When people use a resource without a co-ordinated plan the result is often a tragedy of the commons in which the resource is depleted. Many environmental resources display the characteristics of a developing tragedy of the commons. Many believe that each person is ethically obligated to reduce use of the commons to the sustainable level. I argue that this is mistaken. In a tragedy of the commons there is no reasonable expectation that individual, voluntary action will succeed. Our obligation is (...) not fruitlessly to reduce individual use, but to support a collective agreement to reduce everyone's use to the sustainable level. (shrink)

The dead donor rule (DDR) originally stated that organ donors must not be killed by and for organ donation. Scholars later added the requirement that vital organs should not be procured before death. Some now argue that the DDR is breached in donation after circulatory determination of death (DCDD) programs. DCDD programs do not breach the original version of the DDR because vital organs are procured only after circulation has ceased permanently as a consequence of withdrawal of life-sustaining therapy. We (...) hold that the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics. We propose separating the DDR from two other fundamental normative rules: the duties to prevent harm and to obtain informed consent. (shrink)

Scientists’ sense of social responsibility is particularly relevant for emerging technologies. Since a regulatory vacuum can sometimes occur in the early stages of these technologies, individual scientists’ social responsibility might be one of the most significant checks on the risks and negative consequences of this scientific research. In this article, we analyze data from a 2011 mail survey of leading U.S. nanoscientists to explore their perceptions the regarding social and ethical responsibilities for their nanotechnology research. Our analyses show that (...) leading U.S. nanoscientists express a moderate level of social responsibility about their research. Yet, they have a strong sense of ethical obligation to protect laboratory workers from unhealthy exposure to nanomaterials. We also find that there are significant differences in scientists’ sense of social and ethical responsibility depending on their demographic characteristics, job affiliation, attention to media content, risk perceptions and benefit perceptions. We conclude with some implications for future research. (shrink)

In times of crises, public health leaders may claim that trials of public health interventions are unethical. One reason for this claim can be that equipoise—i.e. a situation of uncertainty and/or disagreement among experts about the evidence regarding an intervention—has been disturbed by a change of collective expert views. Some might claim that equipoise is disturbed if the majority of experts believe that emergency public health interventions are likely to be more beneficial than harmful. However, such beliefs are not always (...) justified: where high quality research has not been conducted, there is often considerable residual uncertainty about whether interventions offer net benefits. In this essay we argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies (PHEs). We contend that this standard applies to both pharmaceutical and non-pharmaceutical interventions, and we elaborate an account of equipoise that captures key features of debates in the recent pandemic. We build our case by analyzing research strategies employed during the COVID-19 pandemic regarding drugs, vaccines, and non-pharmaceutical interventions; and by providing responses to possible objections. Finally, we propose a public health policy reform: whenever a policy implemented during a PHE is not grounded in high-quality evidence that expected benefits outweigh harms, there should be a planned approach to generate high-quality evidence, with review of emerging data at preset time points. These preset timepoints guarantee that policymakers pause to review emerging evidence and consider ceasing ineffective or even harmful policies, thereby improving transparency and accountability, as well as permitting the redirection of resources to more effective or beneficial interventions. (shrink)

Stephen John has recently suggested that the ethics of communication yields important insights as to how values should be incorporated into science. In particular, he examines cases of “wishful speaking” in which a scientific actor endorses unreliable conclusions in order to obtain the consequences of the listener treating the results as credible. He concludes that what is wrong in these cases is that the speaker surreptitiously relies on values not accepted by the hearer, violating what he terms “the value-apt ideal”. (...) I expand on this view by integrating into it Miranda Fricker’s account of testimonial injustice. I find testimonial injustice can arise in a manner unanticipated by Fricker, specifically that a credibility excess given to a speaker typically reduces the ability of others in the epistemic community to transmit knowledge, a phenomenon I term “collateral epistemic injustice”. I argue that this possibility entails that receivers have an ethical obligation to assign credibility judiciously. A further consequence of this view is that the value-apt ideal is insufficient. Because audience members have an obligation to assign credibility judiciously, a speaker cannot merely rely on shared values, they must also be open about the extent to which their conclusions depend on those values. Thus, both wishful speaking and obscuring the value-dependent nature of a conclusion makes one an unreliable source of information. Accordingly, other community members have an ethical obligation to ignore a speaker that frequently engages in either. (shrink)

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C (...) transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives , little work has been done from an Islamic point of view. To fill the gap in the literature around (...) Islamic bioethical perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or conti.. (shrink)

Institutional investors control almost 60% of all assets under management worldwide and encompass a wide variety of organizations. Despite this reach, however, institutional investors have not received the normative scrutiny they merit beyond general discussions around their legally grounded fiduciary obligations to their beneficiaries. This paper offers a discussion of institutional investor ethical obligations in light of their specific attributes. We propose that the different characteristics of institutional investors and the diverse roles they play in the marketplace (...) inform the scope of their activities, and, in turn, the different ways in which their basic ethical obligations can be fulfilled. (shrink)

The Common Rule creates a division of moral labor in research. It implies that investigators and sponsors can outsource their ethical obligations to IRBs and participants, thereby fostering a culture of compliance, rather than one of responsibility. The proposed revisions to the Common Rule are likely to exacerbate this problem. To harness the expressive power of the law, I propose the Common Rule be revised to include the ethical responsibilities of investigators and sponsors.

Imagine a study in which HIV-infected pregnant women are given antiretroviral treatment to determine how effectively it will prevent HIV transmission during childbirth. Each mother’s involvement in this study ends with the birth of her child, at which time her access to antiretrovirals provided by the study also ceases. At the outset of the study, the investigator and sponsor agree that after the child’s birth, they will refer mothers who require treatment for their HIV to a national program that provides (...) antiretroviral treatment and care. Assuming the Institutional Review Board raises no objections to this plan, should the research team consider their ethical obligations to participants fulfilled? If the investigator and sponsor were to consult the Common Rule, they would find little to suggest that there are any further ethical issues to address. (shrink)

Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document (...) did not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists. (shrink)

A murder case that had some features in common with the Tarasoff case occurred in Sasebo City, Japan, in 2014. A 15-year-old high school girl was murdered and her 16-year-old classmate was arrested on suspicion of homicide. One and a half months before the murder, a psychiatrist who had been examining the girl called a prefectural child consultation centre to warn that she might commit murder, but he did not reveal her name, considering it his professional duty to keep it (...) confidential. Article 134 of the Japanese Criminal Law states that doctors should not disclose patient information obtained in clinical practice without a legitimate reason, but the Japanese Supreme Court has not specified what constitutes a legitimate reason. Mass media and commentators suggested that the murder could have been prevented if the psychiatrist had disclosed the girl's name to the authorities or had isolated her coercively in a psychiatric ward. However, the authors disagree with such claims. This article discusses obligations imposed on concerned individuals and third party members in cases involving ethical dilemmas regarding patient confidentiality and information disclosure. It is concluded that everyone should fulfill their obligations to prevent such tragedies and one should judge the appropriateness of others’ actions based not on the consequences of their actions, but on the processes used to decide on a course of action and their commitment. It is necessary for us to establish a society in which concerned parties can do what they think is ethically best without fearing ungrounded charges. (shrink)

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in (...) Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care. (shrink)

This paper considers the obligation higher income countries have to lower and middle income countries during a global pandemic. Further considers which reforms are needed to the global supply-chain of medical resources. The short-comings in distribution and medical infrastructure have exacerbated the health crisis in developing countries. Global justice demands radical redistribution of medical resources in order to prevent mass casualties. This is argued first by highlighting that the COVID-19 pandemic should be acknowledged as an issue of global justice, secondly, (...) higher income countries ought to account for distribution inequity as a matter of rectifying past injustices, and thirdly argue for reform in distribution while considering the vaccine rollout as a prime example. We aim to show how the differences from country to country in response capabilities are a result of the economic foundation colonialism established and a direct result of cyclical poverty, which wealthy countries perpetuate to this day. (shrink)

In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. (...) This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice. (shrink)

The ethics of corruption cannot be analysed without simultaneously addressing the legitimacy of public office or entrusted power. This paper introduces a concept of core unethical corruption, defined as violations of distributed ethical obligations for private gain. In other words, it is suggested that what is ethically wrong with corruption is that it entails the violation of certain obligations attributed to agents. By explicitly relating corruption to obligations, this approach helps make ethical sense of the (...) concepts of public office or entrusted power, attending to the question of their legitimacy. Since distributed obligations are implied by a wide range of ethical theories, the concept of core unethical corruption also reflects a (partial) overlapping consensus on the ethics of corruption. (shrink)

Museums have a long history and practice of trafficking in looted antiquities. An account of the moral mission of museums and the moral obligations of museum trustees is given. Based on that account, a moral critique of the actions of museums and their trustees is provided, addressing some of the rationales that museums and their trustees have offered for justifying this activity of trafficking. Some of the rationale examined involves arguments regarding collective responsibility. It is argued that the loss (...) of provenance and provenience resulting from this practice is a particularly significant moral harm done to humanity as a whole. I argue that it is a mistake to categorize human remains and cultural artifacts as property and doing so is one source of the morally problematic activity. (shrink)

It is patent that society is evolving an ethic for the treatment of animals which goes well beyond the standard prohibitions against cruelty. This new ethic for animals takes the consensus ethic for the treatment of humans in society and extends it,mutatis mutandis, to the treatment of animals. Though this ethic has been applied first to research animals, its extension to agricultural animals is inevitable, and has already begun. This article explores the extent to which veterinary medicine and animal science, (...) the major scientific fields relevant to animal agriculture, can accommodate the emerging ethic. (shrink)

The Financial Crisis in Europe puts pressure on welfare states and its tax systems as well as on considerations of social justice. In this paper, we would like to explore the status of the idea of progressive taxation and its justification (especially the ‘ability-to-pay’ principle) in times of a financial crisis. We will discuss it within a social justice framework following David Miller—using the principles of (i) need, (ii) merit, and (iii) equality. We will conclude that progressive taxation can be (...) justified in the light of these three principles, even more so in the situation of a financial crisis that undermines decent living conditions for millions. The principle of need has to be given priority even if this move violates the principles of equality and desert. (shrink)

The current global wave of nationalism threatens the process of shared critical reflection, driving many of us back to reading Hannah Arendt. These “dark times” are especially challenging from a Deweyan pragmatist perspective because critical and cooperative inquiry requires a free community of thinkers. Having lived in a near-fascist religious group for fifteen years, this essay brings personal experiences to the questions of how we think as well as create spaces for diverse yet shared realities to think and act in (...) freedom. Drawing on Arendt as well as Dewey, Addams, and Minnich, this essay explores three necessities for integrity in dark times: Radical honesty and reflection which requires facing up to reality and being mindful about events in our world; Building communities: creating shared reality and public spaces to appear, Developing the skills of engaged thinking and the capacity for deep reflection as a foundation for action together. (shrink)

A number of authors have commented on the topic of mandated reporting in cases of suspected child maltreatment and the application of this requirement to researchers. Most of these commentaries focus on the interpretation of current legal standards and offer opinions for or against the imposition of mandated reporting laws on research activities. Authors on both sides of the issue offer ethical arguments, although a direct comparison and analysis of these opposing arguments is rare. This article critically examines the (...) ethical arguments made by authors on both sides of the debate. The conclusion is reached that researchers should be mandated reporters of child maltreatment because the current arguments do not justify their exclusion from current ethical and legal standards. The author makes recommendations for the ethically responsible conduct of research in regard to this topic and legal implications are discussed. (shrink)

In this issue of the Hastings Center Report, Mélanie Terrasse, Moti Gorin, and Dominic Sisti respond to recent efforts to address the “digital attention crisis,” arguing that “[b]ioethicists should make their voices heard in the debate on the responsibilities of social media companies toward their consumers and society at large.” I strongly agree. I have frequently been asked by my colleagues why I spend time on social media professionally, on top of all the competing demands associated with my work as (...) a bioethicist and medical educator. There is sometimes a dismissive tone in these questions, a sense that attention to social media is beneath a bioethicist’s proper intellectual pursuits. Such perspectives overlook the extraordinary opportunities of social media and the important role for bioethics, as a field, in examining them. (shrink)

Slot machines gained a high popularity despite a specific element that could limit their appeal: non-transparency with respect to mathematical parameters. The PAR sheets, exposing the parameters of the design of slot machines and probabilities associated with the winning combinations are kept secret by game producers, and the lack of data regarding the configuration of a machine prevents people from computing probabilities and other mathematical indicators. In this article, I argue that there is no rational justification for this secrecy by (...) giving two reasons, one psychological and the other mathematical. For the latter, I show that mathematics provides us with some statistical methods of retrieving the missing data, which are essential for the numerical probability computations in slots. The slots case raises the problem of the exposure of the parametric configuration and mathematical facts of any game of chance as an ethical obligation. (shrink)

While the 2010 EPSRC principles for robotics state a set of 5 rules of what ‘should’ be done, I argue they should differentiate between legal obligations and ethical demands. Only if we make this difference can we state clearly what the legal obligations already are, and what additional ethical demands we want to make. I provide suggestions how to revise the rules in this light and how to make them more structured.

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, (...) unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours, as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities. No data are available. (shrink)

Ethics, Policy & Environment, Volume 15, Issue 2, Page 237-240, June 2012.

Since Oregon implemented its Death with Dignity Act, many additional states have followed suit demonstrating a growing understanding and acceptance of aid in dying processes. Traditionally, the patient has been the one to request and seek this option out. However, as Death with Dignity acts continue to expand, it will impact the role of physicians and bring up questions over whether physicians have the ethical obligation to facilitate a conversation about AID with patients during end of life discussions. Patients (...) have the right to make informed decisions about their health, which implies that physicians have an obligation to discuss with and inform patients of the options that will accomplish the patients’ goals of care. We will argue that physicians have an ethical obligation to inform certain patients about AID during end of life care discussions. We will also address what this obligation encompasses and explore guidelines of when and how these conversations should occur and proceed. Earlier guidelines, presented by various palliative care and ethics experts, for proceeding with such conversations have mostly agreed that the discussion of hospice and end of life care with patients should be initiated early and that the individual goals of a patient during the remaining duration of life should be thoroughly examined before discussion of appropriate options. In discussing AID, physicians should never recommend but inform patients about the basics so that they can make an informed decision. If patients express further interest in AID, the physician should open up the dialogue to address the reasoning behind this decision versus other possible treatments to ensure that patients clearly comprehend the process and implications of their decision. Ultimately, any end of life choice should be made by patients with the full capacity to express what they envision for the remaining duration of life and to comprehend the advantages and disadvantages of all the possible options. (shrink)