In their article, van Gils Schmidt and Salloch defend the claim that physicians have a duty to protect the climate. The logic of the argument in broad terms is that (i) there is a relationship between climate change and the burden of disease, (ii) the healthcare sector is a significant emitter of global greenhouse gasses, thereby enhancing the burden of disease and (iii) since doctors are advocates of health and stakeholders in the healthcare sector, they have a duty to respond (...) to climate change. The authors recognise the ‘ethical basis for the claim of healthcare professionals having a special responsibility in climate change is far from being obvious’. The theoretical framework they choose for making this tentative link more apparent is Korsgaard’s theory of practical identities. The main argument of the authors seems to be that practical identities are pluralistic—a person can identify as a physician and environmentalist simultaneously—and the normative positions attributable to these identities may come into conflict. More than that, they claim that being an environmentalist is increasingly becoming …. (shrink)

Nicholas Makins proposes that doctors should take a deferential attitude towards their patients’ preferences when making decisions, and this includes their risk attitudes.1 He grounds this proposal in the principles of autonomy and beneficence. Makins appears to hold autonomy as a good in and of itself, and so for him it follows that deferring to patients must also be good. He also seems to hold that the satisfaction of personal preferences inevitably leads to improved well-being, and so deferring to patients’ (...) risk attitudes upholds the principle of beneficence. Unfortunately, Makins explicitly avoids defining well-being. His account seems to ignore the possibility of an objective measure of health that could contravene patient preferences, and therefore, challenge a deferential approach. While it is true that medicine is replete with complex decisions and significant uncertainty which require value judgements to navigate, it is not true medicine is purely about satisfying preferences. Patient preferences should always guide clinical decisions, but it seems to me Makins is making the far stronger claim that a doctor should act as a substitute decision-maker of sorts, doing their best to make the decision as if they were the patient themselves. I would contend this is not a good idea, as it would clearly impact a doctor’s …. (shrink)

Decision theorists recognise that information is valuable only insofar as it has the potential to change a decision. This means that since acquiring more information is time-consuming and sometimes expensive, judgements need to be made about what information is most valuable to acquire, and whether it is worth acquiring at all. In this article I apply this idea to informed consent and argue that the most valuable information relates not to what the best treatment option may be but to possible (...) futures a patient may regret. I conclude by proposing a regret-minimisation framework for informed consent that I contend better captures the true nature of shared decision making than existing formulations. (shrink)

Almost any medicine can be purchased online from abroad. Many high-income countries permit individuals to import medicines for their personal use. However, those who import medicines face the risk of purchasing poor-quality products that may not work, or that may even harm them. Many people are willing to accept this risk for the opportunity to purchase more affordable medicines. This is especially true of individuals from low socioeconomic backgrounds who already struggle to afford the medicines they need if they are (...) not subsidised by insurers or if copayments are high. As medicine prices and out-of-pocket healthcare spending continue to climb, the online marketplace provides an important alternative for individuals in high-income countries to source medicines. In this article, I argue that doctors have a responsibility to help patients access medicines online and I propose a framework that can be used to facilitate responsible personal importation. (shrink)

The debate about whether misoprostol should be distributed to low resource communities to prevent post-partum haemorrhage, recognised as a major cause of maternal mortality, is deeply polarised. This is in spite of stakeholders having access to the same evidence about the risks and benefits of misoprostol. To understand the disagreement, we conducted a qualitative analysis of the values underpinning debates surrounding community distribution of misoprostol. We found that different moral priorities, epistemic values, and attitudes towards uncertainty were the main factors (...) sustaining the debate. With this understanding, we present a model for ethical discourse that might overcome the current impasse. (shrink)

Cancer is a major burden on populations and health systems internationally. The development of innovative cancer medicines is seen as a significant part of the solution. These new cancer medicines are, however, expensive, leading to limited or delayed access and disagreements among stakeholders about which medicines to fund. There is no obvious resolution to these disagreements, with stakeholders holding firmly to divergent positions. Access to cancer medicines was recently explored in Australia in a Senate Inquiry into the Availability of New, (...) Innovative, and Specialist Cancer Drugs in Australia. We analysed the resultant Senate Report to identify competing stakeholder values. Our analysis illustrates that there are four main “goods” prioritized by different stakeholders: 1) innovation, 2) compassion, 3) equity, and 4) sustainability. We observe that, with the exception of sustainability, all of these “goods” put pressure on payers to provide access to cancer medicines more quickly and based on less rigorous evaluation processes. We then explore the consequences of giving in to such pressure and suggest that deconstructing the implicit values in calls for “enhanced access” to cancer medicines is necessary so that more nuanced solutions to the challenge of providing access to these high cost medicines can be found. (shrink)

Consumer engagement in decisions about the funding of medicines is often framed as a good in and of itself and as an activity that should be universally encouraged. A common justification for calls for consumer engagement is that it enhances equity. In this paper we systematically critique this assumption. We show that consumer engagement may undermine equity as well as enhance it and show that a simple relationship cannot be assumed but must be justified and demonstrated. In concluding, we present (...) a number of challenges that need to be overcome in order for consumer engagement to contribute to health technology assessment in a morally and politically sound manner. (shrink)

Wiggins and Wilbanks (2019) present citizen science as a range of “models” that fall under the rubric of public participation. They seem to have accepted what they call the “‘populist rhetoric’ tha...

While ethics and evidence‐based medicine are often viewed as separate domains of inquiry and practice, what we know influences what we can ethically justify doing, and what we see as our moral obligations shapes the way we interpret evidence. The boundaries between the moral and epistemic spheres become particularly blurred when the health of people is at stake and even more so when no “officially” recommended medical intervention is available to help a patient in need. The treatment of major hemorrhages (...) using recombinant factor VIIa (rFVIIa), which was originally approved under orphan drug legislation to treat hemophilia, is a case in point.Following reports in the late 1990s that rFVIIa was success­fully used to stop bleeding in gunshot trauma, there was much excitement about its potential to help patients with uncontrolled bleeding in other clinical settings, leading to wide‐spread off‐label use of the drug. In recent years, new evidence has raised questions about the off‐label use of rFVIIa for severe bleeding. Nonetheless, while some clini­cians are now adamantly opposed to prescribing rFVIIa for massive bleed­ing, many remain determined to continue the practice. This raises the question: why do clinicians have such variable responses to the same body of evidence?We analyzed the debate around off‐label use of rFVIIa and character­ized its main conceptual features and tensions. We did not seek to provide a normative analysis as to whether the evidence supports the case for off‐label prescribing, nor did we try to provide a historical analysis of how attitudes and clinical practice have changed. Rather, we sought to make visible the moral and epistemic values underpinning stakeholders’ opinions and practices. On the basis of our analysis, which is described in this ar­ticle, we suggest that debates such as those surrounding rFVIIa will not be resolved simply by conducting more studies and that, therefore, there is also a need for conceptual and pro­cedural frameworks that more sys­tematically incorporate values into clinical policy‐making. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Conflicts of interests are typically divided into those that are financial and those that are not. While there is general agreement that financial COIs have a significant impact on decisions and need to be declared and managed, the status of non-financial COIs continues to be disputed. In a recentBMJfeature article it was proposed that religious beliefs should be routinely declared as an interest. The article generated over 41 responses from the medical community and health researchers, which put forward diverse and (...) opposing views. In this paper, we analyse the discourse to shed further light on the reasons put forward for and against declaring religious beliefs. We argue for a middle path in which only material beliefs should be declared, and then only when there are no extenuating circumstances. To this end, we present a framework to help evaluate the materiality of interests that can be used for both financial and non-financial interests. (shrink)

Effective evaluation of any activity requires, first, that we understand what its objectives are, and second, that we can define and measure these objectives. For instance, a publicly listed compan...

A commentary on “Ethics and Evidence in Medical Debates: The Case of Recombinant Activated Factor VII,” by Narcyz Ghinea, Wendy Lipworth, Ian Kerridge, Miles Little, and Richard O. Day, in the March‐April 2014 issue.

Anthropology of Consciousness, Volume 33, Issue 1, Page 38-62, Spring 2022.

One of the influential contributions to criminalisation theories is Duff’s work on public wrongs, which offers a thin master principle of criminalisation, proposing that we have a reason to criminalise a type of conduct if it constitutes a public wrong; one that violates a polity’s civil order and forms part of that polity’s proper business. The nature of the civil order, the scope of its proper business, and the distinction between the public and private realms of wrongs are context-relative to (...) each polity, structured by their legal, institutional, and informal values and ways of life. Such a context-relative view led to problematic criminalisation examples raised by Duff and his critics. This article engages more fully with the relativism of the civil order and public wrongs in non-democratic and illiberal contexts. It draws on examples such as Saudi Arabi and Iran, and Beetham’s work on the legitimation of power to argue that conceptualising the civil order as an undifferentiated whole that represents a polity’s chosen way of life overlooks the ways in which the civil order’s values and practices are shaped by relations of power and exclusion rules and processes. This, in turn, exposes the theory to the risk of mirroring and legitimising unequal relations of power and impeding efforts to change them. This is also due to the theory’s lack of proper normative guidance on the legitimacy of criminalisation. The potential commitment to – instead of a preference for – democracy and guarantees of equality and freedoms might help strengthen the theory normatively, but it is insufficient to guard against the raised problems. (shrink)

Debates about effective responses to the COVID-19 pandemic have emphasized the paramount importance of digital tracing technology in suppressing the disease. So far, discussions about the ethics of this technology have focused on privacy concerns, efficacy, and uptake. However, important issues regarding power imbalances and vulnerability also warrant attention. As demonstrated in other forms of digital surveillance, vulnerable subpopulations pay a higher price for surveillance measures. There is reason to worry that some types of COVID-19 technology might lead to the (...) employment of disproportionate profiling, policing, and criminalization of marginalized groups. It is, thus, of crucial importance to interrogate vulnerability in COVID-19 apps and ensure that the development, implementation, and data use of this surveillance technology avoids exacerbating vulnerability and the risk of harm to surveilled subpopulations, while maintaining the benefits of data collection across the whole population. This paper outlines the major challenges and a set of values that should be taken into account when implementing disease surveillance technology in the pandemic response. (shrink)

In the Peruvian Amazon, tobacco (Nicotiana rustica) is considered a master plant and is the main curing tool of local healers. Among its several medicinal uses, we find drinking tobacco juice with the purpose of purging in order to heal on a physical, mental, and spiritual level. This specific practice is part of the addiction treatment protocol developed at Takiwasi Center. The goal of this investigation was to focus on the effects of the tobacco purge as reported by therapists at (...) Takiwasi and to elaborate its relevance within the context of addiction treatment. In order to obtain information on this topic, we performed research fieldwork based on a participant-observation approach, and retrospective data analysis on information from interviews conducted by psychotherapists with patients. As alleged effects of the tobacco purge, therapists reported that patients experienced feelings of mental clarity with the greatest frequency (n = 80), followed by noteworthy physical effects including discomfort and intoxication (n = 63). An effect on sleep and dreams was also common (n = 36) and many found the experience directly related to addiction treatment and the desire to consume substances (n = 20). (shrink)

The concept of sex selection for “family balancing” is based on the notion that a family is “balanced” when it includes children of “both genders.” Clinics that offer IVF for family balancing present it as an option for couples who “want to experience the joy of raising both a male and female child”. Families with at least one child of each gender are claimed to have gender diversity and to provide more enriching experiences to all family members. Some theorists call (...) these families “balanced”, while others acknowledge that such a term could be pejorative, implying that families with children of one gender are unbalanced and, thereby, lesser. These theorists... (shrink)

This paper examines dominant arguments advocating for the procreative right to undergo sex selection for social reasons, based on gender preference. I present four of the most recognized and common justifications for sex selection: the argument from natural sex selection, the argument from procreative autonomy, the argument from family balancing, and the argument from children’s well-being. Together these represent the various means by which scholars aim to defend access to sex selection for social reasons as a legitimate procreative choice. In (...) response, I contend that these justifications are flawed and often inconsistent and therefore fail to vindicate the practice. (shrink)

This paper intends to question the conventional wisdom that philosophy should limit its endeavours to the horizon of modern transcendentalism, thus rejecting the presuppositions of faith. By reappraising Edith Stein's views of faith and reason, which are also shared by the magisterial document of John Paul II, Fides et ratio, an argument for the possibility of “thinking in faith” is put forward. But why would it be important nowadays to engage in rational research in philosophy in a quest for truth (...) which also draws its inspiration from faith? First of all, as I shall argue, because the two great modern transcendental projects, namely the Kantian and the Husserlian one, which were both in tune with Spinoza's project to liberate philosophical reason from theology, have failed. Secondly, because “faith” is not based on “irrational sentiments,” but is “intellectual understanding,” as Edith Stein argues. Third, because the natural light of the created intellect is, as was shown by St. Thomas Aquinas, a participated likeness of the supernatural light of the uncreated divine intellect. Therefore, even the natural philosopher gets their own light from the eternal Truth of faith. Finally, by following another Thomistic stance, one may argue that the end of human life is an intelligible one: the contemplation of God. In order to attain this end, the human being should endeavour to attain as much as is possible, in an intelligible way, the thing desired. Even if the philosophical inquiry has its own limits, it may however sustain such progress towards the end of human life. (shrink)

Joss Whedon deserves credit for using the vehicle of his enduringly popular television series, Buffy the Vampire Slayer and Angel, to expose California's colonial history and raise questions regarding sustained responsibilities to the U.S. colonial past. This article, however, points out the ways in which BtVS and Angel, especially in the season four crossover episode of BtVS entitled “Pangs,” perpetuate the notion that this history and the indigenous peoples affected by it have vanished. It argues that this erasure of contemporary (...) American Indian peoples leaves reflective and ethically engaged people like Buffy and her "Scooby Gang"—and, by extension, socially conscientious fans of the show—without resources to be responsive to sustained colonial power structures in the present, and to the living indigenous peoples who continue to both suffer from and resist these structures. (shrink)

Bioethics, Volume 36, Issue 3, Page 305-312, March 2022.

This article investigates conceptions of morality within the framework of ressentimentful victimhood in the manosphere, while also exploring avenues for resistance among young individuals encountering the “hatred pipeline”. In Study 1, we use the emotional mechanism of ressentiment to examine how incels construct narratives of victimhood rooted in the notion of sexual entitlement that remains owed and unfulfilled, alongside its “black pill” variant emphasising moral and epistemic superiority. Through a linguistic corpus analysis and content examination of 4chan and Incel.is blog (...) posts, we find evidence of ressentiment morality permeating the language and communication within the incel community, characterised by blame directed at women, and the pervasive themes of victimhood, powerlessness, and injustice. In Study 2, we delve into young individuals’ reflections on incel morality and victimhood narratives as they engage with online networks of toxic masculinity in the manosphere. Drawing from semi-structured interviews with young participants who have accessed the manosphere, we explore their perceptions of risks, attribution of blame, and experiences of empathy towards individuals navigating the “hatred pipeline”. Our analysis underscores the significance of ressentiment in elucidating alternative conceptions of morality and victimhood, while shedding light on the potential for acceptance or resistance within online environments characterised by hatred. (shrink)

The concept of narrativity and narrative identity has two birth certificates: it is linked to the phenomenological tradition—beginning with Arendt’s “political phenomenology” —and to the tradition of German Idealism gradually slipping into existentialism. In this article, the author focuses on the latter tradition that helped to pave the way of the concept of narrative self. Key among the thinkers of Classical German Idealism has been Hegel, often considered the philosophical storyteller. Yet the author argues that Hegel’s concept of narrativity is (...) not exclusively applied to the self and has hardly any role in the constitution of consciousness. This is the reason why Hegel has the means to formulate a more convincing concept of the self and personal identity. The author does not deny that narrativity is seminal, both for leading a life as a human being and as a concrete person; however, originally consciousness and self-hood are born out of negativity. One enacts one’s selfhood, once one realizes that one has to interrupt narrativity, step in, refuse to live by it, or just ordinarily rephrase it consciously and by this appropriate it. (shrink)

We analyze some normative relations as instances of a general schema of relations among a finite number of parties; in this schema parties can play various roles grouped into two main conceptual layers, called 'subject position' and 'object position'. Relying on the theoretical apparatus introduced, we develop a new symbolic representation for normative reasoning which constitutes an alternative to approaches available in the literature. Our contribution includes a semantic characterization for a series of logical systems built over the proposed framework.

Peasants of the northeastern Pará cultivate cassava (manioc esculenta) using shifting cultivation. This paper discusses some factors in support of cassava production, even though it has some negative environmental impacts. These factors are the importance of cassava in the region's history, dietary traditions, and the cooperative labor systems employed in its cultivation and processing.

A tematização de uma política para o corpo, nas contingências do progresso técnico, leva a reflexão de Walter Benjamin a desenvolver a versão filosófica do torso barroco da arte seiscentista que irá explicar, nesse artigo, a contraposição entre os conceitos de mera vida ( blosses Leben ) ao de espaço para o corpo ( Leibraum ).

The paper concerns a “Note on the Film,” a short appendix to Feeling and Form by Susanne Langer. The interpretation interweaves the Note into a larger context of Langer’s philosophical work – primarily in terms of her understanding of the dream as a lower symbolic form, to which the film is compared – as well as in terms of her account of literary arts among which, she suggests, cinema belongs. Langer’s references to Sergei Eisenstein are discussed and their respective concepts (...) of cinema are compared. An implicit political dimension of Langer’s writing on film is emphasized by relating her critique of modern civilization, as sketched in the last chapter of Philosophy in a New Key, to her film aesthetics. At the end of the paper I compare my interpretation of the Note with the one that was offered by Trisha Curran. (shrink)