Opponents of biotechnology ofteninvoke the Precautionary Principle to advancetheir cause, whereas biotech enthusiasts preferto appeal to ``sound science.'' Publicauthorities are still groping for a usefuldefinition. A crucial issue in this debate isthe distribution of the burden of proof amongthe parties favoring and opposing certaintechnological developments. Indeed, the debateon the significance and scope of thePrecautionary Principle can be fruitfullyre-framed as a debate on the proper division ofburdens of proof. In this article, we attemptto arrive at a more refined way of thinkingabout (...) this problem in order to escape from theexisting polarization of views between ``guiltyuntil proven innocent'' and ``innocent untilproven guilty.'' This way of thinking alsoenables a critical review of currentdemarcations between risk assessment and riskmanagement, or science and politics, and of themorally laden controversy on the relativeimportance of type-I and type-II errors instatistical testing. (shrink)

The World Health Organisation encourages that blood donation becomes voluntary and unremunerated, a system already operated in the UK. Drawing on public documents and videos, this paper argues that blood donation is regarded and presented as altruistic and supererogatory. In advertisements, donation is presented as something undertaken for the benefit of others, a matter attracting considerable gratitude from recipients and the collecting organisation. It is argued that regarding blood donation as an act of supererogation is wrongheaded, and an alternative account (...) of blood donation as moral obligation is presented. Two arguments are offered in support of this position. First, the principle of beneficence, understood in a broad consequentialist framework obliges donation where the benefit to the recipient is large and the cost to the donor relatively small. This argument can be applied, with differing levels of normativity, to various acts of donation. Second, the wrongness of free riding requires individuals to contribute to collective systems from which they benefit. Alone and in combination these arguments present moral reasons for donation, recognised in communication strategies elsewhere. Research is required to evaluate the potential effects on donation of a campaign which presents blood donation as moral obligation, but of wider importance is the recognition that other-regarding considerations in relation to our own as well as others’ health result in a range not only of choices but also of obligations. (shrink)

Disputes about theory in bioethics almost invariablyrevolve around different understandings of morality or practicalreasoning; I here suggest that the field would do well to becomemore explicitly contentious about knowledge, and start the taskof putting together a clinical epistemology. By way of providingsome motivation for such a discussion, I consider two cases ofresistance to shifts in clinical practice that are, by and large,not ethically controversial, highlighting how differentconceptions of epistemic authority may contribute to clinicians'unwillingness to adopt these changes, and sketching out (...) someinitial suggestions for epistemic analysis of clinical practice. (shrink)

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. (...) Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs. (shrink)

Ethical reflection on the justice/injustice of past public health policy can inform current and future policy creation and assessment. For eight years in the 1980s, Haitians were prohibited from donating blood in the USA due to their national origin, a supposed risk factor for AIDS. This case study underlines the racial stereotypes and cultural ignorance at play in risk assignment—which simultaneously marked Haitians as risky ‘others’ and excluded them as significant participants in policy-making. This article also discerns Haitian understandings of (...) justice related to this donor policy and explores how dimensions of this past policy relate to current blood donor policy. (shrink)

Opponents of biotechnology ofteninvoke the Precautionary Principle to advancetheir cause, whereas biotech enthusiasts preferto appeal to ``sound science.'' Publicauthorities are still groping for a usefuldefinition. A crucial issue in this debate isthe distribution of the burden of proof amongthe parties favoring and opposing certaintechnological developments. Indeed, the debateon the significance and scope of thePrecautionary Principle can be fruitfullyre-framed as a debate on the proper division ofburdens of proof. In this article, we attemptto arrive at a more refined way of thinkingabout (...) this problem in order to escape from theexisting polarization of views between ``guiltyuntil proven innocent'' and ``innocent untilproven guilty.'' This way of thinking alsoenables a critical review of currentdemarcations between risk assessment and riskmanagement, or science and politics, and of themorally laden controversy on the relativeimportance of type-I and type-II errors instatistical testing. (shrink)

BACKGROUND: The availability of costly safety measures against transfusion-transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policymaking in five Western countries. STUDY DESIGN AND METHODS: Our qualitative study involved determining which issues had been discussed in advisory committee meetings and capturing these issues in general categories. Appropriate documents were identified in (...) collaboration with local decision-making experts in Canada, Germany, the Netherlands, the United States, and the United Kingdom. The introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever were chosen as cases representing decision-making on safety measures with high costs and low or uncertain added safety. RESULTS: A broad inventory of concerns was established, including: 1) nine categories of advantages and disadvantages of candidate safety policies; 2) six kinds of difficulties in assessing risks and forecasting the effects of safety policies; 3) 13 decision-making principles; and 4) six kinds of practical barriers hampering the translation of candidate policies into decisions. CONCLUSION: Blood safety policymaking involves a wide variety of competing concerns, and approaches to reconcile these considerations are themselves contested. Developing a systematic decision-making approach requires ethical reflection on, among others, reasonable costs of safety and the value of transparency in public policy. (shrink)