Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in (...) global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs. (shrink)

This volume is devoted to a critical discussion and re-appraisal of the work of Anglo-American Idealists of the nineteenth and twentieth centuries. Idealism was the dominant philosophy in Britain and the entire English-speaking world during the last decades of the nineteenth century and the beginning of the twentieth. The British Idealists made important contributions to logic, metaphysics, aesthetics, ethics, social and political philosophy, philosophy of history, philosophy of religion and philosophy of mind. Their legacy awaits further exploration and reassessment, and (...) this book is a contribution to this task. The essays in this collection display many aspects of contemporary concern with idealistic philosophy: they range from treatments of logic to consideration of the Absolute, personal idealism, the philosophy of religion, philosophy of art, philosophy of action, and moral and political philosophy. During the first decade of the twenty-first century, the work of the Anglo-American Idealists has once again been widely discussed and re-considered, and new pathways of research and investigation have been opened. (shrink)

With evidence of vaccine hesitancy in several jurisdictions, the option of making COVID-19 vaccination mandatory requires consideration. In this paper I argue that it would be ethical to make the COVID-19 vaccination mandatory for older people who are at highest risk of severe disease, but if this were to occur, and while there is limited knowledge of the disease and vaccines, there are not likely to be sufficient grounds to mandate vaccination for those at lower risk. Mandating vaccination for those (...) at high risk of severe disease is justified on the basis of the harm principle, as there is evidence that this would remove the grave public health threat of COVID-19. The risk–benefit profile of vaccination is also more clearly in the interests of those at highest risk, so mandatory vaccination entails a less severe cost to them. Therefore, a selective mandate would create fairness in the distribution of risks. The level of coercion imposed by a mandate would need to be proportionate, and it is likely that multiple approaches will be needed to increase vaccine uptake. However, a selective mandate for COVID-19 vaccines is likely to be an ethical choice and should be considered by policy-makers. (shrink)

What do the terms “profession, professional, professionalism” mean in 2002? One dictionary defines profession as “a calling requiring specialized knowledge and often long and intensive academic preparation,” and it defines professionalism as “the conduct, aims, or qualities that characterize or make a profession or professional person.” These definitions are appealingly simple. Complexity arises when we add the term “medical” as in the medical profession, a medical professional, or medical professionalism; and, here a specific understanding of “the conduct, aims, and qualities (...) that characterize” the field of medicine is required. To complicate matters, professionalism applies to both the profession as a whole as well as the individual professional persons, such as the physicians. (shrink)

Community engagement (CE) is gaining prominence in global health research. A number of ethical goals–spanning the instrumental, intrinsic, and transformative–have been ascribed to CE in global health research. This paper draws attention to an additional transformative value that CE is not typically linked to but that seems very relevant: solidarity. Both are concerned with building relationships and connecting parties that are distant from one another. This paper first argues that furthering solidarity should be recognized as another ethical goal for CE (...) in global health research. It contends that, over time, CE can build the bases of solidaristic relationships—moral imagination, recognition, understanding, empathy—between researchers and community members. Applying concepts from existing accounts of solidarity, the paper develops preliminary ideas about who should be engaged and how to advance solidarity. The proposed approach is compared to current CE practice in global health research. Finally, the paper briefly considers how solidaristic CE could affect how global health research is performed. (shrink)

Six planetary boundaries have already been exceeded, including climate change, loss of biodiversity, chemical pollution, and land-system change. The health research sector contributes to the environmental crisis we are facing, though to a lesser extent than healthcare or agriculture sectors. It could take steps to reduce its environmental impact but generally has not done so, even as the planetary emergency worsens. So far, the normative case for why the health research sector should rectify that failure has not been made. This (...) paper argues strong philosophical grounds, derived from theories of health and social justice, exist to support the claim that the sector has a duty to avoid or minimise causing or contributing to ecological harms that threaten human health or worsen health inequity. The paper next develops ideas about the duty’s content, explaining why it should entail more than reducing carbon emissions, and considers what limits might be placed on the duty. (shrink)

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through “herd immunity,” which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to (...) increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination. In addition, it has raised the possibility of banning unvaccinated children from childcare centres. This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices. (shrink)

This paper explores the relationship of various trait emotions to the ethical choices of 189 college students who completed a managerial decision-making task as part of an in-basket exercise in a laboratory setting. Prior research regarding emotion influences on ethical decision-making and linkages between emotions and cognition informed hypotheses about how different types of emotions impact ethical choices. Findings supported our expectations that positive and negative emotions classified as active would be more strongly related to interpersonally-directed ethical choices than to (...) organizationally-directed ones, and that passive emotions would be less related to ethical choices than active emotions. Implications for ethical decision-making research and organizational practices are discussed. (shrink)

I mention this story also as the best method I can advise any person to take in such a case, especially if he be one that makes conscience of his duty, and would be directed what to do in it, namely, that he should keep his eye upon the particular providences which occur at that time, and look upon them complexly, as they regard one another, and as all together regard the question before him: and then, I think, he may (...) safely take them for intimations from Heaven of what is his unquestioned duty to do in such a case; I mean as to going away from or staying in the place where we dwell, when visited with an infectious distemper.Daniel Defoe's fictional narrator H.F. introduces his account of the 1665 plague with the... (shrink)

A number of recent studies have revealed correspondences between song- and language-related neural structures, pathways, and gene expression in humans and songbirds. Analyses of vocal learning, song structure, and the distribution of song elements have similarly revealed a remarkable number of shared characteristics with human speech. This article reviews recent developments in the understanding of these issues with reference to the phonological phenomena observed in human language. This investigation suggests that birds possess a host of abilities necessary for human phonological (...) computation, as evidenced by behavioral, neuroanatomical, and molecular genetic studies. Vocal-learning birds therefore present an excellent model for studying some areas of human phonology, though differences in the primitives of song and language as well as the absence of a human-like morphosyntax make human phonology differ from birdsong phonology in crucial ways. (shrink)

The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We (...) first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change. (shrink)

In clinical research there is a tension between the role of a doctor, who must serve the best interests of the patient, and the role of the researcher, who must produce knowledge that may not have any immediate benefits for the research participant. This tension is exacerbated in HIV research in low and middle income countries, which frequently uncovers comorbidities other than the condition under study. Some bioethicists argue that as the goals of medicine and those of research are distinct, (...) it is a mistake for researchers to assume therapeutic responsibilities while engaging in research. Others propose that there is a duty of care, but disagree as to how this is limited and specified. In this qualitative study, principal investigators from HIV prevention trials discuss their experience of providing medical benefits to participants within the context of conducting research into HIV biomedical prevention technologies. They describe the limitations imposed at times by funders and at times by infrastructure constraints, and canvass the importance of ancillary care provision and capacity building in trial communities. The views of the principal investigators are compatible with the perspective that there is a duty of care, limited by the nature of the research, the depth of the relationship between research and participant, and the capacity of the research site. The therapeutic orientation in HIV prevention trial appears to be indivisible from competent research practise by making concrete and appropriate benefits available to trial participants and their communities that support rather than compete with local infrastructure. (shrink)

ABSTRACT Abduction as a method for sociological explanation is increasingly gaining interest, but questions remain as to what exactly it is and how it differs from other methods of inquiry. This paper compares abduction as conceived in Peircean pragmatism with the critical realist concept of retroduction. I argue that abduction in the Peircean sense and retroduction in the critical realist sense refer to different, but complementary, modes of inference. Abductive conclusions provide the starting point for retroductive inferences; the latter inform (...) the tenability of the former. Together, abduction and retroduction contribute to theoretical explanation. (shrink)

In order to fulfill ABET requirements, Northern Arizona University’s Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to “grey” or multiple possible solution technical problems. To identify (...) and solve these problems, the engineering design process is used. Ethical problems are also “grey” problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue. (shrink)

This article challenges what is now the orthodoxy concerning the heritage of Bourdieu (1930–2002): namely, the judgement that his distinctive sociological innovation has been his theory of social reproduction, and that he has failed to provide a necessary theory of social change. Yet Bourdieu consistently claimed to offer a theory of social transformation as well as accounting for continuities of power. Indeed, he provides two substantive keys for an understanding of historical transformation—first, a theory of prophets (religious or secular) as (...) the authors of heresies or “symbolic revolutions” that dispel current doxa; second, a theory of the “corporatism of the universal”: the role of intellectuals or other educated professionals in pursuit of social justice and other universalistic goals. Moreover, Bourdieu fuses his theories of “symbolic revolutions” with a materialist analysis of their social preconditions, including a fresh account of social crises. Crises—war, famine, recession, and especially the intensified precarity of the educated—have, for him, a profound impact, both within differentiated fields and across fields. Conflicts that become effectivelysynchronizedacross fields acquire great resonance within the wider field of power, particularly due to hysteresis or “maladjusted habitus.” Indeed, the appearance of crises, together with new prophetic heresies, leads the subordinate classes to question the taken-for-granted order of things and to orchestrate their resistance. Alongside his corpus of published writings, this article draws widely on Bourdieu’s posthumously published lectures. These cast a distinctive new light on how his well-known conceptual instruments can aid us in the study of historical change. They also expand on how social science itself might be used to facilitate progressive social movements. (shrink)

Social justice has been identified as a foundational moral commitment for global health research ethics. Yet what a commitment to social justice means for community engagement in such research has not been critically examined. This paper draws on the rich social justice literature from political philosophy to explore the normative question: What should the ethical goals of community engagement be if it is to help connect global health research to social justice? Five ethical goals for community engagement are proposed that (...) promote well-being, agency, and self-development, particularly for those considered disadvantaged and marginalized. The paper also considers how key terms used in the proposed goals should be defined using existing theories of health and social justice. This analysis is done to give global health researchers and their partners a better idea of what the ethical goals mean. Patterns of convergence amongst different theories are identified that support relying on particular definitions of key terms. (shrink)

How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high-income countries owed to parties from low and middle-income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The ‘research for health justice’ framework provides direction on three aspects of international clinical research: (...) the research target, research capacity strengthening, and post-trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity. (shrink)

Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This article takes a (...) conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity. Semi-structured in-depth interviews were performed with 16 grants officers working for 11 funders (...) and organisations that support health systems research: the Alliance for Health Policy and Systems Research, Comic Relief, Doris Duke Foundation, European Commission, International Development Research Centre, Norwegian Agency for Development Cooperation, Research Council of Norway, Rockefeller Foundation, UK Department of International Development, UK Medical Research Council, and Wellcome Trust. Thematic analysis of the data demonstrates their funding schemes promote health systems research with five key features that advance health equity: being conducted with worst-off populations, focusing on research topics that advance equitable health systems, having LMIC ownership of the research agenda, strengthening LMIC research capacity, and having an impact on health disparities. The different types of incentives that encouraged proposed projects to have these features are identified and classified by their strength. It is suggested that research funders ought to create and maintain funding schemes with strong incentives for the features identified above in order to more effectively help reduce global health disparities. (shrink)

During the necromantic ceremony inOdyssey11 Odysseus slits the throats of two sheep and then proceeds to drain their blood into the βόθρος, or pit, which he has dug in the ground (Od. 11.35–6). At this point in the ceremony the dead swarm up from the Underworld, displaying an innate attraction to the blood (Od. 11.36–7). Such is the overwhelming response of the dead that Odysseus must draw his sword in order to hold back the multitudes who clamour to drink the (...) offering (Od. 11.48–50). Odysseus refuses to allow the dead to approach the blood until Tiresias has drunk the offering and offered a prophecy for the future (Od. 11.95–6). After Tiresias has concluded his prophecy for Odysseus some of the other dead step forward and drink the blood, but to what end? Odysseus does not seek prophecies from these figures, nor do they produce any, which means that their reason for desiring and drinking the blood must lie elsewhere. (shrink)

Anglicanism's relationship with its Reformation heritage represents a tension. It looks to the Reformation as the movement from which an English Church, independent of papal authority, was inaugurated. At the same time, it refuses to be labelled as a “church of the Reformation”, pointing to its continuity with a much longer history of Christian practice in Britain. The growth of the Anglican Communion and current controversies over church order, the interpretation of scripture and the exercise of authority make Anglican identity (...) difficult to define. Identity would once have been sought in liturgy, but the view that liturgy completely enshrines Anglican doctrine has been convincingly put to rest by scholarship since the 1970s. This paper argues that the liturgical legacy of the Reformation offers categories that can help to form possible approaches to the current crisis of Anglican identity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recent Acquisitions, 2020–21Bridget Whittle and Kenneth BlackwellThe previous general update of acquisitions appeared in Russell in n.s. 39 (winter 2019): 188–90. The new listing covers items numbered 1,824 to 1,839, plus an addition to 840, with the latest items arriving in December 2021. Largely due to the Covid-19 pandemic, this update is smaller than usual as fewer items were received or available. Several items were received from other institutions (...) and through the generosity of researchers, to whom McMaster Library is very grateful. Internet prints are from the Hon. Russell Archivist. The following abbreviations are used: L(s). or l(s). = letter(s); X. = image copies of any kind.correspondenceArlott, John L. from BR, 1951, re “Rewards of Philosophy” (C48.06) and a cricket book for Conrad. X. Internet print. rec. acq. 1,831.Bell, A. S. L. from BR, 1967. Re Alys Russell’s l. to Haldane. X. Courtesy of Nicholas Bell. rec. acq. 1,827.Cambridge Daily News L. from BR requesting they issue a public statement to clarify use of his title, 1945. Re B&R C45.07a. X. Courtesy of Dr. David Harley. rec. acq. 1,824.Cousins, Norman 2 ls. from BR, re quoting History of the World in Epitome and Manchester speech, 1960. X. Courtesy of David Harley. rec. acq. 1,826.Davies, Mansel 19 documents including ls. to BR, from Edith Russell, drafts, and notes re the Bertrand Russell Peace Fund, 1963 and later; and Dora Russell, also cnd, 1958. rec. acq. 1,828.Dewey, John 3 ls., 1 pc to William Ernest Hocking, 1936–40. Re BR at ccny and Harvard. Purchase. rec. acq. 1,836.Duman, R. Douglas L. from BR, 1963. X. Courtesy of David Harley. rec. acq. 1,826.Furtado, Celso 2 ls. from BR re Goldwater, and American war crimes in Vietnam, 1964, 1967. X. Courtesy of Camilo Furado. rec. acq. 1,829.Greene, Graham L. from BR on a Vietnam statement, 1967. X. Internet print. rec. acq. 1,831.Haldane, Richard Burdon (1st Viscount) L. from Alys Russell regarding BR’s imprisonment status, 3 Mar. 1918. X. rec. acq. 1,827.Hocking, William Ernest 2 ls. from BR, 1939–40. Re Wm. James Lectures at Harvard. Purchase. rec. acq. 1,836. —. See also under Dewey, John.Jones, Lief (Lord Rhayader) L. from BR congratulating him on his election victory in North Westmoreland. 1904–05. Purchase. rec. acq. 1,831.Miller, Lawrence E. L. from BR enclosing signed photo (not present), 1963. X. Internet print. rec. acq. 1,831.Modern Forum (Herman Lissauer) L. from BR declining another us lecture tour, 1954. X. Courtesy of David Harley. rec. acq. 1,831.Newnham College Report from BR to extend G. E. M. Anscombe’s scholarship. He comments on her 2 dissertations. X. Courtesy of Rachel Wiseman. Original at Newnham. rec. acq. 1,831.Post, Stanley Deverin L. from BR, 1962. X. Internet print. rec. acq. 1,824.Russell, Frank L. to Bill/Bull, 1902. Promises to send him a copy of his speech. X. Internet print. Courtesy of Ruth Derham. rec. acq. 1,824.Russell, Patricia L. to Emrys Hughes, ed. of Forward, 1945. Re the war and peace settlement. X. Courtesy of National Library of Scotland. Added to rec. acq. 840.Ryckman, Mr. L. from BR, 1923. X. Internet print. rec. acq. 1,831.Schrödinger, Erwin L. from BR. X. Internet print. Online at U. of Vienna Library. rec. acq. 1,830.Silberstein, Ludwick 3ls. from BR,2in 1918, third in 1941. Silberstein had translated Problems into Polish, 1913. X. Internet print. rec. acq. 1,831.Silverstein, Louis L. from BR regarding nuclear weapons and the Kennedy administration, 1961. X. Internet print. rec. acq. 1,831.Spencer, Herbert L. to Lady Amberley, 1869. Re Spencer’s visit to Rodborough. Purchase. rec. acq. 1,833.Stetler, Jr., Russell Dearnley 20 ls. from BR; 30 from R. Schoenman, C. Farley, P. Wood; 1963–65. On opposing the Vietnam War. X. Donation of Russ Stetler. rec. acq. 1,838.Thirring, Hans 11 ls. from BR, 1 to BR, 1952–62. X. Internet print. Online at U. of Vienna Library. rec... (shrink)

This article investigates whether or not theories of justice from political philosophy, first, support the position that health research should contribute to justice in global health, and second, provide guidance about what is owed by international clinical research (ICR) actors to parties in low- and middle-income countries. Four theories—John Rawls's theory of justice, the rights-based cosmopolitan theories of Thomas Pogge and Henry Shue, and Jennifer Ruger's health capability paradigm—are evaluated. The article shows that three of the four theories require the (...) conduct of health research for justice in global health. The theories help identify the ends of justice to which ICR is to contribute, but they cannot tell us how to organize ICR to promote these ends. Aside from Ruger's health capability paradigm, the theories also lack an allocative principle for assigning specific duties to specific actors. This creates difficulties for establishing obligations for certain types of ICR actors. (shrink)

Published data show that new HIV prevention strategies including treatment‐as‐prevention and pre‐exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV‐based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment‐as‐prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment‐as‐prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment‐as‐prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV‐based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

It has been suggested that community advisory boards can play a role in minimising exploitation in international research. To get a better idea of what this requires and whether it might be achievable, the paper first describes core elements that we suggest must be in place for a CAB to reduce the potential for exploitation. The paper then examines a CAB established by the Shoklo Malaria Research Unit under conditions common in resource-poor settings – namely, where individuals join with a (...) very limited understanding of disease and medical research and where an existing organisational structure is not relied upon to serve as the CAB. Using the Tak Province Border Community Ethics Advisory Board as a case study, we assess the extent to which it might be able to take on a role minimising exploitation were it to decide to do so. We investigate whether, after two years in operation, T-CAB is capable of assessing clinical trials for exploitative features and addressing those found to have them. The findings show that, although T-CAB members have gained knowledge and developed capacities that are foundational for one-day taking on a role to reduce exploitation, their ability to critically evaluate studies for the presence of exploitative elements has not yet been strongly demonstrated. In light of this example, we argue that CABs may not be able to perform such a role for a number of years after initial formation, making it an unsuitable responsibility for many short-term CABs. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and the (...) feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

We propose an account of dynamic predicates which draws on the notion of force, eliminating reference to events in the linguistic semantics. We treat dynamic predicates as predicates of forces, represented as functions from an initial situation to a final situation that occurs ceteris paribus, that is, if nothing external intervenes. The possibility that opposing forces might intervene to prevent the transition to a given final situation leads us to a novel analysis of non-culminating accomplishment predicates in a variety of (...) languages, including the English progressive. We then apply the force-theoretic framework to the composition of basic Vendlerian eventuality types within a lexical-decomposition syntax. The difference between predicates of forces and predicates of situations is argued to underlie the dynamic/stative contrast, and also to allow for a formal treatment of the difference between be and stay. Consequences for the relationship between language and cognition are discussed. (shrink)

Epicurus holds, in _Key Doctrine_ 31, that what is just according to nature is a _súmbolon_ or sign of the interest there is in neither harming one another nor being harmed. Certain readings of this maxim equivocate this legal sign with other signs found in nature, thereby failing to give sufficient weight to the role of reciprocity in its production. Other readings simply import a legal sense from outside of Epicurean doctrine, thereby failing to explain what makes Epicurean _súmbola_ legal. (...) A final set of readings attempt to find a legal rule as a kind of innate concept or Kantian ‘scheme’. This article identifies new sources for understanding _súmbolon_, drawn principally but not exclusively from Aristotle’s _Eudemian Ethics_. This article offers an original argument that Epicurus adopts Aristotle’s’ image of the tally stick (_symbolon_) as a meeting of often divergent interests which constitutes something new and particularly valuable to the Epicurean: friendship. A theoretical argument is also advanced to support this reading which claims that one person’s reflection on a ‘divine image’ of the end (_telos_) is insufficient to constitute a _súmbolon_; rather real (as opposed to abstract or ideal) individual interests are filtered via the mechanism of the tally, that is via the meeting of two given individuals who together generate a sign (_symbolon_) of reciprocal interest in neither harming nor being harmed. (shrink)

In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against placebo. (...) But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)

Both autistic adults and families of autistic children rely heavily on blogs and other digital platforms to create community and gain experiential knowledge about autism, but research on autism blogs has failed to distinguish between the perspectives of autistic adults and neurotypical parent bloggers. Furthermore, intersections in the experiences of BIPOC autistics are rarely examined. Using a content analysis with a feminist Critical Disability Studies lens, I explore six autism parent blogs from diverse demographics: a white neurotypical father, a white (...) autistic mother in an interracial relationship, a white neurotypical mother, an Indigenous autistic trans father, a Black autistic nonbinary mother, and a Black neurotypical mother. I examine the attitudes of these bloggers to get a sampling of their opinions on autism, how they parent autistic children, and how their social location, specifically race, impacts their experiences. More intersectional research needs to be done to boost the perspectives of BIPOC autistics and the expertise of autistic parents. (shrink)

Scholarship focusing on how international research can contribute to justice in global health has primarily explored requirements for the conduct of clinical trials. Yet health systems research in low- and middle-income countries has increasingly been identified as vital to the reduction of health disparities between and within countries. This paper expands an existing ethical framework based on the health capability paradigm – research for health justice – to externally-funded health systems research in LMICs. It argues that a specific form of (...) health systems research in LMICs is required if the enterprise is to advance global health equity. “Research for health justice” requirements for priority setting, research capacity strengthening, and post-study benefits in health systems research are derived in light of the field's distinctive characteristics. Specific obligations are established for external research actors, including governments, funders, sponsors, and investigators. How these framework requirements differ from those for international clinical research is discussed. (shrink)

R G Collingwood is an important twentieth century historian, archaeologist and philosopher whose works are the subject of continued interest, analysis and study. There is an unquestionable need to support this research activity with the provision of a reference guide which is fully up-to-date, informed and authoritative. The Companion will therefore list all primary and secondary material relevant to the study of Collingwood in all his fields of expertise - historical theory, philosophy and archaeology. It will also provide a guide (...) to archive material relevant to his life, together with sources and locations. The resulting volume will provide an essential companion to the understanding of the life and thought of R G Collingwood. (shrink)

This article considers whether there is a specific demand for migrant domestic workers in the UK, or for workers with particular characteristics that in theory could be met by citizens. It discusses how immigration status can make it easier not only to recruit domestic workers, but also to retain them. `Foreignness' may also make the management of the employment relation easier with employers anxious to discover a coincidence of interest with the worker. Employers are not only looking for generic `foreignness' (...) however, but typically also seek particular nationalities or ethnicities of worker, which can raise difficulties for agencies who are not allowed to discriminate on the basis of `race'. (shrink)

We are in the midst of a global crisis of climate change and environmental degradation to which the healthcare sector directly contributes. Yet conceptions of health justice have little to say about the environment. They purport societies should ensure adequate health for their populations but fail to require doing so in ways that avoid environmental harm or injustice. We need to expand our understanding of health justice to consider the environment and do so without reinforcing the epistemic injustice inherent in (...) the field of bioethics. This paper considers what work in philosophy related to the environment should be applied to help build that understanding and develops ideas about the healthcare sector’s responsibilities of justice to the environment. It first introduces the dominant multivalent environmental and ecological justice (EJ) concept in philosophy and each of its dimensions: distribution, participation, recognition and well-being. It then shows why applying that conception alone to broaden our understanding of health justice will reinforce epistemic injustice within bioethics. Drawing on EJ literature from the global South, the paper demonstrates that different ontological and experiential starting points identify additional EJ dimensions—power and harmony—and give rise to a nuanced understanding of the recognition dimension relative to the dominant EJ conception. The paper concludes by applying them to articulate healthcare sector responsibilities of justice to the environment, demonstrating they ground responsibilities beyond reducing its carbon emissions. (shrink)

Recent scholarship has considered what, if anything, rich people owe to poor people to achieve justice in global health and the implications of this for international research. Yet this work has primarily focused on international clinical research. Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that arise (...) during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm). Issues identified include the fact that priority setting for health systems research at the global level is often not driven by national priorities and that capacity-building efforts frequently utilize one-size-fits-all approaches. (shrink)

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such a claim (...) are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare. (shrink)