Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

Published within weeks of Charles Darwin's Origin of Species, Isabelle Duncan's Pre-Adamite Man (1860) is the first full-length treatment of preadamism by an evangelical. Intended as a reconciliation of Genesis and geology, Duncan's work gained immediacy when it was published shortly after the September 1859 revelations that men had walked among the mammoths. Written in the tradition of evangelical 'Christian philosophy', Pre-Adamite Man deploys innovative biblical hermeneutics and recent trends in geology to set out both a biblical preadamite theory, and (...) an unorthodox angelology. Duncan responded to contemporary secular interpretations of geology by pushing evangelical concordist strategies to new frontiers, filling out an acceptance of an ancient earth with new biblically informed catastrophist proposals and extensions of salvation history, while simultaneously retaining a firm commitment to plenary inspiration. The product is a highly readable book that operates both as an accessible treatment of geology and a theological discourse. Running through six printings between 1860 and 1866, the book was reviewed by many of the period's leading journals and created a minor controversy among evangelicals. This study both brings to life this previously neglected episode in scriptural geology, and adds to recent work on Victorian popular science writing. (shrink)

In this paper the coherence of the precautionary principle as a guide to public health policy is considered. Two conditions that any account of the principle must meet are outlined, a condition of practicality and a condition of publicity. The principle is interpreted in terms of a tripartite division of the outcomes of action . Such a division of outcomes can be justified on either “consequentialist” or “deontological” grounds. In the second half of the paper, it is argued that the (...) precautionary principle is not necessarily opposed to risk–cost–benefit analysis, but, rather, should be interpreted as suggesting a lowering of our epistemic standards for assessing evidence that there is a link between some policy and “special bad” outcomes. This suggestion is defended against the claim that it mistakes the nature of statistical testing and against the charge that it is unscientific or antiscientific, and therefore irrational. (shrink)

Background: Despite potential benefits of the return of research results to research participants, the TriCouncil Policy Statement , which reflects Canadian regulatory ethical requirements, does not require this. The policies of Canadian research ethics boards are unknown.Objectives: To examine the policies of Canadian university based REBs regarding returning results to research participants, and to ascertain if the presence/absence of a policy may be influenced by REB member composition.Design: Email survey of the coordinators of Canadian university based REBs to determine the (...) presence/absence of a policy on return of research results to research participants both during an ongoing study and at conclusion. REB coordinators were asked to return a copy of the policy or guidelines and to describe the member composition of their REB.Findings: Of 50 REBs that were contacted 34 responded and 22 met the inclusion criteria. Two had a policy that governed the return of research results while on a study, and seven following the completion of a study. Presence of an ethicist or a lawyer on the REB did not influence the presence/absence of such policies. No REBs had specific guidelines describing how participants should be informed of results.Conclusions: Most REBs did not require researchers to disclose study results to research participants either during or following a study. Thus this study identifies an ethical shortcoming in the conduct of human research in Canada. It has also demonstrated that there are no clear recommendations by REBs to facilitate the return of results to participants following research projects. (shrink)

The practice of prenatal screening for disability is sometimes objected to because of the hurt and offence such practices may cause to people currently living with disabilities. This objection is commonly termed “the expressivist objection”. In response to the objection it is standardly claimed that disabilities are analogous to illnesses. And just as it would be implausible to suppose reduction of the incidence of illnesses such as flu sends a negative message to ill people, so it is not plausible to (...) suppose prevention of disability sends a negative message to disabled people. The expressivist objection hinges, however, upon a view of the relationship between disability and self identity which sees disability as part of the identity of the disabled person, in a way in which illnesses such as flu cannot be. This possibility is generally not considered in critiques of the expressivist objection. In this paper, an “identity claim” to the effect that disabilities can be identity constituting is accepted and the force of the expressivist argument is reconsidered in the light of its acceptance. It is concluded that even when such an identity claim is accepted, the expressivist objection is still not morally compelling. (shrink)

While there is significant consensus that undergraduate medical education should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that (...) medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME. (shrink)

This paper examines one particular justification for the screening and termination of embryos/fetuses which possess genetic features known to cause disability. The particular case is that put forward in several places by John Harris. He argues that the obligation to prevent needless suffering justifies the prevention of the births of disabled neonates. The paper begins by rehearsing Harris's case. Then, drawing upon claims advanced in a recent paper in the Journal of Medical Ethics, it is subjected to critical scrutiny, focusing (...) on Harris's “suffering claim” .1 It is argued that the suffering claim must be false if understood as an empirical claim. And, even if understood as a conceptual truth, it mistakenly assimilates the concepts of harm and suffering. Finally, again focusing on Harris's recent work in this area, his characterisation of disability as a “harmed condition” is shown not to apply in the case of at least some moderate forms of intellectual disability. (shrink)

There are many ways of combining three letters out of an alphabet of 26; yet still there are overlaps which can confuse meaning. So the first duty of anyone using an acronym is to say what it denotes. Here, POM is “problem-oriented medicine”, EBM is “evidence-based medicine”, and CPD is “continuous professional development”. These designations, familiar as they are to clinicians, define what is meant by these terms, but fall well short of describing them for the general reader, something which (...) must now be done.Problem-oriented medicine, described and advocated by Lawrence Weed,1 is an approach which elicits and categorises the patient's problems, both those described by him or her and those discovered on physical examination or in the course of investigation. The list of problems, with the action proposed for each, forms the basis of the clinical record. This approach has the great merit of focusing on what is actually troubling the patient, and it includes the important task of listening to what he says. All approaches to difficult matters have their limitations; those of POM include the inarticulacy of some patients, the impatience of some doctors, the accumulation of problems as age advances, and the inelasticity of time.Evidence-based medicine has …. (shrink)

In this article we examine ethical aspects of the involvement of children in clinical research, specifically those who are incapable of giving informed consent to participate. The topic is, of course, not a new one in medical ethics but there are some tensions in current guidelines that, in our view, need to be made explicit and which need to be responded to by the relevant official bodies. In particular, we focus on tensions between the World Medical Association Declaration of Helsinki, (...) and the guidance offered by the British Medical Association, the Royal College of Paediatrics and Child Health , and the Council for International Organizations of Medical Sciences. We conclude with a call for these organisations to make their guidance explicit in relation to the World Medical Association Declaration. (shrink)

Background: The offer of aggregate study results to research participants following study completion is increasingly accepted as a means of demonstrating greater respect for participants. The attitudes of research ethics board chairs towards this practice, although integral to policy development, are unknown.Objectives: To determine the attitudes of REB chairs and the practices of REBs with respect to disclosure of results to research participants.Design: A postal questionnaire was distributed to the chairs of English-language university-based REBs in Canada. In total, 88 REB (...) chairs were eligible. The questionnaire examined respondents’ attitudes towards offering participants completed study results, methods for delivering this information, and barriers to disclosing results.Findings: The response rate was 89.8%. Chairs were highly supportive of offering results to research participants. Only 19.5% of chairs responded that a policy or guideline that governed the return of research results to participants existed at their institution. Most chairs supported the idea of their REB instituting a set of guidelines recommending that researchers offer results to participants in a lay format. Chairs identified the major impediments to the implementation of programmes offering to return results to participants as being financial cost and retaining contact with research participants .Conclusions: University-based REB chairs overwhelmingly support the offer of research results to participants. This is incongruent with the frequent lack of existing REB guidelines recommending this practice. REBs should support guidelines that diminish identified barriers and promote consistency in offering to return results. (shrink)

Einstein, in his “Zur Elektrodynamik bewegter Körper”, gave a physical (operational) meaning to “time” of a remote event in describing “motion” by introducing the concept of “synchronous stationary clocks located at different places”. But with regard to “place” in describing motion, he assumed without analysis the concept of a system of co-ordinates.In the present paper, we propose a way of giving physical (operational) meaning to the concepts of “place” and “co-ordinate system”, and show how the observer can define both the (...) place and time of a remote event. Following Einstein, we consider another system “in uniform motion of translation relatively to the former”. Without assuming “the properties of homogeneity which we attribute to space and time”, we show that the definitions of space and time in the two systems are linearly related. We deduce some novel consequences of our approach regarding faster-than-light observers and particles, “one-way” and “two-way” velocities of light, symmetry, the “group property” of inertial reference frames, length contraction and time dilatation, and the “twin paradox”. Finally, we point out a flaw in Einstein’s argument in the “Electrodynamical Part” of his paper and show that the Lorentz force formula and Einstein’s formula for transformation of field quantities are mutually consistent. We show that for faster-than-light bodies, a simple modification of Planck’s formula for mass suffices. (Except for the reference to Planck’s formula, we restrict ourselves to Physics of 1905.). (shrink)