This article is a reply to Venkatapuram's critique in his article Health, Vital Goals, Capabilities, this volume. I take issue mainly with three critical points put forward by Venkatapuram with regard to my theory of health. (1) I deny that the contents of my vital goals are relative to each community or context, as Venkatapuram claims. There is no conceptual connection at all between standard circumstances and vital goals, as I understand these concepts. (2) Venkatapuram notes that I (...) stop short of filling the framework of vital goals with any content and thereby make my concept of health less concrete. I reply that some vital goals are indeed universal, viz. the ones which are necessary conditions for survival. Many other vital goals are individual and cannot therefore be included in a universal list. (3) Venkatapuram claims that my definition of vital goals is too broad, since it entails that some persons without any disease can be regarded as ill. However, in my understanding health is a relational concept from a state of complete health to a state of maximal illness. In this framework, a minor reduction of a state of complete health does not entail illness. This article also contains a comparison between my theory of health and Martha Nussbaum's theory of capabilities for dignity. (shrink)

In this article, I analyze the circumstances of justice, that is, the background conditions that are necessary and sufficient for justice to exist between individual parties in society. Contemporary political philosophers almost unanimously accept an account of these circumstances attributed to David Hume. I argue that the conditions of this standard account are neither sufficient nor necessary conditions for justice. In particular, I contend that both a Hobbesian state of nature and a prisoner’s dilemma are cases in (...) which the conditions of the standard account obtain and yet no justice exists between parties. I propose an alternative set of generic circumstances of justice motivated by examples from game theory. Parties are in these generic circumstances with respect to each other when: (1) they are engaged in a conflictual coordination game with multiple strict Nash equilibrium points where, at any of these equilibria, some parties do not receive their greatest payoffs, and (2) they have common knowledge that each party is rational and follows her end of a strict equilibrium where no party receives her greatest payoff. These two conditions reflect the idea that justice requires all parties to make some sacrifices so that others can have more of the goods they need and want. I argue that these generic circumstances are necessary and sufficient conditions for parties to follow generic norms of justice, that is, mutually beneficial practices that require some sacrifices. Key Words: common knowledge • conflictual coordination • correlated equilibrium • moderate selfishness • moderate variable scarcity • rough equality. (shrink)

ABSTRACT In recent years there has been intense debate regarding the level of medical care provided to ‘standard care’ control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions (...) of the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national ‘standard’. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. (shrink)

The paper addresses the nature of duties grounded in human rights. Rather than being protections against harm, per se, I contend that human rights largely shield against risk impositions to protected interests. “Risk imposition” is a normative idea requiring explication, but understanding dutiful action in its terms enables human rights to provide prospective policy guidance, hold institutions accountable, operate in non-ideal circumstances, embody impartiality among persons, and define the moral status of agencies in international relations. Slightly differently, I indicate (...) a general understanding of dutiful action that permits human rights to see to the tasks of an institutional morality. (shrink)

ABSTRACT In recent years there has been intense debate regarding the level of medical care provided to ‘standard care’ control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions (...) of the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national ‘standard’. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. (shrink)

Law wrangles with setting and applying standards for the practice of medicine in many different arenas. One of the most prominent is medical malpractice litigation in which the trial process examines a physician's performance and measures it against the standard of care. The profession's prevailing custom, with some substantial tolerance for “respectable minority” views, has been the gold standard for scrutinizing physician practice and treatment decisions in the malpractice context. Using the profession's custom as the measure against which (...) a physician's performance is judged defers to the expertise of medicine. Deference to the medical profession is attractive as a tool for reining in law. Reliance on customary practice is criticized, however, for driving physicians to the relative safety of the middle of the herd. Creating such a strong incentive for compliance with customary practice can dampen medical innovation and the diffusion of new clinical knowledge. The safety of the herd can also deprive individual patients of the best care in their particular circumstances.Several current trends are strengthening claims that professional practice patterns are an inappropriate tool for distinguishing between high‐quality and substandard care. In particular, advocacy for evidence‐based medicine aggressively asserts that the traditional way of making medical treatment decisions is largely untethered from scientific method or data, rendering professional judgment, even in the aggregate, suspect. (shrink)

The World Medical Association’s revised Declaration of Helsinki endorses the view that all trial participants in every country are entitled to the worldwide best standard of care. In this paper the authors show that this requirement has been rejected by every national and international committee that has examined this issue. They argue that the consensus view now holds that it is ethically permissible, in some circumstances, to provide research participants less than the worldwide best care. Finally, the authors (...) show that there is also consensus regarding the broad conditions under which this is acceptable. (shrink)

An epistemic account of the circumstances of justice allows one to make three important claims about the Humean and Rawlsian ‘standard account’ of those circumstances. First, and contrary to Hume, the possibility and necessity of justice are rooted not in limited beneficence or confined generosity, but in the epistemic insight that the knowledge relevant to deciding what to do with the fruits of social cooperation is for a variety of reasons uncentralisable. Second, and regardless of whether Rawlsian (...) ethical disagreement is more persuasive as a circumstance of justice than Humean confined generosity, it does not explain the possibility and necessity of justice, for the uncentralisability of social knowledge would be decisive even under conditions of unanimity. Finally, the epistemic account not only shows what the circumstances of justice are but, contra Cohen’s critique of the standard account, also provides at least some guidance as to what justice itself may be. (shrink)

It has become more common recently for epistemologists to advocate the pragmatic encroachment on knowledge, the claim that the appropriateness ofknowledge ascriptions is dependent on the relevant practical circumstances. Advocacy of practicalism in epistemology has come at the expense of contextualism, the view that knowledge ascriptions are independent of pragmatic factors and depend alternatively on distinctively epistemological, semantic factors with the result that knowledge ascriptions express different knowledge properties on different occasions of use. Overall, my goal here is to (...) defend a particular version of contextualism drawn from work by Peter Ludlow, called ‘standards contextualism.’ My strategy will be to elaborate on this form of contextualism by defending it from various objections raised by the practicalists Jason Stanley, Jeremy Fantl and Matthew McGrath. In showing how standards contextualism can effectively repel these criticisms I hope to establish that standards contextualism is a viable alternative to practicalism. (shrink)

Judgments of well-being across different circumstances and spheres of life exhibit a staggering diversity. Depending on the situation, we use different standards of well-being and even treat it as being constituted by different things. This is true of scientific studies as well as of everyday life. How should we interpret this diversity? I consider three ways of doing so: first, denying the legitimacy of this diversity, second, treating well-being as semantically invariant but differentially realizable, and, third, adopting contextualist semantics (...) for well-being expressions. I reject the first option on the grounds that it is unable to make sense of much of everyday and scientific linguistic practices, and also because it makes the category of well-being insignificant or even otiose for practical purposes. We should thus pick between the second and the third options. I argue that contextualism about well-being is more plausible and faces fewer objections than the differential realization view. I conclude with a discussion of other features of contextualism: it does not imply that well-being is relative to individual taste, it need not result in eliminativism about well-being, nor in scepticism about a general theory of well-being. It does not commit us to an “anything goes” approach, nor does it threaten anarchy and miscommunication. (shrink)

An applicant to our graduate program in philosophy, accepted as well by one (but only one) other graduate program, wrestles with his decision. Finally he decides to attend the other program, but he thanks me for our offer, telling me, "I'm glad that at least I had a choice." I want to focus a bit on these two stories, for while the central conclusion in each -- something turning on the importance of choice -- is initially compelling, it is also, (...) on reflection, philosophically puzzling. It is compelling, because many of us in similar positions would share this response; phenomenologically, it feels right to us. We want to believe that the central facts of our lives -- whether or not we have children, where we are educated, what career we follow, with 1 whom we join as partners -- contain in them some fundamental element of our own selection and decision. We will be exploring below exactly what will turn out to be important here, and why, but for now, in our pre-reflective grasp of this phenomenon, we can say that it seems to have something to do with the value we place on autonomy, self-governance, self-authorship. We want, metaphorically speaking, to write the story of our own lives. But let me now begin to draw out why I find this insistence on the importance of choice, which so many of us would share, to be so puzzling. Both individuals, in both stories, want to be offered a certain additional option in order to have -- or at least to feel that they have? -- a choice about what they are going to do next. But, on the one hand, we could argue that, even with this added option, they still don't have a "real" choice -- they don't have the choice of doing what they most want to do; and on the other hand, one could argue that even without the added option, they always had some choice. Let me explain. In the first story, my friend certainly doesn't have open to her the option that would have been her first choice (and, in our society, what we might call the standard choice, the most frequently chosen option): to produce a biological child with her partner in a happy marriage.. (shrink)

An epistemic account of the circumstances of justice allows one to make three important claims about the Humean and Rawlsian ‘standard account’ of those circumstances. First, and contrary to Hume,...

A central feature of experimental development economics is the use of randomized controlled trials (RCTs) to evaluate the effectiveness of prospective socioeconomic interventions. The use of RCTs in development economics raises a host of ethical issues which are just beginning to be explored. In this article, I address one ethical issue in particular: the routine use of the status quo as a control when designing and conducting a development RCT. Drawing on the literature on the principle of standard care (...) in medical research ethics, as well as considerations of distributive justice in non-ideal circumstances, I argue that the practice of using the status quo as a control is ethically justifiable. However, I add an important qualification based on the natural duty of rescue to address the concern that my account is overly permissive. (shrink)

Among the alternatives of non-relativistic quantum mechanics (NRQM) there are those that give different predictions than quantum mechanics in yet-untested circumstances, while remaining compatible with current empirical findings. In order to test these predictions, one must isolate one’s system from environmental induced decoherence, which, on the standard view of NRQM, is the dynamical mechanism that is responsible for the ‘apparent’ collapse in open quantum systems. But while recent advances in condensed-matter physics may lead in the near future to (...) experimental setups that will allow one to test the two hypotheses, namely genuine collapse vs. decoherence, hence make progress toward a solution to the quantum measurement problem, those philosophers and physicists who are advocating an information-theoretic approach to the foundations of quantum mechanics are still unwilling to acknowledge the empirical character of the issue at stake. Here I argue that in doing so they are displaying an unwarranted double standard. r 2007 Elsevier Ltd. All rights reserved. (shrink)

SUMMARYCharles Howard Ellis, born in Sydney in 1895 and a Great War veteran, was working as a journalist in Vienna and Geneva when he wrote one of the most comprehensive books of the time on the League: The Origin, Structure and Working of the League of Nations. Dedicated to the progressive literary figures of the era and showing a particular debt to the writings of the British Labour left, Ellis argued that the internationalism of the age marked a necessary rejection (...) of the anarchic conditions that brought forth the Great War. The League and its associated institutions constituted ‘the first step toward a world society’ that would facilitate the suppression and ultimate removal of the causes of conflict. A remarkable work in itself, this progressive volume was written by a member of British intelligence who had already made a reputation in this sphere and was to go on to hold very senior positions in the 1940s. The question is considered whether the ideas expressed were a product of Ellis's genuine beliefs, or whether they were a mask for his substantive professional role. The circumstances around the writing of this book are also reviewed in an attempt to answer this question, especially given the hitherto accepted scholarly view that Konni Zilliacus of the League Secretariat was the actual author. (shrink)

The recent exchange between Robert Brandom and Jürgen Habermas provides an opportunity to compare and contrast some aspects of their systems. Both present broadly inferential accounts of meaning, according to which the content of an expression is determined by its role in an inferential network. Several problems confront such theories of meaning - one of which threatens the possibility of communication because content is relative to an individual's set of beliefs. Brandom acknowledges this problem and provides a solution to it. (...) The point of this paper is to argue that it arises for Habermas's theory as well. I then present several solutions Habermas could adopt and evaluate their feasibility. The result is that Habermas must alter his theory of communicative action by contextualizing the standards for successful communication. (shrink)

Professions have adopted ethical codes and codes of conduct. Physicians, lawyers, engineers, and other professionals have moral responsibilities. They know to whom they are responsible. Professionals in the data processing field, too, need to know that they have moral responsibilities and to whom they are responsible. This paper compares and evaluates the ethical codes of four major organizations of computer professionals in America. The analysis is done along the following obligations that every professional has: to society, to the employer, to (...) clients, to colleagues, to the professional organization, and to the profession.Professionals in the information technology field have no single, agreed upon code of conduct. In the US alone there are four organizations promoting four different codes. While some of the behavioral precepts are similar, others are not. People who are members of more than one organization may wonder how they should act in certain circumstances. Furthermore, computer professionals are not provided with any guidance for cases of ethical conflicts. (shrink)

The standard of proof applied in civil trials is the preponderance of evidence, often said to be met when a proposition is shown to be more than 50% likely to be true. A number of theorists have argued that this 50%+ standard is too weak – there are circumstances in which a court should find that the defendant is not liable, even though the evidence presented makes it more than 50% likely that the plaintiff’s claim is true. (...) In this paper, I will recapitulate the familiar arguments for this thesis, before defending a more radical one: The 50%+ standard is also too strong – there are circumstances in which a court should find that a defendant is liable, even though the evidence presented makes it less than 50% likely that the plaintiff’s claim is true. I will argue that the latter thesis follows naturally from the former once we accept that the parties in a civil trial are to be treated equally. I will conclude by sketching an alternative interpretation of the civil standard of proof. (shrink)

This paper proposes a novel method for identifying the public evaluative standards that contribute to the classification of certain conditions as mental disabilities. Public evaluative standards could contribute to ascertaining disabilities by outlining characteristics whose presence beyond a threshold is fundamentally important for the life of a person and whose absence or reduced occurrence constitutes a disability. Additionally, they can participate in determining disabilities by delineating particularly grave difficulties, impairments, or incapacities. Our method relies on a model of public justification (...) of evaluative standards that is inspired by Gerald Gaus’s theory of public reason. Thus, our approach recommends the justification of evaluative standards through sound deliberative routes from reasons accessible to all persons who participate in the process of justification and the convergence of what is justified in this way to each of them. We deem that disabilities could be caused both by problems in the internal characteristics of a person as well as by unfairness or a lack of hospitality in external circumstances. This is why the method of justification is applied to the assessment of those circumstances as well. If social or environmental circumstances cannot be justified through the convergence of reasons accessible to all persons involved in the process of justification, we have reasons to exclude the presence of a disability and ascertain the presence of inadequate external conditions. (shrink)

In the United Kingdom, the question of how much information is required to be given to patients about the benefits and risks of proposed treatment remains extant. Issues about whether healthcare resources can accommodate extended shared decision-making processes are yet to be resolved. COVID-19 has now stepped into this arena of uncertainty, adding more complexity. U.K. public health responses to the pandemic raise important questions about professional standards regarding how the obtaining and recording of consent might change or be maintained (...) in such emergency conditions, particularly in settings where equipment, medicines, and appropriately trained or specialized staff are in short supply. Such conditions have important implications for the professional capacity and knowledge available to discuss the risks and benefits of and alternatives to proposed treatment with patients. The government’s drive to expedite the recruitment to wards of medical students nearing the end of their studies, as well as inviting retired practitioners back into practice, raises questions about the ability of such healthcare providers to engage fully in shared decision-making.This article explores whether the legal duty on healthcare practitioners to disclose the material risks of a proposed medical treatment to a patient should be upheld during pandemic conditions or whether the pre-eminence of patient autonomy should be partly sacrificed in such exceptional circumstances. We argue that measures to protect public health and to respect autonomous decision-making are not mutually exclusive and that there are good reasons to maintain professional standards in obtaining consent to treatment even during acute pressures on public health systems. (shrink)

‘It is necessary to a Prince to learn how not to be good’. This quotation from Machiavelli’s The Prince has become the mantra of the standard dirty hands thesis. Despite its infamy, it features proudly in most conventional expositions of the dirty hands problem, including Michael Walzer’s original analysis. In this paper, I wish to cast a doubt as to whether the standard conception of the problem of DH—the recognition that, in certain inescapable and tragic circumstances an (...) innocent course of action is unfeasible—fully captures Machiavelli’s message and its terrifying implications. In particular, I argue that the standard DH thesis is inadequately ‘static’: it conceives the conflict between ordinary morality and political morality as a stark, momentary and rare paradox of action—an anomaly disrupting the normality of harmony. As such it misconceives both the extent and the nature of the rupture between morality and politics. In this sense, the argument I shall advance does just involve an exercise in the history of political thought. Rather, I want to suggest that, by virtue of its failure to take Machiavelli’s insights seriously, the standard DH thesis fails to live up to its purported capacity to capture the complexity and fragmentation of our moral cosmos and that, consequently, it is nothing more than a thinly veiled version of the idealism and monism it purports to reject. (shrink)

Recently, there have been a number of government proposals and reforms seeking to ensure that standard setting in risk regulation is carried out in a more accountable and transparent manner. These proposals were a direct and indirect response to distrust in government both in relation to risk regulation and across government more widely. The problem, however, is that few of these proposals and reforms have been grounded in an understanding of the nature of standard setting in risk regulation. (...) Such standard setting has three significant features. It is directly concerned with normative issues about risk acceptability, is carried out in circumstances of scientific uncertainty, and requires some form of expert judgment. Rather, these proposals were based on a presumption that standard setting is primarily an analytical process which is verifiable and objective. There are a number of likely consequences of the disjunction between the nature of standard setting and these developments which include problems of ossification, the submersion of normative debate, and a fundamental shift in the nature of public administration. These problems provide an excellent example of the dangers of implementing accountability mechanisms without regard to the complexities of the decision-making context. (shrink)

The current outbreak of Ebola virus infection in West Africa continues to spread. Several patients have now been treated in the United States and preparations are being made for more. Because of the strict isolation required for their care, questions have been raised about what diagnostic and therapeutic interventions should be available. I discuss the ethical challenges associated with caring for patients in strict isolation and personnel wearing bulky protective gear with reduced dexterity and flexibility, the limitations this may place (...) on available treatments and the permissibility of consequent departures from the standards of care. Restricting access to some interventions such as surgery requiring an operating room, advanced imaging, etc. is reasonable due to concern for protecting other patients, visitors and staff. Cardiopulmonary resuscitation is a special case and the implications for withholding this intervention in situations where it may be desired is discussed, especially with respect to those patients who have suspected, but not proven, infection. These same restrictions are also considered under conditions where there are scarce resources and thus limited numbers of patients may receive care. While it is to be hoped that there is only limited and sporadic infection with Ebola virus in the US, careful thought must be given to the care of these patients under the unusual circumstances demanded by their isolation. I argue that an altered standard of care is reasonable and ethically acceptable under certain conditions. (shrink)

Animals are an important part of our social, economic and corporate world. Their wellbeing is significantly affected by the ways in which humans treat them. However, animals have long remained (and, indeed, continue to remain) effectively invisible in the business ethics and corporate responsibility discourse. This article argues in favor of the moral necessity of according animal welfare a higher priority in business. In line with most streams in both recent and traditional animal ethics, this article derives the avoidance of (...) unnecessary animal suffering as the moral minimum standard for responsible management in the livestock industry. Based on a broad range of different interpretations of what animal suffering may be necessary, the article discusses three distinct ways in which humans working in the animal industry could meet their moral responsibility to avoid unnecessary suffering, and, with this, increase animal welfare: by ameliorating circumstances for animals, by aiming at a two-pronged transformation, or by transforming into a “zero-suffering” business. Considering animal welfare as a legitimate ethical value in and of itself is a first step towards overcoming the anthropocentric bias in today's sustainability and corporate responsibility debate. (shrink)

In this paper we reflect on the challenges of maintaining traditional ethical standards in social health research with asylum seeker detainees. Researchers in this context who begin from a clear advocacy position can face various dilemmas in the research process. The need to demonstrate particular research outcomes that support an advocacy position has the potential to compromise the veracity of the research endeavour. We review the potential benefits and risks to researchers and asylum seekers in this area, and argue that (...) such research must be faithful to the realities encountered, so that rigour is not compromised by the interests of advocacy and a researcher’s own moral imperatives. (shrink)

Over the last decade, cities, counties, and states across the United States have enacted higher minimum wages, paid sick leave and family leave, domestic worker protections, wage theft laws, “Ban the Box” removal of questions about conviction history from job applications, and fair scheduling laws. Nevertheless, vulnerable workers still do not trust government to come forward and report labor law violations. The article argues that while increasing the size of the labor inspectorate and engaging in strategic enforcement are necessary, they (...) are not sufficient. It argues that co-enforcement, in which government partners with organizations that have industry expertise and relationships with vulnerable workers, has the potential to manage the shifting and decentralized structures of twenty-first-century production, which were explicitly designed to evade twentieth-century laws and enforcement capabilities. The article aims to contribute to a broader understanding of the role of organizations in enforcement and the circumstances in which their effectiveness can be maximized. It sets forth a set of scope conditions and mechanisms and examines empirical cases of co-enforcement in Austin, Los Angeles, and San Francisco. The main findings are that co-enforcement is most enduring when government agencies and worker organizations recognize each other’s unique capacities, rather than attempt to substitute for one another ; the effort focuses on a specific industry; and the collaboration receives strong political support. Sustaining the impacts of co-enforcement is found to require greater formalization of the partnership and funding streams. (shrink)

If it is so obvious that international participants should share in the spoils of research profits, why isn’t it equally obvious that participants who share nationality with the researchers should do so as well? I argue that if one believes that some form of benefit-sharing is morally obligatory in research conducted in developing countries, it is very hard to escape the conclusion that it should at least in some circumstances be thought equally obligatory in research conducted within the borders (...) of developed countries. I show that untenable assumptions about solidarity and altruism within developed countries are relied upon to deny fair treatment to research participants in developed countries — treatment that would be considered exploitative if meted out to citizens in developing countries. (shrink)

Studies in several developing countries for treatmen to prevent HIV-transmission from mother to child generated considerable controversy in 1997. Critics of the studies argued that basic principles of research ethics were violated. According to the critics, researchers subjected women in developing countries to studies that would have been unethical in the United States and that the researchers were therefore engaged in unethical exploitation ofcitizens of the developing countries in which the studies were conducted.While the critics agreed that unethical exploitation had (...) occurred, they differed on the exact nature of the exploitation. Some observers condemned the researchers for employing a double standard — because the researchers were applying a standard of care that would have been unacceptable in their own country. In the view of these critics, researchers should have been comparing the experimental treatment to established therapy rather than to placebo, as would have been required in the United States or other developed countries. (shrink)

Studies in several developing countries for treatmen to prevent HIV-transmission from mother to child generated considerable controversy in 1997. Critics of the studies argued that basic principles of research ethics were violated. According to the critics, researchers subjected women in developing countries to studies that would have been unethical in the United States and that the researchers were therefore engaged in unethical exploitation ofcitizens of the developing countries in which the studies were conducted.While the critics agreed that unethical exploitation had (...) occurred, they differed on the exact nature of the exploitation. Some observers condemned the researchers for employing a double standard — because the researchers were applying a standard of care that would have been unacceptable in their own country. In the view of these critics, researchers should have been comparing the experimental treatment to established therapy rather than to placebo, as would have been required in the United States or other developed countries. (shrink)

Families and clinicians approaching a child’s death in the paediatric intensive care unit (PICU) frequently encounter questions surrounding medical decision-making at the end of life (EOL), including defining what is in the child’s best interest, finding an optimal balance of benefit over harm, and sometimes addressing potential futility and moral distress. The best interest standard (BIS) is often marshalled by clinicians to help navigate these dilemmas and focuses on a clinician’s primary ethical duty to the paediatric patient. This approach (...) does not consider a clinician’s potential duty to the patient’s family. This paper argues that when a child is dying in the PICU, the physician has a duty to serve both the patient and the family, and that in some circumstances, the duty to serve the family becomes as important as that owed to the child. We detail the limitations of the BIS in paediatric EOL care and propose the relational potential standard as an additional ethical framework to guide our decisions. (shrink)

BackgroundAdvance research directives (ARD) have been suggested as a means by which to facilitate research with incapacitated subjects, in particular in the context of dementia research. However, established disclosure requirements for study participation raise an ethical problem for the application of ARDs: While regular consent procedures call for detailed information on a specific study (“token disclosure”), ARDs can typically only include generic information (“type disclosure”). The introduction of ARDs could thus establish a double standard in the sense that within (...) the context of ARDs, type disclosure would be considered sufficient, while beyond this context, token disclosure would remain necessary.Main bodyThis paper provides an ethical analysis of ARDs, taking into account the results of numerous empirical studies that have been performed so far. It will be argued that a revised understanding of informed consent can allow for context-sensitive disclosure standards. As a consequence, ARDs that include type disclosure can be acceptable under suitable circumstances. Such an approach raises a number of objections. A thorough examination shows, however, that they are not sufficient to justify a rejection of the approach.ConclusionThe approach presented in this paper avoids introducing a double standard. It is, therefore, more suitable for the implementation of ARDs than established approaches. (shrink)

The treatment of the control group in externally sponsored clinical trials is the issue of one of the most heated debates in international research ethics. The paradigmatic cases are the mother-to-child HIV-transmission trials that took place in 16 developing countries in 1997, where the control group received a placebo while proven treatment was available in industrialized countries. From this circumstance results the controversy as to whether the sponsor and researchers of externally sponsored trials have to supply a treatment that is (...) usually not available in the host country. From the beginning of the debate the controversial level of treatment has been called “standard of care”. However, besides the disagreement about the quality of the care that has to be supplied, there is as yet no widely accepted clear meaning of this concept. This article examines the fundamental ambiguity of the term and its formal function as an ethical criterion including suggestions on its further use. (shrink)

While an accurate assessment of risk is always important, it is especially so in pediatric research. Recognizing the pivotal nature of the minimal-risk standard, we set out to determine under what circumstances pediatric magnetic resonance imaging research does or does not meet this standard. We found that while the physical and psychological risks that attend the MRI procedure do not exceed minimal risk, the sedation and contrast enhancement that are sometimes associated with MRI research do, as both (...) exceed the level of risk encountered by typical, healthy children in their everyday experiences. (shrink)

Contemporary caution of anachronism in intellectual history on the one hand, and currently momentous theoretical emphasis on subjectivity on the other, are two prevailing circumstances that set puzzling constraints for studies in the history of philosophical psychology. Together these circumstances call for heightened awareness of our own interpretive presuppositions as historians: the former urges against assuming ideas, motives, and concepts that may be alien in the historical intellectual setting under study and the latter suggests caution in relying on (...) our intuitions regarding subjectivity due to the specific and historicallycontingent characterisations subjectivity has attained in the contemporary philosophy of mind. In face of these enticements our paper explores subjectivity as a non-textual standard of interpretation. Taking into account recent methodological discussion and examples of denials of the relevance of subjectivity for historical theories, we argue that historical work should be conceived as a reflective investigation into what is and what is not genuinely historical. In particular, we show how subjectivity can function as a pre-conceptualized feature of the world that has an effect on our concept formation. (shrink)

Contemporary caution of anachronism in intellectual history on the one hand, and currently momentous theoretical emphasis on subjectivity on the other, are two prevailing circumstances that set puzzling constraints for studies in the history of philosophical psychology. Together these circumstances call for heightened awareness of our own interpretive presuppositions as historians: the former urges against assuming ideas, motives, and concepts that may be alien in the historical intellectual setting under study and the latter suggests caution in relying on (...) our intuitions regarding subjectivity due to the specific and historicallycontingent characterisations subjectivity has attained in the contemporary philosophy of mind. In face of these enticements our paper explores subjectivity as a non-textual standard of interpretation. Taking into account recent methodological discussion and examples of denials of the relevance of subjectivity for historical theories, we argue that historical work should be conceived as a reflective investigation into what is and what is not genuinely historical. In particular, we show how subjectivity can function as a pre-conceptualized feature of the world that has an effect on our concept formation. (shrink)

Objectives: To test the range of beliefs regarding the ethics of testing, in resource poor settings, new therapies that are less efficacious but more affordable and feasible than the best current therapeutic standard. Design: Using a web-based survey, we presented a hypothetical scenario proposing to test a therapy for HIV disease ("therapeutic inoculation") known to be less efficacious than highly active antiretroviral therapy (HAART). Respondents evaluated various trial designs as ethical or unethical. Participants: 604 subscribers to two listservs for (...) individuals interested in international health research ethics. Main outcome measures: Proportion of respondents endorsing trials testing this "substandard" therapy, and proportion endorsing placebo-controlled trials. Results: There were 215 respondents from 47 countries. Forty-five percent of respondents were from low or middle income countries; 96% devoted at least some time to research activities; and 75% had "some" or "considerable" research experience in developing countries. Of respondents, 97% (95% CI 94.7 to 99.4) endorsed testing therapeutic inoculation, without HAART, in patients with HIV disease; 86% (95% CI 81.4% to 90.7%) endorsed testing against placebo. Sixty-eight percent explicitly endorsed principles where the standard of care for subjects in clinical trials is determined by local, not universal, standards. There were no differences in responses based on respondent education-level or the income-level of their country of citizenship. Conclusion: There was broad agreement that a therapy of potential local benefit may be tested, even when that therapy is known to be inferior to the standard of care in wealthy countries. Most agreed that a placebo control may be used in some circumstances. (shrink)

Most decisions in life involve ambiguity, where probabilities can not be meaningfully specified, as much as they involve probabilistic uncertainty. In such conditions, the aspiration to utility maximization may be self-deceptive. We propose “robust satisficing” as an alternative to utility maximizing as the normative standard for rational decision making in such circumstances. Instead of seeking to maximize the expected value, or utility, of a decision outcome, robust satisficing aims to maximize the robustness to uncertainty of a satisfactory outcome. (...) That is, robust satisficing asks, “what is a ‘good enough’ outcome,” and then seeks the option that will produce such an outcome under the widest set of circumstances. We explore the conditions under which robust satisficing is a more appropriate norm for decision making than utility maximizing. (shrink)

Decision making for incompetent patients is a much-discussed topic in bioethics. According to one influential decision making standard, the substituted judgment standard, the decision that ought to be made for the incompetent patient is the decision the patient would have made, had he or she been competent. Although the merits of this standard have been extensively debated, some important issues have not been sufficiently explored. One fundamental problem is that the substituted judgment standard, as commonly formulated, (...) is indeterminate in content and thus offers the surrogate little or no guidance. What the standard does not specify is just how competent one should imagine the patient to be, and what else one ought to envision about the patient’s hypothetical outlook and the circumstances surrounding his or her decision making. The article discusses this problem of underdetermined decision conditions. (shrink)

The article argues that Rawls’s property-owning democracy should not be understood as a necessary standard of democratic legitimacy. This position contradicts Rawls’s own understanding to some extent, but a rejoinder with elements of political liberalism is possible. He concedes that justice as fairness is a ‘comprehensive liberal doctrine’ and that a well ordered society affirming such a doctrine ‘contradicts reasonable pluralism’. Rawls makes clear that reasonable pluralism in combination with the burdens of judgment lead to rare unanimity in political (...) life and to the necessity of majority and plurality voting procedures. (shrink)

Cohen, Hardin, and McLaughlin (2006) complain that my solution to the puzzle of true blue (Tye 2006) depends upon my assuming that 'all variation in colour experience among standard perceivers in standard circumstances is at the level of fine-grained hues (4)'. That assumption, they say, is false: 'there is in fact variation in colour experience among.

The development of mankind and its concrete manifestations in technical, economic or other spheres is always determined by contradictions, uncertainty and the emergence of non-standard circumstances. At the beginning of the third millennium the world is characterized by acceleration of economic dynamics and complication of the mega environment, which requires mastering the realities of the present and the future. Exactly this problem that necessitates the definition of the Concept and priorities of the direction of socio-economic policy in Ukraine (...) and conducting further research in the field of developing the application framework for their implementation. Definition and development of the paradigm of socio-economic development of Ukraine in the XXI century will create an opportunity to reveal socio-economic and human potential. (shrink)

Our growing understanding of human mind and cognition and the development of neurotechnology has triggered debate around cognitive enhancement in neuroethics. The dissertation examines the normative issues of memory enhancement, and focuses on two issues: the distinction between memory treatment and enhancement; and how the issue of authenticity concerns memory interventions, including memory treatments and enhancements. rnThe first part consists of a conceptual analysis of the concepts required for normative considerations. First, the representational nature and the function of memory are (...) discussed. Memory is regarded as a special form of self-representation resulting from a constructive processes. Next, the concepts of selfhood, personhood, and identity are examined and a conceptual tool—the autobiographical self-model —is introduced. An ASM is a collection of mental representations of the system’s relations with its past and potential future states. Third, the debate between objectivist and constructivist views of health are considered. I argue for a phenomenological account of health, which is based on the primacy of illness and negative utilitarianism.rnThe second part presents a synthesis of the relevant normative issues based on the conceptual tools developed. I argue that memory enhancement can be distinguished from memory treatment using a demarcation regarding the existence of memory-related suffering. That is, memory enhancements are, under standard circumstances and without any unwilling suffering or potential suffering resulting from the alteration of memory functions, interventions that aim to manipulate memory function based on the self-interests of the individual. I then consider the issue of authenticity, namely whether memory intervention or enhancement endangers “one’s true self”. By analyzing two conceptions of authenticity—authenticity as self-discovery and authenticity as self-creation, I propose that authenticity should be understood in terms of the satisfaction of the functional constraints of an ASM—synchronic coherence, diachronic coherence, and global veridicality. This framework provides clearer criteria for considering the relevant concerns and allows us to examine the moral values of authenticity. rn. (shrink)

Which standards should we employ to evaluate the global order? Should they be standards of justice or standards of legitimacy? In this article, I argue that liberal political theorists need not face this dilemma, because liberal justice and legitimacy are not distinct values. Rather, they indicate what the same value, i.e. equal respect for persons, demands of institutions under different sets of circumstances. I suggest that under real-world circumstances – characterized by conflicts and disagreements – equal respect demands (...) basic-rights protection and democratic participation, which I here call ‘political justice’. I conclude the article by considering three possible configurations of the global order – the ‘democratic world-state’, ‘independent democratic states’, and ‘mixed’ models – and argue that a commitment to political justice speaks in favour of the latter. (shrink)

The standard paradigm for mental causation is a person’s acting for a reason. Something happens - she intentionally φ’s - the occurrence of which we explain by citing a relevant belief or desire. In the present context, I simply take for granted the following two conditions on the appropriateness of this explanation. First, the agent φ’s _because_ she believes/desires what we say she does, where this is expressive of a _causal_ dependence.1 Second, her believing/desiring this gives her a _reason_ (...) for φ-ing: recognizing that she has this belief/desire makes her φ-ing intelligible as rational in the light of her other attitudes and circumstances. A further condition must be met, though, if this is to be a genuine psychological explanation, a case of her acting _for_ the reason in question. Consider the following example of Davidson’s (1973, p. 79). An exhausted climber is desperate to rid herself of the weight and danger of holding her partner on a rope; and her sudden realization that simply letting go would achieve this so unnerves her that her grip loosens slightly and he falls. Her releasing him causally depends upon her having this belief and desire, which provide _a_ reason for doing what she does. But this is not _why_ she does it: it would be at best misleading to say that she dropped him, intentionally, because she was fed up with holding his weight, or because she thought that she might otherwise fall. Her letting go does not depend upon her having these reasons in the right way. The reason-giving relation is causally irrelevant. If we are to explain a person’s acting _for_ a reason, then her doing. (shrink)

Standard interpretations of Kant’s moral philosophy portray him as affording agents very little, if any, latitude to exercise practical judgment for determining the proper course of action. It is typically thought that Kant holds that because all moral duties are determinable a priori and in advance of particular circumstances this leaves little to no room for agents to exercise practical judgment. In this paper I discuss two senses in which Kant does allow for the practical judgment of agents. (...) The first is an interpretation of Kant’s view of practical judgment developed by Onora O’Neill and others. The second is an underappreciated dimension of practical judgment contained in Kant’s texts. It is to a defense and examination of the importance of the second sense of practical judgment that the majority of this paper is dedicated. (shrink)