Research drawn from data contained in medical records is a common and immensely important means of scientific investigation in epidemiology and health services research. It provides valuable knowledge regarding risk factors for disease, the safety of pharmaceuticals and medical procedures, and the quality of medical care. Electronic information technology has greatly enhanced the capability of conducting research using medical records, but it has also generated increasing concern about invasions of privacy. Both practical and scientific considerations militate against soliciting consent for (...) population-based observational research. Retrospective review of existing medical records, especially with large samples, poses insuperable barriers to locating human subjects in order to obtain their informed consent. When efforts are made to obtain informed consent for prospective research drawn from disease and treatment registries, mounting evidence has accumulated that substantial selection biases are introduced into the data, as those who consent are not necessarily representative of the population of relevant patients. (shrink)

Left-libertarianism is a version of Lockean libertarianism that combines the idea that each person is the full rightful owner of herself and the idea that each person should have the right to own a roughly equal amount of the world's resources. This essay argues against left-libertarianism. The specific target is an interesting form of left-libertarianism proposed by Michael Otsuka that is especially stringent in its equal world ownership claim. One criticism advanced is that there is more tension than Otsuka acknowledges (...) between private ownership of self and equal ownership of the world. This emerges once one notices that self-ownership should not be conceived merely in a thin, formal way but also as a thicker substantive insistence on wide individual freedom. A second criticism is that in other respects the formal idea of self-ownership that Otsuka and other left-libertarians embrace is an extreme doctrine that merits rejection. (shrink)