We welcome Ballantyne & Schaefer’s discussion of the issues concerning consent and use of health data for research. In response to their acknowledgement of the need for public debate and discussion, we provide evidence from our own public consultation on this topic.

Governments are widely viewed by academics and practitioners as the key societal actors who are capable of compelling businesses to practice corporate social responsibility. Arguably, such government involvement could be seen as a technocratic device for encouraging ethical business behaviour. In this paper, we offer a more politicised interpretation of government engagement with CSR where “CSR” is not a desired form of business conduct but an element of discourse that governments can deploy in structuring their relationships with other social actors. (...) We build our argument through a historical analysis of government CSR discourse in the Russian Federation. Laclau and Mouffe's social theory of hegemony underpins our research. We find that “CSR” in the Russian government’s discourse served to legitimise its power over large businesses. Using this case, we contribute to wider academic debates by providing fresh empirical evidence that allows the development of critical evaluation tools in relation to governments’ engagement with “CSR”. We find that governments are capable of hijacking CSR for their own self-interested gain. We close the paper by reflecting on the merit of exploring the case of the Russian Federation. As a “non-core”, non-western exemplar, it provides a useful “mirror” with which to reflect on the more widely used test-bed of Western industrial democracies when scrutinising CSR. Based on our findings, we invite other scholars to adopt a more critical, politicised stance when researching the role of governments in relation to CSR in other parts of the world. (shrink)

Background: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation. Objective: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care. Research design: The study had a qualitative approach. Method: Data were collected by Flanagan’s critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and (...) humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis. Ethical considerations: The study followed the ethical principles in accordance with the Declaration of Helsinki. Findings: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient’s world and make professional decisions. The ambulance nurse respects the patient’s will and protects the patient’s body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient. Discussion: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human. Conclusion: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students’ ethical obligation results in the courage to see when a patient’s dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient. (shrink)

We distinguish between two different strategies in methodology of economics. The big picture strategy, dominant in the twentieth century, ascribed to economics a unified method and evaluated this m...

Many political theorists today deny that citizenship can be defended on liberal grounds alone. Cosmopolitans claim that loyalty to a particular state is incompatible with universal liberal principles, which hold that we have equal duties of justice to persons everywhere, while nationalist theorists justify civic obligations only by reaching beyond liberal principles and invoking the importance of national culture. In Liberal Loyalty, Anna Stilz challenges both views by defending a distinctively liberal understanding of citizenship. Drawing on Kant, Rousseau, and (...) Habermas, Stilz argues that we owe civic obligations to the state if it is sufficiently just, and that constitutionally enshrined principles of justice in themselves--rather than territory, common language, or shared culture--are grounds for obedience to our particular state and for democratic solidarity with our fellow citizens. She demonstrates that specifying what freedom and equality mean among a particular people requires their democratic participation together as a group. Justice, therefore, depends on the authority of the democratic state because there is no way equal freedom can be defined or guaranteed without it. Yet, as Stilz shows, this does not mean that each of us should entertain some vague loyalty to democracy in general. Citizens are politically obligated to their own state and to each other, because within their particular democracy they define and ultimately guarantee their own civil rights. Liberal Loyalty is a persuasive defense of citizenship on purely liberal grounds. (shrink)

Moral enhancement is an ostensibly laudable project. Who wouldn’t want people to become more moral? Still, the project’s approach is crucial. We can distinguish between two approaches for moral enhancement: direct and indirect. Direct moral enhancements aim at bringing about particular ideas, motives or behaviors. Indirect moral enhancements, by contrast, aim at making people more reliably produce the morally correct ideas, motives or behaviors without committing to the content of those ideas, motives and/or actions. I will argue, on Millian grounds, (...) that the value of disagreement puts serious pressure on proposals for relatively widespread direct moral enhancement. A more acceptable path would be to focus instead on indirect moral enhancements while staying neutral, for the most part, on a wide range of substantive moral claims. I will outline what such indirect moral enhancement might look like, and why we should expect it to lead to general moral improvement. (shrink)

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)

While philosophers are often concerned with the conditions for moral knowledge or justification, in practice something arguably less demanding is just as, if not more, important – reliably making correct moral judgments. Judges and juries should hand down fair sentences, government officials should decide on just laws, members of ethics committees should make sound recommendations, and so on. We want such agents, more often than not and as often as possible, to make the right decisions. The purpose of this paper (...) is to propose a method of enhancing the moral reliability of such agents. In particular, we advocate for a procedural approach; certain internal processes generally contribute to people’s moral reliability. Building on the early work of Rawls, we identify several particular factors related to moral reasoning that are specific enough to be the target of practical intervention: logical competence, conceptual understanding, empirical competence, openness, empathy and bias. Improving on these processes can in turn make people more morally reliable in a variety of contexts and has implications for recent debates over moral enhancement. (shrink)

It has recently been argued that reproductive genetic manipulation technologies like mitochondrial replacement and germline CRISPR modifications cannot be said to save anyone’s life because, counterfactually, no one would suffer more or die sooner absent the intervention. The present article argues that, on the contrary, reproductive genetic manipulations may be life-saving (and, from this, have therapeutic value) under an appropriate population health perspective. As such, popular reports of reproductive genetic manipulations potentially saving lives or preventing disease are not necessarily mistaken, (...) though such terminology still requires further empirical validation. (shrink)

The aim of this study was to describe specialist ambulance nurse students’ experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient’s body and identity; Not (...) agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient’s dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient’s body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Moral disengagement was initially conceptualized as a process through which people reconstrue unethical behaviors, with the effect of deactivating self-sanctions and thereby clearing the way for ethical transgressions. Our article challenges how researchers now conceptualize moral disengagement. The current literature is overly liberal, in that it mixes two related but distinct constructs—process moral disengagement and the propensity to morally disengage—creating ambiguity in the findings. It is overly conservative, as it adopts a challengeable classification scheme of “four points in moral self-regulation” (...) and perpetuates defining moral disengagement via a set of eight psychological mechanisms, narrowing our understanding of the phenomenon. To address these problems, we propose to define process moral disengagement intensionally (specifying the necessary and sufficient conditions for correct application of the term) as intrapsychic cognitive reasoning processes through which people selectively reconstrue a moral judgment “behavior B by actor A is morally wrong” and shift it toward becoming “behavior B is not morally wrong” or “actor A is not responsible for behavior B.” This definition achieves disambiguation and increased concept clarity. We leverage the definition to motivate a classification scheme for psychological mechanisms of moral disengagement along two dimensions—reconstruing morality and reconstruing agency—and to initiate an open inventory of psychological mechanisms that specify how process moral disengagement operates. (shrink)

Nabataean history is significantly overlooked in the works of ancient historians. Josephus is an exception to this, as he includes several important events from Nabataean history in De Bello Judaico and Antiquitates Judaicae. However, his retelling of these events differs between the two works. In this paper, I argue that Josephus became more “pro-Roman” over time and eventually overshadowed an accurate portrayal of Nabataean history in his later narrative. He undermined moments of tension between Rome and Nabataea in order to (...) showcase Roman power in the Near East, even beyond reality. In support of this argument, I analyze the Nabataean sections of Josephus’ works, as each passage has overlapping details, but significantly different emphasis, characterization, and perspective through variations in terminology, imagery, and tone. Though problematic, Josephus has preserved a unique look into Roman-Nabataean relations in the two centuries prior to the incorporation of Nabataea into the Empire. (shrink)

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

_Levinas, Subjectivity, Education_ explores how the philosophical writings of Emmanuel Levinas lead us to reassess education and reveals the possibilities of a radical new understanding of ethical and political responsibility. Presents an original theoretical interpretation of Emmanuel Levinas that outlines the political significance of his work for contemporary debates on education Offers a clear analysis of Levinas’s central philosophical concepts, including the place of religion in his work, demonstrating their relevance for educational theorists Examines Alain Badiou’s critique of Levinas’s work (...) Considers the practical implications of Levinas’ theories for concrete educational practices and frameworks. (shrink)

According to Hobbes, individuals care about their relative standing in a way that shapes their social interactions. To model this aspect of Hobbesian psychology, this paper supposes that agents have social preferences, that is, preferences about their comparative resource holdings. Introducing uncertainty regarding the social preferences of others unleashes a process of trust-unravelling, ultimately leading to Hobbes’s ‘state of war’. This Trust-unravelling Model incorporates important features of Hobbes’s argument that past models ignore.

The “best-medical-interests” standard for reporting findings does not go far enough. Research subjects have a right to know about any comprehensible piece of information about them that is generated by research in which they are participating. An even broader standard may sometimes be appropriate: if subjects agree to accept information that they may not understand, then all information may be disclosed.

Fazekas and Overgaard () present a novel, multidimensional model that explains different ways in which conscious representations can be degraded. Moreover, the authors discuss possible mechanisms that underlie different kinds of degradation, primarily those related to attentional processing. In this letter, we argue that the proposed mechanisms are not sufficient. We propose that attentional mechanisms work differently at various processing stages; and factors that are independent of attentional ones, such as expectation, previous experience, and context, should be accounted for if (...) we are aiming to construct a comprehensive model of conscious visual perception. (shrink)

The French Convention on Bioethics (États généraux de la bioéthique, 2009) were a perfect spot to observe new methods of organizing the participants of public debates into a hierarchy. Indeed, a privileged place was given to the citizen, and quite often the expert and the politician were devoid of their usual roles. This article will focus on the analysis of the very role given to the expert and to the expertise, both in the definition of the general framework of the (...) series of meetings and in public debates that took place in (among others) Marseille and Paris. This analysis makes obvious the idea that the major result of those Conventions does not consist in putting forward some original thoughts on biomedicine and its problems, but rather in promoting a new model of governance. In consequence, and if I am right, this promotion is being made precisely by diminishing the role of the expert (the intellectual). (shrink)

The article aims at challenging the very idea of bioethics. Starting with a thought experiment which puts into perspective relations between law and ethics, a reflexion on founding moments of bioethics as a distinctive discipline will be proposed in order to contest some of its assumptions. Less traditional ways of seeing the field will be subsequently analyzed, yet the conclusion of this exploration will remain critical: we should rather think of an alternative way of seeing moral expertise in the biomedical (...) sphere, founded on plural knowledge of diverse agents who leave their moral presuppositions aside as much as this is possible. (shrink)

This chapter contains sections titled: Introduction Preliminaries: Thinking about Language Oneself as Agent Mistaken Dichotomies Intention Action as a Story about the Agent References.

A Companion to the Philosophy of Action offers a comprehensive overview of the issues and problems central to the philosophy of action. The first volume to survey the entire field of philosophy of action (the central issues and processes relating to human actions) Brings together specially commissioned chapters from international experts Discusses a range of ideas and doctrines, including rationality, free will and determinism, virtuous action, criminal responsibility, Attribution Theory, and rational agency in evolutionary perspective Individual chapters also cover prominent (...) historic figures from Plato to Ricoeur Can be approached as a complete narrative, but also serves as a work of reference Offers rich insights into an area of philosophical thought that has attracted thinkers since the time of the ancient Greeks. (shrink)

L’article explore les rapports entre l’espace, les publics, l’argent et le temps à travers une évolution de divers lieux de rassemblement à Saint-Pétersbourg dans les années 1990-2010. Prenant leur essor durant la période de « l’entre-deux » systèmes, les clubs émergent tels une expérience « underground », un temps continu vécu par une communauté dans un lieu régulier affranchi des impératifs de rentabilité. Durant les années 2000, les clubs subissent une marchandisation, irrégulière et décalée, qui les amène à passer à (...) une ouverture quasi-permanente en diversifiant l’offre de programmation et de consommation. Une partie des clubs, des bars, ainsi que les « time-cafés » émergeant dans les années 2010, visent dès lors à se constituer des noyaux de publics fidèles, à les maintenir longtemps sur place en soignant un « entre-soi », des sociabilités à la fois ouvertes et exclusives, protégées par certains mécanismes de sélection. Cette composante « sociabilité » l’emporte progressivement sur la composante artistique, elle suspend le principe de maximisation du profit et tend à privilégier un usage libre du temps. Cette tendance semble être reprise par certains établissements culturels d’Etat en quête de modernisation, se positionnant dès lors comme des lieux de rassemblement de proximité. (shrink)

Mitochondrial replacement therapy requires oocytes of women whose mitochondrial DNA will be transmitted to resultant children. These techniques are scientifically, ethically and socially controversial; it is likely that some women who donate their oocytes for general in vitro fertilisation usage would nevertheless oppose their genetic material being used in MRT. The possibility of oocytes being used in MRT is therefore relevant to oocyte donation and should be included in the consent process when applicable. In present circumstances, specific consent should be (...) obtained. However, once MRT becomes more routine, such consent could be incorporated into the general consent process for oocyte donation. The reported lack of proper consent for MRT from the oocyte donor in the first baby born via the technique is an ethical failing and should be corrected in any future practice of MRT. (shrink)

Background Several jurisdictions, including Singapore, Australia, New Zealand and most recently Ireland, have a public interest or public good criterion for granting waivers of consent in biomedical research using secondary health data or tissue. However, the concept of the public interest is not well defined in this context, which creates difficulties for institutions, institutional review boards and regulators trying to implement the criterion. Main text This paper clarifies how the public interest criterion can be defensibly deployed. We first explain the (...) ethical basis for requiring waivers to only be granted to studies meeting the public interest criterion, then explore how further criteria may be set to determine the extent to which a given study can legitimately claim to be in the public interest. We propose an approach that does not attempt to measure magnitude of benefit directly, but rather takes into account metrics that are more straightforward to apply. To ensure consistent and justifiable interpretation, research institutions and IRBs should also incorporate procedural features such as transparency and public engagement in determining which studies satisfy the public interest requirement. Conclusion The requirement of public interest for consent waivers in secondary biomedical research should be guided by well-defined criteria for systematic evaluation. Such a criteria and its application need to be periodically subject to intra-committee and intra-institution review, reflection, deliberation and amendment. (shrink)

Given the sordid history of injustices linking genetics to race and ethnicity, considerations of justice are central to ensuring the responsible development of precision medicine programmes around the world. While considerations of justice may be in tension with other areas of concern, such as scientific value or privacy, there are also tensions between different aspects of justice. This paper focuses on three particular aspects of justice relevant to this precision medicine: social justice, distributive justice and human rights. We describe the (...) implications of each for the use of race and ethnicity in precision medicine, and also how they intersect and potentially conflict with each another. By attending to these intersections, we aim to enrich and add nuance to debates over how best to proceed with precision medicine initiatives. (shrink)

It is generally unquestioned that human subjects research review boards should assess the ethical acceptability of protocols. It says so right on the tin, after all: they are explicitly called research ethics committees in the UK. But it is precisely those sorts of unchallenged assumptions that should, from time to time, be assessed and critiqued, in case they are in fact unfounded. John Stuart Mill's objection to suppressers of dissent is instructive here: “If the opinion is right, they are deprived (...) of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error”.1 Andrew Moore and Andrew Donnelly's compelling article, “The job of ‘ethics committees’”, is just this sort of challenge to conventional wisdom, a rejection of the notion that review boards should be considering ethical matters at all.2 If true, we should be substantially reforming our research ethics policies. And if false, rebuttals would help strengthen and ground the otherwise unquestioned assumption of the role of ethics committees. As it happens, I will argue that their critiques fall into the second category. While mistaken, they present a valuable opportunity to clarify the role of ethics committees and their relationship to relevant codes. In particular, I will defend a hybrid account where codes have strict primacy, but leave significant room for review boards …. (shrink)

This commentary examines the role of sustainability in the latest draft of the WHO pandemic accord, highlighting its notable absence from the official list of guiding principles despite being mentioned frequently throughout the text. It argues that sustainability should be explicitly acknowledged as a core principle and given a clear definition tailored to pandemic preparedness, and proposes defining sustainability as ensuring that immediate emergency responses don't compromise future pandemic preparedness and response capabilities. Including sustainability as a guiding principle would serve (...) two key purposes: validating the relevance of ethical principles in the accord's provisions and emphasizing the importance of long-term planning in pandemic preparedness. The commentary notes that while humans naturally discount future consequences, sustainable pandemic planning requires considering impacts beyond the next pandemic. It recommends coupling any reforms, such as intellectual property changes, with alternative innovation incentives to maintain a balanced approach to pandemic preparedness and response. (shrink)

The success of digital COVID-19 contact tracing requires a strategy that successfully addresses the digital divide—inequitable access to technology such as smartphones. Lack of access both undermines the degree of social benefit achieved by the use of tracing apps, and exacerbates existing social and health inequities because those who lack access are likely to already be disadvantaged. Recently, Singapore has introduced portable tracing wearables (with the same functionality as a contact tracing app) to address the equity gap and promote public (...) health. We argue that governments have an ethical obligation to ensure fair access to the protective benefits of contract tracing during the pandemic and that wearables are an effective way of addressing some important equity issues. The most contentious issues about contact tracing apps have been the potential infringements of privacy and individual liberty, especially where the use of apps or other technology (such as wearables or QR codes) is required for access to certain spaces. Here we argue that wearables, as opposed to apps alone, will make a digital contact tracing mandate more practical and explain some conditions under which such a mandate would be justified. We focus on Singapore as a case study that has recently deployed contact tracing wearables nationally, but also reference debate about wearables in Australia and New Zealand. Our analysis will be relevant to counties trialling similar portable tracing wearables. (shrink)

Volume 19, Issue 7, July 2019, Page 28-30.

With the recent report of a live birth after use of Mitochondrial replacement therapy, sometimes called ‘Three-parent IVF’, the clinical application of the technique is fast becoming a reality. While the United Kingdom allows the procedure under regulatory scrutiny, it remains effectively outlawed in many other countries. We argue that such prohibitions may violate individuals’ procreative rights, grounded in individuals’ interest in genetic affinity. The interest in genetic affinity was recently endorsed by Singapore’s highest court, reflecting an emphasis on the (...) importance of biological ties found across the globe. We apply that reasoning to make the case for a right to ‘Three-parent IVF’. (shrink)

The article presents an analysis and critique of Milton Friedman’s argument that the social responsibility of business is merely to increase its profits. The analysis uncovers a central claim that Friedman implies, but does not explicitly defend, namely that the shareholders of a corporation have no duty to direct that corporation’s management to exercise social responsibility. An argument against this claim is then advanced by way of a convergence strategy, whereby multiple influential moral approaches are shown to align themselves against (...) Friedman. The convergence strategy shows that Friedman’s position lies on the lonely fringes of Western moral thought, and that at least some of Friedman’s professed adherents appear to offer incoherent moral views. The convergence strategy is shown to suggest, but not entail, a stakeholder model of the corporation. The article concludes by considering two objections. (shrink)

Volume 20, Issue 2, February 2020, Page 20-22.