It is widely held that individuals who are unable to provide informed consent should be enrolled in clinical research only when the risks are low, or the research offers them the prospect of direct benefit. There is now a rich literature on when the risks of clinical research are low enough to enroll individuals who cannot consent. Much less attention has focused on which benefits of research participation count as ‘direct’, and the few existing accounts disagree over how this crucial (...) concept should be defined. This disagreement raises concern over whether those who cannot consent, including children and adults with severe dementia, are being adequately protected. The present paper attempts to address this concern by considering first what additional protections are needed for these vulnerable individuals. This analysis suggests that the extant definitions of direct benefits either provide insufficient protection for research subjects or pose excessive obstacles to appropriate research. This analysis also points to a modified definition of direct benefits with the potential to avoid these two extremes, protecting individuals who cannot consent without blocking appropriate research. (shrink)

Distance and morality. I argue that in "Faminine Ethics: the Problem of Distance in Morality and Singer's Ethical Theory" Frances Kamm fails to produce a pair of cases in which a moral difference is present that is not attributable to factors other than distance. I also point out that Kamm's attempts at explaining why distance could possibly matter in morality fall far short. I conclude that there is no reason for us to believe that distance matters in morality and offer (...) an explanation for why it might nevertheless appear to us that it does---there are numerous factors, normally correlated with distance, that are of great moral significance. In the process I offer a few methodological remarks. ;The problem of numbers. I argue that John Taurek's conclusion in "Should the Numbers Count?" remains a viable alternative to the standard view of the role of numbers in morality. I claim that Taurek brings up valid concerns regarding the standard view, and that the objections that have so far been raised against Taurek's position are by far insufficient to remove it from contention. I then point out and try to address several problems, including the problem of very large numbers, which should be a concern to anyone who is sympathetic to Taurek's views. I do not claim to have the answers, but I suggest a direction in which one may look for a solution. ;The return of the trolley. I examine several purported solutions to the Trolley Problem and find them all severely deficient. In light of the systematic failure of efforts to solve the Trolley Problem, I suggest that perhaps no solution has been found because there is no solution to find. I proceed to give a positive argument for the claim that diverting the trolley is not morally permissible and try to give an explanation of how the intuitions of the majority could have been so deeply mistaken. Since my proposed "solution" relies heavily on the making/allowing distinction, I conclude with a discussion of that distinction and a defense of its moral significance. (shrink)

The American Journal of Bioethics, Volume 11, Issue 7, Page 28-29, July 2011.