Suppose that you have deeply personal information that you do not want to share. Further suppose that this information could help others, perhaps even saving their lives. Should you reveal the information or keep it secret? With the increasing prevalence of genetic testing, more and more people are finding themselves in this situation. Although a patient's genetic results are potentially relevant to all her biological family members, her first‐degree relatives—parents, children, and full siblings—are most likely to be affected. This is (...) especially true for genetic mutations—like those in the BRCA1 and BRCA2 genes—that are associated with a dramatically increased risk of disease. Fortunately, people are usually willing to share results with their at‐risk relatives. Occasionally, however, a patient refuses to disclose her findings to anyone outside her clinical team. Ethicists have written little on patients’ moral duties to their at‐risk relatives. Moreover, the few accounts that have been advanced are problematic. Some unnecessarily expose patients’ genetic information to relatives who are unlikely to benefit from it, and others fail to ensure that patients’ most vulnerable relatives are informed of their genetic risks. Patients’ duty to warn can be defended in a way that avoids these problems. I argue that the duty to share one's genetic results is grounded in the principle of rescue—the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the expected harm is serious and the cost or risk to oneself is sufficiently moderate. When these two criteria are satisfied, a patient will most likely have a duty to warn. (shrink)

Technological advances in genetic testing have enabled prospective parents to learn about their risk of passing a genetic condition to their future children. One option for those who want to ensure that their biological children do not inherit a genetic condition is to create embryos through in vitro fertilisation and use a technique called preimplantation genetic testing to screen embryos for genetic abnormalities before implantation. Unfortunately, due to its high cost, IVF-with-PGT is out of reach for the vast majority of (...) Americans. This article addresses an issue that has been underexplored in the medical ethics literature: the lack of insurance coverage for IVF-with-PGT.Within the US system, a key concept in insurance is that of medically necessary care, which broadly consists of diagnostic services and treatment services. In this article, I argue that IVF-with-PGT could be classified as either a diagnostic service or as a treatment service. To make this case, I show that IVF-with-PGT is similar to other types of services that are often covered by US insurance providers. In light of these similarities, I argue that the current system is inconsistent with respect to what is—and is not—covered by insurance. To promote consistency and fairness in coverage, like cases should be treated alike—starting with greater coverage for IVF-with-PGT. (shrink)

When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a drug (...) safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over‐the‐counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV‐prevention drugs. (shrink)

This chapter first surveys general issues in the epistemic internalism / externalism debate: what is the distinction, what motivates it, and what arguments can be given on both sides. -/- The second part of the chapter will examine the internalism / externalism debate as regards to the specific case of the epistemology of memory belief.

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and Faden confront foundational (...) issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy. (shrink)

Structural Injustice advances a theory of what structural injustice is and how it works. Powers and Faden present both a philosophically powerful, integrated theory about human rights violations and structural unfairness, alongside practical insights into how to improve them.

A growing body of literature argues that achieving radical change in the agri-food system requires a radical renegotiation of our relationship with the environment alongside a change in our thinking and approach to transformational food politics. This paper argues that relational approaches such as a more-than-human ethic of care (MTH EoC) can offer a different and constructive perspective to analyse agri-food system transformation because it emphasises social structures and relationships as the basis of environmental change. A MTH EoC has not (...) yet been applied to regenerative agriculture, yet other literature on regenerative agriculture suggests that care may be present in these spaces and calls for the need for social science analysis of the regenerative movement. This paper uses a MTH EoC lens to reveal a diverse array of ways in which power is and can be deployed for change in the regenerative agriculture movement in Aotearoa, New Zealand. Globally, regenerative agriculture tends to be analysed through positivist, scientific approaches that focus on biophysical markers of ecological improvement. Yet, a relational approach reveals how engagement in regenerative agriculture is creating significant shifts in mindset towards more holistic and relational understandings of biological and social ecosystems. A regenerative mindset framework is suggested as a method of understanding the connection between a regenerative form of thinking, being and doing for farmers. Interviews suggested that this shift in farmers’ socio-ecological relations is crucial to the transformational potential of regenerative agriculture. This paper argues that relational analyses such as the MTH EoC approach used to analyse regenerative agriculture in this research, refresh the way we analyse agri-food system change. They also are critical to guiding and supporting on-the-ground socio-ecological shifts that are necessary to see agricultural transformation. (shrink)

This paper investigates the adequacy of evidential relevance relations proposed by Glymour and others. These accounts incorporate, as a necessary condition, what I call the Positive Instance Condition (PIC): the evidence statement and auxiliary assumptions entail a "positive instance" of the hypothesis. I argue that any account which incorporates PIC as a necessary condition while allowing "bootstrap testing" is doomed to fail. A nonbootstrapping evidential relevance relation of similar form is proposed, and it is argued that, in addition to avoiding (...) published counter examples, this new relation meets two general requirements which, if not met, would undermine the ability of any account that incorporates PIC to accord with our intuitions of evidential relevance. (shrink)

BackgroundEthical and regulatory guidance on the collection and use of human biospecimens for research forms an essential component of national health systems in Sub-Saharan Africa, where rapid advances in genetic- and genomic-based technologies are fueling clinical trials involving HBS and the establishment of large-scale biobanks.MethodsAn extensive multi-level search for publicly available ethics regulatory guidance was conducted for each SSA country. A second review documented active trials listed in the WHO International Clinical Trials Registry Platform as of January 2015 in which (...) HBS collection was specified in the protocol. Findings were combined to determine the extent to which countries that are study sites for HBS-related research are supported by regulatory guidance language on the collection, use, ownership and storage of biospecimens.ResultsOf the 49 SSA countries, 29 had some form of national ethics guidance, yet only 17 provided language relating to HBS-related research, with specific guidance on consent, ownership, reuse, storage, and export/import/transfer. Ten countries accounted for 84 % of the active clinical trials involving the collection of HBS in SSA. All except one of these countries were found to have some national guidance in the form of regulations, codes of ethics, and/or standard operating procedures; however, only seven of the ten offered any language specific to HBS.ConclusionsDespite the fact that the bulk of registered clinical trials in SSA involving HBS, as well as existing and proposed sites for biorepositories under the H3Africa Initiative, are currently situated in countries with the most complete ethics and regulatory guidance, variability in the regulations themselves may create challenges for planned and future pan-African collaborations and may require legislative action at the national level to revise. Countries in SSA that still lack regulatory guidance on HBS will require extensive health system strengthening in ethics governance before they can be full participants in the modern research enterprise. (shrink)

I Deliberation, Practical Syllogisms , and Intuition. Introduction Aristotle's views on moral reasoning are a difficult and much disputed subject. ...

In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a presumption (...) in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty. (shrink)

In "Pursuits of Wisdom," John Cooper brings this crucial question back to life. This marvelous book will shape the way we think about and engage with ancient philosophical traditions.

There are indications that simple reaction time might have slowed in Western countries, based on both cohort- and multi-study comparisons. A possible limitation of the latter method in particular is measurement error stemming from methods variance, which results from the fact that instruments and experimental conditions change over time and between studies. We therefore set out to measure the simple auditory reaction time (SRT) of 7,081 individuals (2,997 males and 4,084 females) born in Sweden 1959-1985 (subjects were aged between 27 (...) and 54 years at time of measurement). Depending on cut-offs and adjustment for ageing related slowing on SRT, the data suggest that SRT has increased between 3 and 16 ms in the 27 birth years covered in the present sample. The slowing is unlikely to be explained by attrition, as evaluated by comparing the general intelligence × birth-year interactions and standard deviations for both male participants and dropouts, utilizing military conscript cognitive ability data. The present result is consistent with previous studies employing alternative methods, and may result from several synergistic factors, such as possible recent micro-evolutionary trends favouring lower g in Sweden and the effects of industrially produced neurotoxic substances on peripheral nerve conduction velocity. (shrink)

: The increasing reliance upon, and perhaps the growing public and professional skepticism about, the special expertise of bioethicists suggests the need to consider the limits of moral expertise. For all the talk about method in bioethics, we, bioethicists, are still rather far off the mark in understanding what we are doing, even when we may be going about what we are doing fairly well. Quite often, what is most fundamentally at stake, but equally often insufficiently acknowledged, are inherently political, (...) essentially contested visions of the most compelling and attractive forms of life for individuals and social organization. The current situation in bioethics parallels similar debates in eighteenth-century jurisprudence, especially Jeremy Bentham's withering critique of the prevalent forms of judicial argument and his own, equally unsuccessful, attempt to develop a decision-making procedure in ethics that would operate on a plane above politics. The risk, both then and now, is that we will fail to appreciate the wide range of reasonable disagreement that will remain past the point of extended reflection and discussion. (shrink)

Physical activity is important for managing the side effects and long-term outcomes of cancer treatment, yet many adolescents and young adults diagnosed with cancer are not meeting PA guidelines. Body image and social support are two factors that can influence PA behavior and require further attention in this population. The purpose of this study was to examine the associations between body image, social support, and PA among AYAs. An online cross-sectional survey administered through the Research Electronic Data Capture platform was (...) used to assess self-reported body image, social support, and PA in AYAs. Based on findings from path analyses, body image and social support were directly associated with PA. Social support was also directly associated with body image. However, there were no indirect effects. These findings provide preliminary support for the influential role of appearance and fitness body-related emotions and cancer-specific social support on PA. The results have important implications for the development of targeted strategies aimed at improving body image and social support, with the overall goal of increasing AYAs’ PA. (shrink)

Many of the contemporary disagreements regarding privacy are conceptual in nature. They concern the meaning or definition of privacy and the analytic basis of distinguishing privacy rights from other kinds of rights recognized within moral, political, or legal theories. The two main alternatives within this debate include reductionist views, which seek a narrow account of the kinds of invasions or intrusions distinctly involving privacy losses, and anti-reductionist theories, which treat a much broader array of interferences with a person as separate (...) and irreducible kinds of privacy invasions. Other theorists have expressed doubts about the prospects for achieving greater analytical precision even within a fairly expansive anti-reductionist approach. However, a reductionist privacy definition is defended in this article, and its primary theoretical virtues are its ability to unify and explain the insights of several competing definitions and its role in developing an account of privacy rights that is both internally coherent and consistent with a plausible understanding of the theoretical basis for a number of related rights. (shrink)

Articles by Lyn Horn and Alison Thompson highlight several points crucial to understanding how our theory figures in wider debates about social justice as well as the particular relevance of our theory for assessing the overall practice of public health (Horn, 2013; Thompson, 2013). We begin with these two articles, first to respond to and concur with many of their central points, and second to set the stage for dealing more efficiently with some points raised in the other articles.

: The focus of questions of justice in health policy has shifted during the last 20 years, beginning with questions about rights to health care, and then, by the late 1980s, turning to issues of rationing. More recently, attention has focused on alternatives to cost-effectiveness analysis. In addition, health inequalities, and not just inequalities in access to health care, have become the subject of moral analysis. This article examines how such trends have transformed the philosophical landscape and encouraged some in (...) bioethics to seek guidance on normative questions from outside of the contours of traditional philosophical arguments about justice. (shrink)

Spirituality is an important, but oft-overlooked, aspect of the self that may affect college students’ wellbeing and belonging. Few studies have systematically examined closeness to God and spiritual struggles as predictors of college student wellbeing during early college, which is a critical window for identity development. Moreover, research exploring interactions between spiritual struggles and closeness to God in predicting wellbeing outcomes is scarce. We address these gaps in the literature with an analytic sample comprised of 839 first-year college participants who (...) identify as religious. The results of correlational analyses and linear mixed effect models are presented. Closeness to God was associated with greater wellbeing and belonging, and spiritual struggles were associated with lower wellbeing and belonging. In exploratory analyses, a moderating effect of closeness to God on the relation between spiritual struggles and negative outcomes was observed. Implications for higher education and college student development are discussed. (shrink)

Modern life is full of examples of environmentally-mediated “group harms” – what Derek Parfit describes as harms produced by “what we all do together.” Typically, the harms are unintended and arise from the uncoordinated actions of many individuals. Their actions ordinarily are not inherently wrong, no one’s action causes harm to an identifiable individual, and prevention of the expected harm is unlikely unless all, or nearly everyone, reduce or cease to engage in activities that collectively and cumulatively result in harm. (...) Unless the individual’s action is likely to make a difference to the outcome, it is often argued that it is not clear what, if anything, makes it wrong or a breach of personal moral responsibility. Activities that result in climate change and agricultural practices commonly employed within the global system of food production are prominent examples. There are several well-known strategies for dealing with such cases, but often they rest on idealized assumptions regarding the impact that one individual can have, provide answers suitable only in counterfactual circumstances, or rely on the kinds of principles of justice that make it difficult to identify clearly and address directly many important moral problems. The task of this chapter is to examine these strategies and propose alternative freestanding practical principles that can guide our efforts to address the world as we find it and explain the sense of wrongness individuals often experience. (shrink)

The New Evil Demon problem has been hotly debated since the case was introduced in the early 1980’s (e.g. Lehrer and Cohen 1983; Cohen 1984), and there seems to be recent increased interest in the topic. In a forthcoming collection of papers on the New Evil Demon problem (Dutant and Dorsch, forthcoming), at least two of the papers, both by prominent epistemologists, attempt to resist the problem by appealing to the distinction between justification and excuses. My primary aim here is (...) to critically evaluate this new excuse maneuver as a response to the New Evil Demon problem. -/- Their response attempts to give us reason to reject the idea that victims of the New Evil Demon have justification for believing as they do. I shall argue that this approach is ultimately unsuccessful, however much of value can be learned from these attempts. In particular, progress in the debate can be made by following those who advance the excuse maneuver and make explicit the connection between epistemic justification and epistemic norms. By doing so, the questions being debated are clarified, as is the methodology being used to attempt to answer them. (shrink)

In common with traditional forms of epistemic internalism, epistemological disjunctivism attempts to incorporate an awareness condition on justification. Unlike traditional forms of internalism, however, epistemological disjunctivism rejects the so-called New Evil Genius thesis. In so far as epistemological disjunctivism rejects the New Evil Genius thesis, it is revisionary. -/- After explaining what epistemological disjunctivism is, and how it relates to traditional forms of epistemic internalism / externalism, I shall argue that the epistemological disjunctivist’s account of the intuitions underlying the New (...) Evil Genius thought experiment is at best incomplete. As presented, therefore, epistemological disjunctivism is unable to accommodate the core guiding intuitions of epistemic internalism. Given the stated aim of not being revisionary on this score, the view is at a dialectical disadvantage over the traditional forms of epistemic internalism the position is meant to replace. Unfortunately, therefore, at present, the impasse between internalism and externalism remains. (shrink)

In this article I argue that the value of epistemic justification cannot be adequately explained as being instrumental to truth. I intend to show that false belief, which is no means to truth, can nevertheless still be of epistemic value. This in turn will make a good prima facie case that justification is valuable for its own sake. If this is right, we will have also found reason to think that truth value monism is false: assuming that true belief does (...) have value, there is more of final epistemic value than mere true belief. (shrink)

What makes an intellectual virtue a virtue? A straightforward and influential answer to this question has been given by virtue-reliabilists: a trait is a virtue only insofar as it is truth-conducive. In this paper I shall contend that recent arguments advanced by Jack Kwong in defence of the reliabilist view are good as far as they go, in that they advance the debate by usefully clarifying ways in how best to understand the nature of open-mindedness. But I shall argue that (...) these considerations do not establish the desired conclusions that open-mindedness is truth-conducive. To establish these much stronger conclusions we would need an adequate reply to what I shall call Montmarquet’s objection. I argue that Linda Zagzebski’s reply to Montmarquet’s objection, to which Kwong defers, is inadequate. I conclude that it is contingent if open-mindedness is truth-conducive, and if a necessary tie to truth is what makes an intellectual virtue a virtue, then the status of open-mindedness as an intellectual virtue is jeopardised. We either need an adequate reliabilist response to Montmarquet’s objection, or else seek alternative accounts of what it is that makes a virtue a virtue. I conclude by briefly outlining some alternatives. (shrink)

After reviewing some of the insurance-related obstacles to access to health care, some ethical criteria for evaluating proposals aimed at reforming the health insurance marketplace to achieve universal access are developed. The additional reforms needed to eliminate many of the deficiencies in the current health insurance marketplace are discussed. It is suggested that without such substantial reforms some of the other goals such as expanded consumer choice and overall societal health care cost savings may not be effectively promoted.