Visual cortical prostheses (VCPs) have the potential to provide artificial vision for visually impaired persons. However, the nature and utility of this form of vision is not yet fully understood. Participants in the early feasibility trial for the Orion VCP were interviewed to gain insight into their experiences using artificial vision, their motivations for participation, as well as their expectations and assessments of risks and benefits. Analyzed using principles of grounded theory and an interpretive description approach, these interviews yielded six (...) themes, including: the irreducibility of benefit to device functionality, mixed expectations for short-term device functionality and long-term technological advancement of visual prostheses, and a broad range of risks, concerns, and fears related to trial participation. We argue that these narratives motivate a nuanced set of ethical considerations related to the complex relationship between functionality and benefit, the intersection of user experience with disability justice, and the import of expectations and indirect risks on consent. (shrink)

Some suggest that gene editing human embryos to prevent genetic disorders will be in one respect morally preferable to using genetic selection for the same purpose: gene editing will benefit particular future persons, while genetic selection would merely replace them. We first construct the most plausible defence of this suggestion—the benefit argument—and defend it against a possible objection. We then advance another objection: the benefit argument succeeds only when restricted to cases in which the gene-edited child would (...) have been brought into existence even if gene editing had not been employed. Our argument relies on a standard account of comparative benefit which has recently been criticised on the grounds that it succumbs to the so-called ‘pre-emption problem’. We end by considering how our argument would be affected were the standard account revised in an attempt to evade this problem. We consider three revised accounts and argue that, on all three, our critique of the benefit argument stands. (shrink)

This paper critically analyses ‘the paradox of autonomy and consent in maternity care’. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in consent‐centred procedures, as well as in (...) unconsented interventions, in ordinary, non‐medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non‐therapeutic research and transplantation medicine—both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time—and this delivers the titular paradox—the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care. (shrink)

In this paper, I consider the problem of omission for the counterfactual comparative account of harm. A given event harms a person, on this account, when it makes her worse off than she would have been if it had not occurred. The problem arises because cases in which one person merely fails to benefit another intuitively seem harmless. The account, however, seems to imply that when one person fails to benefit another, the first thereby harms the second, since (...) the second person would have been better off if the first had benefited her. I argue that the cases of failing to benefit at issue are in fact cases of harming. They are cases of preventive harm. I also argue that we can explain away the intuition that no harm occurs in these cases, and that the relevant implication of the counterfactual comparative account is consistent with a variety of plausible views about the moral significance of harm. (shrink)

Institutional review boards and investigators are used to talking about risks of harm. Both low risks of great harm and high risks of small harm must be disclosed to prospective subjects and should be explained and categorized in ways that help potential subjects to understand and weigh them appropriately. Everyone on an IRB has probably spent time at meetings arguing over whether a three-page bulleted list of risk description is helpful or overkill for prospective subjects. Yet only a small fraction (...) of all the time and attention lavished on risk disclosure has been devoted to discussing whether and when potential benefit to subjects can reasonably be claimed and, if so, how it should be described in the consent form and process.Traditionally, IRBs and regulators have worked to ensure that clear lines can be drawn between research that, by definition, carries no potential for direct benefit — because it uses healthy volunteers or because it is not foreseeably focused on the development of treatments — and research that does have the development of effective treatments as its goal. (shrink)

One of the key ethical requirements for biomedical research is that it have an acceptable risk-benefit profile (Emanuel, Wendler, and Grady 2000). The International Conference of Harmonization guidelines mandate that clinical trials should be initiated and continued only if “the anticipated benefits justify the risks” (1996). Guidelines from the Council for International Organizations of Medical Sciences state that biomedical research is acceptable only if the “potential benefits and risks are reasonably balanced” (2002). U.S. federal regulations require that the “risks (...) to subjects” be “reasonable in relation to anticipated benefits, if any, to subjects and the importance of the knowledge” to be gained from the .. (shrink)

Green nudges (GNs) are increasingly popular behavioral interventions aimed at mitigating environmentally mediated harm, particularly in the context of climate change. The justification of GNs traditionally relies on cost-benefit analysis (CBA), which quantifies the total costs and benefits, factoring in probabilities to maximize expected utility. However, the application of CBA faces significant challenges when GNs involve potential catastrophic outcomes associated with climate change and climate nudging. We argue that the qualitative distinction between catastrophic and non-catastrophic outcomes poses a challenge (...) for traditional CBA. While CBA is adept at assessing ordinary costs and benefits, it struggles to accommodate the putative catastrophic outcomes linked to climate change and climate nudging. To address this challenge, this article considers the lexical precautionary principle (LPP) as a viable decision-making framework for climate nudging. Unlike CBA's decision rule, maximize expected utility, LPP maximizes lexical utility, thereby prioritizing the avoidance of catastrophic outcomes. (shrink)

ABSTRACT Suppose that, for every possible event and person who would exist whether or not the event were to occur, there is a well-being level that the person would occupy if the event were to occur, and a well-being level that the person would occupy if the event were not to occur. Do facts about such connections between events and well-being levels always suffice to determine whether an event would harm or benefit a person? Many seemingly attractive accounts of (...) harm and benefit entail an affirmative answer to this question, including the widely held Counterfactual Comparative Account (CCA). In this paper, however, we argue that all such accounts will be unsuccessful. (shrink)

Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient’s wellbeing, to promote the patient’s interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient’s goals and wishes, or (...) is it a matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: (1) objective functioning/health and (2) the patient’s view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. (shrink)

This paper proposes a concept of intentional cooperation for mutual benefit. This concept uses a form of team reasoning in which team members aim to achieve common interests, rather than maximising a common utility function, and in which team reasoners can coordinate their behaviour by following pre-existing practices. I argue that a market transaction can express intentions for mutually beneficial cooperation even if, extensionally, participation in the transaction promotes each party’s self-interest.

Indigenous Peoples, Consent and Benefit Sharing is the first in-depth account of the Hoodia bioprospecting case and use of San traditional knowledge, placing it in the global context of indigenous peoples’ rights, consent and benefit-sharing. It is unique as the first interdisciplinary analysis of consent and benefit sharing in which philosophers apply their minds to questions of justice in the Convention on Biological Diversity (CBD), lawyers interrogate the use of intellectual property rights to protect traditional knowledge, environmental (...) scientists analyse implications for national policies, anthropologists grapple with the commodification of knowledge and, uniquely, case experts from Asia, Australia and North America bring their collective expertise and experiences to bear on the San-Hoodia case. -/- While much of the focus is on bioprospecting and natural product development, Indigenous Peoples, Consent and Benefit-Sharing also draws important lessons about informed consent and benefit-sharing from the health sciences and sectors such as mining. Policymakers around the world are under significant pressure to resolve the challenges of implementing the CBD. This book’s analysis and recommendations will help them. -/- ‘It is good to see philosophers engaging with the UN Convention on Biological Diversity, and doing so by looking in depth at a real situation in which it has been invoked.’ Peter Singer, Ira W. DeCamp Professor of Bioethics in the University Center for Human Values, Princeton University . (shrink)

Morality seems to require us to attend to the good of others, but does not require that we assign any importance to our own good. Standard forms of consequentialism thus appear vulnerable to the compulsory self-benefit objection: they require agents to benefit themselves when doing so is entailed by the requirement of maximizing overall impersonal good. Attempts to address this objection by appealing to ideally motivated consequentialist agents; by rejecting maximization; by leveraging consequentialist responses to the more familiar (...) special relationships and demandingness objections; or by appealing to dual rankings of moral and all-things-considered reasons fall short of adequately answering this objection. A satisfactory response to the compulsory self-benefit objection is elusive because of consequentialism struggles to account for directed options (in this case, an option not to maximize one’s own good but not that of others) and for moral considerations that do not rest on the value of outcomes or states of affairs. (shrink)

Faced with evidence that what a person said is false, we can nevertheless trust them and so believe what they say – choosing to give them the benefit of the doubt. This is particularly notable when the person is a friend, or someone we are close to. Towards such persons, we demonstrate a remarkable epistemic partiality. We can trust, and so believe, our friends even when the balance of the evidence suggests that what they tell us is false. And (...) insofar as belief is possible, it is also possible to acquire testimonial knowledge on those occasions when the friends know what they tell us. This paper seeks to explain these psychological and epistemological possibilities. (shrink)

Research on the behavioral theory of the firm has established that the profitability goal triggers various firm actions, but it has yet to thoroughly explore which other goals may gain prominence in directing firm resources if the profitability goal has been achieved. We identify shareholder satisfaction and societal benefit as two additional organizational goals and predict that when firms have achieved their profitability aspirations, the financial resources allocated to pursue these goals depend on the dominance of coalitions supporting or (...) opposing them. Drawing on the coalition theory within the behavioral theory of the firm, we theorize that the prioritization and pursuit of a goal depend on the relative power of its supporting coalition within a firm’s governance body, including top decision-makers like CEOs and board members. By examining 2071 Chinese listed firms, we find that the relative strength of the shareholder-value coalition (supporting shareholder satisfaction) and the state-endorsement coalition (supporting societal benefit) affects firms’ resource allocation toward dividend payments and corporate philanthropy in distinct ways. (shrink)

What next? We are forever making decisions. Typically, when unsure, we try to identify, then compare, our options. We weigh pros and cons. Occasionally, we make the weighing explicit, listing pros and cons and assigning numerical weights. What could be wrong with that? In fact, things sometimes go terribly wrong. This paper considers what cost-benefit analysis can do, and also what it cannot.

In recent literature, several authors attempt to naturalize epistemic normativity by employing an etiological account of functions. The thought is that epistemic entitlement consists in the normal functioning of our belief-acquisition systems, where the latter acquire the function to reliably deliver true beliefs through a history of biological benefit.

Must medical experiments with human subjects offer them a ‘favourable risk-benefit ratio’, that is, more expectation of benefit than harm or burden, if they are to be judged as ethically justified? Ethical justification is easier for experiments that do offer net benefit to subjects, but ethical justification is possible also for some experiments that do not. Basic science experiments with healthy volunteers and ‘Phase I’ drug trials that seek to determine tolerable dosage levels are routinely approved by (...) ethical review committees; moreover, guidance they receive from government funding agencies specifically asks them to weigh risks to subjects against benefits to subjects and also benefits to those who may benefit from the knowledge gained in the experiment. If a puzzle remains, it is why there remains any assumption that research ethics requires a ‘favourable risk-benefit ratio’ for the individual research subject. (shrink)

According to evidentialist views, credence in a proposition p should be proportional to the degree of evidential support that one has in favor of p. However, empirical evidence suggests that our credences are systematically sensitive to practical factors. In this article, I provide a cost–benefit analysis of credences' practical sensitivity. The upshot of this analysis is that credences sensitive to practical factors fare better than practically insensitive ones along several dimensions. All things considered, our credences should be sensitive to (...) practical factors. (shrink)

The counterfactual comparative account of harm and benefit has several virtues, but it also faces serious problems. I argue that CCA is incompatible with the prudential and moral relevance of harm and benefit. Some possible ways to revise or restrict CCA, in order to avoid this conclusion, are discussed and found wanting. Finally, I try to show that appealing to the context-sensitivity of counterfactuals, or to the alleged contrastive nature of harm and benefit, does not provide a (...) solution. (shrink)

Volume 20, Issue 10, October 2020, Page 47-49.

Social enterprises may take a variety of legal forms (limited liability companies, nonprofit entities, etc.). This paper focuses primarily upon one particular new form increasingly popular within the United States—the “Benefit Corporation.” I evaluate whether US Benefit Corporations are likely to realize as much social benefit as is frequently claimed. Part One of the paper describes the features of Benefit Corporations as they are constituted in many states. Part Two lays out the benefits extolled by supporters (...) of this US legal corporate form. Part Three challenges these claims and adduces some reasons for doubting whether Benefit Corporations will prove to be as socially useful as they claim to be. Part Four concludes with some suggestions for future lines of research into the nature of the firm and Benefit Corporations in particular. (shrink)

This chapter discusses the importance of developing an explicitly metaphysical approach to the study of terrorism. Taking its cue from John Carroll’s Break-Out from the Crystal Palace and Terror: A Meditation on the Meaning of September 11, the chapter sheds light on the character of the “terrorist persona” as a means of understanding how individuals become capable of perpetrating crimes of horrific and indiscriminate violence. Identifying a persona that seeks self-realisation through violent overthrow of alienating moral and political institutions, the (...) chapter identifies a specific kind of terrorism that finds its origins in a misreading of Max Stirner and Friedrich Nietzsche. (shrink)

We welcome Blumenthal-Barby’s et al. (2022) plaidoyer for the integration of philosophy in bioethics because of a perceived mutual benefit. Drawing on experience from a collaborative project, funde...

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)

Appealing to African values associated with ubuntu such as communion and reconciliation, elsewhere I have argued that they require compensating those who have been wronged in ways that are likely to improve their lives. In the context of land reform, I further contended that this principle probably entails not transferring unjustly acquired land en masse and immediately to dispossessed populations since doing so would foreseeably lead to such things as capital flight and food shortages, which would harm them and the (...) broader society. Oritsegbubemi Anthony Oyowe has recently argued against my claim that land reform should be enacted in a way expected to benefit victims of colonialism while not greatly burdening innocent third parties, instead supporting the return of land to its rightful owners regardless of how the manner in which it were done would affect people’s quality of life. Here I expound Oyowe’s argumentation and respond to it in defence of my initial position, appealing to examples from southern Africa to illustrate. (shrink)

The return of individual research results and incidental findings from biobanking research is a much debated ethical issue globally but has extensive relevance in India where the burden of out of pocket health care expenses is high for the majority. The views of 21 ethics committee (EC) members and 22 researchers from Bengaluru, India, concerning the ethics of biobanking research were sought through in‐depth interviews using an unfolding case vignette with probes. A shared view among most was that individual research (...) results which are ‘actionable’ or have ‘clinical significance’ should be returned to the sample contributors through their treating physicians. This was seen as an ethical obligation and a moral duty on the side of the researcher to “give back” to the person who contributed to the research. The challenges foreseen were that of resources, both financial and personnel, for the time and counseling needed to accompany the disclosure of results. Perceptions of ‘ownership’ appear to influence the concept of benefit sharing. While benefit sharing in financial terms was considered ethically challenging, certain researchers and ethics committee members made a case for “two way altruism” where the researcher in return for the altruistic ‘valuable contribution’, shares with the contributor/ community, benefits of the research which could include research findings, improved patient care, and more affordable access to the new diagnostic tests or products arising from the research. This defines the emerging ethic of “giving back” which goes beyond individual rights and ensures reciprocity and distributive justice. (shrink)

Current models of scientific inquiry assume that scientists all share the same evaluative standards. However, scientists often rely on different yet legitimate ones, a feature we call evaluative diversity. We investigate how scientific success is affected by diversity in evaluative standards through computer-based simulations. Our results show that communities with diverse standards benefit substantially from scientists sharing all the approaches they explored, regardless of whether they considered them valuable. Moreover, we find that even a moderate degree of evaluative diversity (...) can, under certain conditions, lead scientists to reach more satisfying results than those they would reach in homogeneous communities. (shrink)

“Fair and equitable benefit-sharing” is one of the objectives of the UN Convention on Biological Diversity and the FAO International Treaty on Plant Genetic Resources for Food and Agriculture. In essence, benefit-sharing holds that countries, farmers, and indigenous communities that grant access to their plant genetic resources and/or traditional knowledge should share in the benefits that users derive from these resources. But what exactly is understood by “fair” and “equitable” in this context? Neither term is defined in the (...) international treaties. A complicating factor, furthermore, is that different motivations and perspectives exist with respect to the notion of benefit-sharing itself. This paper looks at six different approaches to benefit-sharing that can be extracted from the current debates on “Access and Benefit-Sharing.” These approaches form the basis of a philosophical reflection in which the different connotations of “fair and equitable” are considered, by analyzing the main principles of justice involved. Finally, the various principles are brought together in order to draw some conclusions as to how a fair and equitable benefit-sharing mechanism might best be realized. This results in several recommendations for policymakers. (shrink)

Do those of us living in the present have an obligation to rectify injustices committed by others in the distant past? This article is an attempt to revisit the problem of historical injustice by bringing together recent work on structural injustice in relation to the problem of wrongful benefit. The problem of benefitting from injustice, I argue, provides firmer grounds of obligation in forward-looking accounts of responsibility for historical injustice specifically. I argue (1) that if the negative effects of (...) historical injustice endure into the present, and (2) if we participate in structures that allow for its reproduction, then (3) our moral responsibility to set matters straight increases to the extent that we derive a benefit from the perpetuation of an unjust _status quo_. Finally, (4) a general moral obligation to make the world less unjust generates a motive for individuals to learn more about their place in a structure that reproduces the negative effects of historical injustice. (shrink)

More than perhaps anybody else in the world, the Swedish social scientist Björn Wittrock has contributed - both on the intellectual and institutional level - to making a truly global science possible. This book is devoted to an appreciation of his contributions.

Bioethics, Volume 36, Issue 7, Page 757-764, September 2022.

David Gauthier's “Lockean proviso” implied the prohibition of parasitic actions—actions that improve one's position through the worsening of the position of someone else. This chapter tests the soundness of this principle as an interpretation of the intentions of John Locke himself. It also discusses another interpretation of the proviso, that of Jeremy Waldron, which would imply that Gauthier's account of it is false. Waldron's contentions imply that the proviso does not prohibit parasitism. It argues against Waldron's position and puts Gauthier (...) in the right on this point. Finally, the chapter considers Robert Nozick's effort to come to terms with some of the problems and ambiguities that are inherent in the Lockean proviso, and argues that he fails. It also shows, on the basis of other elements of his theory, that Nozick is a consistent enemy of exploitation after all. (shrink)

This article proposes a cost-benefit analysis of argumentation, with the aim of highlighting the strategic considerations that govern the agent's decision to argue or not. In spite of its paramount importance, the topic of argumentative decision-making has not received substantial attention in argumentation theories so far. We offer an explanation for this lack of consideration and propose a tripartite taxonomy and detailed description of the strategic reasons considered by arguers in their decision-making: benefits, costs, and dangers. We insist that (...) the implications of acknowledging the strategic dimension of arguing are far-reaching, including promising insights on how to develop better argumentation technologies. (shrink)

In this article, I take for granted agreement on the merits of an unconditional basic income, and I consider the form its distribution might take. I explore the equity, efficiency, and incentive effects of several basic income models in order to provide a plausible example of what a basic income in the US might look like. I present four basic income models, discuss their advantages and disadvantages, and consider whether any one of these models is conclusively superior to the others (...) in terms of the trade-offs involved. I conclude with a tentative proposal for a level and distribution for introducing an unconditional basic income in the US. (shrink)

This article examines benefit sharing within health research, a subject of growing importance in South African regulatory and ethical frameworks. With reference to the National Health Act (NHA), this article builds on previous discussions about defining key terms in benefit sharing and offers health research ethics committees (RECs) in South Africa guidance in evaluating benefit-sharing provisions. It navigates three critical legislative frameworks – the Intellectual Property Rights from Publicly Financed Research and Development Act (IPRA), the Indigenous Knowledge (...) Act (IKA) and the National Environmental Management: Biodiversity Act (NEMBA) – interpreting each for REC evaluation of research protocols involving publicly funded research, indigenous knowledge and non-human biological materials. The article also addresses the implications of section 60(4) of the NHA on benefit sharing for human participant research, dissecting questions around permissible forms of benefits to participants and research institutions. Through a decision-making diagram and two hypothetical scenarios, this article provides practical tools to help RECs assess and regulate benefit sharing in line with ethical and legal standards, ultimately promoting fair research practices. (shrink)

Das Ziel einer so genannten Personalisierten Medizin ist es, verfügbare oder neue Interventionen zielgerichteter einzusetzen, um so ihren Nutzen zu optimieren. Mit dieser Zielsetzung sind an eine Prüfung der Zielerreichung die gleichen Anforderungen zu stellen wie an jede andere Intervention. Der Nutzen ist durch aussagefähige Studien, typischerweise also prospektive, kontrollierte Interventionsstudien, zu belegen. Dort, wo es um den Kern personalisierter Medizin, nämlich die Verbindung von Diagnostik und Behandlung geht, ist genau diese Verbindung in Form einer statistischen Wechselwirkung zu belegen. Enrichment-Designs (...) allein beantworten diese Frage nicht. Die Bewertung von Methoden der personalisierten Medizin ist problemlos in das Konzept evidenzbasierter Medizin einzubinden. (shrink)

In exploring possible justifications for the allocation of resources to patients with DoC, the authors argue that relevant frameworks ought to focus on potential morally important prospective benef...

I could have been more understanding, especially when police brought a man I'll call Mr. Atkins to the emergency room for depression and suicidal ideation. But it was 3:00 a.m. and the ER was a carnival of disease and discontent, a parade of drunk drivers and folks who practiced conflict resolution with knives and bullets. A patient well known for her drug abuse wasn't done yelling at me for refusing to write her a narcotic script when a nurse tweaked at (...) my elbow to please come speak with Mr. Atkins, who was making a case to walk out. (shrink)