The purpose of this article is to show that animal rights are not necessarily at odds with the use of animals for research. If animals hold basic moral rights similar to those of humans, then we should consequently extend the ethical requirements guiding research with humans to research with animals. The article spells out how this can be done in practice by applying the seven requirements for ethical research with humans proposed by Ezekiel Emanuel, David Wendler and Christine (...) Grady to animal research. These requirements are i) social value, ii) scientific validity, iii) independent review, iv) fair subject selection, v) favorable risk-benefit ratio, vi) informed consent, and vii) respect for research subjects. In practice, this means that we must reform the practice of animal research to make it more similar to research with humans, rather than completely abolish the former. Indeed, if we banned animal research altogether, then we would also deprive animals of its potential benefits – which would be ethically problematic. (shrink)

Journal of Social Philosophy, EarlyView.

In this article I investigate several "sorts of naturalism" that have been advanced in recent years as possible foundations for virtue ethics: those of Michael Thompson, Philippa Foot, Rosalind Hursthouse, John McDowell, and Larry Arnhart. Each of these impressive attempts fails in illuminatingly different ways, and in the opening sections I analyze what has gone variously wrong. I next use this analysis to articulate four criteria that any successful Aristotelian naturalism must meet (my goal is to show what naturalism must (...) deliver, not yet to show that it can deliver it). I then look at Alasdair MacIntyre's approach, which begins with our natural trajectory from complete dependency toward becoming independent practical reasoners; I argue that this sort of naturalism meets the aforementioned criteria and thus provides a good example of what Aristotelian naturalists must do. I close with a consideration of two important objections to any broadly MacIntyrean sort of naturalism. (shrink)

Since aesthetic experience is vital for the protection of nature, I address the relationship between environmental aesthetics and environmentalism. I first review two traditional positions, the picturesque approach and formalism. Some environmentalists fault the modes of aesthetic appreciation associated with these views, charging they are anthropocentric, scenery-obsessed, superficial, subjective, and/or morally vacuous. In light of these apparent failings of traditional aesthetics of nature, I suggest five requirements of environmentalism: that aesthetic appreciation of nature should be acentric, environment-focused, serious, objective (...) and morally engaged. I then examine two contemporary positions concerning appropriate aesthetic appreciation of nature, the aesthetics of engagement and scientific cognitivism, assessing each in terms of the requirements of environmentalism. (shrink)

Although convinced by Frankfurt-style cases that moral responsibility does not require the ability to do otherwise, semicompatibilists have not wanted to accept a parallel claim about moral responsibility for omissions, and so they have accepted asymmetrical requirements on moral responsibility for actions and omissions. In previous work, I have presented a challenge to various attempts at defending this asymmetry. My view is that semicompatibilists should give up these defenses and instead adopt symmetrical requirements on moral responsibility for actions (...) and omissions, and in this paper I highlight three advantages of doing so: first, it avoids a strange implication of the truth of determinism; second, it allows for a principled reply to Philip Swenson’s recent ‘No Principled Difference Argument’; third, it provides a reason to reject a crucial inference rule invoked by Peter van Inwagen’s ‘Direct Argument’ for the incompatibility of moral responsibility and determinism. (shrink)

In this paper, I challenge a familiar argument -- a composite of arguments in the literature -- for the view that “Why be moral?” is a pseudo-question. I do so by refuting a component of that argument, a component that is not only crucial to the argument but important in its own right. That component concerns the status of moral reasons in replies to “Why be moral?”; consequently, this paper concerns reasons and rationality no less than it concerns morality. The (...) work I devote to those topics shows not only that the argument I address is unsound, but that the conclusion of that argument is false. “Why be moral?” is no pseudo-question. (shrink)

In 2016, this Journal published an article by Rob Lawlor1 on what we might call the acceptance-refusal asymmetry in competence requirements. This is the view that there can be cases in which a patient is sufficiently competent to accept a treatment, but not sufficiently competent to refuse it. Though the main purpose of Lawlor’s paper was to distinguish this asymmetry from various other asymmetries with which it has sometimes been confused,1 Lawlor also presented a brief case in favour of (...) it. Developing an earlier argument of Ian Wilks’,2 3 Lawlor argued that, when the risks associated with refusing a treatment are graver than those associated with accepting it, a higher level of competence may be required to refuse a treatment than to accept it. This claim could have important implications for the law, since determinations of competence often play a central role in determining the lawfulness of refusing or imposing a treatment. Indeed, the acceptance-refusal asymmetry in competence requirements, or something close to it, has played an important role in court judgments.2 However, Lawlor himself suggests that his conclusion will have practical implications only in a narrow range of cases.3 In this issue, Pickering, Giles Newton-Howes and Simon Walker respond to Lawlor’s piece.4 They deny that competence requirements should depend on the level of risk associated with a decision, and thus that there is any basis for the acceptance-refusal asymmetry in competence requirements. Part of the authors’ argument involves contesting the way in which Lawlor uses cases to support his view. In one case cited by Lawlor—and drawn from Wilks—we are invited to consider a whether …. (shrink)

Despite existing international, regional and national guidance on how to obtain valid consent to health-related research, valid consent remains both a practical and normative challenge. This challenge persists despite additional evidence-based guidance obtained through conceptual and empirical research in specific localities on the same subject. The purpose of this paper is to provide an account for why, despite this guidance, this challenge still persist and suggest conceptual resources that can help make sense of this problem and eventually mitigate it’. This (...) paper argues that despite the existence of detailed official guidance and prior conceptual and empirical research on how to obtain valid consent, the question of ‘how to obtain and ascertain valid consent to participation in health-related research’ cannot always be fully answered by exclusive reference to pre-determined criteria/guidance provided by the guidelines and prior research’. To make intelligible why this is so and how this challenge could be allayed, the paper proposes six concepts. The first five of these are intended to account for the persistent seeming inadequacies of existing guidelines. These are fact-skepticism; guideline insufficiency; generality; context-neutrality and presumptiveness. As an outcome of these five, the paper analyzes and recommends a sixth, called bioethical reflexivity. Bioethical reflexivity is reckoned as a handy tool, skill, and attitude by which, in addition to guidance from context-specific research, the persisting challenges can be further eased. Existing ethical guidelines on how to obtain valid consent to health-related research are what they ought to be – general, presumptive and context-neutral. This explains their seeming inadequacies whenever they are being applied in concrete situations. Hence, the challenges being encountered while obtaining valid consent can be significantly eased if we appreciate the guidelines’ nature and what this means for their implementation. There is also a need to cultivate reflexive mindsets plus the relevant skills needed to judiciously close the unavoidable gaps between guidelines and their application in concrete cases. This equally applies to the gaps which cannot be filled by reference to additional guidance from prior conceptual and empirical research in specific contexts. (shrink)

Investment Management makes heavy ethical demands which are not an optional add‐on, but part of the job of being a financial agent and fiduciary. The author is founder and President of Skandia Fonds, the Norwegian mutual funds management company affiliated with Skandia Group which pioneered the concept of green mutual funds in Norway. This paper was delivered at the Sixth Annual Conference of the European Business Ethics Network, held in Oslo last month. Its views are those of the author, and (...) do not necessarily represent his company's policy. (shrink)

Die Anforderungen an das ethisch-professionelle Handeln Pflegender und somit auch die Forderungen an die professionelle Ethikkompetenz Pflegender im praktischen Berufsfeld wandeln sich sowohl qualitativ als auch quantitativ. Dies wird auch in den veränderten normativen Rahmungen der Pflegebildung deutlich. Der Lernort Praxis als ein zentraler Ort pflegebezogener (Aus‑)Bildungsprozesse rückt somit nochmals stärker in den Fokus der Ethikkompetenzentwicklung professionell Pflegender. Der Beitrag konturiert zentrale Anforderungen und veränderte Bezüglichkeiten für die Ethikbildung im beruflichen Handlungsfeld professioneller Pflege und formuliert davon ausgehend zentrale Prämissen an (...) organisationsethische Rahmenbedingungen mit dem Ziel, eine ethisch fundierte professionelle pflegerische Handlungspraxis zu unterstützen. (shrink)

Two separate regulatory regimes govern research with adults who lack capacity to consent in England and Wales: the Mental Capacity Act (MCA) 2005 and the Medicines for Human Use (Clinical Trials) Regulations 2004 (“the Regulations”). A service evaluation was conducted to investigate how research ethics committees (RECs) are interpreting the requirements. With the use of a coding scheme and qualitative software, a sample of REC decision letters where applicants indicated that their project involved adults who lacked mental capacity was (...) analysed. The analysis focuses on 45 letters about projects covered by the MCA and 12 letters about projects covered by the Regulations. The legal requirements for involving incapacitated adults in research were not consistently interpreted correctly. Letters often lacked explicitness and clarity. Neither consent nor assent from third parties is a legally valid concept for purposes of the MCA, yet they were suggested or endorsed in 10 post-MCA letters, and there was evidence of confusion about the consultee processes. The correct terms were also not consistently used in relation to clinical trials. Inappropriate use of terms such as “relative” had the potential to exclude people eligible to be consulted. Unless the correct terms and legal concepts are used in research projects, there is potential for confusion and for exclusion of people who are eligible to be consulted about involvement of adults who lack capacity. Improved clarity, explicitness and accuracy are needed when submitting and reviewing applications for ethical review of research in this area. (shrink)

According to the beneficiary pays principle (BPP), following an injustice that has produced damages, agents that have received benefits from it may incur a duty to redress the victim even if they are not at fault for it. In this paper, I do not offer either a full-blown defense or a refutation of the principle. Instead, I take issue with the common view, accepted by both sympathetic and critical authors, according to which the BPP is a matter of corrective justice. (...) In the end, I am going to argue that the sole way of defending the BPP is as a principle of distributive justice. Far from a merely semantic dispute, the issue of whether the BPP is corrective or distributive is going to lead to significant normative implications regarding the sense in which we can meaningfully say that beneficiaries owe it to victims to redress the unfairness existing between them. (shrink)

The number of women living with HIV/AIDS is increasing worldwide, and there is an urgent public health need to develop new user-initiated HIV prevention methods, including microbicides. Although funding for microbicide development has increased since 2000, financial support is provided predominantly by governmental agencies and private foundations. Many donors, including the US Agency for International Development (USAID) and the US National Institutes of Health (NIH), have policies that restrict how research funds may be used. Among these are the now-rescinded Mexico (...) City Policy, elements of the US Foreign Assistance Act, and restrictions on non-study-related care. The effect of these restrictions on the design and conduct of clinical research is poorly understood. As part of a recent mapping exercise conducted by the Global Campaign for Microbicides, we reviewed the impact of donor restrictions on seven HIV prevention trials. We found considerable confusion within the HIV prevention field as to whether and how Mexico City and other policies affect the use of research funds. We also found that these donor-imposed policies limited the level of care provided to trial participants and the types of capacity building projects undertaken. (shrink)

Standard decision theory, or rational choice theory, is often interpreted to be a theory of instrumental rationality. This dissertation argues, however, that the core requirements of orthodox decision theory cannot be defended as general requirements of instrumental rationality. Instead, I argue that these requirements can only be instrumentally justified to agents who have a desire to have choice dispositions that are stable over time and across different choice contexts. Past attempts at making instrumentalist arguments for the core (...) requirements of decision theory fail due to a pervasive assumption in decision theory, namely the assumption that the agent’s preferences over the objects of choice – be it outcomes or uncertain prospects – form the standard of instrumental rationality against which the agent’s actions are evaluated. I argue that we should instead take more basic desires to be the standard of instrumental rationality. But unless agents have a desire to have stable choice dispositions, according to this standard, instrumental rationality turns out to be more permissive than orthodox decision theory. (shrink)

Does the law contain implicit exceptions to its own rules? If so, what consequence does that have for understanding the relationship between law and morality? This collection gathers leading legal philosophers to analyse the logical structure of legal norms, advancing the understanding of the general philosophy of law.

In a substantial number of cases, dying patients are brought into a state of lowered consciousness and kept in it until they die in order to prevent or stop severe suffering. Many guidelines and position statements have been published in recent years on sedation until death, as I will call this policy. Some have been published by professional organisations and are meant to be binding for their members, others are the work of task forces and merely aim at providing medical, (...) moral, and legal guidance.1 These guidelines all take the following positions: the patient’s consciousness should not be lowered more than is necessary for preventing her from suffering; it must be impossible to alleviate the suffering in any... (shrink)

This paper puts forward a wish list of requirements for formal fairness in the specific context of triage in emergency departments (EDs) and maps the empirical and conceptual research questions that need to be addressed in this context in the near future. The pandemic has brought to the fore the necessity for public debate about how to allocate resources fairly in a situation of great shortage. However, issues of fairness arise also outside of pandemics: decisions about how to allocate (...) resources are structurally unavoidable in healthcare systems, as value judgements underlie every allocative decision, although they are not always easily identifiable. In this paper, we set out to bridge this gap in the context of EDs. In the first part, we propose five formal requirements specifically applied for ED triage to be considered fair and legitimate: publicity, accessibility, relevance, standardisability and accountability. In the second part of the paper, we map the conceptual and empirical ethics questions that will need to be investigated to assess whether healthcare systems guarantee a formally just ED triage. In conclusion, we argue that there is a vast research landscape in need of an in-depth conceptual and empirical investigation in the context of ED triage in ordinary times. Addressing both types of questions in this context is vital for promoting a fair and legitimate ED triage and for fostering reflection on formal fairness allocative issues beyond triage. (shrink)

Clinical biobanks processing data of participants in the European Union fall under the scope of the General Data Protection Regulation, which among others includes requirements for consent. These requirements are further specified by the Article 29 Working Party —an EU advisory body currently known as the European Data Protection Board. Unfortunately, their guidance is cause for some confusion. While the GDPR allows participants to give broad consent for research when specific research purposes are still unknown, the WP29 guidelines (...) suggest that additional consent for specific uses should be obtained in addition to broad consent when this becomes applicable. This discrepancy elicits the question whether clinical biobanks can fail the requirement of consent if they obtain broad consent, but not a specific consent for each biomedical study. We analysed this discrepancy within the framework of contextual integrity, in order to describe the context-relative informational norms that govern information flows in clinical biobanks. However, our analysis demonstrates that there is no uniform set of norms that can be applied to all clinical biobanks. As such, neither the GDPR nor the WP29 guidance can act as a “one size fits all” approach to all clinical biobanks. Rather, differences between clinical biobanks—especially regarding the scientific aims and patient populations—make the case for context-relative norms that determine the appropriate type of consent. (shrink)

Objectives—To assess the relationship between the approval of trials by a research ethics committee and the fact that informed consent from participants was obtained, with the quality of study design and methods.Design—Systematic review using a standardised checklist.Main measures—Methodological and ethical issues of all trials published between 1993 and 1995 in the New England Journal of Medicine, the Lancet, the Journal of the American Medical Association and the British Medical Journal were studied. In addition, clinical trials conducted in Spain and published (...) by at least one Spanish author during the same period in any other journal were also included.Results—We studied the published articles of 767 trials and found the following indicators of lower methodological quality to be independent predictors for failure to disclose REC approval or ICP: absence of concealment of allocation, lack of justification for unblinded trials, not using a treatment for the patients in the control group, absent information on statistical methods, not including sample size estimation, not establishing the rules to stop the trial, and omitting the presentation of a baseline comparison of groupsConclusion—Trials of higher methodological and scientific quality were more likely to provide information about their ethical aspects. (shrink)

You may remember that a document circulated amongst University of Manchester staff asks, “Can top down management make our university great?” I suspect there is a difficulty with solving this problem by increasing the admission requirements, in terms of the grades you need to get in. At a certain level, one encounters a widespread and strong preference not to be the bottom level.

Automated software engineering has attracted a large amount of research efforts. The use of object-oriented methods for software systems development has made it necessary to develop approaches that automate the construction of different Unified Modeling Language models in a semiautomated approach from textual user requirements. UML use case models represent an essential artifact that provides a perspective of the system under analysis or development. The development of such use case models is very crucial in an object-oriented development method. The (...) main principles used in obtaining these models are described. A natural language processing tool is used to parse different statements of the user requirements written in Arabic to obtain lists of nouns, noun phrases, verbs, verb phrases, etc., that aid in finding potential actors and use cases. A set of steps that represent our approach for constructing a use case model are presented. Finally, the proposed approach is validated using an experiment involving a group of graduate students who are familiar with use case modeling. (shrink)

In april 1872, with the caisson at a depth of seventy-odd feet and still no bedrock, two men died. The strain for Roebling was nearly unbearable, as his wife later said. On May 18, a third man died, and that same day Roebling made the most difficult and courageous decision of the project. Staking everything — the success of the bridge, his reputation, his career - he ordered a halt. The New York tower, he had concluded, could stand where it (...) was, at a depth of 78 feet 6 inches, not on bedrock, but on “hardpack” sand. From examinations of the strata he had determined to his own satisfaction that no movement had occured at the level since the time of deposit millions of years in the geologic past; so, he said, it was “good enough to found upon”. (shrink)

A commonly held view is that giving to the poor is superogatory i.e., that while it is a good thing to do, it is not morally wrong for us not to do so. This essay sets out to show that for the affluent in the world giving to the poor is not superogatory but is rather a moral obligation. The paper critiques Singer's famous argument in ‘Famine, Affluence and Morality’ and finds that although the argument is a cogent and powerful (...) one, Singer, when trying to apply the argument to how we should act, somewhat skews the argument's real implications. Furthermore, it is argued that a cosmopolitan concern for the global poor is the morally correct response to have, and the author defends this view by examining the proper effect that aspects like geographical distance, nationality, reciprocity, and the nature of the global economic system should have on our moral considerations. In conclusion, it is argued that since the way that each person utilises his/her resources is a reflection of what he/she values, then for many of us in positions of affluence, in order to be moral, much more should be done in order to help those experiencing dire, life-threatening poverty across the globe.1. (shrink)

The problem of collecting, analyzing and evaluating evidence on adverse drug reactions (ADRs) is an example of the more general class of epistemological problems related to scientific inference and prediction, as well as a central problem of the health-care practice. Philosophical discussions have critically analysed the methodological pitfalls and epistemological implications of evidence assessment in medicine, however they have mainly focused on evidence of treatment efficacy. Most of this work is devoted to statistical methods of causal inference with a special (...) attention to the privileged role assigned to randomized controlled trials in Evidence Based Medicine. Regardless of whether the RCT’s privilege holds for efficacy assessment, it is nevertheless important to make a distinction between causal inference of intended and unintended effects, in that the unknowns at stake are heterogonous in the two contexts. This point has been emphasized by epidemiologists in the last decade. Their main focus is methodological, and regards the fact that bias and confounding do not affect studies on intended and unintended effects in the same way. However, deeper concerns ground the intuition for such a distinction; these are related to the constraints which we impose on evidence and their epistemological justification. My thesis is that such constraints ought to be understood to be different in the case of evidence for risk vs. benefit assessment. I present the recent debate on the causal association between acetaminophen and asthma in order to illustrate the point at issue. (shrink)

Journal of Political Philosophy, EarlyView.

The U.S. Supreme Court held, in American Manufacturers Mutual Insurance Co. v. Sullivan, 119 S. Ct. 988, that state workers’ compensation system insurers cannot be sued for withholding health care benefits for work-related injuries while they decide whether the treatment is “reasonable” and “necessary.” The respondents, ten employees and two organizations representing employees who received medical benefits under the Workers’ Compensation Act, brought a 42 U.S.C. § 1983 action against state officials, the Pennsylvania State Workers’ Insurance Fund, private insurers, and (...) the school district, alleging that their due process rights were violated by provisions of the Pennsylvania Workers’ Compensation Act, 77 Pa. Cons. Stat. Ann. § 1 et seq.. The Act permits suspension of benefits without notice or opportunity to be heard pursuant to a “utilization review” process.To control costs, Pennsylvania amended its workers’ compensation system in 1993. Under the Act, an employer or its insurer must pay for all reasonable and necessary medical treatment. (shrink)

In the first part, the author characterizes the fundamental contents (principles) of the constitutional state. In the second part, he describes the necessary reforms both at the level of the national constitutional state and at the global and humanity level. In the third part, he examines the methods and procedures of reform in the constitutional state, analysing: a) constitutional formation or complete revision; b) constitutional amendments or partial revision; c) parliamentary constitutional legislation; d) constitutional interpretation; e) government and non‐governmental “outlook” (...) commissions. (shrink)