In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...) and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States’ role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders’ role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved. (shrink)

Abstract: We examine how trustworthy behaviour can be achieved in the financial sector. The task is to ensure that firms are motivated to pursue long-term interests of customers rather than pursuing short-term profits. Firms’ self-interested pursuit of reputation, combined with regulation, is often not sufficient to ensure that this happens. We argue that trustworthy behaviour requires that at least some actors show a concern for the wellbeing of clients, or a respect for imposed standards, and that the behaviour of these (...) actors is copied in such a way that it becomes a behavioural norm. We briefly suggest what such behavioural norms might need to be if trustworthy behaviour is to be achieved, and consider how they might be supported; we describe the research that is necessary in order to understand these norms in more detail. We argue that the norms of traders are different from the norms of those engaged in other activities, since they are inevitably self-interested, and we consider the risk that traders’ norms might undermine those of other actors. We analyse the task for governance in dealing with this problem, and the role which leadership by a corporate board and management might play in doing this. We describe the need for further research in to describe how this might be done. (shrink)

This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO’s) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organization technology (...) transfer proposals. We argue that while various individual mechanisms each have their specific individual merits—and in some cases weaknesses—overall, many of these current and proposed mechanisms could be highly complementary if used together to deliver equitable global access to vaccines. Nonetheless, we also argue that there are risks posed by the proliferation of proposals in this context, including the potential to disperse stakeholder attention or to delay decisive action. Therefore, we argue that there is now a clear need for concerted global multilateral action to recognise the complementarities of specific models and to provide a pathway for collaboration in attaining global equitable access to vaccines. The institutional infrastructure or proposals to achieve this amply exist at this point in time—but much greater cooperation from industry and clear, decisive and coordinated action from states and international organisations are urgently needed. (shrink)

This paper sets up and then solves a puzzle for the sceptical realist interpretation of Hume. The puzzle takes off when the sceptical realist attributes to Hume the following metaphysical theses: Causal powers grounding necessary connections in nature exist. Causal powers grounding necessary connections in nature are what make things happen.It then attributes an epistemological thesis to him: We have no knowledge of causal powers in nature nor of the necessary connections in nature which these powers ground.But putting these three (...) theses together seems to yield a problematic result. The epistemological thesis seems to have two corollaries as its upshot. We cannot know that causal powers grounding necessary connections in nature exist. We cannot know that causal powers grounding necessary connections in nature are what make things happen.That is, we cannot know and. New Hume’s position, the sceptical realist interpretation, seems to make Hume out to be arguing for a view that is self-undermining or dialectically unstable by his own empiricist lights. I argue that there is an overlooked externalist dimension to Hume’s epistemology and draw on this to solve the puzzle. (shrink)

Anti-selection occurs when information asymmetry exists between insurers and applicants. When an applicant knows they are at high risk of loss, but the insurer does not, the applicant may try to use this knowledge differential to secure insurance at a lower premium that does not match risk.

The application of machine learning and artificial intelligence in healthcare domains has received much attention in recent years, yet significant questions remain about how these new tools integrate into frontline user workflow, and how their design will impact implementation. Lack of acceptance among clinicians is a major barrier to the translation of healthcare innovations into clinical practice. In this systematic review, we examine when and how clinicians are consulted about their needs and desires for clinical AI tools. Forty-five articles met (...) criteria for inclusion, of which 24 were considered design studies. The design studies used a variety of methods to solicit and gather user feedback, with interviews, surveys, and user evaluations. Our findings show that tool designers consult clinicians at various but inconsistent points during the design process, and most typically at later stages in the design cycle. We also observed a smaller amount of studies adopting a human-centered approach and where clinician input was solicited throughout the design process. A third of all studies reported on clinician trust in clinical AI algorithms and tools. The surveyed articles did not universally report validation against the “gold standard” of clinical expertise or provide detailed descriptions of the algorithms or computational methods used in their work. To realize the full potential of AI tools within healthcare settings, our review suggests there are opportunities to more thoroughly integrate frontline users’ needs and feedback in the design process. (shrink)

Implicit knowledge is perhaps better understood as latent knowledge so that it is readily apparent that it contrasts with explicit knowledge in terms of the form of the knowledge representation, rather than by definition in terms of consciousness or awareness. We argue that as a practical matter any definition of the distinction between implicit and explicit knowledge further involves the notion of control.

What does it mean for a child to fulfil his or her potential? This article explores the contexts and implications of the much-used concept of potential in educational discourses. We claim that many of the popular, political and educational uses of the term in relation to childhood have a problematic blind spot: interpersonality, and the necessary coexistence for the concept to be receivable of all children’s ‘potentials’. Rather than advocating abandoning the term—a futile gesture given its emotive force—we argue that (...) the concept of children’s potential must be profoundly rethought to be workable as a philosophical notion in education. In an era marked by the unspoken assumption that ‘unlimited potential’ is always a good thing, we argue that it might be necessary to think about the limitations of the notion of individual potential; namely, the moment when it comes into contact with other people’s projects. We propose a conceptualisation of potential as the negotiated, situated, ever-changing creation of a group of individuals, in a process marked by conflict, and which remains essentially difficult. (shrink)

Dewey's pragmatism rejected ‘truth’ as indicative of an underlying reality, instead ascribing it to valuable connections between aims and ends. Surprisingly, his argument mirrors Bishop Berkeley's Idealism, summarised as ‘esse est percepi’ (to be is to be perceived), whose thinking is shown to be highly pragmatist—but who retained a foundationalist ontology by naming God as the guarantor of all things. I argue that while this position is unsustainable, pragmatism could nonetheless be strengthened through an ontological foundation. Koopman's charges of foundationalist (...) ‘givenism’ in Dewey's work, and in his promotion of the scientific method, are not proven. However, Koopman's ‘genealogical pragmatism’ may develop Deweyan educational theory by addressing dilemmas around curricular study. Koopman's arguments also point towards a missing ontological piece in Dewey's theory of knowledge. In the final section of the article I offer a dialogic ontology as compatible with pragmatism. This dialogical ontology provides both an ethical foundation through interrelatedness, and a generative theory of meaning and experience, as emergent from the encounter with difference. In this framework, to be is to respond—or be responded to. I offer the metaphor of ‘realisation’ to capture the human experience implied by this ontological stance. (shrink)

Background: Due to the important role of depression in major illnesses, screening measures for depression are commonly used in medical research. The protocol for managing participants with positive screens is unclear and raises ethical concerns. The aim of this article is to identify and critically discuss the ethical issues that arise when a positive screen for depression is detected, and offer some guidance on managing these issues.DiscussionDeciding on whether to report positive screens to healthcare practitioners is both an ethical and (...) a pragmatic dilemma. Evidence suggests that reporting positive depression screens should only be considered in the context of collaborative care. Possible adverse effects, such as the impact of false-positive results, potentially inappropriate labelling, and potentially inappropriate treatment also need to be considered. If possible, the psychometric properties of the selected screening measure should be determined in the target population, and a threshold for depression that minimises the rate of false-positive results should be chosen. It should be clearly communicated to practitioners that screening scores are not diagnostic for depression, and they should be informed about the diagnostic accuracy of the measure. Research participants need to be made aware of the consequences of the detection of high scores on screening measures, and to be fully informed about the implications of the research protocol.SummaryFurther research is needed and the experiences of researchers, participants, and practitioners need to be collated before the value of reporting positive screens for depression can be ascertained. In developing research protocols, the ethical challenges highlighted should be considered. Participants must be agreeable to the agreed protocol and efforts should be made to minimise potentially adverse effects. (shrink)

The science and technology of genetic testing is rapidly advancing with the consequences that genetic testing may well offer the prospect of being able to detect the onset of future disabilities. Some recent research also indicates that certain behavioural profiles may have a strong genetic basis, such as the determination to succeed and win or the propensity for risk-taking, which may be of interest to third parties. However, as this technology becomes more prevalent there is a danger that the genetic (...) information may be misused by entities such as employers, insurance companies, educational facilities, and finance companies and that people with particular genetic profiles may be discriminated against.This book explores the different types and the potential uses of genetic testing. The book highlights the ethical and legal dilemmas and the challenges arising as a result of emerging and rapidly advancing genetic science. Chapters in the book assess the importance and impact of the US Genetic Information Non-Discrimination Act (GINA) in the employment and health insurance contexts asking whether it is proving to be an effective tool in addressing the issue of genetic discrimination and alleviating individuals' fears of discrimination. The book then goes on to make the case for regulation at the European Union level in order to protect the privacy of genetic information and to prevent the discriminatory use of genetic information in Europe. It considers what can be learnt from the experience of the US in addressing ethical and legal issues as well as the impact that the UN Convention on the Rights of Persons with Disabilities is having on this debate within the EU. (shrink)

Bede's Ecclesiastical History is the most important single source for early medieval English history. Without it, we would be able to say very little about the conversion of the English to Christianity, or the nature of England before the Viking Age. Bede wrote for his contemporaries, not for a later audience, and it is only by an examination of the work itself that we can assess how best to approach it as a historical source. N.J. Higham shows, through a (...) close reading of the text, what light the Ecclesiastical History throws on the history of the period and especially on those characters from seventh- and early eighth-century England whom Bede either heroized, such as his own bishop, Acca, and kings Oswald and Edwin, or villainized, most obviously the British king Cædwalla but also Oswiu, Oswald's brother. In (Re-)Reading Bede, N.J. Higham offers a fresh approach to how we should engage with this great work of history. He focuses particularly on Bede's purposes in writing it, its internal structure, the political and social context in which it was composed and the cultural values it betrays, remembering always that our own approach to Bede has been influenced to a very great extent by the various ways in which he has been both used, as a source, and commemorated, as man and saint, across the last 1,300 years. (shrink)

This article considers the nature of Mr Burke's concerns in bringing his action and the practical implications of similar situations. When artificial nutrition and hydration is provided, practical issues arise regarding future, potentially long-term care. This in turn raises concerns about place of care, provision of carers and funding, which may not easily be resolved. The GMC guidance exists to provide direction and help for practitioners when difficult decisions have to be made about future treatment with the intention that the (...) patients' wishes and benefit of any potential treatment will be central to the discussions. Nevertheless, the reality of having these conversations, raising emotive issues with the patient and/or carers, and the implications of the final decision, may be very different in practice. (shrink)

In this article, I consider three influential poets of the Great War: Siegfried Sassoon, Charles Hamilton Sorley and Rupert Brooke. Since the birth of the modernist movement, the historical legacy of Great War poetry has tended to focus on the differing levels of “disenchantment” expressed in the works of these three poets when considered separately, applauding Sassoon and Sorley and criticizing Brooke. While I recognize a separation of the works of Brooke from those of Sorley and Sassoon in terms of (...) modernist disillusionment, I argue that analysing instead the literary elements which unify the works of all three poets offers a comprehensive understanding of the experience of trench warfare experience, unavailable through traditional methods of evaluating Great War poetry. (shrink)

In this article, I seek to define the status and role of Thomas Paine’s Common Sense as a historical document. I argue that although Paine’s influential pamphlet offers no original ideas and seems simply to reinforce existing trends, its layered text transcends the regurgitation of propaganda and extends to literary achievement in its reflection of social and economic conditions, its deliberate narrative style, and its usage of literary devices and culture references grounded in historical context. Consequently, my methodology is necessarily (...) focused through literary discourse to achieve historical understanding of this key document from the American Revolution. (shrink)

There are four problems to be faced in 710–12. Is πρσει correct? Who was Orestes? What is the construction of 'ρστ? What is the meaning of να μιλν ποδ? A brief review of the evidence collected on the subject of Orestes is the first essential.