This thesis addresses the tension in pragmatic cluster-randomized trials between their social value and the requirement to respect the autonomy of research participants. Pragmatic trials are designed to evaluate the effectiveness of treatments in real-world settings to inform clinical decision-making and promote cost-efficient care. These trials are often embedded into clinical settings and ideally include all patients who would receive the treatments under investigation as a part of routine care. Trialists increasingly adopt cluster-randomized designs—in which intact groups, such as hospitals (...) or clinics, are allocated randomly to study interventions—to simplify the inclusion of all patients. But including all-comers conflicts with the requirement to obtain written informed consent from research participants. Since informed consent is central to respecting patient autonomy, the question arises: how can the ends of autonomy and pragmatism be served simultaneously? Some philosophers argue that patients have an obligation to participate in clinical research and that this may negate consent requirements. I argue that while there may be grounds for a prima facie obligation for patients to participate in clinical research, no compelling argument has demonstrated that the obligation is enforceable. Others assert that broad application of a waiver of consent will facilitate the conduct of pragmatic cluster-randomized trials. I demonstrate that this proposal sharply conflicts with the historical origins of the waiver. I articulate a novel moral foundation for the use of a waiver of consent and show that when trials evaluate treatments delivered directly to patients, the autonomy interests at stake for participants are too substantial to permit its use. My solution draws a distinction between consent requirements in existing policy and consent as an autonomous authorization. As many pragmatic cluster-randomized trials are conducted in primary care settings with no research staff, I argue that patient autonomy can be promoted and protected using clinical-style consent, in which health providers seek verbal informed consent from patients and document it in the electronic health record. This approach has been associated with high rates of recruitment and, thus, may satisfy both requirements for social value and respect for autonomy. (shrink)

In this article I propose to explore two issues. The first concerns what kinds of contributions academics can make to reducing poverty. I argue that academics can contribute in a number of ways, and I seek to spell out the diversity of the options available. I concentrate on four ways in which these contributions might differ.My second aim is to outline some norms that should inform any academic involvement in activities that seek to reduce poverty. I set out six proposals. (...) These concern: (1) the need to construct coalitions among people with different ethical frameworks; (2) the value of constructing nonideal theory on the basis of our best understanding of an ideal world; (3) the need for integrated analysis that connects antipoverty initiatives to other areas of moral concern; (4) the vital importance of interdisciplinarity; (5) the need for epistemic modesty and revisability; and (6) the need for accountability. (shrink)

Global justice is, at its core, about moral obligations to distant others. But which obligations ought to be included is a matter of considerable debate. In the discussion that follows I will explicate and challenge two objections to the inclusion of foundationally positive obligations in our account of global justice. The first objection is based on the proposition that negative obligations possess and positive obligations lack a property necessary for a moral demand to be a matter justice. The second objection (...) is that even the most trivial positive obligation becomes overly burdensome when applied to the global arena. And, though I do not offer any particular substantive account of positive obligations to distant others; I assess some of the implications that would arise were positive obligations to distant others to be included in our account of global justice. (shrink)

The Upaniṣads do deal with moral problems, and one could find a systematic ethical stance in them, though the Upaniṣads are, for the most part, concerned with metaphysics where the Ultimate Reality is explored and mediated upon. For an Upaniṣadic seeker, metaphysics and ethics are inseparable. The present study makes an attempt to examine the ethical stance of the Taittirīya Upaniṣad and see whether it falls in the framework of any ethical theory. This study examines the Taittirīya Upaniṣad’s ethical ideas (...) focussing on the eleventh chapter of the Śikṣā-vallī (first section). The first part of the paper is an unearthing the moral precepts found in the Taittirīya Upaniṣad, whereas the second part explores whether the ethic of the Taittirīya Upaniṣad is deontological. The study concludes with a submission. In this paper, the attempt is to position the moral precepts enunciated in the Taittirīya Upaniṣad in an ethical theory framework in the light of comparative philosophy. I argue that the moral precepts enunciated in the Taittirīya Upaniṣad, though seemingly deontological, are for the maintenance of the social order, unlike in Kant’s ends in themselves; and the ethics of the Taittirīya Upaniṣad has overwhelming elements of consequentialism and virtue ethics. (shrink)

Among the defining characteristics of moral cosmopolitanism are the convictions that personal relations, membership in social or political organizations like local communities or nation-states are insignificant for agents when determining their scope of moral concern. The moral scope is unlimited and the moral duties reach globally. Following up observations made by Onora O’Neill and others, it is argued that Singer’s model needs a complementary tool to allocate duties.That tool can be found by supplementing the agent centered perspective of the model (...) with a regard for the social and institutional circles encompassing right holders. Instead of focusing on the duty holder, I suggest that the cosmopolitan’s “ultimate unit of moral concern” – here, the claimholder is regarded central.Thus, Singer’s cosmological model is kept, but in a rights-based methodological approach for allocating duties. Methodologically, what needs to be investigated is whether the scope of legitimate moral claims expands from the agent for the same reasons that the circle of moral concern expands from Singer’s agent. (shrink)