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)

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 response to calls to expand the scope of research ethics to address justice in global health, recent scholarship has sought to clarify how external research actors from high-income countries might discharge their obligation to reduce health disparities between and within countries. An ethical framework—‘research for health justice’—was derived from a theory of justice (the health capability paradigm) and specifies how international clinical research might contribute to improved health and research capacity in host communities. This paper examines whether and how (...) external funders, sponsors, and researchers can fulfill their obligations under the framework. (shrink)

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 chapter accepts for the sake of argument Ronald Dworkin’s point that the only viable form of normative skepticism is internal, and develops an internal skeptical argument directed specifically at normative realism. There is a striking and puzzling coincidence between normative judgments that are true, and normative judgments that causal forces led us to believe—a practical/theoretical puzzle to which the constructivist view has a solution. Normative realists have no solution, but are driven to conclude that we are probably hopeless at (...) recognizing the independent normative truths they posit. Since this is an unacceptable conclusion, we must conclude that normative realism is false. Drawing on evolutionary considerations, it is explained why this internal skeptical argument does not carry over to our knowledge of objects in our manifest surroundings, and why the challenge does not depend on any assumption that the epistemology of the normative domain must be a causal one. (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)

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)

Undertaking engagement in public health research is ethically essential. There is a growing emphasis on practicing engagement as the co‐construction of knowledge, which goes beyond other common forms of engagement in health research practice: consulting and informing. Taking such an approach means researchers jointly construct knowledge with research users and beneficiaries; all parties design and conduct research together and share decision‐making power. This article makes the normative argument that such engagement is necessary to achieve the foundational moral aims of public (...) health research—building relations of equality and addressing the health needs of those considered disadvantaged—which reflect the field's underlying commitment to social justice. It next identifies and discusses three ways in which co‐constructing knowledge advances those moral aims: by facilitating self‐determination, supporting individuals’ right to research, and maximizing social knowledge to address cognitive and epistemic injustice. Objections to the arguments presented in the article are then articulated and defended against. (shrink)

Habermas élabore une théorie radicale de la démocratie qui entend répondre aux défis posés tant par la mondialisation économique que par la tentation de repli des « peuples » qui cherchent à retrouver une souveraineté perdue. Une telle théorie, qui prend une forme délibérative, projette la démocratie dans la constitutionnalisation du droit international, et implique une perspective cosmopolitique. Dans ce cadre, la réflexion sur la politique européenne et ses institutions est centrale, et permet de montrer que la théorie critique n’a (...) rien perdu de sa lucidité quand il s’agit de mettre en garde notamment contre un « fédéralisme postdémocratique de l’exécutif » dans lequel l’Europe risque de se perdre. (shrink)

Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we (...) convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting—scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting. (shrink)

Published in the year 2004, Philosophy and the Social Sciences is a valuable contribution to the field of Sociology.

Engaging citizens is vital to achieving people‐centred health research. This paper aims to put attention to dynamics of power and dynamics of difference back at the centre of citizen engagement in health research priority‐setting. Without attention to power and difference, engagement can lead to presence without voice and voice without influence, particularly for disadvantaged and marginalised groups. By analysing six key bodies of literature, the paper first identifies the different components of engagement—who initiates, for what purpose, who participates, and how (...) they participate—and the dynamics of power and dynamics of difference relevant to them. For each component of engagement, the ethical considerations relating to those dimensions of power and dimensions of difference are characterised for the research priority‐setting context and preliminary guidance on how they might be addressed is provided. An initial framework comprised of a series of questions reflecting these ethical considerations has been developed for use by researchers and citizens when designing engagement processes for research projects. Where researchers and citizens attend to the framework's questions and then revise their priority‐setting processes’ design to better represent diversity and mitigate power disparities, more inclusive citizen engagement is promoted. Disadvantaged and marginalised groups are more likely to be present and heard, which, in turn, will help generate research projects with topics and questions that encompass and more accurately reflect their health needs. (shrink)

Promises raise two main philosophical problems, one moral and the other conceptual. The moral problem concerns the normative significance of promising: what is the nature and basis of the obligations and rights to which promises typically give rise? The conceptual problem is to say what a promise is: what is involved in making a promise? In this paper I defend three controversial claims about promising. One is about the moral problem of promising, one is about the conceptual problem, and the (...) last one is about the relationship between my conceptual claim and my moral claim. My conceptual claim is that a speaker makes a promise only if he communicates an intention to undertake an obligation to the hearer. (I refer to this as the “Obligation Conception Thesis.”) My moral claim is that the obligations typically attached to promises are such that they can be acquired only by those who communicate an intention to undertake an obligation. (I refer to this as the “Voluntary Obligation Thesis.”) My third claim is that if the Obligation Conception Thesis is true, the Voluntary Obligation Thesis is true. (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)

Contemporary realist theories of value claim to be compatible with natural science. In this paper, I call this claim into question by arguing that Darwinian considerations pose a dilemma for these theories. The main thrust of my argument is this. Evolutionary forces have played a tremendous role in shaping the content of human evaluative attitudes. The challenge for realist theories of value is to explain the relation between these evolutionary influences on our evaluative attitudes, on the one hand, and the (...) independent evaluative truths that realism posits, on the other. Realism, I argue, can give no satisfactory account of this relation. On the one hand, the realist may claim that there is no relation between evolutionary influences on our evaluative attitudes and independent evaluative truths. But this claim leads to the implausible skeptical result that most of our evaluative judgements are off track due to the distorting pressure of Darwinian forces. The realist’s other option is to claim that there is a relation between evolutionary influences and independent evaluative truths, namely that natural selection favored ancestors who were able to grasp those truths. But this account, I argue, is unacceptable on scientific grounds. Either way, then, realist theories of value prove unable to accommodate the fact that Darwinian forces have deeply influenced the content of human values. After responding to three objections, the third of which leads me to argue against a realist understanding of the disvalue of pain, I conclude by sketching how antirealism is able to sidestep the dilemma I have presented. Antirealist theories of value are able to offer an alternative account of the relation between evolutionary forces and evaluative facts —
an account that allows us to reconcile our understanding of evaluative truth with our understanding of the many non-rational causes that have played a role in shaping our evaluative judgements. (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)

This paper explores two questions in moral philosophy that might at first seem unrelated. The first question is practical. While it’s not a truth we like to contemplate, each of us faces the eventual loss of everyone and everything we love. Is there a way to live in full awareness of that fact without falling into anxiety or depression, or resorting to one form or another of forgetfulness, denial or numbing out? The second question is metaethical. Is it possible to (...) vindicate a strong form of ethical objectivity without positing anything metaphysically or epistemologically mysterious? In this paper, I sketch a partially Buddhist-inspired metaethical view that would, if it could be made to work, give a positive answer to both questions. The overall view is too much to defend in one paper, so I focus on developing one limited part of it. I begin by characterizing the general constructivist strategy for vindicating the objectivity of ethics. After briefly discussing Christine Korsgaard’s Kantian implementation of the strategy, I suggest an alternative implementation. I explore the idea that every agent necessarily faces what I call the problem of attachment and loss. I close with some speculative remarks about why, even though the problem of attachment and loss presents itself in a different substantive guise to each individual agent, it is still possible that the best solution to the problem is universal, and involves taking up an ethical perspective on the world. (shrink)

Fractal patterns offer one way to represent the rough complexity of the natural world. Whilst they dominate many of our visual experiences in nature, little large-scale perceptual research has been done to explore how we respond aesthetically to these patterns. Previous research (Taylor et al., 2011) suggests that the fractal patterns with mid-range fractal dimensions have universal aesthetic appeal. Perceptual and aesthetic responses to visual complexity have been more varied with findings suggesting both linear (Forsythe et al., 2011) and curvilinear (...) (Berlyne, 1970) relationships. Individual differences have been found to account for many of the differences we see in aesthetic responses but some, such as culture, have received little attention within the fractal and complexity research fields. This 2-study paper aims to test preference responses to fractal dimension and visual complexity, using a large cohort (N=443) of participants from around the world to allow universality claims to be tested. It explores the extent to which age, culture and gender can predict our preferences for fractally complex patterns. Following exploratory analysis that found strong correlations between fractal dimension and visual complexity, a series of linear mixed-effect models were implemented to explore if each of the individual variables could predict preference. The first tested a linear complexity model (likelihood of selecting the more complex image from the pair of images) and the second a mid-range fractal dimension model (likelihood of selecting an image within mid-range). Results show that individual differences can reliably predict preferences for complexity across culture, gender and age. However, in fitting with current findings the mid-range models show greater consistency in preference not mediated by gender, age or culture. This paper supports the established theory that the mid-range fractal patterns appear to be a universal construct underlying preference but also highlights the fragility of universal claims by demonstrating individual differences in preference for the interrelated concept of visual complexity. This highlights a current stalemate in the field of empirical aesthetics. (shrink)

Although scholars have invoked the escalation framework as a means of explaining the occurrence of numerous organizationally undesirable behaviors on the part of decision makers, to date no empirical research on the potential influences of escalating commitment on the likelihood of unethical behavior at the individual level of analysis has been reported in either the escalation or the ethical decision-making literatures. Thus, the main purpose of this project is to provide a theoretical foundation and empirical support for the contention that (...) escalating commitment situations can induce unethical behavior in decision makers. An experimental research design utilizing a computerized investment task was administered to 155 undergraduate business majors as a means of assessing the hypotheses presented here. Results from a hierarchical logistic regression analysis found strong support for the contention that exposure to an escalation situation increases the likelihood of unethical behavior on the part of decision makers. Further, results also supported previous ethical decision-making findings by confirming the effects of locus of control (LOC) on ethical behavior. Specifically, the data indicated that individuals with an external LOC orientation were significantly more likely to select the unethical option than were individuals with an internal LOC orientation. Interestingly, support was not found for the effects of Machiavellianism or gender on ethical decision-making. (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)

BackgroundEngagement of people with lived experience and members of the public is an ethically and scientifically essential component of health research. Authentic engagement means they are involved as full partners in research projects. Yet engagement as partnership is uncommon in practice, especially during priority-setting for research projects. What is needed for agenda-setting to be shared by researchers and people with lived experience and/or members of the public (or organisations representing them)? At present, little ethical guidance exists on this matter, particularly (...) that which has been informed by the perspectives of people with lived experience and members of the public. This article provides initial evidence about what they think are essential foundations and barriers to shared decision-making in health research priority-setting and health research more broadly.MethodsAn exploratory, qualitative study was conducted in 2019. 22 semi-structured interviews were performed with key informants from the UK and Australia.ResultsThree main types of foundations were thought to be essential to have in place before shared decision-making can occur in health research priority-setting: relational, environmental, and personal. Collectively, the three types of foundations addressed many (but not all) of the barriers to power sharing identified by interviewees.ConclusionsBased on study findings, suggestions are made for what researchers, engagement practitioners, research institutions, and funders should do in their policy and practice to support meaningful engagement. Finally, key international research ethics guidelines on community engagement are considered in light of study findings. (shrink)

The Helen of Gorgias is designed to provoke the aspiring speaker to consider his relationship with society as a whole. The speech's extreme claims regarding the power of logos reflect simplistic ideas about speaker-audience relations current among Gorgias' target audience, ideas reflected in an interpretive stance towards model speeches that privileges method over truth. The Helen pretends to encourage this conception of logos and interpretive stance in order to expose the intense desire and naïve credulity that drive a coolly technical (...) appraisal of model speeches. The Helen thus manifests, with a playfulness suited to its liminal position, a concern for the ethical and social formation of those who might accept the invitation to study logos. (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)

Universal health coverage is often implemented within countries through several national insurance schemes that collectively cover their populations. Yet the extent of services and benefits available can vary substantially between different schemes. This paper argues that these variations in coverage comprise tiering and then reviews different accounts of health and social justice that consider whether and when a tiered health system is fair. Using these accounts, it shows that the fairness of tiering can be determined by assessing whether differences in (...) coverage mean enrolees under some national insurance schemes do not achieve sufficient health or normal functioning and/or feel inferior relative to those belonging to other national insurance schemes. The paper further contends that these determinations of fairness should involve the people covered by different insurance schemes. Key universal health coverage questions to involve the public in answering are: Do the sum of differences between the schemes in your country generate feelings of unequal moral worth and/or mean enrolees struggle to achieve sufficient health or normal functioning? Which specific differences between health insurance schemes generate the greatest feelings of unequal moral worth in individuals? Which specific differences generate the greatest barriers to individuals achieving sufficient health or normal functioning? Rather than identifying which services to extend coverage to first, answering these questions will identify which disparities in services and benefits are the most morally urgent to address. Finally, some initial thoughts are offered on who from the public should be involved in making these decisions and how they might be involved as a matter of justice. (shrink)

We study the fluted fragment, a decidable fragment of first-order logic with an unbounded number of variables, motivated by the work of W. V. Quine. We show that the satisfiability problem for this fragment has nonelementary complexity, thus refuting an earlier published claim by W. C. Purdy that it is in NExpTime. More precisely, we consider ${\cal F}{{\cal L}^m}$, the intersection of the fluted fragment and the m-variable fragment of first-order logic, for all $m \ge 1$. We show that, for (...) $m \ge 2$, this subfragment forces $\left\lfloor {m/2} \right\rfloor$-tuply exponentially large models, and that its satisfiability problem is $\left\lfloor {m/2} \right\rfloor$-NExpTime-hard. We further establish that, for $m \ge 3$, any satisfiable ${\cal F}{{\cal L}^m}$-formula has a model of at most -tuply exponential size, whence the satisfiability problem for this fragment is in -NExpTime. Together with other, known, complexity results, this provides tight complexity bounds for ${\cal F}{{\cal L}^m}$ for all $m \le 4$. (shrink)

In 1914, Francis E. Leupp, former commissioner of the Bureau of Indian Affairs, presented an answer to the so-called Indian Problem that some have called pluralist. This paper examines the development of Leupp’s pluralism as part of the policies and practices of the genocide of American Indians as it was carried out in the years following the US Civil War. Rather than being a singular event in the history of US-Indian relations, I argue that Leupp’s pluralism is part of the (...) settler colonial system that persists and finds present expression in contemporary liberal pluralism. I consider two examples of recent pluralist theory, those of Charles Taylor and William Galston. I conclude by arguing that what both forms of pluralism—Leupp’s and recent liberal varieties—have in common is a conception of agency that rejects the American Indian conception and conserves structural genocide as a central part of present-day society. (shrink)

The ethics of health incentive research—a form of public health research—are not well developed, and concerns of justice have been least examined. In this paper, we explore what potential long term harms in relation to justice may occur as a result of such research and whether they should be considered as part of its ethical evaluation. ‘Long term harms’ are defined as harms that contribute to existing systematic patterns of disadvantage for groups. Their effects are experienced on a long term (...) basis, persisting even once an incentive research project ends. We will first establish that three categories of such harms potentially arise as a result of health incentive interventions. We then argue that the risk of these harms also constitutes a morally relevant consideration for health incentive research and suggest who may be responsible for assessing and mitigating these risks. We propose that responsibility should be assigned on the basis of who initiates health incentive research projects. Finally, we briefly describe possible strategies to prevent or mitigate the risk of long term harms to members of disadvantaged groups, which can be employed during the design, conduct and dissemination of research projects. (shrink)

The ethical concept of responsiveness has largely been interpreted in the context of international clinical research. In light of the increasing conduct of externally funded health systems research in low- and middle-income countries, this article examines how responsiveness might be understood for such research and how it can be applied. It contends that four features set HSR in LMICs apart from international clinical research: a focus on systems; being context-driven; being policy-driven; and being closely linked to development objectives. These features (...) support reinterpreting responsiveness for HSR in LMICs as responsiveness to systems needs, where health system performance assessments can be relied upon to identify systems needs, and/or responsiveness to systems priorities, which entails aligning research with HSR priorities set through country-owned processes involving national and sub-national policymakers from host countries. Both concepts may be difficult to achieve in practice. Country ownership is not an established fact for many countries and alignment to their priorities may be meaningless without it. It is argued that more work is, therefore, needed to identify strategies for how the responsiveness requirement can be ethically fulfilled for HSR in LMICs under non-ideal conditions such as where host countries have not set HSR priorities via country-owned processes. Embeddedness is proposed as one approach that could be the focus of further development. (shrink)

Several authors have suggested that a more parsimonious and conceptually elegant treatment of everyday mereological and topological reasoning can be obtained by adopting a spatial ontology in which regions, not points, are the primitive entities. This paper challenges this suggestion for mereotopological reasoning in two-dimensional space. Our strategy is to define a mereotopological language together with a familiar, point-based interpretation. It is proposed that, to be practically useful, any alternative region-based spatial ontology must support the same sentences in our language (...) as this familiar interpretation. This proposal has the merit of transforming a vague, open-ended question about ontologies for practical mereotopological reasoning into a precise question in model theory. We show that (a version of) the familiar interpretation is countable and atomic, and therefore prime. We conclude that useful alternative ontologies of the plane are, if anything, less parsimonious than the one which they are supposed to replace. (shrink)

marilyn fischer's book Jane Addams's Evolutionary Theorizing sets a new standard for reading the central works of American philosophy. By situating Addams's Democracy and Social Ethics in the context of late nineteenth-century evolutionary theory, the text takes on meanings different from some that have become canonical. Context, in this case, is not simply historical context, but also the intellectual context in which Addams's work was written and read. Fischer argues that the meanings of terms such as "evolution," "democracy," "sympathy," and (...) "social ethics" cannot be taken at today's face value, but rather must be understood in light of the ideas and theories with which they were associated in Addams's day—what... (shrink)

Legal orthodoxy has it that the wrong involved in breaking a promise, like that involved in breaking a contract, depends essentially on the making of a binding promise. It is in this sense sui generis. But philosophers are not so sanguine. T.M. Scanlon is the latest in a long line of moral philosophers who have sought to reduce the wrong of promise-breaking to a wider class of wrongs associated with a duty, variously formulated, not to disappoint the expectations one induces (...) in another. I argue that Scanlon's theory founders on a logical impasse that plages all such reductionist accounts. (shrink)

Engagement in health research is increasingly practised worldwide. Yet many questions remain under debate in the ethics field about its contribution to health research and these debates have largely not been informed by those who have been engaged in health research. This paper addresses the following key questions: what should the ethical goals of engagement in health research be and how should it be performed? Qualitative data were generated by interviewing 22 people with lived experience, members of the public, and (...) engagement managers about power sharing in health research. Thematic analysis of study data identified the following five themes: the value of engagement in research, ideal engagement, tokenistic engagement, terms to describe those engaged, and engagement roles in research. The paper presents that data and then considers what insights it offers for what engagement should look like—its ethical goals and approach—according to those being engaged. (shrink)

Research misconduct is harmful because it threatens public health and public safety, and also undermines public confidence in science. Efforts to eradicate ongoing and prevent future misconduct are numerous and varied, yet the question of “what works” remains largely unanswered. To shed light on this issue, this study used data from both mail and online surveys administered to a stratified random sample of tenured and tenure-track faculty members (N = 613) in the social, natural, and applied sciences at America’s top (...) 100 research universities. Participants were asked to gauge the effectiveness of various intervention strategies: formal sanctions (professional and legal), informal sanctions (peers), prevention efforts (ethics and professional training), and reducing the pressures associated with working in research-intensive units. Results indicated that (1) formal sanctions received the highest level of support, (2) female scholars and researchers working in the applied sciences favored formal sanctions, and (3) a nontrivial portion of the sample supported an integrated approach that combined elements of different strategies. A key takeaway for university administrators is that a multifaceted approach to dealing with the problem of research misconduct, which prominently features enhanced formal sanctions, will be met with the support of university faculty. (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)

The topic of epistemic injustice in global health ethics is complex, important and vast. While presenting as nuanced and complete a picture of the challenge as we possibly could, we were acutely aware of our positionality and how it gave us a certain viewpoint that would need to be expanded by others with different positions and experiences. We were, therefore, delighted to receive the collected commentaries by Atuire,1 Abimbola,2 Frimpong-Mansoh,3 Nyamnjoh and Ewuoso,4 Tangwa,5 Ambrogi et al.6 We would like to (...) thank these authors for furthering our account by raising questions, pointing out gaps or complementing our analysis. The points raised by these authors—and many points that will undoubtedly be raised by others in future—should be critically engaged with as we collectively define and work towards a more epistemically just global health ethics. Specifically, two points stand out. First, Frimpong-Mansoh accurately diagnoses our ambiguity about being drawn into debates about relativism in bioethics. We …. (shrink)