Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. (...) The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula. (shrink)

Distinctions in fundamentality between different levels of description are central to the viability of contemporary decoherence-based Everettian quantum mechanics (EQM). This approach to quantum theory characteristically combines a determinate fundamental reality (one universal wave function) with an indeterminate emergent reality (multiple decoherent worlds). In this chapter I explore how the Everettian appeal to fundamentality and emergence can be understood within existing metaphysical frameworks, identify grounding and concept fundamentality as promising theoretical tools, and use them to characterize a system of explanatory (...) levels (with associated laws of nature) for EQM. This Everettian level structure encompasses and extends the ‘classical’ levels structure. The ‘classical’ levels of physics, chemistry, biology, etc. are recovered, but they are emergent in character and potentially variable across Everett worlds. EQM invokes an additional fundamental level, not present in the classical levels picture, and a novel potential role for self-location in interlevel metaphysics. When given a modal realist interpretation, EQM also makes trouble for supervenience-based approaches to levels. (shrink)

Background HIV prevention research has been fraught with ethical concerns since its inception. These concerns were highlighted during HIV vaccine research and have been elaborated in microbicide research. A host of unique ethical concerns pervade the microbicide research process from trial design to post-trial microbicide availability. Given the urgency of research and development in the face of the devastating HIV pandemic, these ethical concerns represent an enormous challenge for investigators, sponsors and Research Ethics Committees (RECs) both locally and internationally. Discussion (...) Ethical concerns relating to safety in microbicide research are a major international concern. However, in the urgency to develop a medically efficacious microbicide, some of these concerns may not have been anticipated. In the risk-benefit assessment of research protocols, both medical and psycho-social risk must be considered. In this paper four main areas that have a potential for medical and/or psycho-social harm are examined. Male partner involvement is controversial in the setting of covert use of microbicides. However, given the long-term exposure of men to experimental products, this may be methodologically, ethically and legally important. Covert use of microbicides may impact negatively on relationship dynamics leading to psychosocial harm to varying extents. The unexpectedly high rates of pregnancy during clinical trials raise important methodological and ethical concerns. Enrollment of adolescents without parental consent generates ethical and legal concerns that must be carefully considered by RECs and trial sites. Finally, paradoxical outcomes in recent trials internationally have advanced the debate on the nature of informed consent and responsibility of researchers to participants who become HIV positive during or after trials. Summary Phase 3 microbicide trials are an undisputed research and ethical priority in developing countries. However, such trials must be conducted with attention to both methodological and ethical detail. It is imperative that guidelines are formulated to ensure that high ethical standards are maintained despite the scientific urgency of microbicide development. Given the controversy raised by emergent ethical issues during the course of microbicide development, it is important that international consensus is reached amongst the various ethics and regulatory agencies in developing and developed countries alike. (shrink)

Background and objectives: There are few insights from sub-Saharan Africa on research participants’ experiences of the informed consent process, particularly in the context of randomised controlled trials, where issues of randomisation and the use of placebos may be confusing concepts for participants. This study investigated the knowledge and perceptions of the informed consent process among individuals participating in influenza vaccine trials in two disadvantaged communities in South Africa.Method: Four to 12 months after completion of the trials, participants were contacted to (...) return to participate in the informed consent study. The semistructured questionnaire administered to assess recall of trial procedures and the informed consent process covered key issues including: purpose of the study; awareness that the study was not part of routine treatment; voluntary nature of participation and freedom to withdraw; randomisation; placebos; and remuneration.Results: A total of 334 participants completed the questionnaire. Only 21% were able to recall that they were allocated randomly to the different treatment arms. Only 19% of those involved in the placebo controlled study had interpreted the concept of placebo as an inactive medication.Conclusion: Although a good general recall of trial concepts was demonstrated, only a small proportion of the participants correctly interpreted and recalled the concepts of randomisation and placebos. Informed consent in this and similarly disadvantaged communities may often be inadequate and new ways to improve understanding of the research process should be explored. (shrink)

This article offers an analysis of the construction and deployment of the ideas of ‘the West’ and ‘tradition’ in the social commentary of Ashis Nandy. It argues that Nandy's ‘critical’ defence of tradition is framed and animated by occidentalism and renders tradition into a paradoxical space of redemption and innocence. The first part of the paper shows that Nandy's nativist narratives of loss and his suspicion of political ideologies place him both in and against post-colonial cultural politics. The second section (...) examines and illustrates the mutually defining nature of occidentalism and traditionalism. It is shown that Nandy's stereotypes of authentic Indian culture undermine the critical capabilities of his ‘critical traditionalism’. Part three explores Nandy's dilemmas further by reference to his attempts to align tradition with reflexivity. (shrink)

In this chapter, I shall give an account of the emergence of bioethics as a field of study and then describe its common features in an international context. In the final section I shall suggest how some concept of public reason might be used to meet the challenges thrown up by the contentious nature of the field.

Marxists should reconsider their usual attitude to universal human rights. On the Jewish Question did not reject the entire French Declaration of 1791. In 1843 Marx and Engels were close to Babouvism, the continuation of French rights. Nor was their view that the 1791 Declaration must be completed by economic and social rights; rather, their criticism concerned the reduction of universal rights to citizen rights because it left the state the final arbiter of justice, denying the ‘voice from below’. The (...) source of human rights cannot be the state or its hegemonic rule of law. The article concludes that a politics of human rights would return justice to individuals and create a counter-hegemony. (shrink)

There is a systematic and suggestive analogy between grounding and causation. In my view, this analogy is no coincidence. Grounding and causation are alike because grounding is a type of causation: metaphysical causation. In this paper I defend the identification of grounding with metaphysical causation, drawing on the causation literature to explore systematic connections between grounding and metaphysical dependence counterfactuals, and I outline a non-reductive counterfactual theory of grounding along interventionist lines.

Quantum physics is believed to be the fundamental theory underlying our understanding of the physical universe. However, it is based on concepts and principles that have always been difficult to understand and controversial in their interpretation. This book aims to explain these issues using a minimum of technical language and mathematics. After a brief introduction to the ideas of quantum physics, the problems of interpretation are identified and explained. The rest of the book surveys, describes and criticises a range of (...) suggestions that have been made with the aim of resolving these problems; these include the traditional, or 'Copenhagen' interpretation, the possible role of the conscious mind in measurement, and the postulate of parallel universes. This new edition has been revised throughout to take into account developments in this field over the past fifteen years, including the idea of 'consistent histories' to which a completely new chapter is devoted. (shrink)

Machine generated contents note: 1.Lost Spaces -- Sandy Island -- Leningrad -- Arne -- Old Mecca -- New Moore -- Time Landscape -- The Aralqum Desert -- 2.Hidden Geographies -- The Labyrinth -- Zheleznogorsk -- The Underground Cities of Cappadocia -- Fox Den -- North Cemetery, Manila -- North Sentinel Island -- 3.No Man's Lands -- Between Border Posts (Guinea and Senegal) -- Bir Tawil -- Nahuaterique -- Twayil Abu Jarwal -- Traffic Island -- 4.Dead Cities -- Wittenoom -- Kangbashi (...) -- Kijong-dong -- Aghdam -- Pripyat -- The Archaeological Park of Sicilian Incompletion -- 5.Spaces of Exception -- Camp Zeist -- Geneva Freeport -- Bright Light, 4 Mures Street, Bucharest -- International Airspace -- Gutterspace -- Bountiful -- Mount Athos -- Ranch of Sprouts: Brotas Quilombo -- FARC-controlled Colombia -- Hobyo -- 6.Enclaves and Breakaway Nations -- Baarle-Nassau and Baarle-Hertog -- Chitmahals -- Sealand -- United Kingdom of Lunda Tchokwe -- Gagauzia -- 7.Floating Islands --. (shrink)

Five leading thinkers on the concept of 'rights' in an era of rightlessness Sixty years ago, the political theorist Hannah Arendt, deprived of her German citizenship as a Jew and in exile from her country, observed that before people can enjoy any of the 'inalienable' Rights of Man--before there can be any specific rights to education, work, voting, and so on--there must first be such a thing as 'the right to have rights.' The concept received little attention at the time, (...) but in our age of refugee crises and extra-state war, the phrase has become the center of a crucial and lively debate. Here five leading thinkers from varied disciplines, including history, law, and politics, discuss the critical issue of the basis of rights and the meaning of radical democratic politics today. (shrink)

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in (...) 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country. (shrink)

This book equips readers with a sound understanding of the value-base of mental health care and provides them with the skills and knowledge to demystify complex values in decision-making in order to reach outcomes which are focused on the needs of service users. Engaging case examples and exercises link theory and practice throughout.

BackgroundThe use of a Community Advisory Board is one method of ensuring community engagement in community based research. To identify the process used to constitute CABs in Zambia, this paper draws on the perspectives of both research team members and CAB members from research groups who used CABs in Lusaka. Enabling and restricting factors impacting on the functioning of the CAB were identified.MethodsAll studies approved by the University of Zambia Bioethics Research Committee from 2008 – 2012 were reviewed to identify (...) those studies that were likely to include a CAB. Eight teams with studies that included a CAB were identified. For each of these studies, consent was obtained to conduct an informal interview with a research team member and to obtain contact details for one CAB member. In total 14 interviews were conducted with 8 research team members and 6 CAB members from 12–30 August 2013.ResultsIdentification of potential CAB members from the community and their participation in developing the terms of reference for CABs was perceived to have contributed to the success of the CAB. Due to the trust that the community had in members of their community the CABs were then in a stronger position to influence community participation in the research. Training of CAB members was identified as a factor that enhanced the functioning of a CAB. Lack of commitment and low literacy levels of CAB members posed a threat to the role of the CAB. Although compensation in the form of a stipend was not provided, CAB members were provided with transport reimbursements for attending meetings.ConclusionsSelection of CAB members from within the community contributed to community confidence in the CAB, enhancing its ability to act as an effective link between study team and community. This contributed positively to the conduct of the study and enhanced community awareness and acceptance of the research. However, establishment of study specific CABs has the potential to compromise CAB independence due to support provided by the research team in the form of transport reimbursements and other forms of support. Consideration should be given to establishing community wide Community Advisory Boards that could function across a range of studies to increase independent objective decision-making. (shrink)

This book defends a radical new theory of contingency as a physical phenomenon. Drawing on the many-worlds approach to quantum theory and cutting-edge metaphysics and philosophy of science, it argues that quantum theories are best understood as telling us about the space of genuine possibilities, rather than as telling us solely about actuality. When quantum physics is taken seriously in the way first proposed by Hugh Everett III, it provides the resources for a new systematic metaphysical framework encompassing possibility, necessity, (...) actuality, chance, counterfactuals, and a host of related modal notions. -/- Rationalist metaphysicians argue that the metaphysics of modality is strictly prior to any scientific investigation; metaphysics establishes which worlds are possible, and physics merely checks which of these worlds is actual. Naturalistic metaphysicians respond that science may discover new possibilities and new impossibilities. This book's quantum theory of contingency takes naturalistic metaphysics one step further, allowing that science may discover what it is to be possible. As electromagnetism revealed the nature of light, as acoustics revealed the nature of sound, as statistical mechanics revealed the nature of heat, so quantum physics reveals the nature of contingency. (shrink)

Fortunately, to be a commentator on a lecture does not entail that one disagrees with it! I heartily endorse a great deal of what Jonathan has argued for in this lecture; and I cannot think of a more timely moment to speak up for respect for human dignity in an absolute opposition to humiliation, when In the USA and in the UK political leaders have used public humiliation of minority groups as a way of gaining power, and such denial of (...) basic human rights has seemingly become acceptable to large section of the population. (shrink)

The best studies on the relationship between pharmaceutical corporations and medicine have recognized that it is an ambiguous one. Yet most scholarship has pursued a simpler, more saleable narrative in which pharma is a scheming villain and medicine its maidenly victim. In this article, I argue that such crude moral framing blunts understanding of the murky realities of medicine's relationship with pharma and, in consequence, holds back reform. My goal is to put matters right in respect to one critical area (...) of scholarly interest, the medical journal publication.Pharma relies on peer advocacy to sell its wares to prescribing doctors. This is an arrangement in which clinicians’ qualified colleagues, including “key opinion leaders,” are recruited by pharmaceutical corporations and marketing agencies to deliver commercially expedient content to their professional fellows. Precisely how this practice works in the setting of publications is not well understood because ethicists studying the problem have made too much of the narrative of corporate villainy and medical victimhood. Accordingly, criticism of industry publications has been preoccupied with the crudely dishonest practices of ghostwriting, ghost authorship, and “ghost management,” vices condemned as “dirty little secrets” perpetrated from “behind the scenes” with the connivance of academic “shills” or “guest authors,” in contempt of standards set by the International Committee of Medical Journal Editors. This account is appealing, and yet it is wrong or, at the very least, seriously incomplete, with only limited relevance to the actualities of contemporary industry practices. In truth, many commercial publications are not developed in secret but fashioned within a culture of open collaboration, where academic authors make substantial, independent contributions; pharmaceutical companies are showcased rather than hidden; and medicine's editorial standards assist rather than impede the workings of commerce. (shrink)

BackgroundThe International Committee of Medical Journal Editors Recommendations set ethical and editorial standards for article publication in most leading medical journals. Here, I examine the strengths and weaknesses of the Recommendations in the prevention of commercial bias in industry-financed journal literature, on three levels – scholarly discourse, article content, and article attribution.DiscussionWith respect to overall discourse, the most important measures in the ICMJE Recommendations are for enforcing clinical trial registration and controlling duplicate publication. With respect to article content, the ICMJE (...) promotes stringent author accountability and adherence to established reporting standards. However, the ICMJE accepts the use of commercial editorial teams to produce manuscripts, which is a potential source of bias, and accepts private company ownership and analysis of clinical trial data. New ICMJE guidance on data sharing will address but not eliminate problems of commercial data access. With respect to attribution, the Recommendations oppose guest authorship and encourage clear documentation of author contributions. However, they exclude writers from coauthorship; provide no specific advice on the attribution of commercial literature, for instance with respect to company authorship, author sequence or prominent commercial labeling; and endorse the use of fine print and euphemism. The ICMJE requires detailed author interest disclosures, but overlooks the interests of non-authors and companies, and does not recommend that interests most salient to the publication are highlighted. Together, these weaknesses facilitate “advocacy”-based marketing, in which literature planned, financed and produced by companies is fronted by academics, enabling commercial messages to be presented to customers by their respected clinical peers rather than companies themselves.ConclusionsThe ICMJE Recommendations set important research and reporting standards, without which commercial bias would likely be a significantly greater problem than it is today. However, they also support practices of commercial data control, content development and attribution that run counter to science’s values of openness, objectivity and truthfulness. These weaknesses could be addressed with appropriate modifications to the Recommendations. The ICMJE should also disclose its own commercial interests and funding – not least because publishing organizations that finance it and pay the salaries of some member editors derive substantial revenues from industry. (shrink)

Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper presents a comparison of the policies of Brazil, Russia, India, China and South Africa. A systematic search of good clinical practice guidelines was conducted employing search strategies modeled in line with the recommendations of ADPTE Collaboration. The search focused on three (...) main areas namely bibliographic data bases, clinical practice guidelines data bases and a restricted internet search. A manual search of references cited in relevant guideline documents was also conducted. The search terms, Medical Subject Headings and key words were developed for a PubMed platform and then adapted for all other data bases. The search terms were kept constant for each country with the only difference being the country name. The documents so obtained were subjected to systematic content analysis. The study revealed that there is vast panoply of regulations which exist on a continuum. On one extreme is India with comprehensive regulations that are codified into law, and on the other end there is China which does not have specific laws regulating research related injuries. There are a number of differences and similarities such as mandatory insurance requirements, existence of no fault compensation, compensable injuries and the role of research ethics committees. It is imperative to enact legislations that protect participants without stifling the research enterprise. There is need for consistency and ideally harmonization of such regulations at a global level. A model policy on compensation for research related injuries should borrow from the best aspects of the different country policies and should be informed by the cardinal ethics principles of autonomy, justice and beneficence. (shrink)

This paper outlines a non-reductive counterfactual account of grounding along interventionist lines, and uses the account to argue that taking grounding seriously requires ascribing non-trivial truth-conditions to a range of counterpossible counterfactuals. This result allows for a diagnosis of a route to scepticism about grounding, as deriving at least in part from scepticism about non-trivial counterpossible truth and falsity.

The use of biological samples in research raises a number of ethical issues in relation to consent, storage, export, benefit sharing and re-use of samples. Participant perspectives have been explored in North America and Europe, with only a few studies reported in Africa. The amount of research being conducted in Africa is growing exponentially with volumes of biological samples being exported from the African continent. In order to investigate the perspectives of African research participants, we conducted a study at research (...) sites in the Western Cape and Gauteng, South Africa. (shrink)

Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers (...) must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa. (shrink)

BackgroundThe International Committee of Medical Journal Editors Recommendations set ethical and editorial standards for article publication in most leading medical journals. Here, I examine the strengths and weaknesses of the Recommendations in the prevention of commercial bias in industry-financed journal literature, on three levels – scholarly discourse, article content, and article attribution.DiscussionWith respect to overall discourse, the most important measures in the ICMJE Recommendations are for enforcing clinical trial registration and controlling duplicate publication. With respect to article content, the ICMJE (...) promotes stringent author accountability and adherence to established reporting standards. However, the ICMJE accepts the use of commercial editorial teams to produce manuscripts, which is a potential source of bias, and accepts private company ownership and analysis of clinical trial data. New ICMJE guidance on data sharing will address but not eliminate problems of commercial data access. With respect to attribution, the Recommendations oppose guest authorship and encourage clear documentation of author contributions. However, they exclude writers from coauthorship; provide no specific advice on the attribution of commercial literature, for instance with respect to company authorship, author sequence or prominent commercial labeling; and endorse the use of fine print and euphemism. The ICMJE requires detailed author interest disclosures, but overlooks the interests of non-authors and companies, and does not recommend that interests most salient to the publication are highlighted. Together, these weaknesses facilitate “advocacy”-based marketing, in which literature planned, financed and produced by companies is fronted by academics, enabling commercial messages to be presented to customers by their respected clinical peers rather than companies themselves.ConclusionsThe ICMJE Recommendations set important research and reporting standards, without which commercial bias would likely be a significantly greater problem than it is today. However, they also support practices of commercial data control, content development and attribution that run counter to science’s values of openness, objectivity and truthfulness. These weaknesses could be addressed with appropriate modifications to the Recommendations. The ICMJE should also disclose its own commercial interests and funding – not least because publishing organizations that finance it and pay the salaries of some member editors derive substantial revenues from industry. (shrink)

The evolutionary framework suggested by Müller & Schumann (M&S) can be extended further by considering drug-taking in terms of Niche Construction Theory (NCT). It is suggested here that genetic and environmental components of addiction are modified by cultural acceptance of the advantages of non-addicted drug taking and the legitimate supply of performance-enhancing drugs. This may then reduce the prevalence of addiction.

One property of the emulator framework presented by Grush is that imagery operates off-line. Contrary to this viewpoint, we present evidence showing that mental rotation of a simple figure modulates low-level features of drawing articulation. This effect is dependent upon the type of rotation, suggesting a more integrative online role for imagery than proposed by the target article.

In ‘Quiddistic Knowledge’ (Schaffer in Philos Stud 123:1–32, 2005), Jonathan Schaffer argued influentially against the view that the laws of nature are metaphysically necessary. In this reply I aim to show how a coherent and well-motivated form of necessitarianism can withstand his critique. Modal necessitarianism—the view that the actual laws are the laws of all possible worlds—can do justice to some intuitive motivations for necessitarianism, and it has the resources to respond to all of Schaffer’s objections. It also has certain (...) advantages over contingentism in the domain of modal epistemology. I conclude that necessitarianism about laws remains a live option. (shrink)

The Covid‐19 pandemic has sparked rapid and voluminous production of bioethics commentary in popular media and academic publications. Many of the discussions are new twists on an old theme: how to fairly allocate scarce medical resources, such as ventilators and intensive care unit beds. In this essay, we do not add another allocation scheme to the growing pile, partly out of appreciation that such schemes should be products of inclusive and transparent community engagement and partly out of recognition of their (...) limited utility for physicians working in the field. Instead, we make the more modest claim that context matters when making such decisions and, more specifically, that recommendations from high‐income countries about fair allocation during Covid‐19 should not be cut and pasted into low‐income settings. We offer a few examples of why seemingly universal, well‐intentioned ethical recommendations could have adverse consequences if unreflectively applied in sub‐Saharan Africa. (shrink)

Industrial production imposes geographical, economic and cultural distances between producers and consumers. The concept of constituting 'missing objects' can help shrink these distances by enabling actors to engage in discourses and practices about contexts beyond what is materially present. Since the mid-1990s, food miles have emerged as an example of missing objects, representing the distance that agricultural products travel from the farm to the dining table, and the environmental effects of transportation. I analyse how consumers, farmers, activists, industry and policy-makers (...) in the United States and Europe are building agency in making and using food miles. (shrink)

One of the currently popular dogmata of anti-consequentialism is that consequentialism doesn't respect, recognize, or in some important way account for what is referred to as the The charge is often made, but rarely explained in any detail, much less argued for. In this paper I explain what I take to be the most plausible interpretation of the separateness of persons charge. I argue that the charge itself can be deconstructed into at least two further objections to consequentialist theories. These (...) objections amount to (i) the rejection of axiological aggregation, and (ii) the rejection of deontic aggregation. Of these two objections, I argue that the first one, though often made, is untenable. I also argue that the second objection, in its various forms, relies on distinctions whose moral significance is vigorously denied by almost all consequentialist theorists. I thus argue that the separateness of persons objection poses no special threat to consequentialism. (shrink)