The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations — who and what are studied and why? — and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in the (...) context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. (shrink)

St. Amand could count among his many feats the extraordinary achievement of social equilibrium. “The way he was in the midst of the rich and the poor,” his hagiographer marveled, “the poor saw him as a poor man, and the rich treated him as their better.” On a résumé of miracles performed and peoples converted, this accomplishment was no less impressive. Bishops in the post-Roman kingdoms of Gaul/Francia maintained an ongoing balancing act between seeking social and political distinction, on the (...) one hand, and fulfilling their obligation to defend the poor, on the other. Their authority increasingly depended upon both, even as it engendered a tension between elitism and inclusivity. To study bishops' choice of company is therefore to highlight the difficulty inherent in an ambitious pastoral and political positioning. Linked to the subject of the episcopal entourage, and to the issue of episcopal authority and its representation more generally, was a change in the culture of Merovingian government, for bishops were becoming more and more valuable to a monarchy that confronted new standards of responsibility toward its subjects. (shrink)

The past thirty years have seen a surge of empirical research into political decision making and the influence of framing effects — the phenomenon that occurs when different but equivalent presentations of a decision problem elicit different judgments or preferences. During the same period, political philosophers have become increasingly interested in democratic theory, particularly in deliberative theories of democracy. Unfortunately, the empirical and philosophical studies of democracy have largely proceeded in isolation from each other. As a result, philosophical treatments of (...) democracy have overlooked recent developments in psychology, while the empirical study of framing effects has ignored much contemporary work in political philosophy. In Framing Democracy, Jamie Terence Kelly bridges this divide by explaining the relevance of framing effects for normative theories of democracy. -/- Employing a behavioral approach, Kelly argues for rejecting the rational actor model of decision making and replacing it with an understanding of choice imported from psychology and social science. After surveying the wide array of theories that go under the name of democratic theory, he argues that a behavioral approach enables a focus on three important concerns: moral reasons for endorsing democracy, feasibility considerations governing particular theories, and implications for institutional design. Finally, Kelly assesses a number of methods for addressing framing effects, including proposals to increase the amount of political speech, mechanisms designed to insulate democratic outcomes from flawed decision making, and programs of public education. -/- The first book to develop a behavioral theory of democracy, Framing Democracy has important insights for democratic theory, the social scientific understanding of political decision making, economics, and legal theory. (shrink)

What is the optimal size of a democratic society? While not taking an explicit stand on this issue, Hélène Landemore's model of democracy in Democratic Reason suggests that democracies ought to be small, certainly smaller than many existing states. If, as Landemore argues, we must rely on the random selection of representatives, then we should be concerned about both the size of the population and the way cognitive diversity is distributed within it. Given the realities of party politics and media (...) framing, this means that smaller political societies will yield wiser decisions than very large ones. (shrink)

In a number of recent publications, Cass Sunstein and Richard Thaler have argued for a novel approach to the design of public policy. Their proposal has received a great deal of attention, both within academic circles and the public at large. Drawing upon evidence from behavioral economics and empirical psychology, the authors attempt to demonstrate that the conventional antagonism between libertarians and paternalists within political theory dissolves in conditions that obtain widely in public decision-making. Where free choice and the promotion (...) of individual welfare can coexist, the authors believe that designers of public policy ought to be libertarian paternalists. -/- In this paper I criticize their proposal on grounds that the authors are unable to sufficiently motivate the paternalistic element of their approach. I argue that the empirical evidence cited by the authors is capable of supporting a number of competing approaches, including what I call libertarian utilitarianism and libertarian justice. Since the evidence that the authors draw upon does not provide us any grounds for selecting between these rival approaches, I conclude that Sunstein and Thaler are unable to provide us with a convincing guide for the design of public policy. In order to show that this is the case, I consider three arguments in favor of libertarian paternalism, and find each lacking. I end with some comments about what we can properly conclude on the basis of Sunstein and Thaler’s arguments. (shrink)

In a number of recent publications, Cass Sunstein and Richard Thaler have argued for a novel approach to the design of public policy. Their proposal has received a great deal of attention, both within academic circles and the public at large. Drawing upon evidence from behavioral economics and empirical psychology, the authors attempt to demonstrate that the conventional antagonism between libertarians and paternalists within political theory dissolves in conditions that obtain widely in public decision-making. Where free choice and the promotion (...) of individual welfare can coexist, the authors believe that designers of public policy ought to be libertarian paternalists. In this paper I criticize their proposal on grounds that the authors are unable to sufficiently motivate the paternalistic element of their approach. I argue that the empirical evidence cited by the authors is capable of supporting a number of competing approaches, including what I call libertarian utilitarianism and libertarian justice. Since the evidence that the authors draw upon does not provide us any grounds for selecting between these rival approaches, I conclude that Sunstein and Thaler are unable to provide us with a convincing guide for the design of public policy. In order to show that this is the case, I consider three arguments in favor of libertarian paternalism, and find each lacking. I end with some comments about what we can properly conclude on the basis of Sunstein and Thaler’s arguments. (shrink)

Robert Talisse’s recent attempt to justify liberal democracy in epistemic terms is in many ways a breath of fresh air. However, in the present paper we argue that his defense faces two inter-related problems. The first problem pertains to his defense of liberalism, and owes to the fact that a commitment to the folk-epistemological norms in terms of which he makes his case does not commit one to partaking in liberal institutions. Consequently, our (alleged) commitment to the relevant epistemic norms (...) does not justify liberal democracy. The second problem pertains to his defense of democracy. The problem is that, if Talisse provides what we take to be the most plausible response to the first problem, framed in terms of his acceptance of a form of epistemic perfectionism, he is able to maintain his commitment to liberal institutions, but at the price of leaving democracy behind in favor of what we will refer to as a liberal epistocracy. (shrink)

Robert Talisse’s recent attempt to justify liberal democracy in epistemic terms is in many ways a breath of fresh air. However, in the present paper we argue that his defense faces two inter-related problems. The first problem pertains to his defense of liberalism, and owes to the fact that a commitment to the folk-epistemological norms in terms of which he makes his case does not commit one to partaking in liberal institutions. Consequently, our (alleged) commitment to the relevant epistemic norms (...) does not justify liberal democracy. The second problem pertains to his defense of democracy. The problem is that, if Talisse provides what we take to be the most plausible response to the first problem, framed in terms of his acceptance of a form of epistemic perfectionism, he is able to maintain his commitment to liberal institutions, but at the price of leaving democracy behind in favor of what we will refer to as a liberal epistocracy. (shrink)

This article reviews three books written by Larry May concerning the foundations of international criminal law: Crimes Against Humanity: A Normative Account (2005), War Crimes and Just War (2007), and Aggression and Crimes Against Peace (2008).

This article responds to Nir Eisikovits’ recent book Sympathizing with the Enemy: Reconciliation, Transitional Justice, Negotiation (Martinus Nijhoff Publishers, 2010).

This paper points out an ambiguity in Cass Sunstein’s recent work concerning whose lives and interests are to be promoted by libertarian paternalism, and argues that this ambiguity stems from a lack of clarity regarding how we should understand the relevance of the heuristics and biases literature for democratic theory. The paper attempts to extract from Sunstein’s work an account of how we should go about identifying biases in social choices. It argues that Sunstein’s view on this issue has changed (...) over the years, and identifies a trend in his thinking moving away from libertarian paternalism and toward libertarian welfarism. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

The purpose of this study was to determine if reading achievement of students from high-poverty US schools differs as a function of participation in summer tutoring versus access to books. Data fro...

Modes-of-being figure centrally in Heidegger's masterwork Being and Time. Testimony to this is Heidegger's characterisation of two of his most celebrated enquiries—the Existential analytic and the Zeug analysis—as investigations into the respective modes-of-being of the entities concerned. Yet despite the importance of this concept, commentators disagree widely about what a mode-of-being is. In this paper, I systematically outline and defend a novel and exegetically grounded interpretation of this concept. Strongly opposed to Kantian readings, such as those advocated by Taylor Carman (...) and Cristina Lafont, I interpret a mode-of-being as a universal that defines a district —that is, a natural class of entities that ought to be conceptualised in a special way. As such, every mode-of-being plays an important metaphysical and epistemic role: serving both to unify a natural class of a high degree of generality and as the interpretandum of an act yielding the basic-concepts pertaining to the entities therein. In explicating and arguing for this interpretation, I attribute a characteristically Aristotelian philosophical position to the early Heidegger, encompassing both metaphysical and epistemological realism and a conceptualist theory of universals. (shrink)

Amongst intellectuals and activists, neoliberalism has become a potent signifier for the kind of free-market thinking that has dominated politics for the past three decades. Forever associated with the conviction politics of Ronald Reagan and Margaret Thatcher, the free-market project has since become synonymous with the 'Washington consensus' on international development policy and the phenomenon of corporate globalization, where it has come to mean privatization, deregulation, and the opening up of new markets. But beyond its utility as a protest slogan (...) or buzzword as shorthand for the political-economic Zeitgeist, what do we know about where neoliberalism came from and how it spread? Who are the neoliberals, and why do they studiously avoid the label? Constructions of Neoliberal Reason presents a radical critique of the free-market project, from its origins in the first half of the 20th Century through to the recent global economic crisis, from the utopian dreams of Friedrich von Hayek through the dogmatic theories of the Chicago School to the hope and hubris of Obamanomics. The book traces how neoliberalism went from crank science to common sense in the period between the Great Depression and the age of Obama. Constructions of Neoliberal Reason dramatizes the rise of neoliberalism and its uneven spread as an intellectual, political, and cultural project, combining genealogical analysis with situated case studies of formative moments throughout the world, like New York City's bankruptcy, Hurricane Katrina, and the Wall Street crisis of 2008. The book names and tracks some of neoliberalism's key protagonists, as well as some of the less visible bit-part players. It explores how this adaptive regime of market rule was produced and reproduced, its logics and limits, its faults and its fate. (shrink)

In biomedicine, practitioners often treat risk of disease as an illness in itself—suitable for monitoring and intervention. In some cases, increased diagnostics improve health outcomes by detecting problems early. Recently, however, science and technology studies scholars and medical practitioners have noted that the treatment of risk can also lead to unnecessary intervention and possible harm. Despite these findings, it is often hard to see changes in practice. Childbirth serves as an illuminating case because two models of health risk operate simultaneously—in (...) addition to the model valuing frequent intervention, there is another that seeks to mitigate risk by refusing medical surveillance. Based on interviews with birth providers and an analysis of professional documents, this article uses the case of fetal heart rate monitoring in American childbirth to demonstrate how some health providers are framing “intentional non-knowing” as a moral imperative to reduce medical risk. Studying the success and limitations of this “risk counterculture” illuminates how risk societies are changing in response to data suggesting that more information can have hurtful effects. This case integrates well-developed theories of knowledge production with less-developed theories of knowledge nonproduction, leading to a more fruitful discussion of the boundaries of responsible knowledge in risk management. (shrink)

This investigation is motivated by the lack of scholarship examining the content of what firms are communicating to various stakeholders about their commitment to socially responsible behaviors. To address this query, a qualitative study of the legal, ethical and moral statements available on the websites of Forbes Magazine''s top 50 U.S. and top 50 multinational firms of non-U.S. origin were analyzed within the context of stakeholder theory. The results are presented thematically, and the close provides implications for social responsibility among (...) managers of global organizations as well as researchers interested in business ethics. (shrink)

Ethical medical care of pregnant women in Australia should include the real provision of information regarding the risks and benefits of vaginal birth. Routinely obtaining consent for the different ways in which childbirth is commonly intervened on and the assistance involved (such as midwife-led care or a planned caesarean section) and providing sufficient information for women to evaluate the harms and benefits of the care on offer, would not only enable the empowerment of women but would align with the current (...) standard of care as established by Rogers v Whittaker. (shrink)

Chat Generative Pre-Trained Transformer (ChatGPT) has been a growing point of interest in medical education yet has not been assessed in the field of bioethics. This study evaluated the accuracy of ChatGPT-3.5 (April 2023 version) in answering text-based, multiple choice bioethics questions at the level of US third-year and fourth-year medical students. A total of 114 bioethical questions were identified from the widely utilised question banks UWorld and AMBOSS. Accuracy, bioethical categories, difficulty levels, specialty data, error analysis and character count (...) were analysed. We found that ChatGPT had an accuracy of 59.6%, with greater accuracy in topics surrounding death and patient–physician relationships and performed poorly on questions pertaining to informed consent. Of all the specialties, it performed best in paediatrics. Yet, certain specialties and bioethical categories were under-represented. Among the errors made, it tended towards content errors and application errors. There were no significant associations between character count and accuracy. Nevertheless, this investigation contributes to the ongoing dialogue on artificial intelligence’s (AI) role in healthcare and medical education, advocating for further research to fully understand AI systems’ capabilities and constraints in the nuanced field of medical bioethics. (shrink)

The Vitruvian Man is a metaphor for the “ideal man” by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the “ideal nurse” (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self‐sacrificial language (re)producing self‐sacrificing expectations. (...) The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self‐sacrifice and exhaustion among nurses. (shrink)

Discussion of a metaphysical sense of 'inheritance' and cognate notions relevant to fundamentality.

Ethicists, policy-makers, and the general public have questioned whether artificial entities such as robots warrant rights or other forms of moral consideration. There is little synthesis of the research on this topic so far. We identify 294 relevant research or discussion items in our literature review of this topic. There is widespread agreement among scholars that some artificial entities could warrant moral consideration in the future, if not also the present. The reasoning varies, such as concern for the effects on (...) artificial entities and concern for the effects on human society. Beyond the conventional consequentialist, deontological, and virtue ethicist ethical frameworks, some scholars encourage “information ethics” and “social-relational” approaches, though there are opportunities for more in-depth ethical research on the nuances of moral consideration of artificial entities. There is limited relevant empirical data collection, primarily in a few psychological studies on current moral and social attitudes of humans towards robots and other artificial entities. This suggests an important gap for psychological, sociological, economic, and organizational research on how artificial entities will be integrated into society and the factors that will determine how the interests of artificial entities are considered. (shrink)

The moral/conventional task has been widely used to study the emergence of moral understanding in children and to explore the deficits in moral understanding in clinical populations. Previous studies have indicated that moral transgressions, particularly those in which a victim is harmed, evoke a signature pattern of responses in the moral/conventional task: they are judged to be serious, generalizable and not authority dependent. Moreover, this signature pattern is held to be pan‐cultural and to emerge early in development. However, almost all (...) the evidence for these claims comes from studies using harmful transgressions of the sort that primary school children might commit in the schoolyard. In a study conducted on the Internet, we used a much wider range of harm transgressions, and found that they do not evoke the signature pattern of responses found in studies using only schoolyard transgressions. Paralleling other recent work, our study provides preliminary grounds for skepticism regarding many conclusions drawn from earlier research using the moral/conventional task. (shrink)

Recent philosophical literature has turned its attention towards assessments of how to judge scientific proposals as worthy of further inquiry. Previous work, as well as papers contained within this special issue, propose criteria for pursuitworthiness (Achinstein, 1993; Whitt, 1992; DiMarco & Khalifa, 2019; Laudan, 1977; Shan, 2020; Šešelja et al., 2012). The purpose of this paper is to assess the grounds on which pursuitworthiness demands can be legitimately made. To do this, I propose a challenge to the possibility of even (...) minimal criteria of pursuitworthiness, inspired by Paul Feyerabend. I go on to provide a framework for identifying the contexts in which pursuitworthiness criteria may promote the efficiency of scientific inquiry. I then spell out some implications this framework has for values and pursuit. (shrink)

Knowledge closure is the claim that, if an agent S knows P, recognizes that P implies Q, and believes Q because it is implied by P, then S knows Q. Closure is a pivotal epistemological principle that is widely endorsed by contemporary epistemologists. Against Knowledge Closure is the first book-length treatment of the issue and the most sustained argument for closure failure to date. Unlike most prior arguments for closure failure, Marc Alspector-Kelly's critique of closure does not presuppose any (...) particular epistemological theory; his argument is, instead, intuitively compelling and applicable to a wide variety of epistemological views. His discussion ranges over much of the epistemological landscape, including skepticism, warrant, transmission and transmission failure, fallibilism, sensitivity, safety, evidentialism, reliabilism, contextualism, entitlement, circularity and bootstrapping, justification, and justification closure. As a result, the volume will be of interest to any epistemologist or student of epistemology and related subjects. (shrink)

Future Politics confronts the most important question of our time: how will digital technology change society?

In the following review essay I provide some background in order to place Margaret Archer's edited Volume 3 text, Generative Mechanisms, in context of the series from which it derives. In doing so I provide some sense of the significance of the series. Thereafter, I provide an overview of the key substantive claims of the essays, with some comment on how they may be linked together in terms of the theme of the series.

In reference to the philosophical theology of medieval Islamic theologian Ibn Taymiyya, this paper outlines a parallel between Taymiyyan thought and Alvin Plantinga’s thesis of ‘Reformed Epistemology’. In critiquing a previous attempt to build an account of ‘Islamic externalism’, the Taymiyyan model offers an account that can be seen as wholly ‘Plantingan’.

The problem of religious disagreement between epistemic peers is a potential threat to the epistemic justification of one’s theistic belief. In this paper, I develop a response to this problem which draws on the central epistemological thesis of skeptical theism concerning our inability to make proper judgements about God’s reasons for permitting evil. I suggest that this thesis may extend over to our judgements about God’s reasons for self-revealing, and that when it does so, it can enable theists to remain (...) steadfast amid disagreement with epistemic peers who hold a contrary theistic belief (i.e., atheistic belief). For if we’re unable to make proper judgements about God’s reasons for self-revealing, then for all we know, God has some reason for not revealing Himself to our apparent epistemic peer. Thus, their epistemic credentials needn’t provide reason to reduce one’s confidence to such a degree as to no longer uphold one’s theistic belief. (shrink)

What does it mean to be an expert? What sort of authority do experts really have? And what role should they play in today's society? Addressing why ever larger segments of society are skeptical of what experts say, Expertise: A Philosophical Introduction reviews contemporary philosophical debates and introduces what an account of expertise needs to accomplish in order to be believed. Drawing on research from philosophers and sociologists, chapters explore widely held accounts of expertise and uncover their limitations, outlining a (...) set of conceptual criteria a successful account of expertise should meet. By providing suggestions for how a philosophy of expertise can inform practical disciplines such as politics, religion, and applied ethics, this timely introduction to a topic of pressing importance reveals what philosophical thinking about expertise can contribute to growing concerns about experts in the 21st century. (shrink)

In this work, Jamie Mayerfeld undertakes a careful inquiry into the meaning and moral significance of suffering. Understanding suffering in hedonistic terms as an affliction of feeling, he claims that it is an objective psychological condition, amenable to measurement and interpersonal comparison, although its accurate assessment is never easy. Mayerfeld goes on to examine the content of the duty to prevent suffering and the weight it has relative to other moral considerations. He argues that the prevention of suffering is (...) morally more important than the promotion of happiness, and that the duty to relieve suffering is much stronger than most of us acknowledge. (shrink)

Among social epistemologists, having a certain proportion of reliably formed beliefs in a subject matter is widely regarded as a necessary condition for cognitive expertise. This condition is motivated by the idea that expert testimony puts subjects in a better position than non-expert testimony to obtain knowledge about a subject matter. I offer three arguments showing that veritism is an inadequate account of expert authority because the reliable access condition renders expertise incapable of performing its social role. I then develop (...) an alternative explanation of expert authority that I call the epistemic facility account, arguing that having a certain type of competence in a subject matter or domain of subject matters is sufficient for explaining expert authority while avoiding the problems with veritistic accounts. (shrink)

There are three primary aims of the book. The first, set out in the book's introduction, is to explain how two fairly recent developments in philosophy, externalism and modalism, provide the basis for a promising account of knowledge - an account that achieves anti-skeptical results and avoids Gettier-style counterexamples that are based on an agent having warranted beliefs that are merely luckily true. Epistemological externalism is the thesis that not all the factors that make a true belief a case of (...) knowledge need to be cognitively accessible or "internal" to the agent. Modalism, as the author construes it, is the use of possible worlds talk in clarifying what would or might be the case and what is necessarily so." "The second objective is to work through the different modalized epistemologies extant in the literature, assessing their strengths and weaknesses, with a view toward constructing a working theory. Finally, the author proposes the theory that knowledge is reliably formed, sensitive true belief, and defends the theory against objections."--Jacket. (shrink)