In this paper I attempt a new reading of the passage found in 1 Timothy 2.8-15, to try to show how it might be read by women today. The difficulties of reading such patriarchal texts from the canon of biblical literature are not trivialized or overlooked, and are addressed by a selective survey of how this passage has been read in different contexts through the history of interpretation. The resulting reading neither removes this problematic material from the canon, nor denies (...) the oppressive uses it has been put to in keeping women out of positions of power in various church communities. (shrink)

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such a claim (...) are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare. (shrink)

Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in (...) global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs. (shrink)

With evidence of vaccine hesitancy in several jurisdictions, the option of making COVID-19 vaccination mandatory requires consideration. In this paper I argue that it would be ethical to make the COVID-19 vaccination mandatory for older people who are at highest risk of severe disease, but if this were to occur, and while there is limited knowledge of the disease and vaccines, there are not likely to be sufficient grounds to mandate vaccination for those at lower risk. Mandating vaccination for those (...) at high risk of severe disease is justified on the basis of the harm principle, as there is evidence that this would remove the grave public health threat of COVID-19. The risk–benefit profile of vaccination is also more clearly in the interests of those at highest risk, so mandatory vaccination entails a less severe cost to them. Therefore, a selective mandate would create fairness in the distribution of risks. The level of coercion imposed by a mandate would need to be proportionate, and it is likely that multiple approaches will be needed to increase vaccine uptake. However, a selective mandate for COVID-19 vaccines is likely to be an ethical choice and should be considered by policy-makers. (shrink)

The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We (...) first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

This article challenges what is now the orthodoxy concerning the heritage of Bourdieu (1930–2002): namely, the judgement that his distinctive sociological innovation has been his theory of social reproduction, and that he has failed to provide a necessary theory of social change. Yet Bourdieu consistently claimed to offer a theory of social transformation as well as accounting for continuities of power. Indeed, he provides two substantive keys for an understanding of historical transformation—first, a theory of prophets (religious or secular) as (...) the authors of heresies or “symbolic revolutions” that dispel current doxa; second, a theory of the “corporatism of the universal”: the role of intellectuals or other educated professionals in pursuit of social justice and other universalistic goals. Moreover, Bourdieu fuses his theories of “symbolic revolutions” with a materialist analysis of their social preconditions, including a fresh account of social crises. Crises—war, famine, recession, and especially the intensified precarity of the educated—have, for him, a profound impact, both within differentiated fields and across fields. Conflicts that become effectivelysynchronizedacross fields acquire great resonance within the wider field of power, particularly due to hysteresis or “maladjusted habitus.” Indeed, the appearance of crises, together with new prophetic heresies, leads the subordinate classes to question the taken-for-granted order of things and to orchestrate their resistance. Alongside his corpus of published writings, this article draws widely on Bourdieu’s posthumously published lectures. These cast a distinctive new light on how his well-known conceptual instruments can aid us in the study of historical change. They also expand on how social science itself might be used to facilitate progressive social movements. (shrink)

Much of the research that has been carried out on occupational health and safety involves studies of regulatory practices. OHS studies linearly maintain that early legislations were of minimal consequence. Implementation is a two-tier structure—policy-making and enforcement. This article considers the main themes and findings of this body of research. It is structured around a “natural history” approach to understanding law. This approach regards law as a process which starts with the recognition of a problem demanding legal intervention and the (...) subsequent enactment of legislation. Several jurisdictions additionally encourage workers to join the enforcement procedure. Law being intrinsic to OHS, enforcement emerges as the key to explain its impact, while evidence suggests the role of sanctions on it. The article highlights areas that remain relatively uncharted and those that warrant more research. (shrink)

In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against placebo. (...) But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)

Both autistic adults and families of autistic children rely heavily on blogs and other digital platforms to create community and gain experiential knowledge about autism, but research on autism blogs has failed to distinguish between the perspectives of autistic adults and neurotypical parent bloggers. Furthermore, intersections in the experiences of BIPOC autistics are rarely examined. Using a content analysis with a feminist Critical Disability Studies lens, I explore six autism parent blogs from diverse demographics: a white neurotypical father, a white (...) autistic mother in an interracial relationship, a white neurotypical mother, an Indigenous autistic trans father, a Black autistic nonbinary mother, and a Black neurotypical mother. I examine the attitudes of these bloggers to get a sampling of their opinions on autism, how they parent autistic children, and how their social location, specifically race, impacts their experiences. More intersectional research needs to be done to boost the perspectives of BIPOC autistics and the expertise of autistic parents. (shrink)

ABSTRACT Abduction as a method for sociological explanation is increasingly gaining interest, but questions remain as to what exactly it is and how it differs from other methods of inquiry. This paper compares abduction as conceived in Peircean pragmatism with the critical realist concept of retroduction. I argue that abduction in the Peircean sense and retroduction in the critical realist sense refer to different, but complementary, modes of inference. Abductive conclusions provide the starting point for retroductive inferences; the latter inform (...) the tenability of the former. Together, abduction and retroduction contribute to theoretical explanation. (shrink)

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and (...) a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

The virtues are under fire. Several decades’ worth of social psychological findings establish a correlation between human behavior and the situation moral agents inhabit, from which a cadre of moral philosophers concludes that most moral agents lack the virtues. Mark Alfano and Christian Miller introduce novel versions of this argument, but they are subject to a fatal dilemma. Alfano and Miller wrongly assume that their requirements for virtue apply universally to moral agents, who vary radically in their psychological, physiological, and (...) personal situations; I call this the ‘content problem.’ More troubling, however, the content problem leads to what I call the ‘structural problem:’ Alfano and Miller each structure their argument against the virtues as a modus tollens argument and, owing to the breadth of the content problem, each must constrain their argument with a ceteris paribus clause. But the ceteris paribus clause precludes each argument’s validity. More important, however, the resulting conception of virtue implicitly endorsed by Alfano and Miller holds that virtues are idealized models; but since idealized models do not even purport accurately to describe the world, neither novel version of EAV gains any empirical traction against the virtues. The upshot is an old story whose moral has yet, within the empirical study of the virtues, adequately to be internalized: it is imperative that the empirical observation of character traits proceed via longitudinal studies. (shrink)

In order to fulfill ABET requirements, Northern Arizona University’s Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to “grey” or multiple possible solution technical problems. To identify (...) and solve these problems, the engineering design process is used. Ethical problems are also “grey” problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue. (shrink)

Research from cognitive science and geoscience education has shown that sketching can improve spatial thinking skills and facilitate solving spatially complex problems. Yet sketching is rarely implemented in introductory geosciences courses, due to time needed to grade sketches and lack of materials that incorporate cognitive science research. Here, we report a design-centered, collaborative effort, between geoscientists, cognitive scientists, and artificial intelligence researchers, to characterize spatial learning challenges in geoscience and to design sketch activities that use a sketch-understanding program, CogSketch. We (...) developed 26 CogSketch worksheets that use cognitive science–based principles to scaffold problem solving of spatially complex geoscience problems and report observations of an implementation in an introductory geoscience course where students used CogSketch or human-graded paper worksheets. Overall, this research highlights the principles of interdisciplinary design between cognitive scientists, geoscientists, and AI researchers that can inform the collaborative design process for others aiming to develop effective educational materials. (shrink)

Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we (...) convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting—scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting. (shrink)

Much of the research that has been carried out on occupational health and safety involves studies of regulatory practices. OHS studies linearly maintain that early legislations were of minimal consequence. Implementation is a two-tier structure—policy-making and enforcement. This article considers the main themes and findings of this body of research. It is structured around a “natural history” approach to understanding law. This approach regards law as a process which starts with the recognition of a problem demanding legal intervention and the (...) subsequent enactment of legislation. Several jurisdictions additionally encourage workers to join the enforcement procedure. Law being intrinsic to OHS, enforcement emerges as the key to explain its impact, while evidence suggests the role of sanctions on it. The article highlights areas that remain relatively uncharted and those that warrant more research. (shrink)

Health systems research is widely identified as an indispensable means to achieve the goal of health equity between and within countries. Numerous health systems research consortia comprised of institutions from high-income countries and low and middle-income countries are currently undertaking programs of research in LMICs. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Recent conceptual work has explored what features might be necessary for (...) health systems research consortia and their research programs to promote health equity. Identified features include selecting research priorities that focus on improving access to high-quality health services and/or financial protection for disadvantaged populations in LMICs and conducting research capacity strengthening that promotes the independent conduct of health systems research in LMICs. Yet, there has been no attempt to investigate whether existing consortia have such characteristics. This paper describes the results of a survey undertaken with health systems research consortia leaders worldwide to assess how consistent current practice is with the proposed ethical guidance. The findings suggest that consortia may be fairly well organised to promote health equity, but have scope for improvement, particularly in terms of achieving inclusive priority-setting. (shrink)

Situational Design lays out a new methodology for designing and critiquing videogames. While most game design books focus on games as formal systems, Situational Design concentrates squarely on player experience. It looks at how playfulness is not a property of a game considered in isolation, but rather the result of the intersection of a game with an appropriate player. Starting from simple concepts, the book advances step-by-step to build up a set of practical tools for designing player-centric playful situations. While (...) these tools provide a fresh perspective on familiar design challenges as well as those overlooked by more transactional design paradigms. Key Features Introduces a new methodology of game design that concentrates on moment-to-moment player experience Provides practical design heuristics for designing playful situations in all types of games Offers groundbreaking techniques for designing non-interactive play spaces Teaches designers how to create games that function as performances Provides a roadmap for the evolution of games as an art form. (shrink)

Technological advancements, especially with regard to enhancements of human capacities and powers, have instigated a collision between opposing views of the human person. I begin with the premise that the predominant classical view of the human person attained its clearest and most cogent expression in the philosophy of Thomas Aquinas and can be termed the theory of the homo integralis. The human person is, for Thomas, the integrated being par excellence: he is a union of the material (body) and the (...) immaterial (soul); his freedom is guided by a normative nature; he is himself a product of and participant in nature; he is a member of a common species from which he draws his identity; and he balances the needs of his embodied state with a recognition that his existence is not limited to it. Due to the philosophical and technological revolutions of the modern period, themselves an outgrowth perhaps of earlier attitudes, a contrasting view of the human person emerged: the homo technologicus. Technological man, unlike his classical predecessor, is marked by fundamental disintegration: he is divided in himself, between mind and body; he is dissociated from a normative human nature; he is divided from nature itself as he sets himself against it through technological means; he is divided from the human community in radical, self-determining autonomy; and he is severed from any sense of transcendent purpose or value aside from that which can be attained through his own powers, technological or otherwise. By recovering a sense of the homo integralis as articulated by Thomas Aquinas, a fresh appraisal of contemporary issues regarding the human relationship to technology, human capacities and powers as evaluated by movements like transhumanism, and ultimately, human meaning and value, is made possible and is shown to provide a consistent and appealing rejoinder to the disintegrated vision of man that emerges in a technologized world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recent Acquisitions, 2020–21Bridget Whittle and Kenneth BlackwellThe previous general update of acquisitions appeared in Russell in n.s. 39 (winter 2019): 188–90. The new listing covers items numbered 1,824 to 1,839, plus an addition to 840, with the latest items arriving in December 2021. Largely due to the Covid-19 pandemic, this update is smaller than usual as fewer items were received or available. Several items were received from other institutions (...) and through the generosity of researchers, to whom McMaster Library is very grateful. Internet prints are from the Hon. Russell Archivist. The following abbreviations are used: L(s). or l(s). = letter(s); X. = image copies of any kind.correspondenceArlott, John L. from BR, 1951, re “Rewards of Philosophy” (C48.06) and a cricket book for Conrad. X. Internet print. rec. acq. 1,831.Bell, A. S. L. from BR, 1967. Re Alys Russell’s l. to Haldane. X. Courtesy of Nicholas Bell. rec. acq. 1,827.Cambridge Daily News L. from BR requesting they issue a public statement to clarify use of his title, 1945. Re B&R C45.07a. X. Courtesy of Dr. David Harley. rec. acq. 1,824.Cousins, Norman 2 ls. from BR, re quoting History of the World in Epitome and Manchester speech, 1960. X. Courtesy of David Harley. rec. acq. 1,826.Davies, Mansel 19 documents including ls. to BR, from Edith Russell, drafts, and notes re the Bertrand Russell Peace Fund, 1963 and later; and Dora Russell, also cnd, 1958. rec. acq. 1,828.Dewey, John 3 ls., 1 pc to William Ernest Hocking, 1936–40. Re BR at ccny and Harvard. Purchase. rec. acq. 1,836.Duman, R. Douglas L. from BR, 1963. X. Courtesy of David Harley. rec. acq. 1,826.Furtado, Celso 2 ls. from BR re Goldwater, and American war crimes in Vietnam, 1964, 1967. X. Courtesy of Camilo Furado. rec. acq. 1,829.Greene, Graham L. from BR on a Vietnam statement, 1967. X. Internet print. rec. acq. 1,831.Haldane, Richard Burdon (1st Viscount) L. from Alys Russell regarding BR’s imprisonment status, 3 Mar. 1918. X. rec. acq. 1,827.Hocking, William Ernest 2 ls. from BR, 1939–40. Re Wm. James Lectures at Harvard. Purchase. rec. acq. 1,836. —. See also under Dewey, John.Jones, Lief (Lord Rhayader) L. from BR congratulating him on his election victory in North Westmoreland. 1904–05. Purchase. rec. acq. 1,831.Miller, Lawrence E. L. from BR enclosing signed photo (not present), 1963. X. Internet print. rec. acq. 1,831.Modern Forum (Herman Lissauer) L. from BR declining another us lecture tour, 1954. X. Courtesy of David Harley. rec. acq. 1,831.Newnham College Report from BR to extend G. E. M. Anscombe’s scholarship. He comments on her 2 dissertations. X. Courtesy of Rachel Wiseman. Original at Newnham. rec. acq. 1,831.Post, Stanley Deverin L. from BR, 1962. X. Internet print. rec. acq. 1,824.Russell, Frank L. to Bill/Bull, 1902. Promises to send him a copy of his speech. X. Internet print. Courtesy of Ruth Derham. rec. acq. 1,824.Russell, Patricia L. to Emrys Hughes, ed. of Forward, 1945. Re the war and peace settlement. X. Courtesy of National Library of Scotland. Added to rec. acq. 840.Ryckman, Mr. L. from BR, 1923. X. Internet print. rec. acq. 1,831.Schrödinger, Erwin L. from BR. X. Internet print. Online at U. of Vienna Library. rec. acq. 1,830.Silberstein, Ludwick 3ls. from BR,2in 1918, third in 1941. Silberstein had translated Problems into Polish, 1913. X. Internet print. rec. acq. 1,831.Silverstein, Louis L. from BR regarding nuclear weapons and the Kennedy administration, 1961. X. Internet print. rec. acq. 1,831.Spencer, Herbert L. to Lady Amberley, 1869. Re Spencer’s visit to Rodborough. Purchase. rec. acq. 1,833.Stetler, Jr., Russell Dearnley 20 ls. from BR; 30 from R. Schoenman, C. Farley, P. Wood; 1963–65. On opposing the Vietnam War. X. Donation of Russ Stetler. rec. acq. 1,838.Thirring, Hans 11 ls. from BR, 1 to BR, 1952–62. X. Internet print. Online at U. of Vienna Library. rec... (shrink)

How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high‐income countries owed to parties from low and middle‐income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The ‘research for health justice’ framework provides direction on three aspects of international clinical research: (...) the research target, research capacity strengthening, and post‐trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity. (shrink)

Health research has been identified as a vehicle for advancing global justice in health. However, in bioethics, issues of global justice are mainly discussed within an ongoing debate on the conditions under which international clinical research is permissible. As a result, current ethical guidance predominantly links one type of international research (biomedical) to advancing one aspect of health equity (access to new treatments). International guidelines largely fail to connect international research to promoting broader aspects of health equity – namely, healthier (...) social environments and stronger health systems. Bioethical frameworks such as the human development approach do consider how international clinical research is connected to the social determinants of health but, again, do so to address the question of when international clinical research is permissible. It is suggested that the narrow focus of this debate is shaped by high-income countries' economic strategies. The article further argues that the debate's focus obscures a stronger imperative to consider how other types of international research might advance justice in global health. Bioethics should consider the need for non-clinical health research and its contribution to advancing global justice. (shrink)

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through “herd immunity,” which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to (...) increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination. In addition, it has raised the possibility of banning unvaccinated children from childcare centres. This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices. (shrink)

Volume 20, Issue 10, October 2020, Page 47-49.

Upton Sinclair, one of America's foremost and most prolific authors, addresses the cultivation of the mind and the body in this 1922 volume. Sinclair's goal was to attempt to tell the reader how to live, how to find health, happiness and success, and how to develop fully both the mind and the body. Part One: The Book of the Mind covers such subjects as faith, reason, morality, and the subconscious. Part Two: The Book of the Body develops such subjects (...) as errors in diet, the fasting cure, food and poisons, work and play, and diseases and their cures . (shrink)

Debates about justice in international clinical research problematically conflate two quite different forms of obligation. International research ethics guidelines were intended to describe how to conduct biomedical research in a just manner at the micro or clinical level (within the researcher-participant interaction) but have come to include requirements that are clearly intended to promote justice at the global level. Ethicists have also made a variety of claims regarding what international research should contribute to global justice. This paper argues that the (...) conflation of debates about justice at the micro and macro-levels has not only resulted in the placement of obligations upon the wrong actors but has also served to exclude relevant actors from the ethical picture. Suggestions for who should properly bear macro-level obligations of justice in international clinical research are offered. The paper further contends that, unlike researchers who violate informed consent requirements, no similar type of accountability exists for obligations of global justice, even for those obligation-bearers (incorrectly) identified by current ethics guidelines. (shrink)

Universal health coverage is often implemented within countries through several national insurance schemes that collectively cover their populations. Yet the extent of services and benefits available can vary substantially between different schemes. This paper argues that these variations in coverage comprise tiering and then reviews different accounts of health and social justice that consider whether and when a tiered health system is fair. Using these accounts, it shows that the fairness of tiering can be determined by assessing whether differences in (...) coverage mean enrolees under some national insurance schemes do not achieve sufficient health or normal functioning and/or feel inferior relative to those belonging to other national insurance schemes. The paper further contends that these determinations of fairness should involve the people covered by different insurance schemes. Key universal health coverage questions to involve the public in answering are: Do the sum of differences between the schemes in your country generate feelings of unequal moral worth and/or mean enrolees struggle to achieve sufficient health or normal functioning? Which specific differences between health insurance schemes generate the greatest feelings of unequal moral worth in individuals? Which specific differences generate the greatest barriers to individuals achieving sufficient health or normal functioning? Rather than identifying which services to extend coverage to first, answering these questions will identify which disparities in services and benefits are the most morally urgent to address. Finally, some initial thoughts are offered on who from the public should be involved in making these decisions and how they might be involved as a matter of justice. (shrink)

We propose an account of dynamic predicates which draws on the notion of force, eliminating reference to events in the linguistic semantics. We treat dynamic predicates as predicates of forces, represented as functions from an initial situation to a final situation that occurs ceteris paribus, that is, if nothing external intervenes. The possibility that opposing forces might intervene to prevent the transition to a given final situation leads us to a novel analysis of non-culminating accomplishment predicates in a variety of (...) languages, including the English progressive. We then apply the force-theoretic framework to the composition of basic Vendlerian eventuality types within a lexical-decomposition syntax. The difference between predicates of forces and predicates of situations is argued to underlie the dynamic/stative contrast, and also to allow for a formal treatment of the difference between be and stay. Consequences for the relationship between language and cognition are discussed. (shrink)

This article undertakes a critical analysis of the work of Gisèle Sapiro, with reference to sociology of literature. From 1999 (Sapiro, 2014a), Sapiro has developed the Bourdieusian research tradition, amplifying especially Bourdieu’s theory of crisis. Focusing on the antagonisms between literary “prophets” and “priests”, she has drawn on a rich sample of 184 writers to elucidate the struggles inherent in World War II between writers from different field positions and literary habitus. Further, her historical analyses of the ethical commitments of (...) nineteenth century writers via a fresh microsociology of literary trials (Sapiro, 2011) has reminded us of the importance of popular poets in articulating the suffering of the subordinate classes. Her most recent book (Sapiro, 2018) has expanded on her earlier themes, whilst identifying the recuperation of certain 1930s’ fascist worldviews within contemporary literature. This article notes that there is a telling divergence between Bourdieu and Sapiro on the issue of interests behind disinterestedness, exemplified in the case of Zola. On this issue, Sapiro’s reading (Sapiro, 2011) is found convincing. Finally, the dialectic of avant-garde consecration and routinisation is questioned as a universal structure. It is suggested that certain avant-garde – the Harlem Renaissance, for example – did not undergo swift consecration or routinisation, although this contention deserves greater research. The paper concludes by showing that Sapiro’s conception of writers’ responsibility owes its origins less to Sartre than to the Durkheimian/ Bourdieusian notion of the expertise of the “specific intellectual”. It welcomes Sapiro’s concern for literature as a potential force for social change. (shrink)

Democracy surrounds us like the air we breath, and is normally taken very much for granted. Across the world democracy has become accepted as an unquestionably good thing. Yet upon further examination the merits of democracy are both paradoxical and problematic, and the treasured values of liberty and equality can be used to argue both for and against it. In the historical section of the book, Ross Harrison clearly traces the history of democracy by examining the works of, amongst others, (...) Plato and Aristotle, Hegel and Marx. Informed by facts and detailed knowledge of these famous thinkers, Harrison provides a clear and cogent justification of democracy. (shrink)

It has been suggested that community advisory boards can play a role in minimising exploitation in international research. To get a better idea of what this requires and whether it might be achievable, the paper first describes core elements that we suggest must be in place for a CAB to reduce the potential for exploitation. The paper then examines a CAB established by the Shoklo Malaria Research Unit under conditions common in resource-poor settings – namely, where individuals join with a (...) very limited understanding of disease and medical research and where an existing organisational structure is not relied upon to serve as the CAB. Using the Tak Province Border Community Ethics Advisory Board as a case study, we assess the extent to which it might be able to take on a role minimising exploitation were it to decide to do so. We investigate whether, after two years in operation, T-CAB is capable of assessing clinical trials for exploitative features and addressing those found to have them. The findings show that, although T-CAB members have gained knowledge and developed capacities that are foundational for one-day taking on a role to reduce exploitation, their ability to critically evaluate studies for the presence of exploitative elements has not yet been strongly demonstrated. In light of this example, we argue that CABs may not be able to perform such a role for a number of years after initial formation, making it an unsuitable responsibility for many short-term CABs. (shrink)

In many countries around the world, people who inject drugs remain at high risk of HIV acquisition not because effective forms of prevention are unknown, nor because they find effective prevention undesirable, but because those in charge, mainly politicians but also bureaucrats, find evidence-based practice politically unacceptable. The evidence for preventive efficacy of harm reduction strategies, most prominently needle and syringe programmes but also treatment programmes such as opiate substitution, is irrefutable.1 However, political responses to drug use issues are varied (...) and complex, so the will to implement appropriate harm reduction programmes in the interests of public health remains lacking in too many jurisdictions. As a consequence, the discussion of how best, in the context of research, to reduce HIV incidence in populations of people who inject drugs but are not offered comprehensive access to known prevention strategies is—tragically—an important one. Dawson et al 2 focus on access to sterile injecting equipment and recognise that this should remain the ‘default’ standard of prevention for HIV prevention trials involving people for whom injecting drug use is the primary risk factor for HIV acquisition. ‘Standard of prevention’ means the background or minimal HIV risk reduction interventions offered to all participants in a trial, regardless of what other investigational interventions they are assigned to receive. The standard of prevention concept is grounded in the ethical principle of beneficence—that researchers and sponsors are obliged to maximise benefits and minimise risks to participants in research studies.3 …. (shrink)

We are in the midst of a global crisis of climate change and environmental degradation to which the healthcare sector directly contributes. Yet conceptions of health justice have little to say about the environment. They purport societies should ensure adequate health for their populations but fail to require doing so in ways that avoid environmental harm or injustice. We need to expand our understanding of health justice to consider the environment and do so without reinforcing the epistemic injustice inherent in (...) the field of bioethics. This paper considers what work in philosophy related to the environment should be applied to help build that understanding and develops ideas about the healthcare sector’s responsibilities of justice to the environment. It first introduces the dominant multivalent environmental and ecological justice (EJ) concept in philosophy and each of its dimensions: distribution, participation, recognition and well-being. It then shows why applying that conception alone to broaden our understanding of health justice will reinforce epistemic injustice within bioethics. Drawing on EJ literature from the global South, the paper demonstrates that different ontological and experiential starting points identify additional EJ dimensions—power and harmony—and give rise to a nuanced understanding of the recognition dimension relative to the dominant EJ conception. The paper concludes by applying them to articulate healthcare sector responsibilities of justice to the environment, demonstrating they ground responsibilities beyond reducing its carbon emissions. (shrink)