This article examines the relationship between compromise and fairness, and considers in particular why, if a fair outcome to a conflict is available, the conflict should still be subject to compromise. It sets out the defining features of compromise and explains how fair compromise differs from both principled and pragmatic compromise. The fairness relating to compromise can be of two types: procedural or end-state. It is the coherence of end-state fairness with (...) class='Hi'>compromise that proves the more puzzling case. We offer reasons why people should be allowed to resolve conflicting or competing claims through compromise, even if compromise comes at the expense of end-state fairness, but we resist the suggestion that the primary rationale for compromise is to be found in non-ideal circumstances. (shrink)

_Many philosophers have pointed out that a compromise that is fair in one sense can be unfair in another. In this paper, I will briefly introduce different ways in which compromises can be “fair” and then analyze them. In particular, I compare the importance of what I call (a) split-the-difference fairness and (b) end-state fairness. I will defend split-the-difference fairness against an important objection—that a person’s false belief about her fair share does not change what her (...) fair share actually is. To allow such a notion would be rather like allowing her false belief to alter what is actually true. Nevertheless, I aim to provide support for the idea that sometimes it may make sense to consider people’s actual beliefs, even if they are false. However, I do not take a strong position on the question of what the most important sense of fairness is with regard to compromises.__ _ _Keywords_: Compromise, fairness, distribution, agreement, false beliefs. (shrink)

It seems natural to think that compromises ought to be fair. But it is false. In this paper, I argue that it is never a moral desideratum to reach fair compromises and that we are sometimes even morally obligated to try to establish unfair compromises. The most plausible conception of the fairness of compromises is David Gauthier’s principle of minimax relative concession. According to that principle, a compromise is fair when all parties make equal concessions relative (...) to how much they can gain from an agreement and relative to how much they would lose without an agreement. To find out whether reaching a fair compromise sometimes is a moral desideratum, I discuss several paradigmatic cases in friendships, economics and politics, and I try to show that even when the parties have moral reasons to refrain from trying to maximize utility in the negotiations, they do not have moral reasons to aim at a fair compromise. My second claim is that we are sometimes morally obligated to try to establish unfair compromises, in particular when we are dealing with parties that try to establish morally very bad political arrangements. In such cases, we should try to concede as little as possible to achieve an outcome that is morally acceptable. Fair compromises, in other words, are morally much more dubious than is usually appreciated. (shrink)

A compromise is an agreement that involves mutual concessions. Each party gets less than it feels entitled to, but agrees to it because the situation it anticipates under the deal is better than the one it expects in the absence of a deal: conflict, exit or arbitration by a third party. Some compromises, however, are bad, and others are good. This article discusses three conjectures about what it is that makes a compromise good. Is a good compromise (...) an honourable compromise, one that enables each party to save face? Is it rather a fair compromise, one that contributes to the progress of justice independently defined? Or is it a Pareto-improving compromise, one that changes things in such a way that it ends up making everyone better off than under the status quo? A compromise is never as good as a consensus, but it is generally better than nothing, and often achievable when a consensus is not. And when it is, trying to make it as good as possible in each of the three ways described is always worthwhile. © 2012 Government and Opposition Ltd. (shrink)

What is a fair distribution of resources and other goods when individuals are partly responsible for their achievements? This book develops a theory of fairness incorporating a concern for personal responsibility, opportunities and freedom. With a critical perspective, it makes accessible the recent developments in economics and philosophy that define social justice in terms of equal opportunities. It also proposes new perspectives and original ideas. The book separates mathematical sections from the rest of the text, so that the main (...) concepts and ideas are easily accessible to non-technical readers. -/- It is often thought that responsibility is a complex notion, but this monograph proposes a simple analytical framework that makes it possible to disentangle the different concepts of fairness that deal with neutralizing inequalities for which the individuals are not held responsible, rewarding their effort, respecting their choices, or staying neutral with respect to their responsibility sphere. It dwells on paradoxes and impossibilities only as a way to highlight important ethical options and always proposes solutions and reasonable compromises among the conflicting values surrounding equality and responsibility. -/- The theory is able to incorporate disincentive problems and is illustrated in the examination of applied policy issues such as: income redistribution when individuals may be held responsible for their choices of labor supply or education; social and private insurance when individuals may be held responsible for their risky lifestyle; second chance policies; the measurement of inequality of opportunities and social mobility. (shrink)

Compromise is a valuable decision-making procedure. This article argues that its value lies in the norms of reciprocity and consent. Reciprocity structures the practice of concession-giving. Compliance with this tacit rule expresses an ethos of mutual concern and achieves a shared sense of fairness. Consent is a useful safeguard against asymmetric deals and makes compromise morally binding. The procedural value of compromise gives us important reasons to choose this method for resolving conflicts.

Funders (located primarily in high‐income countries) and high‐income country researchers have historically dominated decision‐making within global health research collaborations: from setting agendas and research design to determining how data are collected and analysed and what happens with findings and outputs. The ethical principle of shared decision‐making has been proposed as a way to help address these imbalances within collaborations and to reduce semicolonial and exploitative forms of global health research. It is important to be clear about what shared decision‐making means (...) in order to ensure that it is not done in a tokenistic, shallow way. Thus far, the principle’s content has not been examined and articulated in detail. This paper aims to start the process of delineating a concept of fair shared decision‐making as a minimum standard for global health research. Using two hypothetical case examples, the paper will demonstrate that global health research practice is often inconsistent with ideal shared decision‐making. In such instances, it can be difficult to decide whether shared decision‐making within collaborations is fair. The paper describes how the two cases do not meet criteria for unfair or non‐ideal shared decision‐making, despite having potentially morally troubling features. The nuances of these examples of research practice help to generate clearer ideas about how to judge fairness in shared decision‐making. The paper concludes by presenting ideas about when soft power can be fairly employed between high‐income‐country and low‐ and middle‐income‐country partners and what fair compromise agreements may look like in shared decision‐making. (shrink)

We study a controversial application of algorithmic profiling in the public sector, the Austrian AMAS system. AMAS was supposed to help caseworkers at the Public Employment Service (PES) Austria to allocate support measures to job seekers based on their predicted chance of (re-)integration into the labor market. Shortly after its release, AMAS was criticized for its apparent unequal treatment of job seekers based on gender and citizenship. We systematically investigate the AMAS model using a novel real-world dataset of young job (...) seekers from Vienna, which allows us to provide the first empirical evaluation of the AMAS model with a focus on fairness measures. We further apply bias mitigation strategies to study their effectiveness in our real-world setting. Our findings indicate that the prediction performance of the AMAS model is insufficient for use in practice, as more than 30% of job seekers would be misclassified in our use case. Further, our results confirm that the original model is biased with respect to gender as it tends to (incorrectly) assign women to the group with high chances of re-employment, which is not prioritized in the PES’ allocation of support measures. However, most bias mitigation strategies were able to improve fairness without compromising performance and thus may form an important building block in revising profiling schemes in the present context. (shrink)

It is fairly uncontroversial that when you encounter disagreement with some view of yours, you are often epistemically required to become at least somewhat less confident in that view. This includes political disagreements, where your level of confidence might in various ways affect your voting and other political behavior. But suppose that your opponents don’t comply with the epistemic norms governing disagreement – that is, they never reduce their confidence in their views in response to disagreement. If you always reduce (...) your confidence, but your opponents never reduce theirs – and everyone participates in the political process accordingly – then it seems like the deliberative process will be unfairly skewed in favor of your opponents. In this paper, I do two things. First, I try to explain how this can be so, even though the process by stipulation represents everyone’s beliefs equally. Second, I defend the view that in such cases, you should remedy the unfairness by voting out of accord with your beliefs. By introducing a distinct state that I call a “personal take,” which you can vote on the basis of in such a case, I explain how doing this need not be problematically insincere, nor incoherent from the inside. The discussion has a number of independent upshots for both democratic theory and the epistemology of disagreement. (shrink)

The term "fairness," in everyday language, seems to be used in two main ways: to express the idea of a fair division of something, and to express the idea of a fair response to the behavior of other people. This latter, by extension, captures the more general notion of reciprocity. Ernst Fehr refers to reciprocity and conditional cooperation as resulting from the operation of social norms. In this paper I suggest a different framework, recognizing differences between social norms (...) and of moral norms, in terms of both operation and substantive content, and establishing a third category of "quasi-moral norms," comprising norms of reciprocity and of conditional cooperation and bearing both conditional and unconditional aspects. In conclusion, I offer two observations about the social consequences of fairness motivations. First, strategic or self-deceptive charges of unfairness can raise the stakes, create deadlock and prevent compromise. Reactions to perceived unfairness, and anticipation of such reactions, can make the world a better place, but may also generate waste and inefficiency. Second, the conditional motivation of fairness requires some unconditional cooperators to get activated. Once activated, it will pick up not only some who are motivated by the quasi-moral norm of fairness, but also some who are under the sway of social norms. Fairness motivations can make the world a better place, but they need help. (shrink)

This book argues that moral philosophy should be based on seven scientific principles of theory selection. It then argues that a new moral theory—Rightness as Fairness—satisfies those principles more successfully than existing theories. Chapter 1 explicates the seven principles of theory-selection, arguing that moral philosophy must conform to them to be truth-apt. Chapter 2 argues those principles jointly support founding moral philosophy in known facts of empirical moral psychology: specifically, our capacities for mental time-travel and modal imagination. Chapter 2 then (...) shows that these capacities present human decisionmakers with a problem of diachronic rationality that includes but generalizes beyond, L.A. Paul’s problem of transformative experience: a problem that I call “the problem of possible future selves.” Chapter 3 then argues that a new principle of rationality—the Categorical-Instrumental Imperative—is the only rational solution to this problem, as it requires our present and future selves to forge and uphold a recursive, bi-directional contract with each another given mutual recognition of the problem. Chapter 4 then shows that the Categorical-Instrumental Imperative has three identical formulations analogous but superior to Immanuel Kant’s various formulations of his ‘categorical imperative.’ Chapter 5 shows that these unified formulas jointly entail a particular test of moral principles: a Moral Original Position similar to John Rawls’ famous ‘original position’, but which avoids a variety of problems with Rawls' model. Chapter 6 then shows that the Moral Original Position generates Four Principles of Fairness, which can then be combined into a single principle of moral rightness: Rightness as Fairness. This new conception of rightness is shown to reconcile four dominant moral frameworks (deontology, consequentialism, virtue ethics, and contractualism), as well as entail a new method of moral decisionmaking for applied ethics: a method of “principled fair negotiation” according to which applied ethical issues cannot be wholly resolved through principled debate, but must instead be resolved by actual negotiation and compromise. This method is then argued to generate novel, nuanced analyses of a variety of applied moral issues, including trolley cases, torture, and the ethical treatment of nonhuman animals. Chapter 7 then shows that Rightness as Fairness reconciles three leading political frameworks—libertarianism, egalitarianism, and communitarianism—showing how all three embody legitimate moral ideals that can, and should, be fairly negotiated against each other to settle the scope, and nature, of domestic, international, and global justice on an ongoing, iterated basis. Finally, Chapter 8 argues that Rightness as Fairness satisfies all seven of the principles of theory-selected defended in Chapter 1 more successfully than rival theories. (shrink)

In the 1970s, both Denmark and Norway passed abortion legislation that is still the basis for the regulation of abortion in these countries. The legislation was fairly liberal with abortion on demand until 12 weeks of gestation and a permission system for later abortions. This article provides a brief history of the developments leading up to these political compromises and an analysis of the reasons why they have proved remarkably stable. It ends by looking at some factors that may now (...) destabilize 50 years of stable compromise about abortion. (shrink)

The agonistic vs. epistemic dichotomy is fairly widespread in contemporary democratic theory and is endorsed by scholars as outstanding as Luis Felipe Miguel, Chantal Mouffe, and Nadia Urbinati. According to them, the idea that democratic deliberation can work as a rational exchange of arguments that aims at truth is incompatible with the recognition of conflict as a central feature of politics. In other words, the epistemic approach is bound to obliterate the agonistic and conflictive dimension of democracy. This article takes (...) this dichotomized way of thinking to task by reconstructing the association between democracy and compromise made by John Stuart Mill, John Morley, and Hans Kelsen. It concludes that the conceptualization of democracy as compromise offers an alternative to the agonistic vs. epistemic divide that disconcerts a significant part of political philosophy today. (shrink)

A growing body of literature has identified potential problems that can compromise the quality, fairness, and integrity of journal peer review, including inadequate review, inconsistent reviewer reports, reviewer biases, and ethical transgressions by reviewers. We examine the evidence concerning these problems and discuss proposed reforms, including double-blind and open review. Regardless of the outcome of additional research or attempts at reforming the system, it is clear that editors are the linchpin of peer review, since they make decisions that have (...) a significant impact on the process and its outcome. We consider some of the steps editors should take to promote quality, fairness and integrity in different stages of the peer review process and make some recommendations for editorial conduct and decision-making. (shrink)

Distributional fairness of corporate distributions is an important social issue linked to accounting for equality. Value added and the information contained in the value added statement can conceptually be regarded as a reflection of how the company is managed for all stakeholders. We investigate value added information published in sustainability reports to determine if the information provided is useful for assessing distributional fairness between stakeholders. We find that the value added information disclosed lack conciseness, comparability and understandability. The divergence is (...) considerable and the explanations of the disclosed information so limited that the usefulness of the value added disclosures must be questioned. Our results suggest several obfuscating techniques in the disclosure of value added information, including disclosing information that is conceptually compromised, resulting in comparability issues and disclosing information that can’t be verified by reconciling back to the financial statements. Our findings have clear ethical and moral implications as they stress the societal issue of distributional fairness. It seems that companies are either reluctant to provide value added information that is useful, or deliberately use value added disclosures to obfuscate. Information reflecting distributional fairness is therefore compromised. (shrink)

The presumption of innocence (POI) requires all judges, juries, and other officials in a trial, to presume and treat any accused of criminal wrongdoing as innocent, until he or she is proven guilty. Although a POI lacks an authoritative definition, this overarching principle of procedural fairness is so robust and vital for the exercise of legal power in matters of criminal law that one rarely finds anyone questioning its standing. In this article I examine the rationale behind the POI from (...) a different perspective. The basic assumption is that this procedural standard captures the tenor of a broader principle which seeks to ensure fairness in criminal proceedings as well as in criminal law doctrine. I argue that honouring a principle of fairness is not exclusively a matter of criminal procedural law but also something that is deeply rooted in other areas of criminal law doctrine. Hence: not maintaining a principle of fairness in criminal law doctrine could lead to the POI being compromised or even undermined. In the article, I draw attention to three areas in which I believe that criminal law policies threaten a principle of fairness: criminalising remote harm, doctrine of ignorance of law and inversed presumptions of guilt. My conclusion is that some solutions to so called doctrinal problems in criminal law, are questionable and their practical consequences (on a general level) are, at least partially, equal to treating an individual (in a trial) as guilty for something for which he or she ought not to be accountable. Hence: gaining the support of a POI could thus work as principle for keeping the use of criminal law moderate and in accordance with a principle of fairness. (shrink)

Suppose you and I are dividing a cake between us. If you divide and I choose, then—under standard assumptions—the distribution will be not only fair, but also envy-free. That is, neither of us prefers the other slice. The question that interests me in this essay, however, is the relationship between envy and fairness. Specifically, is it merely a coincidence that the envy-free distribution is fair, or does envy-freeness capture something important about fairness? I argue that envy-freeness does indeed (...) capture something about fairness. Yet, envy-minimizing—the compromise approach—does not. I first show that fairness does not plausibly require envy-minimizing; I then offer an explanation. Namely, envy-minimizing depends on the assumption that all envy is normatively equivalent. This assumption, however, is false. To illustrate, I introduce two types of envy—personal envy and impersonal envy—and show that impersonal envy is normatively significant in a way that personal envy is not. Specifically, impersonal envy is compatible with the rules of mutual justifiability; personal envy is not. I then use this distinction to explain the relationship between fairness and envy-freeness. In the process, the essay provides guidance on the fair division of heterogeneous and non-divisible goods. (shrink)

We study the allocation of cadaveric donor kidneys for transplantation based merely on waiting time. This simple allocation rule turns out to possess very attractive ethical and medical properties. Current allocation rules, on the other hand, violate some basic requirements of distributive justice. Perhaps for fear of exacerbating these problems, these rules also fail to consider criteria such as sex, age and race although certain combinations of these criteria are known to affect graft survival rates. We demonstrate that allocation by (...) waiting time automatically protects disadvantaged patient types and puts them in a near to optimal position. The inclusion of sex, age and race will therefore not lead to morally unacceptable allocations. This allows individual patients to improve the expected survival time of their graft relative to the status quo without being penalized by the allocation rule. Moreover, decisions ab out when to start compromising on expected graft survival rates in favour of shorter waiting times are made locally by patients and their medical advisers rather than by a centralized protocol. (shrink)

A long-standing puzzle for moral philosophers and psychologists alike is the concept of psychopathy, a personality disorder marked by tendencies to defy moral norms despite cognitive knowledge about right and wrong. Previously, discussions of the moral deficits of psychopathy have focused on willingness to harm and cheat others as well as reasoning about rule-based transgressions. Yet recent research in moral psychology has begun to more clearly define the domains of morality, en- compassing issues of harm, fairness, loyalty, authority, and spiritual (...) purity. Clinical descriptions and theories of psychopathy suggest that deficits may exist primarily in the areas of harm and fairness, although quantitative evidence is scarce. Within a broad sample of participants, we found that scores on a measure of psychopathy predicted sharply lower scores on the harm and fairness subscales of a measure of moral concern, but showed no relationship with authority, and very small relationships with ingroup and purity. On a measure of willingness to violate moral standards for money, psychopathy scores predicted greater willingness to violate moral concerns of any type. Results are further explored via potential mediators and analyses of the two factors of psychopathy. (shrink)

In modern society, democracy as a symbol of social civilization and progress is cherished. Any government or organization, whether truly democratic or not, will claim that it is democratic while its opponents are not. However, as a historical notion, democracy does not possess the quality of absoluteness. In my view, democracy, in its original meaning, should be understood as a way to social compromise, whose aim is to guarantee a relatively fair political life.

This paper takes a simple, informal suggestion by Broome and another more explicit suggestion by Kamm for how to deal with asymmetric claims and shows how they can be interpreted to be consistent with two different social welfare functions: Sum-of-square-roots of individual utilities, and product of utilities. These functions are then used to analyze more complicated situations but I show that the first yields more intuitive results, and a better compromise of efficiency and justice, than the other. (Published Online (...) July 11 2006). (shrink)

Solomon has made the case, in Social Empicism (2001) for socially naturalized analysis of the dynamics of scientific inquiry that takes seriously two critical insights: that scientific rationality is contingent, disunified, and socially emergent; and that scientific progress is often fostered by factors traditionally regarded as compromising sources of bias. While elements of this framework are widely shared, Solomon intends it to be more resolutely social, more thoroughly naturalizing, and more ambitiously normative than other contextualizing epistemologies currently on offer. Four (...) focal issues are addressed in the commentaries that follow: Solomon's characterization of empirical success as a goal of science (Clough); her distinction between empirical and non-empirical decision vectors and the viability of the multivariate analysis she proposes for assessing epistemic fairness in their distribution (Clough; Richardson); the plausibility of her thesis that normatively appropriate consensus is a (rare) limiting case rather than an intrinsically desirable outcome of inquiry (Oreskes; Richardson); and her conviction that a socially naturalized analysis of science can ground norms of scientific rationality (Longino; Oreskes). (shrink)

At a time when social and ethical responsibilities of companies and CEOs are being increasingly emphasised, this paper examines conduct of social business in a different age and culture to discern features of enduring relevance for ethical business practices today.The personal correspondence of three fourth‐century saints gives insights into their relationships and decision‐making.Community expectations were those of sharing rather than of outright giving, with ‘fusion of interest’ prevailing over concerns for ‘con?ict of interest’. Selected incidents show two entrepreneurial bishops, Basil (...) and Gregory of Nyssa, struggling to balance tensions between ’liberality’ and ‘fairness’.They compromised, competed robustly for revenues and were vexed over limited budgets and resources for projects while their disapproving cousin, the academic Gregory of Nazianzus, criticised their worldliness. Their historical experiences suggest four pragmatic and possibly normative ways of blending altruism and self‐interest for the overall advancement of bene?cial change. (shrink)

An increasingly popular objection to anti-intellectualism about know-how is that there are clear cases where an agent having the dispositional ability to φ does not suffice for her knowing how to φ. Recently, Adam Carter has argued that anti-intellectualism can only rise to meet this sufficiency objection if it imposes additional constraints on know-how. He develops a revisionary anti-intellectualism, on which knowing how to φ not only entails that the agent possesses a reliable ability to φ, but also that she (...) is equipped with certain kind of intellectual grasp of the method by which she is able to reliably φ. This paper argues that Carter's revisionary know-how does not constitute an improvement over the more standard version of anti-intellectualism. Moreover, it is argued that Carter's additional demands concede too much to the intellectualist, and, as a result, commit his revised anti-intellectualism to familiar problems facing the intellectualist account of know-how. In other words, his attempts to respond to the sufficiency objection constitutes a dangerous compromise to the intellectualist. The paper finishes with a final analysis that suggests, in the end, there are still reasons to prefer standard anti-intellectualism over intellectualism. (shrink)

In this paper, we respond to Andrew Avins's recent review of methods whose use he advocates in clinical trials, to make them more ethical. He recommends in particular, “unbalanced randomisation”. However, we argue that, before such a recommendation can be made, it is important to establish why unequal randomisation might offer ethical advantages over equal randomisation, other things being equal. It is important to make a pragmatic distinction between trials of treatments that are already routinely available and trials of restricted (...) treatments. We conclude that unequal randomisation could, indeed, be an ethical compromise between protecting the interests of participants and those of society. (shrink)

Hamas’s deliberate attack on October 7th against innocent civilians is absolutely wrong. Therefore, it should be universally condemned. And yet, I wonder how a universal recognition of an absolute duty of respect for human dignity can help solving the existential conflict confronting Israelis and Palestinians. Ideally, a two-state solution proposed by the international community can be seen as a reasonable and fair compromise. Nevertheless, the reality on the ground is different. Thus far the existence of one state has (...) precluded the existence of another with no end in sight to their mutually destructive violence. Their conflict demands that people who are reasonable and fair-minded try to understand it holistically and to offer an impartial assessment of this intractable conflict without relativizing the undeserved human suffering of all those involved and affected by it. (shrink)

Background Fair prioritization of healthcare resources has been on the agenda for decades, but resource allocation dilemmas in clinical practice remain challenging. Can clinical ethics committees be of help? The aim of the study was to explore whether and how CECs handle priority setting dilemmas and contribute to raising awareness of fairness concerns. Method Descriptions of activities involving priority setting in annual reports from Norwegian CECs were studied and categorized through qualitative content analysis. Results Three hundred thirty-nine reports from (...) 38 CECs were studied. We found 78 activities where resource use or priority setting were explicitly highlighted as main topics. Of these, 29 were seminars or other educational activities, 21 were deliberations on individual patient cases, whereas 28 were discussions of principled or general cases. Individual patient cases concerned various distributional dilemmas where values were at stake. Six main topics and seven roles for the CEC were identified. CECs handle issues concerning the introduction of new costly drugs, extraordinarily costly established treatment, the application of priority setting criteria, resource use for vulnerable groups, resource constraints compromising practice, and futility of care. The CEC can act as an analyst, advisor, moderator, disseminator, facilitator, watch dog, and guardian of values and laws. Discussion In order to fulfil their responsibilities in handling priority setting cases, CECs need knowledge of both the ethics and the institutionalized systems of priority setting. There is potential for developing this aspect of the CECs’ work further. Conclusions The Norwegian CECs are involved in priority setting decisions where they can play multiple constructive roles. In particular, they advise and raise awareness of ethical aspects in resource allocations; bridge clinical practice with higher-level decisions; and promote fair resource allocation and stakeholder rights and interests. (shrink)

As a step towards a systematic comparative evaluation of the fairness of different language policies, a rationale is presented for the design of an index of linguistic justice based on public policy analysis. The approach taken is to define a ‘minimum threshold of linguistic justice’ with respect to government language policy in three domains: law and order, public administration, and essential services. A hypothetical situation of pure equality and freedom in the choice of language used by all members of society (...) in communicating with the state is used as a theoretical benchmark to study the distributive effects of policy alternatives. Departures from this standard incur lower scores. Indicators are chosen to assess effective access to three kinds of language rights: toleration (the lack of state interference in private language choices), accommodation (accessibility of public services in different languages), and compensation (symbolic and practical recognition of languages outside the dominant one). In order to take account of the cost-benefit trade-offs involved in providing language-related goods to language groups of varying sizes, a method is adopted for weighting scores with respect to compensation rights so that lack of recognition for larger groups incurs greater penalties, while factoring in the particular characteristics of each language-related good. A trial set of ten indicators illustrates the compromises entailed in balancing theoretical rigour with empirical feasibility. (shrink)

This article critically examines the evolving policies surrounding the inclusion of transgender women in women’s sports categories, with a focus on the International Olympic Committee’s (IOC) framework. The author highlights the implications of prioritizing inclusion over fairness, arguing that the fundamental value of fairness in sports is compromised when male-bodied athletes compete in female categories. Through a detailed analysis, the article explores the role of categorization in preserving equitable competition, the impact of physiological advantages, and the socio-cultural narratives influencing policy (...) shifts. It concludes by questioning the long-term consequences of redefining sports to prioritize social justice concerns over their traditional purpose of fair competition. (shrink)

Les personnes appelées à faire partie d'un comité national d'éthique sont choisies à raison de leurs connaissances pratiques d'un domaine de la recherche biomédicale, ou d'un secteur particulier de la vie sociale, ou d'une tradition philosophique ou spirituelle, – le théologien entrant évidemment dans cette troisième catégorie sans être pour autant le représentant attitré d'une Église. Le bon fonctionnement du comité requiert, comme première base éthique, un apprentissage de la communication entre ces différents experts et une grande attention aux données (...) techniques des questions à élucider. Chaque groupe d'experts aborde, en effet, les enjeux éthiques de ces questions du point de vue propre à leurs disciplines professionnelles ; cependant, à défaut d'intérêts ou de convergences idéologiques, des références communes à la dignité de la personne, aux droits de l'homme, au devoir moral, à la responsabilité, permettent de négocier des compromis prudentiels entre des valeurs opposées. Le théologien intervient dans ces débats, souvent de concert avec le philosophe, pour approfondir l'approche rationnelle des problèmes, soutenir l'irréductibilité de la personne, élargir le regard aux dimensions de l'humanité entière.Those called to participate in a national committee on ethics are cbosen on the basis of their practical knowledge in a field of biomedical researcb, or of a particular sector of social life, or of a philosophical or spiritual tradition. The theologian, wbo obviously belongs to this third category, is not necessarily a qualified representative of a Church. The smooth functioning of the committee requires, as its first ethical basis, an apprenticeship in communication between these different experts and witb great attention given to the technical aspects of the questions to be clarified. Each group of experts tackles the ethical stakes of these questions from their own professional disciplines point of view. However, in the absence of common interests or ideological convergencies, the references they share as regards human dignity, human rights, moral duty, and responsibility, permit the negociation of prudent compromises concerning contradictory values. It is at this point that theologians enter into the debate. They often work with philosophers in order to deepen a rational approach to the problems, to support the integrity of the person, and to broaden their perpective to encompass all of humanity. (shrink)

David Brink’s book Fair Opportunity & Responsibility is a meticulously argued and ultimately convincing book that carefully articulates the requirements for criminal guilt and punishment. As the title suggests, Brink argues that only one who has a fair opportunity to be law-abiding ought to be held responsible when they commit a crime. It is unfair to hold a person responsible if they lack abilities necessary to legal agency at the time of a wrongful act, or if these abilities (...) are severely compromised. In this essay I focus on Brink’s handling of structural injustice and the way it can impact our responsibility practices. Structural injustice is a serious and pervasive problem in the U.S., and it is closely related to crime rates. I argue that structural injustice can ground a partial excuse based on compromised normative competence. This is a possibility that Brink does not explore. Marginalization can compromise one’s ability to make and follow normative judgments in keeping with one’s larger society and the criminal law; and what makes some marginalized persons less culpable is that their ability to recognize and respond to moral and legal reasons is compromised compared to those that are not marginalized. (shrink)

Accused persons who are subjected to a saturation level of negative media coverage may be denied an impartial hearing, which is perhaps the most important aspect of the right to a fair hearing. Despite this, the courts have generally held that the social imperative of prosecuting accused trumps the interests of the accused. The justification for an impartial hearing stems from the repugnance of convicting the innocent. Viewed dispassionately, this imperative is not absolute, given that every legal system condones (...) procedures which result in the conviction of some innocent people. While the importance of guarding against wrongful convictions has been overstated, the imperative to bring to trial all accused has been even more exaggerated. The legal system has displayed a capacity to deal with cases where the guilty walk free. The institutional integrity of the criminal justice system would be significantly compromised by convictions that are tarnished by pre-judgment. Confidence in the criminal justice system is more important than individual criminal accountability. The inability to receive an impartial hearing should result in a permanent stay. The only exception is where the alleged crime has the capacity to cause widespread fear or social unrest. This only applies in relation to serious acts of terrorism. This article focuses on recent legal fair trial developments in Australia, however, the analysis, reasoning and conclusion applies in relation to all jurisdictions where juries determine guilt and innocence. (shrink)

As part of a continuous process to explore the factors that might weaken or corrupt traditional peer review, in this paper, we query the ethics, fairness and validity of the request, by editors, of authors to suggest peer reviewers during the submission process. One of the reasons for the current crisis in science pertains to a loss in trust as a result of a flawed peer review which is by nature biased unless it is open peer review. As we indicate, (...) the fact that some editors and journals rely on authors’ suggestions in terms of who should peer review their paper already instills a potential way to abuse the trust of the submission and publishing system. An author-suggested peer reviewer choice might also tempt authors to seek reviewers who might be more receptive or sympathetic to the authors’ message or results, and thus favor the outcome of that paper. Authors should thus not be placed in such a potentially ethically compromising situation, especially as a mandatory condition for submission. However, the fact that they do not have an opt-out choice during the submission process—especially when using an online submission system that makes such a suggestion compulsory—may constitute a violation of authors’ rights. (shrink)

Cities and local governments loom large on the sustainability agenda. Networks such as Fair Trade Towns International (FTT) and the Organic Cities Network aim to bring about global policy change from below. Given the new enthusiasm for local approaches, it seems relevant to ask to what extent local groups exercise power and in what form. City networks present their members as “ethical places” exercising _power with_, rather than _power over_ others. The article provides an empirical analysis of the power (...) of FTT and Organic Cities in Germany. In both cases, we found cities that are eager to emphasize their inclusive potential. Their willingness to compromise is demonstrated most illustratively by the fact that several cities are members of both networks: While the FTT campaign aims to address problems of international trade but does not abandon it, Organic Cities advocate for a new localism based on food supply from farmers in the same region. In both cases, city networks use their purchasing power to increase the share of certified products. By doing so, the city networks reproduce privileged positions of consumers benefitting from the global capitalist order (_power over_). However, our analysis revealed that networks also make citizens reflect upon agri-food challenges and allow developing alternatives for more sustainable systems (_power with_). (shrink)

We deal with the ranking problem of the nodes in a directed graph. The bilateral relationships specified by a directed graph may reflect the outcomes of a sport competition, the mutual reference structure between websites, or a group preference structure over alternatives. We introduce a class of scoring methods for directed graphs, indexed by a single nonnegative parameter α. This parameter reflects the internal slackening of a node within an underlying iterative process. The class of so-called internal slackening scoring methods, (...) denoted by λα, consists of the limits of these processes. It is seen that λ0 extends the invariant scoring method, while λ∞ extends the fair bets scoring method. Method λ1 corresponds with the existing λ-scoring method of Borm et al. (Ann Oper Res 109(1):61–75, 2002) and can be seen as a compromise between λ0 and λ∞. In particular, an explicit proportionality relation between λα and λ1 is derived. Moreover, the internal slackening scoring methods are applied to the setting of social choice situations where they give rise to a class of social choice correspondences that refine both the Top cycle correspondence and the Uncovered set correspondence. (shrink)

The ‘tobacco-free generation’ policy, which bans cigarette sales based on birth year, presents a bold public health initiative but raises significant ethical and practical concerns. As behaviours like drug use become legal and criminal penalties are reduced, singling out smoking for generational restriction appears inconsistent within an increasingly permissive society. Kniess1 critiques this approach for creating inequities by selectively limiting freedoms, conflicting with principles of fairness and adult autonomy. A more balanced public health strategy could involve uniform restrictions on harmful (...) substances or prioritising informed personal choice, supported by harm reduction and education to encourage healthier alternatives. The generational smoking ban targets specific birth cohorts, prohibiting tobacco sales to those born after a certain year. Unlike universal bans, it creates two distinct adult classes—those permitted to smoke and those who are not—resulting in an apparently arbitrary division. Critics, including Schmidt,2 point to the ethical inconsistency of restricting liberties for some while leaving others untouched. This policy design has been defended as a pragmatic compromise, aiming to protect future generations without infringing on the established habits of current smokers (Grill and Voigt).3 Kniess1 evaluates this selective restriction through relational egalitarianism which emphasises the importance of equal social relationships. The cut-off, …. (shrink)

In 1987, the Brundtland Commission urged nations to improve present conditions without compromising the ability of future generations to meet their needs. Against the background of this appeal for sustainable development, there is a call for intergenerational justice, under a sufficientarian framework. Despite their strong relation, we claim that, to some degree, intergenerational sufficientarianism disregards relevant sustainability notions. This neglect undermines intergenerational sufficientarianism in the context of sustainability, here operationalized as sustainable development. In response, we propose the concept of irreplaceable (...) goods as a necessary bridge between the two frameworks. Simultaneously, we stress the need for scholars to consider sufficientarianism as a valid alternative to egalitarianism for achieving resource justice. To harmonize intergenerational sufficientarianism and sustainability, we firstly delineate sustainability theoretical notions that influence fair distributive futures. Secondly, we incorporate those sustainability constraints into the conceptual background of intergenerational sufficientarianism. We also establish the concept of irreplaceable goods as a pivot and anchor for further theoretical development on the sufficient well-being of future generations. Finally, we discuss the implications of this concept in terms of expenditure and investment by contemporary people. With the proposed adjustments, we advocate that intergenerational sufficientarianism is a robust framework to deliver just futures. (shrink)

L'intransigeance en morale, en politique ou en religion a une longue histoire mais, de nos jours, elle trouve des accents nouveaux. En dépit de tous les clichés sur l'actuel relativisme, elle ne manque pas d'imprimer sa marque, notamment dans l'Eglise catholique. Pourquoi en est-il ainsi? Comment expliquer la mauvaise réputation de l'idée de compromis alors que toute vie humaine est une négociation permanente avec principes, normes et valeurs? Telles sont les questions agitées dans ce livre, qui touchent tout à la (...) fois aux domaines religieux, politique et culturel. Entre le relativisme total des valeurs et une intransigeance qui traduit souvent une fragilité, existe-t-il une voie possible? Plus largement, Paul Valadier se livre à une critique de l'attitude intransigeante et à un plaidoyer pour un compromis bien compris, seul capable de faire droit à ce qu'il en est de l'homme et de ses relations, tant avec la nature qu'avec les autres. (shrink)

This book explores secession from three normative disciplines: political philosophy, international law and constitutional law. The author first develops a moral theory of secession based on a hypothetical multinational contract. Under this contract theory, injustices do not determine the existence of a right to secede, but the requirements to exercise it. The book’s second part then argues that international law is more inclined to accept and advance a remedial right approach to secession. Therefore, justice as multinational fairness is to be (...) fully institutionalized under the constitutional law of liberal democracies. The final part proposes constitutionalizing a qualified right to secede with the aim of fostering recognition and accommodation of national pluralism as well as cooperation and compromise between majority and minority nations. (shrink)

Moral diversity is a fundamental reality of today’s world, but moral theorists have difficulty responding to it. Some take it as evidence for skepticism – the view that there are no moral truths. Others, associating moral reasoning with the search for overarching principles and unifying values, see it as the result of error. In the former case, moral reasoning is useless, since values express individual preferences; in the latter, our reasoning process is dramatically at odds with our lived experience. Moral (...) Reasoning in a Pluralistic World takes a different approach, proposing an alternative way of thinking about moral reasoning and progress by showing how diversity and disagreement are compatible with theorizing and justification. Patricia Marino demonstrates that, instead of being evidence for skepticism and error, moral disagreements often arise because we value things pluralistically. This means that although people share multiple values such as fairness, honesty, loyalty, and benevolence, we interpret and prioritize those values in various ways. Given this pluralistic evaluation process, preferences for unified single-principle theories are not justified. Focusing on finding moral compromises, prioritizing conflicting values, and judging consistently from one case to another, Marino elaborates her ideas in terms of real-life dilemmas, arguing that the moral complexity and conflict we so often encounter can be part of fruitful and logical moral reflection. Aiming to draw new connections and bridge the gap between theoretical ethics and applied ethics, Moral Reasoning in a Pluralistic World offers a sophisticated set of philosophical arguments on moral reasoning and pluralism with real world applications. (shrink)

At no time in the past century have there been fiercer battles over our public schools than there are now. Parents and educational reformers are challenging not only the mission, content, and structure of mass compulsory schooling but also its underlying premise—that the values promoted through public education are neutral and therefore acceptable to any reasonable person. In this important book, Rosemary Salomone sets aside the ideological and inflammatory rhetoric that surrounds today’s debates over educational values and family choice. She (...) offers instead a fair-minded examination of education for democratic citizenship in a society that values freedom of conscience and religious pluralism. And she proposes a balanced course of action that redefines but does not sever the relationship between education and the state. Salomone demonstrates how contemporary conflicts are the product of past educational and social movements. She lays bare some of the myths that support the current government monopoly over education and reveals how it privileges those of economic means. Through a detailed case study of recent controversy in a suburban New York school district, the author explores the legal and policy issues that arise when widely disparate world views stand in the way of political compromise on educational materials, techniques, and programs. Salomone builds a case for educational governance that places the developmental needs of the child at the center of family autonomy. She advances a plan that respects diverse values and visions of schooling while preserving the core commitments that bind our nation. (shrink)

Resumo: Tomando o pensamento lukacsiano, podemos afirmar que as distorções que se apresentam no trabalho refletem diretamente nos atos reprodutivos do homem, na sua sociabilidade. Portanto, todas as categorias da superestrutura ficam comprometidas, inclusive a educação, visto que o espelhamento da realidade estará fundamentado na exploração promovida pelo capital. Partindo dessas considerações o presente artigo objetiva mostrar como o duplo aspecto da reprodução também se reflete na educação. Para tanto tomamos o pensamento do filósofo György Lukács, a partir da sua (...) obra Ontologia do Ser Social, demonstrando ainda que essa dupla face pode ser relacionada à tematização de Saviani em relação às Teorias Não-Críticas, Teorias Crítico-Reprodutivistas e à Pedagogia Histórico-Crítica. Em nossas conclusões afirmamos que a educação no sentido omnilateral, correspondente à face positiva da reprodução, sendo uma das alternativas viáveis para a mudança do estado atual de coisas. Palavras-chave: Trabalho; Reprodução; Educação. The double aspect of reproduction and its influence on education: Taking lukacsian thought, we can say that the distortions that appear at work reflect directly on the reproductive acts of man, on his sociability. Therefore, all categories of the superstructure are compromised, including the education, since the mirroring of reality will be based on the exploration promoted by capital. From these considerations the present article aims to show how the double aspect of reproduction is also reflected in education. For this we take the thought of the philosopher György Lukács, from his work Ontology of the Social Being, further demonstrating that this double face can be related to Saviani's thematization in relation to Non-Critical Theories, Critical-Reproductive Theories and Pedagogy Historical-Criticism. In our conclusions we affirm state that education in the omnilateral sense, corresponding to the positive face of reproduction, is one of the viable alternatives for changing the current state of things. Key-words: Work; Reproduction; Education. Le double aspect de la reproduction et son influence en education Résumé: Selon la pensée lukacsienne, nous pouvons affirmer que les distorsions existantes dans le travail influent directement sur les actes de reproduction de l’homme, sur sa sociabilité. Par conséquent, toutes les catégories de la superstructure sont compromises, notamment l’éducation, puisque le reflet de la réalité sera fondé sur l’exploitation promue par le capital. A partir de ces considérations, le présent article cherche à montrer comment le double aspect de la reproduction se reflète également en éducation. Pour ce faire, nous nous référons à la pensée du philosophe György Lukács, dans son œuvre L’ontologie de l’être social, en démontrant de même que cette double face peut être mise en relation avec la conceptualisation de Saviani, à propos des Théories non critiques, des Théories reproductivistes critiques et de sa Pédagogie historique-critique. Nous affirmons, pour conclure, que l’éducation en un sens omnilatéral correspond à la face positive de la reproduction, ce qui en fait une des alternatives viables en vue du changement de l’état actuel des choses. Mots clés: Travail; Reproduction; Education. Data de registro: 07/09/2021 Data de aceite: 19/01/2022. (shrink)

The opinion of the American Medical Association (AMA) Council on Ethical and Judicial Affairs (CEJA) on the accommodation of conscientious objectors among medical doctors aims to balance fairly patients’ rights of access to care and accommodating doctors’ deeply held personal beliefs. Like similar documents, it fails. Patients will not find it persuasive, and neither should they. The lines drawn aim at a reasonable compromise between positions that are not amenable to compromise. They are also largely arbitrary. This article (...) explains why that is the case. The view that conscientious objection accommodation has no place in modern medicine is defended. (shrink)

The fundamental question of political reparation is: why should a state provide redress for an injustice? The predominant answer justifies redress in terms of debts—the perpetration of an injustice creates a debt, and a state is required to make redress for the same reasons that it is required to repay its debts . Other approaches justify redress on the grounds that it will facilitate the achievement of some broader political goal, like the fair distribution of social resources or political (...) reconciliation.In Transitional Justice in Established Democracies, Stephen Winter provides a novel answer to this fundamental question in terms of political legitimacy. On Winter’s “legitimating account,” the state’s perpetuation of certain injustices compromises its political legitimacy. Redress is a required for a (liberal, democratic) state to bolster its legitimacy and to live up to its political commitments.Winter’s book makes a number of contributions to thinking about redress and transitional .. (shrink)

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider (...) whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them. (shrink)

Liberal egalitarians argue that the state is justified in taxing members of a political community to achieve distributive justice and ensure political equality and regime stability. This involves an uneasy compromise between equality and efficiency, a compromise that many argue has recently been undermined by the growth of unchecked wealth and income inequality. This essay argues that there is also a trade-off between selecting fair processes for taxation and aiming for particular distributive outcomes. The way people accumulate (...) wealth, and the way states tax often matters more than distributive outcomes. Policymakers must allow for the fair assessment of tax liabilities, avoid excessive enforcement costs and prevent political actors from using tax systems to achieve their partial ends. Recognizing these considerations justifies a systematic scheme of taxation while constraining the mechanisms for collecting revenue. I justify this position using comparative analysis, which I contrast with the conceptual intuitionistic approach associated with egalitarianism. (shrink)

My dissertation examines the rights of children in the context of liberal conceptions of justice. The theoretical aspects of the dissertation concern liberal paternalism, autonomy, and the adequacy of Rawls's argument for the lexical priority of liberty. I apply my theoretical conclusions to practical issues of medical decision making for children, compulsory education, parental and state authority, and the age of majority. ;I begin with an analysis of paternalism in liberal political theory and its justificatory bases in the concepts of (...) rationality and autonomy. On the basis of empirical studies of children's rationality I draw the preliminary conclusion that the age of majority should be lowered to fourteen years. Next, I consider utilitarian justifications for paternalistic treatment of children. I conclude that utilitarianism leads to an illiberal paternalism that would both maintain the present age of majority and call for expanded compulsory education and compulsory parent training. ;In light of utilitarian objections to rationality-based paternalism I consider whether the scope of liberal paternalism might be expanded to give greater weight to welfarist concerns. I argue against Rawls's lexical priority of liberty and for a more flexible balancing of liberty against welfare within the conception of justice as fairness. ;Turning to concrete problems, I analyze recent cases in law involving transplantation of organs between siblings, and argue that the nature of intimate relationships provides a ground for the partial compromise of freedom of the person in the context of family medical needs. However, I contend that adolescents should have authority to make their own medical decisions at age fourteen. I consider the proper scope of parental authority to shape the lives and values of children. I consider the justification and scope of compulsory education and propose a non-compulsory incentive system for continued education after the age of fourteen years. On the basis of my earlier argument for balancing welfare against liberty, I claim that it is permissible and advisable to set a higher age threshold for drinking, driving, marriage, and military service than is set for majority generally. (shrink)

Backgrounds Most countries are facing increased pressure on healthcare resources. A better understanding of how healthcare providers respond to new demands is relevant for future pandemics and other crises. Objectives This study aimed to explore what nurses and doctors in Norway reported as their main ethical challenges during two periods of the COVID-19 pandemic: February 2021 and February 2022. Research design A longitudinal repeated cross-sectional study was conducted in the Western health region of Norway. The survey included an open-ended question (...) about ethical challenges among doctors and nurses in hospital departments. Free-text comments were analysed using Systematic Text Condensation and also presented in a frequency table. Ethical considerations Ethical approval was granted by the Regional Research Ethics Committee in Western Norway (131,421). All participants provided consent when participating in the study. Results In 2021, 249 and in 2022, 163 healthcare professionals responded to the open-ended question. Nurses and doctors reported three main categories of ethical challenges related to the COVID-19 pandemic: (1) barriers that hindered them in acting as they ethically would have wanted to do; (2) priority-setting dilemmas linked to overtreatment, transfer of resources and ranking patient needs; and (3) workload expansion threatening work–life balance and employees’ health. Category one comprised of resource barriers, regulatory barriers, system barriers, and personal barriers. Regulatory barriers, especially visitor restrictions for next-of-kin, were the most frequently reported in 2021. Resource barriers, related to the increased scarcity of qualified staff, were most frequently reported in 2022. Clinicians stretched themselves thin to avoid compromising on care, diagnostics, or treatment. Conclusions Developing clinicians’ ability to handle and cope with limited healthcare resources is necessary. To foster resilience and sustainability, healthcare leaders, in collaboration with their staff, should ensure fair priority-setting and initiate reflections among doctors and nurses on what it implies to provide ‘good enough’ care. (shrink)

The Article critically examines the adaptation of citizenship rights to industrial relations and labor law. Starting with T.H. Marshall’s discussion of industrial citizenship, the Article examines the coupling of industrial citizenship with trade unions. While Marshall’s concept of industrial citizenship may seem to be in decline, other labor market institutions are trying to bridge the divide between citizenship and labor rights: workplace democracy, which assumes the constituency of workers in the corporation; and corporate citizenship, which is used to entrust corporations (...) with obligations that are traditionally expected of human citizens. Citizenship’s contribution to the analysis of labor market institutions lies in the emphasis on the public nature of workers’ rights, in the association of rights with obligations, and in the emphasis on active participation. However, citizenship also has "blind spots" that other theories address more coherently. Human rights are a preferred concept for distinguishing fundamental rights from "ordinary" rights. Labor rights are more effective in identifying power structures that citizenship rights may overlook. Consequently, the concept of citizenship may compromise workers’ capacity to negotiate fair remuneration, protection from dismissal and the dignity of labor. (shrink)

A balance needs to be struck between facilitating compassionate access to innovative treatments for those in desperate need, and the duty to protect such vulnerable individuals from the harms of untested/unlicensed treatments. We introduced a principle-based framework to evaluate such requests and describe its application in the context of recently evolved UK, US and European regulatory processes. 24 referrals were received by our quaternary children's hospital Clinical Ethics Committee over the 5-year period. The CEC-rapid response group evaluated individual cases within (...) 48-hours; the main referrers being haematology/oncology, immunology or transplant services. Most requests were for drug/vaccine/pre-trial access or biological/cellular therapies. The majority of individual requests were approved ; neutral or negative opinions were given in 5, including 3 group requests. Recently evolved regulatory processes share common criteria and conditions to our framework including: demonstration of clinical need; sound scientific basis with lack of viable alternative; risks-benefit/best interests evaluation; arrangements for fully informed consent; no compromise of arrangements to test treatment for licensing purposes; consideration of resource implications. There are differences between individual processes and with our framework, with respect to procedures, scope, application format, costs and obligation to make available all outcome data. Our experience has emphasized the need for an independent, principled, consistent, fair and transparent response to the increasing demand for innovative treatment on a compassionate basis. We believe that there is a need for harmonization of the recent proliferation of regulation and legislation in this area. (shrink)