit from it, and others fail to ensure that patients’ most vulnerable relatives are informed of their genetic risks. Patients’ duty to warn can be defended in a way that avoids these problems. I argue that the duty to share one's genetic results is grounded in the principle of rescue—the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the expected harm is serious and the cost or risk to oneself is sufficiently moderate. When these two criteria are satisfied, a patient will most likely have a duty to warn. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

BackgroundHealth screening is undertaken to identify individuals who are deemed at higher risk of disease for further diagnostic testing so that they may possibly benefit from interventions to modify the natural course of disease. In Singapore, screening tests are widely available in the form of a package, which bundles multiple tests in one session and commonly includes non-recommended tests. There are various ethical issues associated with such testing as they may not be clinically appropriate and can result in more (...) harm than benefit. This article describes the practice of health screening packages, identifies the ethical issues arising from such packages and discusses the implications of these ethical issues on policy and practice of screening in Singapore.MethodsA content analysis of the websites of providers offering general health screening packages to individuals was conducted. A total of 14 health screening package providers were analysed for how packages were conducted and promoted, how clinically appropriate screening tests were, and the price range and composition of screening packages. A normative ethical analysis based on the four principles approach of beneficence, non-maleficence, autonomy and justice in biomedical ethics was used.ResultsTwelve of the 14 providers included non-recommended tests such as tumour markers, treadmill stress tests and MRI scans in their general health screening packages. Package prices ranged from S$26 to S$10,561, with providers charging higher when more tests were included. Health screening packages were broadly conducted in three stages: the offer and selection of a health screening package; medical assessment and performance of screening tests; a post-screening review. While material provided by all providers was factual, there was no information on the potential risks or harms of screening.ConclusionSeveral ethical issues were identified that should be addressed with regard to health screening packages in Singapore. A key issue was the information gap between providers and patients, which may result in patients undergoing inappropriate testing that may be more harmful than beneficial. Health screening packages can stimulate unnecessary demand for healthcare and contribute to an inequitable distribution of healthcare resources. (shrink)

This paper investigates one of Anderson’s (2007) objections to individually-allocating principles of distributive justice: that they are incompatible with the free market. I argue that Anderson’s objection applies only to the specific principle she discusses, associated with luck egalitarianism, and not to individually-allocating principles generally. I then discuss different individually-allocating principles, the precepts of justice, broached by Rawls (1971,1999) but never developed by him. The precepts determine people’s distributive entitlements based on their contributions, efforts, and needs. I offer an (...) interpretation of each precept, explain why its distributive standard is compelling, show how the precepts avoid Anderson’s objection, and address Rawls’s rationale for not using the precepts in his account of distributive justice. I conclude by comparing the precepts to the kind of principle that Anderson prefers, range-constraining rules, arguing that the precepts meet the key standard associated with those rules. (shrink)

In this article, I comment on Simester and von Hirsch’s theory of criminalization and discuss general principles of criminalization. After some brief comments on punishment theories and the role of moral wrongdoing, I examine main lines of contemporary criminalization theories which tend to focus on the issues of harm, offense, paternalism and side-constraints. One of the points of disagreement with Simester and von Hirsch concerns the role of the harm principle. I rely on a straightforward normative concept of “rights (...) of others,” not in the sense of rights granted in positive law but in the sense of rights which are to be justified in political philosophy. With a rights-centered rather than a harm-centered approach, a prima facie reason for criminalization is the violation of others’ rights. It is unnecessary to develop a separate category of “offense to others,” and paternalistic interventions can be criticized straightforwardly because rights can be waived. (shrink)

The introduction of new technologies in society is sometimes met with public resistance. Supported by public policy calls for “upstream engagement” and “responsible innovation,” recent years have seen a notable rise in attempts to attune research and innovation processes to societal needs, so that stakeholders’ concerns are taken into account in the design phase of technology. Both within the social sciences and in the ethics of technology, we see many interdisciplinary collaborations being initiated that aim to address tensions between various (...) normative expectations about science and engineering and the actual outcomes. However, despite pleas to integrate social science research into the ethics of technology, effective normative models for assessing technologies are still scarce. Rawls’s wide reflective equilibrium is often mentioned as a promising approach to integrate insights from the social sciences in the normative analysis of concrete cases, but an in-depth discussion of how this would work in practice is still lacking. In this article, we explore to what extent the WRE method can be used in the context of technology development. Using cases in engineering and technology development, we discuss three issues that are currently neglected in the applied ethics literature on WRE. The first issue concerns the operationalization of abstract background theories to moral principles. The second issue concerns the inclusiveness of the method and the demand for openness. The third issue is how to establish whether or not an equilibrium has been reached. These issues should be taken into account when applying the methods to real-world cases involving technological risks. Applying the WRE method in the context of engaged interdisciplinary collaboration requires sensitivity for issues of power and representativeness to properly deal with the dynamics between the technical and normative researchers involved as well as society at large. (shrink)

How much should someone contribute to trying to prevent unnecessary deaths and severe hardships? MacAskill, Mogensen, and Ord propose tithing for most of the rich (as measured by income), which has been influential in the effective altruism community. My aim in this article is to contribute, through amending their proposal, to their important project of searching for a weak or very weak principle of sacrifice that would still revise upward how much money goes to the most effective organizations. (...) I do so by presenting four objections to their argument based on demandingness, fairness, net wealth, and historical and contemporary injustices. Then, I show that a principle of progressive can overcome these objections and better fits the reasons MacAskill, Mogensen, and Ord give in favour of their principle than their proposed operationalization of tithing. (shrink)

This article describes the peculiarities of the formation and modeling of the enterprise risk management system in modern conditions. The main purpose of the research is further development of theoretical and methodical principles and development of practical recommendations aimed at improvement of management of business risks of wholesale enterprises. The critical analysis of literature sources and approaches to solving problems of enterprise risk management testifies to the lack of attention of scientists of the present-day to the investigated problem (...) in the sphere of activity of enterprises of wholesale trade. The urgency of this problem is caused by the existing losses of wholesale companies due to imperfect management as a result of the influence of various business risks. The methodological basis of the research is the system of methods used to obtain the final results: theoretical generalization, scientific abstraction and comparison – to deepen the essence of the concept of "business risk"; analysis and synthesis, grouping – for classification of business risks in the sphere of wholesale trade; methods of analysis, synthesis and logical generalization – to obtain conclusions during determination of the state and problems of realization of business activity in the sphere of wholesale trade of enterprises of Ukraine; systematic approach – for improvement of system of management of business risks of enterprises of wholesale trade on the basis of commercial values. The object of the research is the business risk in the wholesale trade environment. In the article the further development of the risk-based apparatus has been made, the negative consequences of the impact of business risks on the activities of the wholesale trade enterprises have been clarified, the enterprise risk management system of the enterprises has been built, which will reflect an integrated approach to its realization, practical recommendations on the formation of a model of management of business risks of the wholesale trade enterprises on the basis of commercial values. The results of the survey can be useful for business structures, which are focused on improving the management of business risks. (shrink)

In this paper, we present a Capabilities-based Approach to the acceptability and the tolerability of risks posed by natural and man-made hazards. We argue that judgments about the acceptability and/or tolerability of such risks should be based on an evaluation of the likely societal impact of potential hazards, defined in terms of the expected changes in the capabilities of individuals. Capabilities refer to the functionings, or valuable doings and beings, individuals are able to achieve given available personal, material, and social (...) resources. The likely impact of a hazard on individuals’ capabilities should, we argue, be compared against two separate thresholds. The first threshold specifies the minimum level of capabilities attainment that is acceptable in principle for individuals to have in the aftermath of a hazard over any period of time. This threshold captures the level that individuals’ capabilities ideally should not fall below. A risk is acceptable if the probability that the attained capabilities will be less than the acceptable level is sufficiently small. In practice, it can be tolerable for some individuals to temporarily fall below the acceptable threshold, provided this situation of lower capabilities attainment is temporary, reversible, and the probability that capabilities will fall below a tolerability threshold is sufficiently small. This second, tolerable threshold delimits an absolute minimum level of capabilities attainment below which no individual in a society should ever fall, regardless of whether that level of capabilities attainment is temporary or reversible. In this paper, we describe and justify this Capabilitiesbased Approach to the acceptability and tolerability of risks. We argue that the proposed theoretical framework avoids the limitations in current approaches to.. (shrink)

My goal in this dissertation is to start a conversation about the role of risk in the decision-theoretic assessment of partial beliefs or credences in formal epistemology. I propose a general theory of epistemic risk in terms of relative sensitivity to different types of graded error. The approach I develop is broadly inspired by the pragmatism of the American philosopher Charles Sanders Peirce and his notion of the ``economy of research.'' I express this framework in information-theoretic terms and (...) show that epistemic risk, so understood, is dual to information entropy. As a result, every unit increase in risk comes with a corresponding unit decrease in information entropy and epistemic risk may be expressed in terms of entropic change. I explain the significance of this for the selection of priors and the Laplacian principle of indifference. I also extend this notion of epistemic risk to the assessment of updating rules, where a similar duality between risk and information holds. In the dynamic context, epistemic risk is given by cross-entropic change. Here I explore the relationship between risk, the Value of Knowledge Theorem, dynamic coherence, and the role of expected accuracy in the selection of update rules. Finally, I apply these considerations to a social institution where attitudes to error are especially salient -- namely, legal decision-making -- and argue that considerations regarding the relative severity of different types of error are central to understanding evidentiary burdens of proof and the probative value of statistical evidence. (shrink)

Nicholas Makins proposes that doctors should take a deferential attitude towards their patients’ preferences when making decisions, and this includes their risk attitudes.1 He grounds this proposal in the principles of autonomy and beneficence. Makins appears to hold autonomy as a good in and of itself, and so for him it follows that deferring to patients must also be good. He also seems to hold that the satisfaction of personal preferences inevitably leads to improved well-being, and so deferring to (...) patients’ risk attitudes upholds the principle of beneficence. Unfortunately, Makins explicitly avoids defining well-being. His account seems to ignore the possibility of an objective measure of health that could contravene patient preferences, and therefore, challenge a deferential approach. While it is true that medicine is replete with complex decisions and significant uncertainty which require value judgements to navigate, it is not true medicine is purely about satisfying preferences. Patient preferences should always guide clinical decisions, but it seems to me Makins is making the far stronger claim that a doctor should act as a substitute decision-maker of sorts, doing their best to make the decision as if they were the patient themselves. I would contend this is not a good idea, as it would clearly impact a doctor’s …. (shrink)

The construction industry consistently ranks amongst the highest contributors to global gross domestic product, as well as, amongst the most corrupt. Corruption therefore inflicts significant risk on construction activities, and overall economic development. These facts are widely known, but the various sources and nature of corruption risks endemic to the Iranian construction industry, along with the degree to which such risks manifest, and the strength of their impact, remain undescribed. To address the gap, a mixed methods approach is used; (...) with a questionnaire, 103 responses were received, and these were followed up with semi-structured interviews. Results were processed using social network analysis. Four major corruption risks were identified: procedural violations in awarding contracts, misuse of contractual arrangements, neglect of project management principles, and, irrational decision making. While corruption risks in Iran align with those found in other countries, with funds being misappropriated for financial gain, Iran also shows a strong inclination to champion projects that serve the government’s political agenda. Root cause identification of corruption risks, namely, the noticeable impact of authoritarianism on project selection in Iran, over criterion of economic benefit or social good, is a significant outcome of this study. (shrink)