Cet article fait valoir que la recherche sur le développement international devrait être soumise à la surveillance des comités d’éthique de la recherche dans les pays où les données seront collectées. Cela inclut les personnes ayant un statut qui leur permet de se soustraire des lignes directrices ou des politiques d’éthique, telles que les personnes engagées par des organisations non gouvernementales. L’argument repose sur une compréhension de la justice sociale qui reconnaît que ne pas rechercher l’approbation éthique au niveau local (...) peut être un affront au mouvement de décolonisation et peut entraîner des dommages directs importants pour les participants. La supervision éthique au niveau local favorise une meilleure prise en compte des législations locales, des règlements, des priorités et du contexte. Par exemple, un comité d’éthique de la recherche local est souvent mieux placé qu’un comité étranger pour évaluer si un projet proposé comporte des risques spécifiques au contexte donné. En outre, le fait de soumettre un projet à un comité d’éthique de la recherche local permet de reconnaître la légitimité des autorités locales, prenant ainsi position contre l’histoire de la perte de pouvoir en lien avec la colonisation. La supervision locale permet d’accroître la responsabilité des chercheurs travaillant à l’étranger : si l’autorité locale et l’adaptation au contexte spécifique doivent être respectées, il doit y avoir des mécanismes pour s’assurer que la recherche qui ne satisfait pas à ces exigences ne peut avoir lieu. Les objections fondées sur la capacité limitée de supervision dans certains pays et sur les préoccupations liées à la politisation du processus d’évaluation sont abordées. Enfin, les rôles et les responsabilités des différentes parties prenantes dans la mise en œuvre d’une plus grande supervision éthique au niveau local sont définis. (shrink)

While most contemporary proposals of ethics for machines draw upon principle-based ethics, a number of recent studies attempt to build machines capable of acting virtuously. This paper discusses the promises and limitations of building virtue-ethical machines. Taking inspiration from various philosophical traditions—including Greek philosophy (Aristotle), Chinese philosophy (Zhuangzi), phenomenology (Hubert and Stuart Dreyfus) and contemporary virtue theory (Julia Annas)—we argue for a novel model of machine ethics we call the “skillful-expert model.” This model sharply distinguishes human virtues and their machine (...) analogues and rejects the direct transposition of human virtues to machines, as suggested by most proposals for machine virtues. Instead, we propose that human skills are better candidates for machine virtues. (shrink)

By the time this essay is published, it will be a matter of weeks before doctors and nurse practitioners in Canada can legally end the lives (by medical assistance in dying, or MAID) of non-dying p...

Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. (...) We respond to the critics’ main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations. (shrink)

In the United States, the dominant model of decision‐making capacity (DMC) is the “four abilities model,” which judges DMC according to four criteria: understanding, appreciation, reasoning, and communicating a choice. Some critics argue that this model is “too cognitive” because it ignores the role of emotions and values in decision‐making. But so far there is no consensus about how to incorporate such factors into a model of DMC while still ensuring that patients with unusual or socially disapproved values still have (...) their autonomous decisions respected. In this paper, we aim to give an account of the role of values in decision‐making which can answer some of the lingering questions about capacity. In the current literature, defenders of the inclusion of values in DMC tend to propose solutions which focus on the distorted or incoherent attributes of the values themselves. We argue that shifting the focus onto valuing as an ability is a better solution and that a complete picture of capacity includes understanding, appreciation, reasoning, communicating a choice, and the ability to value. On the basis of a conceptual analysis of the necessary conditions for autonomous decision‐making, we derive a conception of the ability to value. On our account, the ability to value has four components: the possession of values, the ability to access those values, the ability to engage in practical reasoning with one's values, and the ability to act on the result of that reasoning. We describe the positive components of the ability to value, some indicators of impairment, and some implications of our account. (shrink)

If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

Shavelson et al. (2023) raise the familiar question of parity or fairness in the assisted dying1 debate: if we legally permit the practice for one person, should we not permit everyone similarly si...

Florijn’s helpful discussion of the Heringa case illustrates the difficulties in drawing a boundary on eligibility conditions for EAS. In Heringa, the Dutch Supreme Court reaffirmed...

The image of nature as causality has been a major theme of science and poetry. It has been a symbol of hope and fear, of progress and futility. Yet its meaning has seldom been clear. Prior to any statement about the relation of causality to physical nature, life, and mind, its meaning should be established. I shall therefore first define causality, and I shall then discuss its applicability to nature.

The modern legal and ethical movement against traditional welfare paternalism in medical decision-making extends to how decisions are made for patients lacking decisional capacity, prioritising surrogates’ judgment about what patients would have decided over even their best interests. In England and Wales, the Mental Capacity Act 2005 follows this trend of prioritising the patient’s prior wishes, values and beliefs but the dominant interpretation in life-sustaining treatment cases does so by in effect calling those values the ‘best interests’ of the patient (...) and focusing nearly exclusively on the ‘subjective’ viewpoint of the patient. In this article, we examine the recent Court of Protection judgment inBarnsley Hospitals NHS Foundation Trust v MSP[2020] EWCOP 26, which adhered closely to this approach, to suggest that it could have unexpected negative consequences. These include insufficient information gathering about and attention to patients’ objective medical interests, inadequacy of the evidentiary standard used for the substituted decision-making and, in some cases, even prioritising a surrogate’s current substituted judgment over the potential for an actual judgment by the patient. (shrink)

The determination of the place of life in nature has been a major philosophic issue. Some, in their attempt to show the continuity of nature, have resorted to the reductive method and have argued that the living differ in no significant sense from the non-living, unless it be in their complexity; others, in their desire to emphasize the qualitatively varied aspects of nature, have drifted to disjunctive method and have claimed that there is an unbridgeable gap between the living and (...) the non-living. Yet life in its natural setting presents both continuity with the physical world and a distinctive difference from it. One need neither sunder the continuity in nature nor deny the empirically observable qualitative differences. It is this principle that will guide the present discussion of life. (shrink)

Meanings have an empirical genesis and status. This simple claim has often been denied or ignored. Some metaphysicians in their exaltation of the eternal have regarded meanings as essences, or eternal objects, or neutral entities, in a subsistential or supernatural realm that is changeless and has no roots in nature. Some logicians in their zest to manipulate meanings isolate them so completely as forms of reason, or as syntactical symbols that at no point is their connection with natural events made (...) intelligible. Yet meanings, all meanings, have relation to mind. It is this empirical, psychological aspect of meaning that I shall analyze. The larger philosophic question as to what the relation of the psychological aspect is to the metaphysical or the logical will not concern us except indirectly. (shrink)

All these activities of living beings, and the functioning of their organs, and the functioning of instruments demand a teleological explanation. Why do human beings toil? Why do living beings try to maintain the activities of the organism? What are the functions of specific organs or instruments? Intelligible answers can be given in teleological terms. Of course, one could ask many questions about these situations that would not require the teleological explanation; for example, questions concerning the mechanical structure of living (...) beings or of instruments. Yet this fact would not eliminate the legitimacy nor the utility of the teleological category. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

One of the hot research topics today is relationship marketing. However, little research has been carried out in understanding the complex concepts of Guanxi (relationship) in a Chinese society. This research describes a study to operate the constructs of guanxi and explores the importance of guanxi in relationship development in order to present a new Guanxi framework. A study of both Western and Chinese literature provides foundations of the Guanxi perspectives. The constructs of adaptation, trust, opportunism and favour are identified. (...) Adaptation and trust are found to be positively correlated with sales stability and quality. Whilst, adaptation is negatively correlated with relationship termination costs. Both theoretical framework (a new perceptual map) and managerial implications are given. In addition, recommendations for future research are made. (shrink)

Book Information On the Emotions. By R. Wollheim. Yale University Press. New Haven/London. 1999. Pp. xiii + 269. Hardback, US$25.00.