Pub Date : 2023-01-01DOI: 10.1353/ken.2023.a899457
Alex John London, Patrick Bodilly Kane, Jonathan Kimmelman
The judgments of conscientious and informed experts play a central role in two elements of clinical equipoise. The first, and most widely discussed, element involves ensuring that no participant in a randomized trial is allocated to a level of treatment that everyone agrees is substandard. The second, and less often discussed, element involves ensuring that trials are likely to generate social value by producing the information necessary to resolve a clinically meaningful uncertainty or disagreement about the relative merits of a set of interventions. The distribution of judgments in expert communities can take many forms, each with important implications for whether a trial satisfies one or both elements of clinical equipoise. In this article we use a graphical approach to represent three ways in which expert community uncertainty can vary: by spread, modality, and skew. Understanding these different distributions of expert judgment has three important implications: it helps to make operational the requirement of social value, it shows that some conditions for initiating studies to promote social value diverge from common assumptions about clinical equipoise, and it has important implications for how trials should be designed and monitored, and what patients should be told during informed consent.
{"title":"Varieties of Community Uncertainty and Clinical Equipoise.","authors":"Alex John London, Patrick Bodilly Kane, Jonathan Kimmelman","doi":"10.1353/ken.2023.a899457","DOIUrl":"10.1353/ken.2023.a899457","url":null,"abstract":"<p><p>The judgments of conscientious and informed experts play a central role in two elements of clinical equipoise. The first, and most widely discussed, element involves ensuring that no participant in a randomized trial is allocated to a level of treatment that everyone agrees is substandard. The second, and less often discussed, element involves ensuring that trials are likely to generate social value by producing the information necessary to resolve a clinically meaningful uncertainty or disagreement about the relative merits of a set of interventions. The distribution of judgments in expert communities can take many forms, each with important implications for whether a trial satisfies one or both elements of clinical equipoise. In this article we use a graphical approach to represent three ways in which expert community uncertainty can vary: by spread, modality, and skew. Understanding these different distributions of expert judgment has three important implications: it helps to make operational the requirement of social value, it shows that some conditions for initiating studies to promote social value diverge from common assumptions about clinical equipoise, and it has important implications for how trials should be designed and monitored, and what patients should be told during informed consent.</p>","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"33 1","pages":"1-19"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49078519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1353/ken.2023.a904083
Ricky Mouser
Effective altruism has a strategy problem. Overreliance on a strategy of donating to the most effective charities keeps us on the firefighter's treadmill, continually pursuing the next-highest quantifiable marginal gain. But on its own, this is politically shortsighted. Without any long-term framework within which these individual rescues fit together to bring about the greatest overall impact, we are almost certainly leaving a lot of value on the table. Thus, effective altruists' preferred means undercut their professed aims. Alongside the charity framework, the more effective altruist ought to consider a mutual aid framework, which better acknowledges and honors the unavoidably political commitments of effective altruism to reimagine and remake the world.
{"title":"Mutual Aid as Effective Altruism.","authors":"Ricky Mouser","doi":"10.1353/ken.2023.a904083","DOIUrl":"10.1353/ken.2023.a904083","url":null,"abstract":"<p><p>Effective altruism has a strategy problem. Overreliance on a strategy of donating to the most effective charities keeps us on the firefighter's treadmill, continually pursuing the next-highest quantifiable marginal gain. But on its own, this is politically shortsighted. Without any long-term framework within which these individual rescues fit together to bring about the greatest overall impact, we are almost certainly leaving a lot of value on the table. Thus, effective altruists' preferred means undercut their professed aims. Alongside the charity framework, the more effective altruist ought to consider a mutual aid framework, which better acknowledges and honors the unavoidably political commitments of effective altruism to reimagine and remake the world.</p>","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"33 1","pages":"201-226"},"PeriodicalIF":1.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47869681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Remy Debes, Douglas Mackay, M. Barcelos, Laura Guidry-Grimes, David Wendler, Jake Earl, N. Berlinger
ABSTRACT:In these Conversations, Robert Veatch reveals remarkable moments of his intellectual journey through bioethics. In Part I, he recalls some of the major historical events that contributed to modern bioethics development from the 1970s onward. Going back more than one decade, he emphasizes the impact of the Antiwar and Civil Rights movements, his pacifist ideals, and his engagement as an activist. In Part II, Veatch discusses the core of his theoretical proposal for bioethics, which is based on seven principles. He explains how his principles work in practice and why he defends the lexical ordering strategy, prioritizing the duty-based principles over consequentialist ones. Finally, he addresses the issue of the universality of ethical principles while, at the same time, acknowledging that different cultural values may condition the interpretation of a problem and, thus, lead to a different conclusion.
{"title":"Contributors","authors":"Remy Debes, Douglas Mackay, M. Barcelos, Laura Guidry-Grimes, David Wendler, Jake Earl, N. Berlinger","doi":"10.1353/ken.2022.0013","DOIUrl":"https://doi.org/10.1353/ken.2022.0013","url":null,"abstract":"ABSTRACT:In these Conversations, Robert Veatch reveals remarkable moments of his intellectual journey through bioethics. In Part I, he recalls some of the major historical events that contributed to modern bioethics development from the 1970s onward. Going back more than one decade, he emphasizes the impact of the Antiwar and Civil Rights movements, his pacifist ideals, and his engagement as an activist. In Part II, Veatch discusses the core of his theoretical proposal for bioethics, which is based on seven principles. He explains how his principles work in practice and why he defends the lexical ordering strategy, prioritizing the duty-based principles over consequentialist ones. Finally, he addresses the issue of the universality of ethical principles while, at the same time, acknowledging that different cultural values may condition the interpretation of a problem and, thus, lead to a different conclusion.","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"237 - 259 - 261 - 296 - 297 - 311 - 313 - 327 - E-1 - E-13 - E-13 - E-2 - E-28 - E-4 - vi - vi - vii"},"PeriodicalIF":1.4,"publicationDate":"2022-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45109934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Almost Over: Aging, Dying, Dead by F.M. Kamm (review)","authors":"N. Berlinger","doi":"10.1353/ken.2022.0021","DOIUrl":"https://doi.org/10.1353/ken.2022.0021","url":null,"abstract":"","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"E-1 - E-2"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44674123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Review of Suzy Killmister, Contours of Dignity","authors":"Remy Debes","doi":"10.1353/ken.2022.0014","DOIUrl":"https://doi.org/10.1353/ken.2022.0014","url":null,"abstract":"","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"E-13 - E-4"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42233619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
[ e-13 ] 12. Unfortunately, Killmister doesn’t seem aware of Darwall’s revision of his own view, which distinguishes two kinds of recognition respect: honor respect and moral respect. Given that Darwall ties the former to the idea of socially constructed “human kinds,” which Killmister considers later in her discussion of status dignity, her take on this revision would have been relevant. Indeed, because Darwall further argues that social kinds are tied up with hierarchical interpersonal attitudes, this revision complicates any attempt, like Killmister’s, to make human dignity a species of status dignity. See e.g. Stephen Darwall, “Respect As Honor and As Accountability,” In Honor, History, & Relationship: Essays in Second-Personal Ethics II (New York: Oxford University Press, 2013).
{"title":"Review of For the Common Good: Philosophical Foundations of Research Ethics","authors":"Douglas Mackay","doi":"10.1353/ken.2022.0015","DOIUrl":"https://doi.org/10.1353/ken.2022.0015","url":null,"abstract":"[ e-13 ] 12. Unfortunately, Killmister doesn’t seem aware of Darwall’s revision of his own view, which distinguishes two kinds of recognition respect: honor respect and moral respect. Given that Darwall ties the former to the idea of socially constructed “human kinds,” which Killmister considers later in her discussion of status dignity, her take on this revision would have been relevant. Indeed, because Darwall further argues that social kinds are tied up with hierarchical interpersonal attitudes, this revision complicates any attempt, like Killmister’s, to make human dignity a species of status dignity. See e.g. Stephen Darwall, “Respect As Honor and As Accountability,” In Honor, History, & Relationship: Essays in Second-Personal Ethics II (New York: Oxford University Press, 2013).","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"E-13 - E-28"},"PeriodicalIF":1.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42577818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-21DOI: 10.21428/3e88f64f.31304008
J. Guiliano, Roopika Risam
{"title":"Editors' Note: March 2022","authors":"J. Guiliano, Roopika Risam","doi":"10.21428/3e88f64f.31304008","DOIUrl":"https://doi.org/10.21428/3e88f64f.31304008","url":null,"abstract":"","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"1 1","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67758809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Review of When Death Becomes Life: Notes from a Transplant Surgeon","authors":"A. Omelianchuk","doi":"10.1353/ken.2022.0007","DOIUrl":"https://doi.org/10.1353/ken.2022.0007","url":null,"abstract":"","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"E-12 - E-8"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49251733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Both the distinction between the 'internal' and 'external' phases of science and the concept of 'inductive risk' are core constructs in the values in science literature. However, both constructs have shortcomings, which, we argue, have concealed the unique significance of values in scientific representation. We defend three closely-related proposals to rectify the problem: i) to draw a conceptual distinction between endorsing a 'fact' and making a decision about representation; ii) to employ a conception of inductive risk that aligns with this distinction, not one between internal/external phases in science; iii) to conceptualize 'representational risk' as a unique epistemic risk, no less significant than inductive risk. We outline the implications of each proposal for current debates in the values in science literature.
{"title":"The Epistemic Risk in Representation","authors":"S. Harvard, Eric Winsberg","doi":"10.1353/ken.2022.0001","DOIUrl":"https://doi.org/10.1353/ken.2022.0001","url":null,"abstract":"ABSTRACT:Both the distinction between the 'internal' and 'external' phases of science and the concept of 'inductive risk' are core constructs in the values in science literature. However, both constructs have shortcomings, which, we argue, have concealed the unique significance of values in scientific representation. We defend three closely-related proposals to rectify the problem: i) to draw a conceptual distinction between endorsing a 'fact' and making a decision about representation; ii) to employ a conception of inductive risk that aligns with this distinction, not one between internal/external phases in science; iii) to conceptualize 'representational risk' as a unique epistemic risk, no less significant than inductive risk. We outline the implications of each proposal for current debates in the values in science literature.","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"1 - 31"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46951490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT:Scientists have the ability to influence policy in important ways through how they present their results. Surprisingly, existing codes of scientific ethics have little to say about such choices. I propose that we can arrive at a set of ethical guidelines to govern scientists' presentation of information to policymakers by looking to bioethics: roughly, just as a clinician should aim to promote informed decision-making by patients, a scientist should aim to promote informed decision-making by policymakers. Though this may sound like a natural proposal, I show it offers guidance that conflicts with standard scientific practices. I conclude by considering one cost of the proposal: that it would prevent scientists from acting as advocates in a way that is currently common in certain fields. I accept that the proposal would restrict scientists' political advocacy rights, but argue that the benefits of adopting it—promoting democratic governance—justify the restriction.
{"title":"An Ethical Framework for Presenting Scientific Results to Policy-Makers","authors":"S. Schroeder","doi":"10.1353/ken.2022.0002","DOIUrl":"https://doi.org/10.1353/ken.2022.0002","url":null,"abstract":"ABSTRACT:Scientists have the ability to influence policy in important ways through how they present their results. Surprisingly, existing codes of scientific ethics have little to say about such choices. I propose that we can arrive at a set of ethical guidelines to govern scientists' presentation of information to policymakers by looking to bioethics: roughly, just as a clinician should aim to promote informed decision-making by patients, a scientist should aim to promote informed decision-making by policymakers. Though this may sound like a natural proposal, I show it offers guidance that conflicts with standard scientific practices. I conclude by considering one cost of the proposal: that it would prevent scientists from acting as advocates in a way that is currently common in certain fields. I accept that the proposal would restrict scientists' political advocacy rights, but argue that the benefits of adopting it—promoting democratic governance—justify the restriction.","PeriodicalId":46167,"journal":{"name":"Kennedy Institute of Ethics Journal","volume":"32 1","pages":"33 - 67"},"PeriodicalIF":1.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46363026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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