In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a (...) policy RCT, policy experts must either reasonably disagree about whether the trial arms are more effective than this policy, or know that they are. (shrink)

The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to whom (...) they might possess a duty to rescue. Investigators may often ask themselves, what can I do, what should I do, to help? Such investigators often help people in the future by carrying out their... (shrink)

A few years ago, the New York City Department of Health introduced a public health campaign entitled “Cut Your Portions, Cut Your Risk”, a series of posters in which images of food in increasingly large portion sizes appear. In one example, three packets of french fries are featured; in another, cheeseburgers are shown. In a red box in each, the text, in large, all-capital letters in English and Spanish, reads “Portions have grown,” and, below this, in all capitals, “so has (...) obesity, which can lead to many health problems” or “so has type 2 diabetes, which can lead to amputations.” Beneath the food, the posters admonish, again in all-capital... (shrink)

The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...) appealing to controversial conceptions of the good life, liberals committed to this principle face a significant puzzle. (shrink)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. I examine (...) two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care. (shrink)

A person of average height would assert a truth by the conditional ‘if I were seven feet tall, I would be taller than I am,’ in which an indicative clause ‘I am’ is embedded in a subjunctive conditional. By contrast, no one would assert a truth by ‘if I were seven feet tall, I would be taller than I would be’ or ‘if I am seven feet tall, I am taller than I am’. These examples exemplify the fact that whether (...) a sentence's evaluation remains at the actual world in the scope of a modal or conditional depends on the combination of mood in the embedded and matrix clauses rather than, as is commonly thought, just on the presence of an operator ‘actually’. This essay argues that this phenomenon provides evidence that mood admits of bound and free readings along the lines of tenses and pronouns. It therefore favors the hypothesis that natural language contains variables and quantifiers for possible worlds in the object language. This, in turn, requires that the truth of a semantic value of a sentence (or whatever structure is embedded in a modal) be relativized to a sequence of worlds rather than to an individual world, and thus be distinguished from a proposition in the traditional sense. The essay also compares the framework defended with an alternative account of similar phenomena by Kai Wehmeier. (shrink)

Many high-income countries have skill-selective immigration policies, favoring prospective immigrants who are highly skilled. I investigate whether it is permissible for high-income countries to adopt such policies. Adopting what Joseph Carens calls a " realistic approach " to the ethics of immigration, I argue first that it is in principle permissible for high-income countries to take skill as a consideration in favor of selecting one prospective immigrant rather than another. I argue second that high-income countries must ensure that their skill-selective (...) immigration policies do not contribute to the non-fulfillment of their duty to aid residents of low-and middle-income countries. (shrink)

Although the principle of fair subject selection is a widely recognized requirement of ethical clinical research, it often yields conflicting imperatives, thus raising major ethical dilemmas regarding participant selection. In this paper, we diagnose the source of this problem, arguing that the principle of fair subject selection is best understood as a bundle of four distinct sub-principles, each with normative force and each yielding distinct imperatives: (1) fair inclusion; (2) fair burden sharing; (3) fair opportunity; and (4) fair distribution of (...) third-party risks. We first map out these distinct sub-principles, and then identify the ways in which they yield conflicting imperatives for the design of inclusion and exclusion criteria, and the recruitment of participants. We then offer guidance for how decision makers should navigate these conflicting imperatives to ensure that participants are selected fairly. (shrink)

The Popperian epistemology underlying Levelt's commentary and other aspects of contemporary psychology has limited application and, in particular, does not apply to the creation or development of theory, the main goal of MacKay . This is relevant to Levelt's questions, “What has changed?” and “What is the harvest?”: From a non-Popperian perspective, both changes and harvest are greater than Levelt's commentary would suggest and carry implications for the field at large.

How has feminism changed in the UK since the 1960s? This was the question I set out to explore in my research on the British Women’s Liberation Movement, published as Radical Feminism: Feminist Activism in Movement. I found that the motivations and aspirations of activists today were similar to those reported by feminists of the Second Wave; but the methods and tactics were more professionalized and there was less of a focus on women-only space.

In Rescuing Justice and Equality, G.A. Cohen argues that the incentive inequalities permitted by John Rawls's difference principle are unjust since people cannot justify them to their fellow citizens. I argue that citizens of a Rawlsian society can justify their acceptance of a wide range of incentive inequalities to their fellow citizens. They can do so because they possess the right to freedom of occupational choice, and are permitted – as a matter of justice – to exercise this right by (...) making occupational decisions on the basis of a wide range of values and preferences. (shrink)

In the case discussion, ‘Equity in Public Health Ethics: The Case of Menu Labelling Policy at the Local Level’ , Mah and Timming state that menu labelling would ‘place requirements for information disclosure on private sector food businesses, which, as a policy instrument, is arguably less intrusive than related activities such as requiring changes to the food content’. In this commentary on Mah and Timming’s case study, I focus on discussing how menu-labelling policy permits governments to avoid addressing the heart (...) of the problem, which is high-calorie, high-sodium restaurant food. Menu labelling policy does not address food content in a way that is meaningful for change, instead relying on individuals to change their behaviour given new information. Besides having questionable efficacy, this raises concerns about moralizing food choices. (shrink)

Political philosophers often formulate the problem of distributive justice as the problem of how the government ought to distribute different types of goods—for example, income or health care—to its citizens. They therefore presuppose that the government is a unitary agent that governs its citizens directly. However, although a number of governments are unitary in this way, many are federations, exhibiting a division of sovereignty between two or more levels of government having independent grounds of authority. In contrast to unitary states, (...) therefore, within a federation, two or more levels of government directly govern their citizens and are directly accountable to them. Because of the way in which different levels of government in a federation can separately affect the distribution of goods in society, federations face resource allocation problems that are far more complex than those of unitary states. In addition to determining what a just distribution of goods is, federations must also determine (1) whether distributive justice is a shared responsibility amongst different levels of government, and, if so, (2) how this shared responsibility should be allocated between them. (shrink)

Reasons for the limited uptake of the clinician–scientist role within nursing are examined, specifically: the lack of consensus about the nature of nursing science; the varying approaches to epistemology; and the influence of post-modern thought on knowledge development in nursing. It is suggested that under-development of this role may be remedied by achieving agreement that science is a necessary, worthy pursuit for nursing, and that rigorous science conducted from a clinical perspective serves nursing well. Straddling practice and research is a (...) powerful strategy for ensuring relevant research while forging strong links with practice. The clinician–scientist role, typically requiring a 75:25 ratio between research and clinical activities, is well established in medicine. Nursing, however, has been slow to institute the role; it is rare within North America, Australia, and western European countries, and almost non-existent outside those areas. Beyond structural obstacles, philosophical issues may explain nursing's reluctance to implement the role. Following a survey of clinician–scientist roles throughout the world, the nature of nursing science and epistemology, and the influence of post-modern thought on nursing attitudes to research are examined with respect to their influence on this role. The nurse clinician–scientist role holds promise for making strides in clinically relevant research, and for accelerating the knowledge cycle from clinical problem to research question to change in clinical practice. (shrink)

Most characters that distinguish one individual from another, like height or weight, vary continuously in populations. Continuous variation of these ‘quantitative’ traits is due to the simultaneous segregation of multiple quantitative trait loci (QTLs) as well as environmental influences. A major challenge in human medicine, animal and plant breeding and evolutionary genetics is to identify QTLs and determine their genetic properties. Studies of the classic quantitative traits, abdominal and sternopleural bristle numbers of Drosophila, have shown that: (1) many loci have (...) small effects on bristle number, but a few have large effects and cause most of the genetic variation; (2) ‘candidate’ loci involved in bristle development often have large quantitative effects on bristle number; and (3) alleles at QTLs affecting bristle number have variable degrees of dominance, interact with each other, and affect other quantitative traits, including fitness. Lessons learned from this model system will be applicable to studies of the genetic basis of quantitative variation in other species. (shrink)

The methodological device of or, as sometimes euphemistically labeled, does not enjoy much support among institutional review boards (IRBs) and a large portion of scholars in bioethics. The reasons for this have been documented sufficiently, beginning with the now-paradigmatic attack on the well-known study by Milgram and the unsavory study of Laud Humphries on male homosexual activities in public restrooms. But are the current attitudes interfering with some worthwhile approaches to data gathering that seem to have no other methodology of (...) equal effectiveness? (shrink)

The burden of the Christian religion is not primarily that certain attitudes are desirable nor that certain practices are comfortable, but that certain things are true. Certain facts have to be faced, certain claims recognized. Questions of the meaningfulness and truth-status of religious language are thus central to Christian apologetic. However much emphasis we give to the vital link between true belief and action - and for the Bible the two are inseparable - there is no escaping the obligation to (...) enquire into the meaning and truth of Christian affirmations as well as their personal or social effectiveness. (shrink)