Uncertainty and the Ethics of Clinical Trials

A probabilistic explication is offered of equipoise and uncertainty in clinical trials. In order to be useful in the justification of clinical trials, equipoise has to be interpreted in terms of overlapping probability distributions of possible treatment outcomes, rather than point estimates representing expectation values. Uncertainty about treatment outcomes is shown to be a necessary but insufficient condition for the ethical defensibility of clinical trials. Additional requirements are proposed for the nature of that uncertainty. The indecisiveness of our criteria for cautious decision-making under uncertainty creates the leeway that makes clinical trials defensible.     

What is ceteris paribus preference?

A general format is introduced for deriving preferences over states of affairs from preferences over a set of contextually complete alternatives. Formal results are given both for this general format and for a specific instance of it that is a plausible explication of ceteris paribus prefence.     

A note on the deontic system DL of Jones and Pörn

I would like to thank Ingmar Pörn for valuable comments on an earlier version of this paper.     

John Stuart Mill and the Conflicts of Equality

John Stuart Mill commented on the relationship between equality and liberty in general terms, and he also discussed the relationships between equality and four more concrete social goals: equality vs. diversity and individual spontaneity, equality vs. freedom of trade and entrepreneurial activity, equality vs. economic incentives for workpeople, and equality vs. welfare. In his more general statements he wrote off potential conflicts between equality and liberty, claiming that only those liberties that can be enjoyed by all are real liberties—or at least they are the only ones worth defending. However, in several of his more concrete discussions he gave higher priority to various liberty-related goals than to equality. This seeming contradiction can be resolved if we assume that he distinguished between valuing a liberty per se and valuing it as a means to achieve something else.

     

Where should we draw the line between quality of care and other ethical concerns related to medical registries and biobanks?

Together with large biobanks of human samples, medical registries with aggregated data from many clinical centers are vital parts of an infrastructure for maintaining high standards of quality with regard to medical diagnosis and treatment. The rapid development in personalized medicine and pharmaco-genomics only underscores the future need for these infrastructures. However, registries and biobanks have been criticized as constituting great risks to individual privacy. In this article, I suggest that quality with regard to diagnosis and treatment is an inherent, morally normative requirement of health care, and argue that quality concerns in this sense may be balanced with privacy concerns.     

The Moral Oracle’s Test

When presented with a situation involving an agent’s choice between alternative actions, a moral oracle says what the agent is allowed to do. The oracle bases her advice on some moral theory, but the nature of that theory is not known by us. The moral oracle’s test consists in determining whether a series of questions to the oracle can be so constructed that her answers will reveal which of two given types of theories she adheres to. The test can be applied to moral theories in order to determine if they differ in their recommendations for action. Based on this test, a terminology is developed to specify different forms and degrees of distinguishability between moral theories, or types of theories, in terms of their recommendations for action. In conclusion, the test is applied to consequentialism and utilitarianism.     

Maximal and perimaximal contraction

Generalizations of partial meet contraction are introduced that start out from the observation that only some of the logically closed subsets of the original belief set are at all viable as contraction outcomes. Belief contraction should proceed by selection among these viable options. Several contraction operators that are based on such selection mechanisms are introduced and then axiomatically characterized. These constructions are more general than the belief base approach. It is shown that partial meet contraction is exactly characterized by adding to one of these constructions the condition that all logically closed subsets of the belief set can be obtained as the outcome of a single (multiple) contraction. Examples are provided showing the counter-intuitive consequences of that condition, thus confirming the credibility of the proposed generalization of the AGM framework.     

The Harmful Influence of Decision Theory on Ethics

In the last half century, decision theory has had a deep influence on moral theory. Its impact has largely been beneficial. However, it has also given rise to some problems, two of which are discussed here. First, issues such as risk-taking and risk imposition have been left out of ethics since they are believed to belong to decision theory, and consequently the ethical aspects of these issues have not been treated in either discipline. Secondly, ethics has adopted the decision-theoretical idea that action-guidance has to be based on cause–effect or means–ends relationships between an individual action and its possible outcomes. This is problematic since the morally relevant connections between an action and future events are not fully covered by such relationships. In response to the first problem it is proposed that moral theory should deal directly and extensively with issues such as risk-taking and risk imposition, thereby intruding unabashedly into the traditional territory of decision theory. As a partial response to the second problem it is proposed that moral theorizing should release itself from the decision-theoretical requirement that the moral status of an action has to be derivable from the consequences (or other properties) that are assignable to that action alone. In particular, the effects that an action can have in combination with other actions by the same or other agents are valid arguments in an action-guiding moral discourse, even if its contribution to these combined consequences cannot be isolated and evaluated separately.