Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

Principles of distributive justice are normative principles designed to guide the allocation of the benefits and burdens of economic activity.

Radical empiricists at the turn of the twentieth century described organisms as experiencing the relations they maintain with their surroundings prior to any analytic separation from their environment. They notably avoided separating perception of the material environment from social life. This perspective on perceptual experience was to prove the inspiration for Gibson’s ecological approach to perceptual psychology. Gibson provided a theory of how the direct perception of the organism-environment relation is possible. Central to his account was the notion of a (...) medium for direct perception. However Gibson provided two mutually inconsistent accounts of the medium leading to problems for his radical empiricism. We develop an account of the medium that does justice to ecological psychology’s radical empiricist roots. To complement this account of the medium we detail a usage-based account of information. Together they allow us to propose a novel radical empiricist view of direct perception. We then return to the notion of medium and expand it to include sociomaterial practices. We show how direct perception happens in the midst of social life, and is made possible by an active achieving and maintaining of a pragmatic relation with the environment. (shrink)

If a doctor is trying to decide whether or not to provide a medical treatment, does it matter ethically whether that treatment has already been started? Health professionals sometimes find it harder to stop a treatment (withdraw) than to refrain from starting the treatment (withhold). But does that feeling correspond to an ethical difference? In this article, we defend equivalence—the view that withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. We argue that preference for (...) withholding over withdrawal could represent a form of cognitive bias—withdrawal aversion. Nevertheless, we consider whether there could be circumstances in which there is a moral difference. We identify four examples of conditional nonequivalence. Finally, we reflect on the moral significance of diverging intuitions and the implications for policy. We propose a set of practical strategies for helping to reduce bias in end-of-life decision making, including the equivalence test. (shrink)

Deflationists about truth hold that the function of the truth predicate is to enable us to make certain assertions we could not otherwise make. Pragmatists claim that the utility of negation lies in its role in registering incompatibility. The pragmatist insight about negation has been successfully incorporated into bilateral theories of content, which take the meaning of negation to be inferentially explained in terms of the speech act of rejection. We implement the deflationist insight in a bilateral theory by taking (...) the meaning of the truth predicate to be explained by its inferential relation to assertion. We combine this account of the meaning of the truth predicate with a new diagnosis of the liar paradox: its derivation requires the truth rules to preserve evidence, but these rules only preserve commitment. The result is a novel inferential deflationist theory of truth, which solves the liar paradox in a principled manner. We end by showing that our theory and simple extensions thereof have the resources to axiomatize the internal logic of several supervaluational hierarchies, including Cantini’s. This solves open problems of Halbach (2011) and Horsten (2011). (shrink)

ABSTRACTTaking some controversial claims philosopher Jason Brennan makes in his book Against Democracy as a starting point, this paper argues in favour of two theses: There is No Such Thing as Superior Political Judgement; There Is No Such Thing as Uncontroversial Social Scientific Knowledge. I conclude that social science experts need to be kept in check, not given more power.

Francesco Guala once wrote that ‘The problem of extrapolation is a minor scandal in the philosophy of science’. This paper agrees with the statement, but for reasons different from Guala’s. The scandal is not, or not any longer, that the problem has been ignored in the philosophy of science. The scandal is that framing the problem as one of external validity encourages poor evidential reasoning. The aim of this paper is to propose an alternative—an alternative which constitutes much better evidential (...) reasoning about target systems of interest, and which makes do without consideration of external validity. (shrink)

This paper presents arguments that challenge what I call the fact/value separability thesis: the idea, roughly, that factual judgements can be made independently of judgements of value. I will look at arguments to the effect that facts and values are entangled in the following areas of the scientific process in economics: theory development, economic concept formation, economic modelling, hypothesis testing, and hypothesis acceptance.

In this paper we make a proposal for reforming biomedical research that is aimed to align re-search more closely with the so-called fair-share principle according to which the proportions of global resources as-signed to different diseases should agree with the ratios of human suffering associated with those diseases.

In recent years, tech evangelists have made headlines predicting that in the future manual driving will be outlawed. This essay will investigate the question whether a ban of human driven cars can be defended on moral grounds in a future scenario in which autonomous cars are going to be significantly safer than manually driven cars. This article will argue that in such a future scenario manually driven cars, for moral reasons, indeed should be banned from participating in regular traffic. Since (...) the moral argument for outlawing manually driven cars will likely be met by resistance by car-aficionados, in the final part of the paper, we are devising a proposal for reconciling the strong moral case for a ban of manually driven cars with the widespread fondness of manual driving. (shrink)

In this book, Reiss argues in favor of a tight fit between evidence, concept and purpose in our causal investigations in the sciences. There is no doubt that the sciences employ a vast array of techniques to address causal questions such as controlled experiments, randomized trials, statistical and econometric tools, causal modeling and thought experiments. But how do these different methods relate to each other and to the causal inquiry at hand? Reiss argues that there is no "gold standard" in (...) settling causal issues against which other methods can be measured. Rather, the various methods of inference tend to be good only relative to certain interpretations of the word "cause", and each interpretation, in turn, helps to address some salient purpose but not others. The main objective of this book is to explore the metaphysical and methodological consequences of this view in the context of numerous cases studies from the natural and social sciences. (shrink)

Economic environmental valuation remains a much debated and contested issue. Concerns have been voiced that it is unable to capture the manifold immaterial values of ecosystems due to conceptual and methodological issues. Thus, additional value categories (social values) as well as novel valuation approaches like deliberative (monetary) valuation are areas of growing interest, yet the theoretical foundations are rather weak. Against this background, this article aims to develop a consistent conceptual framework for making sense of social values in economic environmental (...) valuation. Based on a holistic view of society and individuals, the role of institutions, the social environment, culture and transcendental values is emphasised. To synthesise diverging concepts of value into an economic concept and to account for the multidimensionality of social values, the framework consists of three spheres: social, natural and contextual. The novel framework demonstrates that social values may be integrated into a preference-based utility framework when denoting a holistic understanding of social preferences and human embeddedness in nature and society. (shrink)

The past few years have brought significant breakthroughs in understanding human genetics. This knowledge has been used to develop ‘polygenic scores’ which provide probabilistic information about the development of polygenic conditions such as diabetes or schizophrenia. They are already being used in reproduction to select for embryos at lower risk of developing disease. Currently, the use of polygenic scores for embryo selection is subject to existing regulations concerning embryo testing and selection. Existing regulatory approaches include ‘disease-based' models which limit embryo (...) selection to avoiding disease characteristics, and 'laissez-faire' or 'libertarian' models, under which embryo testing and selection remain unregulated. We introduce a novel 'Welfarist Model' which limits embryo selection according to the impact of the predicted trait on well-being. We compare the strengths and weaknesses of each model as a way of regulating polygenic scores. Polygenic scores create the potential for existing embryo selection technologies to be used to select for a wider range of predicted genetically influenced characteristics including continuous traits. Indeed, polygenic scores exist to predict future intelligence, and there have been suggestions that they will be used to make predictions within the normal range in the USA in embryo selection. We examine how these three models would apply to the prediction of non-disease traits such as intelligence. The genetics of intelligence remains controversial both scientifically and ethically. This paper does not attempt to resolve these issues. However, as with many biomedical advances, an effective regulatory regime must be in place as soon as the technology is available. If there is no regulation in place, then the market effectively decides ethical issues. (shrink)

Philosophie ist der Versuch, durch überzeugendes und durchsichtiges Argumentieren bestimmte Fragen zu lösen. Philosophische Grundthemen sind Fragen nach dem Verständnis der Welt im Ganzen und unserer Stellung in ihr. Diese Fragen können prinzipiell nur kontrovers beantwortet werden. Die Reihe Grundthemen Philosophie möchte der Diskussion solcher philosophischen Grundthemen einen Ort geben. Anstelle einer umfassenden einführenden Darstellung werden in den einzelnen Bänden in Auseinandersetzung mit ausgewählten historischen Positionen die jeweiligen Probleme analysiert und Lösungsmöglichkeiten diskutiert. Dabei setzt der Verfasser/die Verfasserin eigene Akzente und (...) bezieht Stellung, so dass sich nicht bloß ein Blick auf die Geschichte der Philosophie, sondern zugleich auch ein systematischer Beitrag zur Problemdiskussion ergibt. Zur Zeit sind weitere Bände zu den Themen Beziehungen, Kultur, Wissenschaft und Moralbegründung geplant. Die Bände der Reihe richten sich gleichermaßen an Studierende der Philosophie und anderer Fächer sowie an professionelle Philosophen. Außerdem wendet sich die Reihe an alle, die an Grundthemen der Philosophie interessiert sind. (shrink)

This essay criticizes the current approach to epistemic democracy. Epistemic democrats are preoccupied with the question of how a society can best exploit a given stock of knowledge. This article argues that the problem-solving capability of a society depends on two factors rather than one. The quality of decision-making depends both on how a democracy is able to make use of its stock of knowledge and on the size of the knowledge stock. Society’s problem-solving capability over time is therefore a (...) function of its ability to develop its knowledge exploitation mechanisms and the growth rate of its knowledge stock. Based on this enhanced model of social problem-solving, this essay compares two different political ideal types: experimental democracy, as commonly defended by epistemic democrats; and polycentric democracy, a model defended most commonly by political economists. (shrink)

Anti-realism is plagued by Fitch’s paradox: the remarkable result that if one accepts that all truths are knowable, minimal assumptions about the nature of knowledge entail that every truth is known. Dorothy Edgington suggests to address this problem by understanding p is knowable to be a counterfactual claim, but her proposal must contend with a forceful objection by Timothy Williamson. I revisit Edgington’s basic idea and find that Williamson’s objection is obviated by a refined understanding of counterfactual knowability that is (...) grounded in possible courses of inquiry. I arrive at a precise definition of knowability that is not just a technical avoidance of paradox, but is metaphysically sound and does justice to the anti-realist idea. (shrink)

Dementia affects millions of people throughout the world. Thinking through Dementia offers a critique of the main models used to understand dementia-the biomedical, neuropsychological, and social constructionist. It discusses clinical issues and cases, together with philosophical work that might help us to better understand and treat this illness.

Public health policies often require individuals to make personal sacrifices for the sake of protecting other individuals or the community at large. Such requirements can be more or less demanding for individuals. This paper examines the implications of demandingness for public health ethics and policy. It focuses on three possible public health policies that pose requirements that are differently demanding: vaccination policies, policy to contain antimicrobial resistance, and quarantine and isolation policies. Assuming the validity of the ‘demandingness objection’ in ethics, (...) we argue that states should try to pose requirements that individuals would have an independent moral obligation to fulfil, and therefore that are not too demanding. In such cases, coercive measures are ethically justified, especially if the interventions also entail some benefits to the individuals; this is, for example, the case of vaccination policies. When public health policies need to require individuals to do something that is too demanding to constitute an independent moral obligation, states have an obligation to either provide incentives to give individuals non-moral reasons to fulfil a certain requirement – as in the case of policies that limit antibiotic prescriptions – or to compensate individuals for being forced to do something that is too demanding to constitute an independent moral obligation – as in the case of quarantine and isolation policies. (shrink)

The recent tragic and widely publicised death of Jesse Gelsinger in a gene therapy trial has many important lessons for those engaged in the ethical review of research. One of the most important lessons is that ethics committees can give too much weight to ensuring informed consent and not enough attention to minimising the harm associated with participation in research. The first responsibility of ethics committees should be to ensure that the expected harm associated with participation is reasonable. Jesse was (...) an 18-year-old man with a mild form of ornithine transcarbamylase (OTC) deficiency, a disorder of nitrogen metabolism. His form of the disease could be controlled by diet and drug treatment. On September 13 1999 a team of researchers lead by James Wilson at the University of Pennsylvania's Institute for Human Gene Therapy (IHGT) injected 3.8 X 1013 adenovirus vector particles containing a gene to correct the genetic defect. He was the eighteenth and final patient in the trial. The virus particles were injected directly into the liver. He received the largest number of virus particles in a gene therapy trial.1 Four days later he was dead from what was probably an immune reaction to the virus vector. This was the first death directly attributed to gene therapy. It resulted in worldwide publicity, an independent investigation, the Federal Drug Administration (FDA) suspending all trials at the IHGT, an FDA, and a senate subcommittee investigation. At a special public meeting at the National Institutes of Health (NIH) in December 1999, James Wilson, also the director of the IHGT, said they still did not understand fully what had gone wrong.2 Even though a massive dose had been used, only 1% of transferred genes reached the target cells. (None of the patients in the trial showed significant gene expression. Art …. (shrink)

This paper aims (a) to provide characterizations of realism and instrumentalism that are philosophically interesting and applicable to economics; and (b) to defend instrumentalism against realism as a methodological stance in economics. Starting point is the observation that ‘all models are false’, which, or so I argue, is difficult to square with the realist's aim of truth, even if the latter is understood as ‘partial’ or ‘approximate’. The three cheers in favour of instrumentalism are: (1) Once we have usefulness, truth (...) is redundant. (2) There is something disturbing about causal structure. (3) It's better to do what one can than to chase rainbows. (shrink)

I discuss a puzzle that shows there is a need to develop a new metaphysical interpretation of mathematical theories, because all well-known interpretations conflict with important aspects of mathematical activities. The new interpretation, I argue, must authenticate the ontological commitments of mathematical theories without curtailing mathematicians' freedom and authority to creatively introduce mathematical ontology during mathematical problem-solving. Further, I argue that these two constraints are best met by a metaphysical interpretation of mathematics that takes mathematical entities to be constitutively constructed (...) by human activity in a manner similar to the constitutive construction of the US Supreme Court by certain legal and political activities. Finally, I outline some of the philosophical merits of metaphysical interpretations of mathematical theories of this type. (shrink)

We examine the philosophical and ethical issues associated with conjoined twins and their surgical separation. In cases in which there is an extensive sharing of organs, but nevertheless two distinguishable functioning brains, there are a number of philosophical and ethical challenges. This is because such conjoined twins: 1. give rise to puzzles concerning our identity, about whether we are identical to something psychological or biological;2. force us to decide whether what matters from an ethical point of view is the biological (...) life of our organisms or the existence of our consciousness or mind; 3. raise questions concerning when, if ever, it is morally acceptable to sacrifice one of us to save another;4. force us to reflect on the conditions for ownership of organs and the justification of removal of organs for transplantation which causes the death of the donor; 5. raise questions about who should take decisions about life-risking treatments when this cannot be decided by patients themselves.We examine and suggest answers to these questions. (shrink)

Este artículo muestra los paralelismos y las divergencias del giro ontológico y de la antropología fenomenológica. Ambas corrientes, en fidelidad al dato etnográfico, comparten el rechazo al régimen de representación y ambas corrientes cuestionan los compromisos epistémicos del investigador. Sin embargo, el giro ontológico presenta una orientación conceptual, que deriva a menudo en tipología, mientras que la antropología fenomenológica atiende a las relaciones perceptivas del mundo de la vida desde una apertura hermenéutica.

Many have argued that individuals should receive income in proportion to their contribution to society. Others have believed that it would be fairer if people received income in proportion to the effort they expend in so contributing, since people have much greater control over their level of effort than their productivity. I argue that those who believe this are normally also committed, despite appearances, to increasing the social product — which undermines any sharp distinction between effort- and productivity-based distributive proposals. (...) However, effort-based proposals do emphasise more the importance of people having control over factors affecting their income. The second set of problems I consider is how to implement policies which hold true to this emphasis. I show that there are major problems with the accuracy of using any objective criteria to measure the level of effort a person is expending. Moreover, once any such criteria are employed the problem of ‘moral hazard’arises because people modify their behaviour in such a way as to maximise their income while minimising their effort. This violates the original motivation for using effort. Because of this and other empirical considerations, I argue that productivity may well be a better criterion on which to distribute income even if one is motivated by the same concerns which have prompted effort-based proposals. (shrink)

Hughes offers a consequentialist response to our rejection of accommodation of conscientious objection in medicine. We argue here that his compromise proposition has been tried in many jurisdictions and has failed to deliver unimpeded access to care for eligible patients. The compromise position, entailing an accommodation of conscientious objection provided there is unimpeded access, fails to grasp that the objectors are both determined not to provide services they object to as well as to subvert patient access to the objected to (...) services. Unpredictable future developments in drug R&D and resulting treatment and prevention options in medicine make the compromise position unrealistic. (shrink)

At the University of Pretoria the author, a practical theologian, experiences a fruitful soil for the development of an interdisciplinary process. He referred to concrete examples of cooperation, but used the article to reflect on best practices for the interdisciplinary dialogue. He came to the conclusion that it probably made more sense to talk of Practical-theological alternatives rather than to describe the subject in a single fixed manner of understanding and action. Our goal should rather be to open up the (...) boundaries between Practical Theology, Human, Social and Natural Sciences. (shrink)

The aim of this paper is to introduce the instrumental variables technique to the discussion about causal inference in econometrics. I show that it may lead to causally incorrect conclusions unless some fairly strong causal background assumptions are made, assumptions which are usually left implicit by econometricians. These assumptions are very similar to, albeit not identical with, James Woodward's definition of an ‘intervention’. I discuss similarities and differences of the two points of view and argue that—understood as a practical method (...) of causal inference—the set presented here is superior. (shrink)

In 2002, I wrote an editorial in this Journal arguing that it was time to review the structure and function of ethics committees in the USA, Australia and the UK.1 This followed the deaths of Ellen Roche and Jesse Gelsinger, which were at least in significant part due to the poor functioning of research ethics committees in the USA.2 In the case of Ellen Roche, it was the failure to require a systematic review of the existing literature which led to (...) her death. Iain Chalmers and I had previously documented in 1996 the failure of ethics committees to require systematic review.3 In 1998, at the time of revising the previous guidelines and forming the first Australian National Statement on Research Ethics, I made a public submission to the Australian Health Ethics Committee arguing that the new guidelines for RECs should include a person with skills in conducting systematic reviews of the literature and that the requirement to have a religious representative on the committee be replaced with the requirement to have an ethicist. Neither of these changes was made. I argued, ‘It is time to ask whether institutional RECs should be abandoned in favour of expert committees that cover many institutions—suprainstitutional specialist committees. Supraregional specialist ethics committees could specialise—for example, in genetic research, cancer clinical trials, dermatology, respiratory physiology and each of the specialist areas of medical research. An example of such a committee is provided by the Thoracic Society of Australia and New Zealand research ethics committee, which reviews multicentre trials of respiratory drugs’.4 Around that time, I was involved ‘at the coal face’ as Chair of the Department of Human Services Ethics Committee in Victoria. In a public presentation, I arguedThere are two philosophical views of what ethics review is. On the …. (shrink)

The notion of “event” is often used, in contemporary philosophy, as a way to overcome the end of metaphysics since it challenges both the metaphysical conditions of appearing and knowing. Thanks to a comparative analysis of the works of Hannah Arendt and Jean-Luc Marion, the authors show that even though the event appears as a questioning of the modern concept of history in the texts of the former, and as a modality of saturated phenomena in the Marion’s phenomenology of givenness, (...) its use allows us to re-evaluate the relationship of both philosophers with metaphysics. After pointing out a fundamental difference of the conception of the event in Arendt and Marion, it is then possible to reveal their position regarding the possibility of thinking after the end of metaphysics. (shrink)

When we applied for the editorship of the JME 7 years ago, we said that we considered the JME to be the most important journal in medicine. The most profound questions that health professionals face are not scientific or technical, but ethical. Our enormous scientific and medical progress already outstrips our capability to provide treatment. Life can be prolonged at enormous cost, sometimes far beyond the point that the individual appears to be gaining a net benefit from that life. Science (...) can tell us how to achieve something, but it cannot tell us whether we should achieve that end—whether it is good. For that, we need ethics. Ethics grows in importance as our technology creates new possibilities. Where there are no options, there are no ethical questions. However, once there are options, there arise pressing questions about whether to pursue them. We require values and principles to decide how to use medicine and science. During the last 7 years, issues like the creation of brain organoids, human non-human chimeras, mitochondrial transfer, gene editing of embryos and in vitro gametogenesis have grown in prominence. These raise deep questions about moral status and how it should be determined, the limits of modification of humans, and what is good in life. As editors of the JME, we are proud of our small contribution to thinking about these challenges. We are grateful to the hard work of our associate editors and administrative staff, but there is still much more to do. During our term as editors, we have published papers from diverse perspectives, on a wide range of topics. We have seen vigorous debate within the pages of the journal and have often sought to deliberately encourage that debate …. (shrink)

Use of a placebo control in surgical trials is a divisive issue. We argue that, in principle, placebo controls for surgery are necessary in the same way as for medicine. However, there are important differences between these types of trial, which both increase justification and limit application of surgical studies. We propose that surgical randomised placebo-controlled trials are ethical if certain conditions are fulfilled: the presence of equipoise, defined as a lack of unbiased evidence for efficacy of an intervention; clinically (...) important research question; the risk to patients is minimised and reasonable; there is uncertainty about treatment allocation rather than deception; there is preliminary evidence for efficacy, which justifies a placebo-controlled design; and ideally, the placebo procedure should have some direct benefit to the patient, for example, as a diagnostic tool. Placebo-controlled trials in surgery will most often be justified when surgery is performed to improve function or relieve symptoms and when objective outcomes are not available, while the risk of mortality or significant morbidity is low. In line with medical placebo-controlled trials, the surgical trial should be sufficiently powered and standardised so that its results are valid, consent should be valid, the standard treatment or rescue medication should be provided if possible, and after the trial, the patients should be told which treatment they received and there should be provision for post-trial care if the study may result in long-term negative effects. We comment and contrast our guidelines with those of the American Medical Association. (shrink)

This paper looks at an appeal to the authority of biomedical research that has recently been used by empirical economists to motivate and justify their methods. I argue that those who make this appeal mistake the nature of biomedical research. Randomised trials, which are said to have revolutionised biomedical research, are a central methodology, but according to only one paradigm. There is another paradigm at work in biomedical research, the inferentialist paradigm, in which randomised trials play no special role. I (...) outline the inferentialist alternative in broad strokes, apply it to a recent controversy in econometrics and draw some general conclusions concerning econometric methodology. (shrink)

Here, a moral case is presented as to why sign languages such as Auslan should be made compulsory in general school curricula. Firstly, there are significant benefits that accrue to individuals from learning sign language. Secondly, sign language education is a matter of justice; the normalisation of sign language education and use would particularly benefit marginalised groups, such as those living with a communication disability. Finally, the integration of sign languages into the curricula would enable the flourishing of Deaf culture (...) and go some way to resolving the tensions that have arisen from the promotion of oralist education facilitated by technologies such as cochlear implants. There are important reasons to further pursue policy proposals regarding the prioritisation of sign language in school curricula. (shrink)