Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)
Design of clinical trials for germline gene editing stretches current accepted standards for human subjects research. Among the challenges involved is a set of issues concerning intergenerational monitoring—long-term follow-up study of subjects and their descendants. Because changes made at the germline would be heritable, germline gene editing could have adverse effects on individuals’ health that can be passed on to future generations. Determining whether germline gene editing is safe and effective for clinical use thus may require intergenerational monitoring. The aim (...) of this paper is to identify and argue for the significance of a set of ethical issues raised by intergenerational monitoring in future clinical trials of germline gene editing. Though long-term, multigenerational follow-up study of this kind is not without precedent, intergenerational monitoring in this context raises unique ethical challenges, challenges that go beyond existing protocols and standards for human subjects research. These challenges will need to be addressed if clinical trials of germline gene editing are ever pursued. (shrink)
:Since the advent of recombinant DNA technology, expectations about the potential for altering genes and controlling our biology at the fundamental level have been sky high. These expectations have gone largely unfulfilled. But though the dream of being able to control our biology is still far off, gene editing research has made enormous strides toward potential clinical use. This paper argues that when it comes to determining permissible uses of gene editing in one important medical context—germline intervention in reproductive medicine—issues (...) about enhancement and eugenics are, for the foreseeable future, a red herring. Current translational goals for gene editing research involve a different kind of editing than would be required to achieve manipulation of complex traits such as intelligence, and there are more pressing questions that need attention if clinical use of gene editing in reproductive medicine ever becomes a possibility. (shrink)
In debates about the moral foundations of intellectual property, one very popular strand concerns the role of labor as a moral basis for intellectual property rights. This idea has a great deal of intuitive plausibility; but is there a way to make it philosophically precise? That is, does labor provide strong reasons to grant intellectual property rights to intellectual laborers? In this paper, I argue that the answer to that question is “yes”. I offer a new view, different from existing (...) labor theories of intellectual property, which I call the productive capacities view. This view gives us a way to make sense of the idea of labor as the basis for intellectual property rights, as well as a tool for critically evaluating existing intellectual property institutions. (shrink)
What is well-being? This is one of humanity's oldest and deepest questions; Valerie Tiberius offers a fresh answer. She argues that our lives go well to the extent that we succeed in what matters to us emotionally, reflectively, and over the long term. So when we want to help others achieve well-being, we should pay attention to their values.
When developing computational models to analyze the tradeoffs between climate risk management strategies (i.e., mitigation, adaptation, or geoengineering), scientists make explicit and implicit decisions that are influenced by their beliefs, values and preferences. Model descriptions typically include only the explicit decisions and are silent on value judgments that may explain these decisions. Eliciting scientists’ mental models, a systematic approach to determining how they think about climate risk management, can help to gain a clearer understanding of their modeling decisions. In order (...) to identify and represent the role of values, beliefs and preferences on decisions, we used an augmented mental models research approach, namely values-informed mental models (ViMM). We conducted and qualitatively analyzed interviews with eleven climate risk management scientists. Our results suggest that these scientists use a similar decision framework to each other to think about modeling climate risk management tradeoffs, including eight specific decisions ranging from defining the model objectives to evaluating the model’s results. The influence of values on these decisions varied between our scientists and between the specific decisions. For instance, scientists invoked ethical values (e.g., concerns about human welfare) when defining objectives, but epistemic values (e.g., concerns about model consistency) were more influential when evaluating model results. ViMM can (i) enable insights that can inform the design of new computational models and (ii) make value judgments explicit and more inclusive of relevant values. This transparency can help model users to better discern the relevance of model results to their own decision framing and concerns. (shrink)
In this article, we describe a project in which philosophy, in combination with methods drawn from mental modeling, was used to structure dialogue among stakeholders in a region-scale climate adaptation process. The case study we discuss synthesizes the Toolbox dialogue method, a philosophically grounded approach to enhancing communication and collaboration in complex research and practice, with a mental modeling approach rooted in risk analysis, assessment, and communication to structure conversations among non-academic stakeholders who have a common interest in planning for (...) a sustainable future. We begin by describing the background of this project, including details about climate resiliency efforts in West Michigan and the Toolbox dialogue method, which was extended in this project from academic research into community organization involving the West Michigan Climate Resiliency Framework Initiative. This extension involved application of several methods, which are the focus of the Methods section. We then present and discuss preliminary results that suggest the potential for philosophical dialogue to enhance mutual understanding in complex community initiatives that focus on sustainable responses to climate change. Overall, the article supplies a detailed, instructive example of how philosophy can support policy-relevant decision-making processes at the community level. (shrink)
Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literature on clinical care as well as clinical research (...) (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains. (shrink)
To what extent should we focus on implicit bias in order to eradicate persistent social injustice? Structural prioritizers argue that we should focus less on individual minds than on unjust social structures, while equal prioritizers think that both are equally important. This article introduces the framework of transactive memory into the debate to defend the equal priority view. The transactive memory framework helps us see how structure can emerge from individual interactions as an irreducibly social product. If this is right, (...) then debiasing interventions are structural interventions. One upshot is that the utility of the individual versus structural distinction is not apparent for the purposes of intervention. (shrink)
How can we live life wisely? Tiberius argues that we need to develop the kind of wisdom that emphasizes the importance of learning from experience. We need to care about things that sustain us and give us good experiences, have perspective on our successes and failures, and be moderately self-aware and cautiously optimistic about human nature.
Intuitively, there is a difference between knowledge and mere belief. Contemporary philosophical work on the nature of this difference has focused on scenarios known as “Gettier cases.” Designed as counterexamples to the classical theory that knowledge is justified true belief, these cases feature agents who arrive at true beliefs in ways which seem reasonable or justified, while nevertheless seeming to lack knowledge. Prior empirical investigation of these cases has raised questions about whether lay people generally share philosophers’ intuitions about these (...) cases, or whether lay intuitions vary depending on individual factors (e.g. ethnicity) or factors related to specific types of Gettier cases (e.g. cases that include apparent evidence). We report an experiment on lay attributions of knowledge and justification for a wide range of Gettier Cases and for a related class of controversial cases known as Skeptical Pressure cases, which are also thought by philosophers to elicit intuitive denials of knowledge. Although participants rated true beliefs in Gettier and Skeptical Pressure cases as being justified, they were significantly less likely to attribute knowledge for these cases than for matched true belief cases. This pattern of response was consistent across different variations of Gettier cases and did not vary by ethnicity or gender, although attributions of justification were found to be positively related to measures of empathy. These findings therefore suggest that across demographic groups, laypeople share similar epistemic concepts with philosophers, recognizing a difference between knowledge and justified true belief. (shrink)
Freedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion. We conducted a systematic review (...) of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection. Of an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons. The reasons and their associated mentions in this category outnumber those in the sum of the other three categories. We identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals. (shrink)
This basic guide introduces the relationships between observation, perception, and learning that form the substance of hierarchy theory. This theory aims to answer the question of whether there is a basic structure to nature, comprising discreet levels of organization within an overall pattern.
This is the first philosophy textbook in moral psychology, introducing students to a range of philosophical topics and debates such as: What is moral motivation? Do reasons for action always depend on desires? Is emotion or reason at the heart of moral judgment? Under what conditions are people morally responsible? Are there self-interested reasons for people to be moral? Moral Psychology: A Contemporary Introduction presents research by philosophers and psychologists on these topics, and addresses the overarching question of how empirical (...) research is relevant to philosophical inquiry. (shrink)
The number of distributors selling Fair Trade products is constantly increasing. What are their motivations to distribute Fair Trade products? How do they organise this distribution? Do they apply and communicate the Fair Trade values? This research, based on five case studies in Switzerland, aims at understanding and structuring the strategies and the managerial practices related to Fair Trade product distribution, as well as analysing if they denote an engagement with Fair Trade principles. The results show a high heterogeneity of (...) strategies and engagement. In general, strategies implemented by mainstream actors contribute to increase Fair Trade global sales but do not convey the transformative message of Fair Trade through their engagement. The latter is rather communicated through alternative channels. Problems and potential solutions to this issue are discussed. (shrink)
The classical view that equates rationality with adherence to the laws of probability theory and logic has driven much research on inference. Recently, an increasing number of researchers have begun to espouse a view of rationality that takes account of organisms' adaptive goals, natural environments, and cognitive constraints. We argue that inference is carried out using boundedly rational heuristics, that is, heuristics that allow organisms to reach their goals under conditions of limited time, information, and computational capacity. These heuristics are (...) ecologically rational in that they exploit aspects of both the physical and social environment in order to make adaptive inferences. We review recent work exploring this multifaceted conception of rationality. (shrink)
Valéry’s conceptions of mind, literature and even philosophy often stress the importance of an effort against heterogeneity that should be led in the name of what the author himself calls pureté. On the other hand, the theories that Valéry develops about composition - which is intended both as an aesthetic and a theoretical concept - show the importance of complexity in his representation of the esprit and allows to compare Valéry’s descriptions of the self with the way he represents creative (...) process and even draws the structure of his own works. (shrink)
Although widely studied in other domains, relatively little is known about the metacognitive processes that monitor and control behaviour during reasoning and decision-making. In this paper, we examined the conditions under which two fluency cues are used to monitor initial reasoning: answer fluency, or the speed with which the initial, intuitive answer is produced, and perceptual fluency, or the ease with which problems can be read. The first two experiments demonstrated that answer fluency reliably predicted Feeling of Rightness judgments to (...) conditional inferences and base rate problems, which subsequently predicted the amount of deliberate processing as measured by thinking time and answer changes; answer fluency also predicted retrospective confidence judgments. Moreover, the effect of answer fluency on reasoning was independent from the effect of perceptual fluency, establishing that these are empirically independent constructs. In five experiments with a variety of reasoning problems similar to those of Alter et al., we found no effect of perceptual fluency on FOR, retrospective confidence or accuracy; however, we did observe that participants spent more time thinking about hard to read stimuli, although this additional time did not result in answer changes. In our final two experiments, we found that perceptual disfluency increased accuracy on the CRT, but only amongst participants of high cognitive ability. As Alter et al.’s samples were gathered from prestigious universities, collectively, the data to this point suggest that perceptual fluency prompts additional processing in general, but this processing may results in higher accuracy only for the most cognitively able. (shrink)
One hundred and three participants solved conflict and non-conflict versions of four reasoning tasks using a two-response procedure: a base rate task, a causal reasoning task, a denominator neglect task, and a categorical syllogisms task. Participants were asked to give their first, intuitive answer, to make a Feeling of Rightness judgment, and then were given as much time as needed to rethink their answer. They also completed a standardized measure of IQ and the actively open-minded thinking questionnaire. The FORs of (...) both high- and low-capacity reasoners were responsive to conflict, such that FORs were lower for conflict relative to non-conflict problems. Consistent with the quantity hypothesis, high-capacity reasoners made a greater distinction between conflict and non-conflict items on measures of Type 2 thinking, namely, rethinking time and probability of changing answers. In contrast to the quality hypothesis, however, this rethinking time did not advantage the ability of the high-capacity group to produce normative answers, except for the base rate task. Indeed, we observed that the correlation between capacity and the probability of normative answers emerged at the initial response, rather than after rethinking. (shrink)
Feminist Political Theory provides both a wide-ranging history of western feminist thought and a lucid analysis of contemporary debates. It offers an accessible and thought-provoking account of complex theories, which it relates to 'real-life' issues such as sexual violence, political representation and the family. This timely new edition has been thoroughly updated to incorporate the most recent developments in feminism and feminist scholarship throughout, in particular taking into account the impact of black and postmodern feminist thought on feminist political theory.
Hubris among CEOs is generally considered to be undesirable: researchers in finance and in management have documented its unwelcome effects and the media ascribe many corporate failings to CEO hubris. However, the literature fails to provide a precise definition of CEO hubris and is mostly silent on how to prevent it. We use work on hubris in the fields of mythology, psychology, and ethics to develop a framework defining CEO hubris. Our framework describes a set of beliefs and behaviors, both (...) psycho-pathological and unethical in nature, which characterize the problematic relationship of the hubris-infected CEO towards his or her own self, others and the world at large. We then demonstrate how the development of authentic leadership may contribute to preventing or attenuating hubris by addressing its psycho-pathological nature through the true self and meaningful relationships with others. In addition to its psycho-pathological dimension, CEO hubris also contains an ethical dimension. We therefore propose that the development of the virtue of reverence might contribute to the prevention or attenuation of CEO hubris, because reverence makes the individual aware of his or her place in the world order and membership of the community of humans. (shrink)
Whether it is to be maximized or promoted as the object of a duty of beneficence, well-being is a vitally important notion in ethical theory. Well-being is a value, but to play the role it has often been assigned by ethical theory it must also be something we can measure and compare. It is a normative concept, then, but it also seems to have empirical content. Historically, philosophical conceptions of well-being have been responsive to the paired demands for normative and (...) empirical adequacy. However, recent work has yet to pay serious attention to the burgeoning field of well-being research in empirical psychology. This might be because the research is new and unknown, or it might be due to uncertainty about how a philosophical investigation would take such research into account. This chapter offers solutions to both of these problems. It provides an overview of well-being research in empirical psychology. It then uses this overview as part of an argument for an empirical informed account of well-being that we call the Value-Based Life Satisfaction Account. (shrink)
"Paul Valery: Illusions of Civilization" opens a vast discussion of the meaning of civilization, in particular, Western civilization. It causes us to face the problems of survival, meaning, and ends. This discussion with Valery is unique - never before has such an encounter taken place. The reader is overwhelmed and challenged. The problems are presented with amazing clarity and depth.".