Qualifying Confidentiality Obligations

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.     

Perfect and Imperfect Obligations

Philosophical Studies -     

Collectivizing Rescue Obligations in Bioethics

Bioethicists invoke a duty to rescue in a wide range of cases. Indeed, arguably, there exists an entire medical paradigm whereby vast numbers of medical encounters are treated as rescue cases. The intuitive power of the rescue paradigm is considerable, but much of this power stems from the problematic way that rescue cases are conceptualized—namely, as random, unanticipated, unavoidable, interpersonal events for which context is irrelevant and beneficence is the paramount value. In this article, I critique the basic assumptions of the rescue paradigm, reframe the ethical landscape in which rescue obligations are understood, and defend the necessity and value of a wider social and institutional view. Along the way, I move back and forth between ethical theory and a concrete case where the duty to rescue has been problematically applied: the purported duty to regularly return incidental findings and individual research results in genomic and genetic research.     

Ethical Obligations of Special Services Personnel

Although there is increased lip-service paid to the need for educators to behave ethically, special services personnel are aware of many situations in which their colleagues or supervisors show little awareness of ethical principles. In this article, we address this issue from a variety of perspectives. First, we discuss the relationship between professional ethics and the broader concept of "professionalism." and discuss some of the reasons why education has not reached the level of commitment to ethics training and enforcement that is found in more mature vrofessions. Second, we present a list of ethical principles that appear to have universal applicability across professions and illustrate some of he ways in which special services personnel sometimes violate these principles. Third. we discuss some of the reasons why ethical violations occur and what might be done to address this problem. Particular explanatory attention is paid to the interdisciplinary and hierarchical/bureaucratic nature of school settings, and the tendency of administrators to emphasize the primacy of perceived organizational needs. Among the suggestions made is the call for educational agencies at all levels to develop their own detailed ethical codes and casebooks and to establish interdisciplinary ethics committees that will provide training, consultation and complaint resolution.     

Rule-Consequentialism and Obligations Toward the Needy

Most of us believe morality requires us to help the desperately needy. But most of us also believe morality doesn't require us to make enormous sacrifices in order to help people who have no special connection with us. Such self-sacrifice is of course praiseworthy, but it isn't morally mandatory. Rule-consequentialism might seem to offer a plausible grounding for such beliefs. Tim Mulgan has recently argued in Analysis and Pacific Philosophical Quarterly that rule-consequentialism cannot do so. This paper replies to Mulgan's arguments.     

Structural Injustice and Massively Shared Obligations

It is often argued that our obligations to address structural injustice are collective in character. But what exactly does it mean for ‘ordinary citizens’ to have collective obligations vis‐à‐vis large‐scale injustice? In this article, I propose to pay closer attention to the different kinds of collective action needed in addressing some of these structural injustices and the extent to which these are available to large, unorganised groups of people. I argue that large, dispersed, and unorganised groups of people are often in a position to perform distributive collective actions. As such, ordinary citizens can have massively shared obligations to address structural injustice through distributive action, but, ultimately, such obligations are ‘collective’ only in a fairly weak sense.     

Joint Duties and Global Moral Obligations

In recent decades, concepts of group agency and the morality of groups have increasingly been discussed by philosophers. Notions of collective or joint duties have been invoked especially in the debates on global justice, world poverty and climate change. This paper enquires into the possibility and potential nature of moral duties individuals in unstructured groups may hold together. It distinguishes between group agents and groups of people which – while not constituting a collective agent – are nonetheless capable of performing a joint action. It attempts to defend a notion of joint duties which are neither duties of a group agent nor duties of individual agents, but duties held jointly by individuals in unstructured groups. Furthermore, it seeks to illuminate the relation between such joint duties on the one hand and individual duties on the other hand. Rebutting an argument brought forward by Wringe, the paper concludes that it is not plausible to assume that all humans on earth can together hold a duty to mitigate climate change or to combat global poverty given that the members of that group are not capable of joint action. ¹      

The Friendship Model of Filial Obligations

ABSTRACT This paper [1] is a defence of a modified version of Jane English's model of filial obligations based on adult children's friendship with their parents. (I) Unlike the more traditional view that filial obligations are a repayment for parental sacrifices, the friendship model puts filial duties in the appealing context of voluntary, loving relationships. (II) Contrary to English's original statement of this view, which is open to the charge of tolerating filial ingratitude, the friendship model can generate obligations to help our parents even if we are no longer friendly with them. (III) Joseph Kupfer has pointed out several ways in which parent-child relationships differ from peer friendships; but his arguments do not preclude our enjoying a type of friendship with our parents. (IV) In response to Christina Hoff Sommers, who objects that feelings of friendship toward our parents are too flimsy a ground for filial duties, the friendship model can provide a plausible, robust account of filial obligations. (V) As for adult children who have never formed friendships with their loving, caring parents, and refuse to give them much-needed assistance, they can be criticised by moral considerations independent of but compatible with the friendship model .     

Filial Obligations: A Comparative Study

The nature of the special obligation that a child has towards her parent(s) is widely discussed in Confucianism. It has also received considerable discussion by analytic commentators. This essay compares and contrasts the accounts of filial obligation found in the two philosophical traditions. The analytic writers mentioned above have explored filial obligations by relating them to other special obligations, such as obligations of debt, friendship, or gratitude. I examine these accounts and try to uncover the implicit assumptions therein about the scope and nature of such filial obligations. I then similarly examine Confucian filial obligations (CFOs) by relating them to these other special obligations of debt, gratitude, and so on. My findings are used to highlight crucial differences in the scope and conception of filial obligations in these two traditions.     

Reasons,Motivations, and Obligations

I argue against Reasons Internalism, the view that possession of a normative reason for the performance of an action entails that one can be motivated to perform that action, and Motivational Existence Internalism, the view that if one is obligated to perform an action, then one can be motivated to perform that action. My thesis is that these positions cannot accommodate the fact that reasonable moral agents are frequently motivated to act only because they believe their contemplated actions to be morally obligatory. The failure to accommodate this fact is reason to reject these two types of internalism about reasons.