The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the (...) Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. (shrink)

It is often claimed that surveillance should be proportionate, but it is rarely made clear exactly what proportionate surveillance would look like beyond an intuitive sense of an act being excessive. I argue that surveillance should indeed be proportionate and draw on Thomas Hurka’s work on proportionality in war to inform the debate on surveillance. After distinguishing between the proportionality of surveillance per se, and surveillance as a particular act, I deal with objections to using proportionality as a legitimate ethical (...) measure. From there I argue that only certain benefits and harms should be counted in any determination of proportionality. Finally I look at how context can affect the proportionality of a particular method of surveillance. In conclusion, I hold that proportionality is not only a morally relevant criterion by which to assess surveillance, but that it is a necessary criterion. Furthermore, while granting that it is difficult to assess, that difficulty should not prevent our trying to do so. (shrink)

As opposed to a ‘one size fits all’ approach, precision medicine uses relevant biological, medical, behavioural and environmental information about a person to further personalize their healthcare. This could mean better prediction of someone’s disease risk and more effective diagnosis and treatment if they have a condition. Big data allows for far more precision and tailoring than was ever before possible by linking together diverse datasets to reveal hitherto-unknown correlations and causal pathways. But it also raises ethical issues relating to (...) the balancing of interests, viability of anonymization, familial and group implications, as well as genetic discrimination. This article analyses these issues in light of the values of public benefit, justice, harm minimization, transparency, engagement and reflexivity and applies the deliberative balancing approach found in theEthical Framework for Big Data in Health and Research to a case study on clinical genomic data sharing. Please refer to that article for an explanation of how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. Our discussion is meant to be of use to those involved in the practice as well as governance and oversight of precision medicine to address ethical concerns that arise in a coherent and systematic manner. (shrink)

Some have objected to human enhancement on the grounds that it violates the autonomy of the enhanced. These objections, however, overlook the interesting possibility that autonomy itself could be enhanced. How, exactly, to enhance autonomy is a difficult problem due to the numerous and diverse accounts of autonomy in the literature. Existing accounts of autonomy enhancement rely on narrow and controversial conceptions of autonomy. However, we identify one feature of autonomy common to many mainstream accounts: reasoning ability. Autonomy can then (...) be enhanced by improving people’s reasoning ability, in particular through cognitive enhancement; given how valuable autonomy is usually taken to be, this gives us extra reason to pursue such cognitive enhancements. Moreover, autonomy-based objections will be especially weak against such enhancements. As we will argue, those who are worried that enhancements will inhibit people’s autonomy should actually embrace those enhancements that will improve autonomy. (shrink)

Volume 19, Issue 7, July 2019, Page 28-30.

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

Moral enhancement is an ostensibly laudable project. Who wouldn’t want people to become more moral? Still, the project’s approach is crucial. We can distinguish between two approaches for moral enhancement: direct and indirect. Direct moral enhancements aim at bringing about particular ideas, motives or behaviors. Indirect moral enhancements, by contrast, aim at making people more reliably produce the morally correct ideas, motives or behaviors without committing to the content of those ideas, motives and/or actions. I will argue, on Millian grounds, (...) that the value of disagreement puts serious pressure on proposals for relatively widespread direct moral enhancement. A more acceptable path would be to focus instead on indirect moral enhancements while staying neutral, for the most part, on a wide range of substantive moral claims. I will outline what such indirect moral enhancement might look like, and why we should expect it to lead to general moral improvement. (shrink)

It has recently been argued that reproductive genetic manipulation technologies like mitochondrial replacement and germline CRISPR modifications cannot be said to save anyone’s life because, counterfactually, no one would suffer more or die sooner absent the intervention. The present article argues that, on the contrary, reproductive genetic manipulations may be life-saving (and, from this, have therapeutic value) under an appropriate population health perspective. As such, popular reports of reproductive genetic manipulations potentially saving lives or preventing disease are not necessarily mistaken, (...) though such terminology still requires further empirical validation. (shrink)

The right to withdraw from participation in research is recognized in virtually all national and international guidelines for research on human subjects. It is therefore surprising that there has been little justification for that right in the literature. We argue that the right to withdraw should protect research participants from information imbalance, inability to hedge, inherent uncertainty, and untoward bodily invasion, and it serves to bolster public trust in the research enterprise. Although this argument is not radical, it provides a (...) useful way to determine how the right should be applied in various cases. (shrink)

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)

The prospect of consumable meat produced in a laboratory setting without the need to raise and slaughter animals is both realistic and exciting. Not only could such in vitro meat become popular due to potential cost savings, but it also avoids many of the ethical and environmental problems with traditional meat productions. However, as with any new technology, in vitro meat is likely to face some detractors. We examine in detail three potential objections: 1) in vitro meat is disrespectful, either (...) to nature or to animals; 2) it will reduce the number of happy animals in the world; and 3) it will open the door to cannibalism. While each objection has some attraction, we ultimately find that all can be overcome. The upshot is that in vitro meat production is generally permissible and, especially for ethical vegetarians, worth promoting. (shrink)

This chapter provides an introduction to panpsychism, panprotopsychism, and neutral monism to an interdisciplinary audience.

While philosophers are often concerned with the conditions for moral knowledge or justification, in practice something arguably less demanding is just as, if not more, important – reliably making correct moral judgments. Judges and juries should hand down fair sentences, government officials should decide on just laws, members of ethics committees should make sound recommendations, and so on. We want such agents, more often than not and as often as possible, to make the right decisions. The purpose of this paper (...) is to propose a method of enhancing the moral reliability of such agents. In particular, we advocate for a procedural approach; certain internal processes generally contribute to people’s moral reliability. Building on the early work of Rawls, we identify several particular factors related to moral reasoning that are specific enough to be the target of practical intervention: logical competence, conceptual understanding, empirical competence, openness, empathy and bias. Improving on these processes can in turn make people more morally reliable in a variety of contexts and has implications for recent debates over moral enhancement. (shrink)

In their recent article, Koplin, Gyngell and Savulescu (2019) assess the viability of the precautionary principle as a decision-making tool to determine whether and under what circumstances germline gene editing should proceed. While their survey of different forms of the precautionary principle is illuminating, the most novel contribution is a new account of the precautionary principle, what they dub the Sufficientarian Precautionary Principle (SPP). SPP is meant to avoid several problems with existing accounts, while comporting with at least some of (...) the intuitive force behind the general idea of the precautionary principle. However, as it is only one subsection of a larger paper, SPP is not fully worked out. In this brief response, I will flesh out some problems with SPP as a decision-making tool – particularly that there is a lack of adequate normative justification for adopting it. While this does not constitute a decisive refutation of the approach, SPP needs considerable refinement and clarification before it can be considered viable for use in decision-making. (shrink)

Many currently working on a Russellian notion of perceptual acquaintance and its role in perceptual experience (including Campbell 2002a, 2002b, and 2009 and Tye 2009) treat naïve realism and indirect realism as an exhaustive disjunction of possible views. In this paper, I propose a form of direct realism according to which one is directly aware of external objects and their features without perceiving a mind-dependent intermediary and without making any inference. Nevertheless, it also maintains that the qualitative character of perceptual (...) experience is a feature of our internal states of sentient awareness and so is to be distinguished from the features of objects in the perceptual scene. On this proposal, we are pre-reflectively aware of the qualitative character of our sensations simply in virtue of having them, and we are non-inferentially aware of external objects and their features by being attuned to what the occurrence of our sensations tells us about the rest of the world. Consequently, we are presented with, and thus acquainted with, both the external objects and the qualitative character of our sensory experiences, albeit in very different ways. Drawing on resources from Perry (2001) and Searle (in draft), I explain how perceptual experience has this “two-faced presentational character”. (shrink)

Beauvoir’s Ethics of Ambiguity appears to defend a distinctly existentialist, deontologically-constrained version of consequentialism. On that interpretation, her belief that freedom consists in the real possibilities provided by our concrete situation leads her to reject Kantian autonomy to allow for some consequentialist decisions, while her belief that our situation derives its meaning from freely-chosen projects leads her to limit such choices to their consequences for situated freedom rather than general happiness. However, I will argue that Beauvoir’s view is better understood (...) as a non-deontological, internal critique of consequentialism, rooted in Marx’s historical materialism rather than her existentialist commitments. Beauvoir challenges consequentialism’s tendency to evaluate decision-making over actions, and intended or predicted consequences over actual ones, considering consequences during a limited time-frame despite their variable, contingent future value. In other words, consequentialism is insufficiently consequentialist, a view rooted in historical materialism in two ways. First, her materialist understanding of freedom as situated possibility requires an ethics that prioritizes real rather than projected consequences. Materialist consequentialism acknowledges outcomes are never final and so refuses to assign unambiguous moral value. A decision’s ethical value is preserved only to the degree that the value of its real consequences for existing individuals’ projects is maintained into the indefinite future. Second, her view that value is historical, a human creation based in our actual situation’s contingent utility to our individually chosen projects, denies that any consequence has a fixed value independent of the historical development of humanity as realized through individual choices. Historical-materialist consequentialism demands moral agents retroactively reassess the moral status of every action in order to repair consequences that have, because of changing human purposes, become obstacles to freedom. Together, these historical materialist constraints ground Beauvoir’s demand for an ethics that is ambiguous in principle as well as practice: no decision, action, or consequence has a fixed moral value because consequences are always incomplete and, even when they do not change, the projects that give them value change. While compatible with existentialist conceptions of freedom, responsibility, and authenticity, her ethics does not require such commitments, making it more Marxist than existentialist in character. (shrink)

Background Several jurisdictions, including Singapore, Australia, New Zealand and most recently Ireland, have a public interest or public good criterion for granting waivers of consent in biomedical research using secondary health data or tissue. However, the concept of the public interest is not well defined in this context, which creates difficulties for institutions, institutional review boards and regulators trying to implement the criterion. Main text This paper clarifies how the public interest criterion can be defensibly deployed. We first explain the (...) ethical basis for requiring waivers to only be granted to studies meeting the public interest criterion, then explore how further criteria may be set to determine the extent to which a given study can legitimately claim to be in the public interest. We propose an approach that does not attempt to measure magnitude of benefit directly, but rather takes into account metrics that are more straightforward to apply. To ensure consistent and justifiable interpretation, research institutions and IRBs should also incorporate procedural features such as transparency and public engagement in determining which studies satisfy the public interest requirement. Conclusion The requirement of public interest for consent waivers in secondary biomedical research should be guided by well-defined criteria for systematic evaluation. Such a criteria and its application need to be periodically subject to intra-committee and intra-institution review, reflection, deliberation and amendment. (shrink)

In this paper I argue that Nietzsche’s rejection of egalitarianism depends on equivocation between distinct conceptions of power and equality. When these distinct views are disentangled, Nietzsche’s arguments succeed only against a narrow sense of equality as qualitative similarity (die Gleichheit as die Ähnlichkeit), and not against quantitative forms that promote equality not as similarity but as multiple, proportional resistances (die Gleichheit as die Veilheit and der Widerstand). I begin by distinguishing the two conceptions of power at play in Nietzsche’s (...) arguments, power as quantitative superiority of ability and as qualitative feeling of power (das Gefühl der Macht), an affective state that does not directly correlate with quantitative ability and, because based in resistance (der Widerstand), requires relative equality as its condition. Nietzsche presents four principal arguments against egalitarianism, each concluding that equality harms the flourishing of humanity’s highest individuals. First, equality directly promotes qualitative similarity (die Ähnlichkeit) at the expense of multiplicity (die Vielheit). Second, because material inequalities ground the ‘pathos of distance’ (the recognition of spiritual inequality), equality indirectly undermines the desire for self-development. Third, because it opposes aristocratic conditions, egalitarianism promotes a form of liberalism that removes conditions of constraint necessary to human development. Finally, equality is a less efficient means to human enhancement, which is best promoted through unequal distribution of resources to the most able individuals. I argue that in each case Nietzsche’s argument succeeds only if interpreted according to the quantitative conception of power as superiority, but fails when we also consider the qualitative conception of power as feeling. For the promotion of an individual’s qualitative power is compatible with quantitative power equality. Moreover, because power is felt only in resistance, the feeling of power requires relative equality as its precondition—an alternate sense of equality construed, not as qualitative similarity, but as quantitative resistance from proportional counter-powers. I conclude that Nietzsche’s commitment to the promotion of humanity’s highest individuals does not entail the rejection of moral egalitarianism in every form and even supports certain forms. (shrink)

Volume 20, Issue 2, February 2020, Page 20-22.

In this paper, I argue that Nietzsche’s published works contain a substantial, although implicit, argument for the will to power as ontology—a critical and descriptive, rather than positive and explanatory, theory of reality. Further, I suggest this ontology is entirely consistent with a naturalist methodology. The will to power ontology follows directly from Nietzsche’s naturalist rejection of three metaphysical presuppositions: substance, efficient causality, and final causality. I show that a number of interpretations, including those of Clark, Schacht, Reginster, and Richardson, (...) are inconsistent with Nietzsche’s naturalism, because they presuppose efficient or final causality. In contrast, I argue that the will to power is not an explanatory theory, but a description of the basic, necessary character of reality, designed to critically reveal and minimize metaphysical presuppositions—to reject false explanations of reality and human behavior. It avoids substance-metaphysics by describing reality as will, a causal process without discrete efficient causes or agents. It eliminates efficient causality by describing events as maximal manifestations of power, rather than as agent-actualized potentialities. Finally, it opposes teleology by describing life as tending toward the activity of resistance as such, rather than toward explanatory end-states, such as the accumulation of power or overcoming of resistances. (shrink)

This chapter examines Bertrand Russell's developing views--roughly from 1911 to 1918--on the nature of introspective knowledge and subjects' most basic knowledge of themselves as themselves. It argues that Russell's theory of introspection distinguishes between direct awareness of individual psychological objects and features, the presentation of psychological complexes involving those objects and features, and introspective judgments which aim to correspond with them. It also explores his transition from believing that subjects enjoy introspective self-acquaintance, to believing that they only know themselves by (...) self-description, and eventually to believing that self-knowledge is a logical construction. It concludes by sketching how Russell's views about introspection and self-knowledge change as a result of his adoption of neutral monism. Along the way, it sheds additional light on his acquaintance-based theory of knowledge, preference for logical constructions over inferred entities, and gradual progression towards neutral monism. (shrink)

Mitochondrial replacement therapy requires oocytes of women whose mitochondrial DNA will be transmitted to resultant children. These techniques are scientifically, ethically and socially controversial; it is likely that some women who donate their oocytes for general in vitro fertilisation usage would nevertheless oppose their genetic material being used in MRT. The possibility of oocytes being used in MRT is therefore relevant to oocyte donation and should be included in the consent process when applicable. In present circumstances, specific consent should be (...) obtained. However, once MRT becomes more routine, such consent could be incorporated into the general consent process for oocyte donation. The reported lack of proper consent for MRT from the oocyte donor in the first baby born via the technique is an ethical failing and should be corrected in any future practice of MRT. (shrink)

It is generally unquestioned that human subjects research review boards should assess the ethical acceptability of protocols. It says so right on the tin, after all: they are explicitly called research ethics committees in the UK. But it is precisely those sorts of unchallenged assumptions that should, from time to time, be assessed and critiqued, in case they are in fact unfounded. John Stuart Mill's objection to suppressers of dissent is instructive here: “If the opinion is right, they are deprived (...) of the opportunity of exchanging error for truth: if wrong, they lose, what is almost as great a benefit, the clearer perception and livelier impression of truth, produced by its collision with error”.1 Andrew Moore and Andrew Donnelly's compelling article, “The job of ‘ethics committees’”, is just this sort of challenge to conventional wisdom, a rejection of the notion that review boards should be considering ethical matters at all.2 If true, we should be substantially reforming our research ethics policies. And if false, rebuttals would help strengthen and ground the otherwise unquestioned assumption of the role of ethics committees. As it happens, I will argue that their critiques fall into the second category. While mistaken, they present a valuable opportunity to clarify the role of ethics committees and their relationship to relevant codes. In particular, I will defend a hybrid account where codes have strict primacy, but leave significant room for review boards …. (shrink)

With the recent report of a live birth after use of Mitochondrial replacement therapy, sometimes called ‘Three-parent IVF’, the clinical application of the technique is fast becoming a reality. While the United Kingdom allows the procedure under regulatory scrutiny, it remains effectively outlawed in many other countries. We argue that such prohibitions may violate individuals’ procreative rights, grounded in individuals’ interest in genetic affinity. The interest in genetic affinity was recently endorsed by Singapore’s highest court, reflecting an emphasis on the (...) importance of biological ties found across the globe. We apply that reasoning to make the case for a right to ‘Three-parent IVF’. (shrink)

This chapter considers how the adoption of autonomous weapons systems (AWS) may affect jus ad bellum principles of warfare. In particular, it focuses on the use of AWS in non-international armed conflicts (NIAC). Given the proliferation of NIAC, the development and use of AWS will most likely be attuned to this specific theater of war. As warfare waged by modernized liberal democracies (those most likely to develop and employ AWS at present) increasingly moves toward a model of individualized warfare, how, (...) if at all, will the principles by which we measure the justness of the commencement of such hostilities be affected by the introduction of AWS, and how will such hostilities stack up to current legal agreements surrounding their more traditional engagement? This chapter claims that such considerations give us reason to question the moral and legal necessity of ad bellum proper authority. (shrink)

This paper draws on Friedrich Nietzsche’s work to defend the (admittedly non-Nietzschean) conclusion that a non-liberal egalitarian society is superior in two ways: first, as a moral ideal, it does not rest on questionable claims about essential human equality and, second, such a society would provide the optimal psychological and political conditions for individual wellbeing, social stability, and cultural achievement. I first explain Nietzsche’s distinction between forms of egalitarianism: noble and slavish. The slavish form promotes equality, defined negatively as the (...) elimination of privilege. It is non-liberal in its prioritization of equality over the interests of the advantaged. Nietzsche rejects both slavish egalitarianism and liberalism for the same reasons: they questionably assume the equal value of all persons, and they harm cultural achievement, sacrificing the potential of those who are most valuable to cultural development to the interests of the majority. Noble egalitarianism, in contrast, exemplifies Nietzsche’s conception of justice as ‘equality among equals’. It demands that individuals of equal worth or power (such as members of an artistic or political elite) treat each other as what they, in fact, are: equals. It avoids asserting essential equality, demanding instead—against both slavish and liberal forms—respect on the basis of shared superiority. And it escapes the charge of harm to cultural development, commanding respect only where equality already exists. Although Nietzsche quickly assumes that ‘noble egalitarianism’ requires the rejection of all forms of universal egalitarianism, concluding that we should ‘never make equal what is unequal’, in fact it only entails the rejection of slavish methods: equalization through harm to the advantaged. However, non-liberal forms of egalitarianism can be ‘noble’, promoting equality without harm to the advantaged—through, for example, unequal distribution of resources, the equalization of economic opportunities, and economic regulation to prevent the creation of substantial wealth disparities. If egalitarianism can ‘make equal’ without slavish methods, then Nietzsche’s demand for ‘equality for equals’ applies to the newly equal, too. More importantly, his moral psychology of power—the view that our source of happiness and incentive to self-development is the feeling of power in relation to equal resistance or ‘opponents who are our equals’ —supports the superiority of a nobly-achieved, non-liberal egalitarian society. For achieved, practical equality of wealth and opportunity would optimize conditions for the feeling of power: a balance of equal, oppositional powers serving as mutual limitation and resistance. Such a society is superior in three ways. First, it maximizes social happiness by promoting and maintaining the feeling of power in all. Liberal and aristocratic societies, in contrast, allow radical inequalities that not only diminish the power of the disadvantaged, but diminish the opportunities of the advantaged to encounter equal resistance, thus undermining the happiness of all. Second, it promotes social stability by preserving a balance of powers that prevents domination and exploitation, in contrast to the inevitable class conflicts of aristocratic and liberal societies. Finally, it promotes cultural achievement, since the feeling of power in relation to proportional resistance is the psychological incentive for self-development and cultural achievement. (shrink)

The Blood of Others begins at the bedside of a mortally wounded Résistance fighter named Hélène Bertrand. We encounter her from the point of view of Jean Blomart, her friend and lover, who recounts the story of their relationship : their first meeting, unhappy romance, bitter breakup, and eventual reunion as fellow fighters for the liberation of occupied France. The novel invites the reader to interpret Hélène and Jean’s story as one of positive ethical development. On this progressive reading, although (...) both characters are initially mired in bad faith and ethical irresponsibility, they ultimately transform themselves into ethically exemplary figures. Through their participation in violent political resistance against the occupation, they recognize their responsibility to humanity and actualize that responsibility in the form of positive political engagement. I will argue, on the contrary, that Jean and Hélène exhibit a unique form of bad faith that Beauvoir identifies in The Ethics of Ambiguity, a dangerous form of bad faith, distinct from the Sartrean conception, that promotes the indiscriminate use of violence for political ends. (shrink)

Ethical debates about liberal eugenics frequently focus on the supposed unnaturalness of its means and possible harm to autonomy. I present a Nietzsche-inspired critique focusing on intention rather than means and harm to abilities rather than to autonomy. I first critique subjective eugenics, the selection of extrinsically valuable traits, drawing on Nietzsche’s notion of ‘slavish’ values reducible to the negation of another’s good. Subjective eugenics slavishly evaluates traits relative to a negatively evaluated norm (eg, above-average intelligence), disguising a harmful intention (...) to diminish the relative value of that norm. I then argue there is no objective form of eugenics on the Nietzschean ground that abilities are not valuable intrinsically; they are valuable only if one possesses the relative power to exercise them. Abilities frustrated by conflict with other abilities or environment are harmful, while disabilities that empower one’s other abilities are beneficial. Consequently, all forms of eugenics are subject to the prior ethical critique of subjective eugenics. (shrink)

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

Freud introduces his dualistic theory of the life and death drives in Beyond the Pleasure Principle. Much of that essay is devoted to the justification of the death drive, while little is said in defense of the introduction of “life drives” and “Eros,” which he claims are simply an extension of his libido theory from the psychological into the biological realm. In this essay, I argue that Eros is, on the contrary, fundamentally incompatible with Freud’s metapsychology. I first show that (...) Freud’s theory of society permits the production and preservation of social bonds only through the restraint of sexual aims rather than, as the theory of Eros would require, through the satisfaction of sexual drives. I then demonstrate that Eros is incompatible with three key elements of Freud’s metapsychology: the theories of the drives, the pleasure principle, and the principle of constancy. Finally, I argue that the death drive is indistinguishable from the early and late theories of the principle of constancy. Consequently, it is the death drive, and not Eros, that is merely an extension of the original libido theory. Because Eros is incompatible with the very foundations of Freud’s metapsychology, his drive theory can only consistently be interpreted as a monism of the death drive. (shrink)

Freud’s discussion of uncanny [unheimlich] experiences focuses on their peculiar ambivalence. On his view, the uncanny is a paradoxical feeling of both familiarity and alienation. While Freud’s analysis of this paradoxical feeling does succeed in explaining it away, it does little to explain it. One might expect a psychoanalytical demystification of the real experience that is hidden behind the superstitious overtones of uncanny experiences. Instead, the uncanny is attributed rather anti- climactically to the combination of a previous superstition (maintained unconsciously) (...) and an entirely coincidental verification of that superstition. The implication is that there is no uncanny per se. There is no distinctive category of experience, the unique character of which tends to cause or encourage superstitious beliefs; rather, such beliefs are prerequisite to having the experience. In other words, the experience suits the belief, and not vice-versa. The uncanny is the fantasized verification of a repressed fantasy. It involves a breakdown of the reality principle and the projection of beliefs into the external world, rather than a peculiarity of feeling that can be linked intrinsically to a specific category of experience. I do not intend to reject this analysis in its entirety. The basic structure, repression and return, is sound. However, Freud’s analysis of the uncanny, which resolves uncanny ambivalence into the separate categories of consciousness and unconsciousness, merely reinstates the problematical opposition of das heimliche and das unheimliche, familiar and unfamiliar, within the mind rather than in the external world. The coincidence of the two feelings in uncanny experience cannot be explained without an intervening stage between repression and return. I will suggest that Freud’s characterization of uncanniness as the return, in superstition, of the repressed is a misplacement of the experience of uncanniness. The aesthetical feeling is the cause of, but not identical to, the projected superstitions and ideas which surround it. An explanation of the feeling of uncanniness must fall not on the side of the repressed, but on the side of consciousness. The import of my position is that the feeling of uncanniness refers, in a manner of speaking, to something “real,” rather than merely to infantile ideas projected upon the external world. Freud’s explanation makes the unconscious a kind of scapegoat to be blamed for imposing fundamentally irrational beliefs into our interpretation of present experience, in that way preserving a model of the conscious ego as autonomous, fundamentally attuned to reality and ultimately independent of the unconscious. I will argue, on the contrary, that the experience of the uncanny is not merely a falling back into irrational or infantile beliefs, but an experience of a deep disunity in personhood that rightly causes us to question our everyday confidence in the unity, independence, and rationality of our conscious sense of self. The ambivalence of the feeling has its source in an irresolvable ambivalence that can exist in consciousness, and not simply in an analytically resolvable psychical ambivalence between consciousness and the unconscious. (shrink)

In this essay I suggest that Heidegger’s Being and Time provides a ground for ethics in the notion of Dasein’s ‘Being-guilty.’ Being-guilty is not a ground for ethics in the sense of a demonstration of the moral ‘ought’ or a refutation of moral skepticism. Rather, Being-guilty serves as a foundation for ethical life in a way uniquely suited to a phenomenological form of ethics, a way that clarifies, from a phenomenological point of view, why the traditional approach to ethics is (...) misguided. The traditional attempt to ground ethics through demonstration or refutation depends upon a misunderstanding of obligation as an imposition that is distinct from, and inflicted upon, the subject in a way that is in need of justification. Heidegger’s conception of Being-guilty, on the contrary, identifies the basis of moral obligation in a form of primary selfobligation that is constitutive of human nature, rather than an imposition upon it. Although primordial guilt or self-obligation does not justify ethical obligation, it does ‘ground’ ethics. For it is the primary source and support of our ethical activity in two distinct senses. First, it serves as the condition for the possibility of our indebtedness to others—it enables us to be morally obligated. It enables moral obligation towards others by determining Dasein as ontologically indebted to care for its own being—a being which is, in turn, ontologically determined as care for others. Second, Being-guilty provides a criterion for distinguishing what we call ethical and unethical behavior. Ethical behavior is distinguished according to the appropriateness of one’s care for the other according to proper recognition of the nature of the Other’s Being as Dasein. (shrink)

Given the sordid history of injustices linking genetics to race and ethnicity, considerations of justice are central to ensuring the responsible development of precision medicine programmes around the world. While considerations of justice may be in tension with other areas of concern, such as scientific value or privacy, there are also tensions between different aspects of justice. This paper focuses on three particular aspects of justice relevant to this precision medicine: social justice, distributive justice and human rights. We describe the (...) implications of each for the use of race and ethnicity in precision medicine, and also how they intersect and potentially conflict with each another. By attending to these intersections, we aim to enrich and add nuance to debates over how best to proceed with precision medicine initiatives. (shrink)

Michael Hauskeller (“Reflections from a Troubled Stream: Giubliani and Minerva on ‘After-Birth Abortion’) has recently suggested that we should resist rationalist tendencies in moral discourse: “[I]s not all morality ultimately irrational? Even the most strongly held moral convictions can be shown to lack a rational basis.” (Hauskeller 2012, p. 18) Hauskeller was responding to Alberto Giubliani and Francesca Minverva’s (2012) recent defense of the permissibility of killing infants, but his anti-rationality arguments have wide-reaching implications. Yet pace Hauskeller, rationality is indeed (...) of crucial importance to any ethical argument. We should not abandon rationality for the sake of refuting one discomforting hypothesis; instead, rationality must be rigorously employed, here and elsewhere, in the search for the truth. (shrink)

Individual health assessments (IHAs) for asymptomatic individuals provide a challenge to traditional distinctions between patient care and non-medical practice. They may involve undue radiation exposure, lead to false positives, and involve high out-of-pocket costs for recipients. A recent paper (Journal of the American College of Radiology 13(12): 1447–1457.e1, 2016) has criticised the use of IHAs and argued that recipients should be classified as ‘presenters’, not ‘patients’, to distinguish it from regular medical care. I critique this classificatory move, on two grounds: (...) one, it is conceptually suspect. Two, it obviates the medical ethics framework for IHAs, potentially exposing recipients of IHAs to lower standards of oversight and protection. Responsible regulation of IHAs will be easier to ethically justify if those seeking IHAs are considered patients and not merely presenters. (shrink)

Despite his rejection of the metaphysical conception of freedom of the will, Nietzsche frequently makes positive use of the language of freedom, autonomy, self-mastery, self-overcoming, and creativity when describing his normative project of enhancing humanity through the promotion of its highest types. A number of interpreters have been misled by such language to conclude that Nietzsche accepts some version of compatibilism, holding a theory of natural causality that excludes metaphysical or “libertarian” freedom of the will, while endorsing morally substantial alternative (...) conceptions of freedom, autonomy, and responsibility. I argue to the contrary that although Nietzsche’s rejection of... (shrink)

Nietzsche’s Immoralism begins a two-volume critical reconstruction of a socialist, democratic, and non-liberal Nietzschean politics. Nietzsche’s ideal of amor fati (love of fate) cannot be individually adopted because it is incompatible with deep freedom of agency. However, we can create its social conditions thanks to an under-appreciated aspect of his will-to-power psychology. We are driven not toward domination and conquest but toward resistance, contest, and play―a heightened feeling of power provoked by equal challenges that enables the non-instrumental affirmation of suffering. (...) This incompatibilist, anti-teleological psychology leads to Nietzsche’s distinctive immoralism: the abandonment of cultural means of human improvement for a historical materialist politics of breeding that produces future higher types through changes to our political order’s material conditions. Politics becomes first philosophy: it is not grounded in moral values but is instead the very source of their legitimacy. Moreover, despite Nietzsche’s professed aristocratism, his immoralism offers a stronger foundation for a renewed left, attacking conservative politics at its very root: the belief in moral order, authority, and responsibility. (shrink)

This book completes the project, begun in Nietzsche’s Immoralism: Politics as First Philosophy, of critically reconstructing a Nietzschean left politics. Nietzsche's incompatibilist ideal of amor fati requires reconceiving legitimacy as the breeding of a people whose material conditions enable it to affirm its social order. Justice is founded in a future, higher type’s right to exist against present individuals who internalize the contradictions of past societies. In opposition to Nietzsche’s self-undermining aristocratism, this right can only be realized through a universal (...) promotion of the pluralistic unity of the manifold soul, secured by an equally manifold form of democracy. Against the covert aristocratism of liberal proceduralism, authentic democracy produces a true people grounded in shared, concrete happiness, requiring a comprehensive egalitarianism maintained by a permanent socialist state and achievable only through a populist, coalitional politics across identities that radically transforms the material conditions of our shared social life. (shrink)

Both Theodor Adorno and Walter Benjamin borrow from Freudian theory in their analyses of fetishism’s relation to the contemporary reception of cultural products. I will argue that both authors have confused the Marxian and Freudian theories of fetishism, resulting in mistaken conclusions about artistic reception. By disentangling the Marxian and Freudian elements in both authors’ positions, I want to show that 1) Adorno’s characterization of regressive listening implies, contrary to his intentions, that the current reception of artwork is in fact (...) antagonistic to fetishism, and that 2) his criticism of Benjamin’s optimism toward “reception in distraction” is nevertheless justified. If I am correct, it may be necessary to reassess Adorno’s demand for asceticism in advanced art. The current danger may not be “fetishism” at all, but rather the troublesome consequences of fetishism’s decline. (shrink)

In the following essay, I argue that in the case of some works of art, moral evaluation should not play a role in artistic appraisal. While I reject the strong ethicist’s view—the view that moral evaluation may inform the artistic evaluation of any artwork—I will not do so in favor of the aestheticist’s position. The aestheticist argues for a rigid distinction between the moral and aesthetic evaluation of an artwork. On this view, the moral status of the work is independent (...) of and irrelevant to artistic value. This view would allow us, for example, to evaluate Leni Reifenstahl’s film The Triumph of the Will as a superior work of cinematic art, while at the same time condemning it on moral grounds. Rather than support a strict separation of aesthetic and moral elements in an artwork, I will suggest that in the case of certain types of artwork, it is inappropriate to use moral criteria in their artistic evaluation—even though the work’s moral content contributes to its artistic value. This is the case in artworks that (1) are “interrogative” in form and (2) have moral dilemmas as their principal theme. Briefly put, an interrogative artwork is one that poses a question or problem that remains unresolved in the work. I will begin by explaining in more detail what I mean by an interrogative artwork. Using the example of Duchamp’s “ready-made” sculpture Fountain, I will argue that it is inappropriate to artistically evaluate such works by appeal to criteria that they themselves call into question. I will then turn to the specific issue of morally interrogative artworks. I will consider Mark Twain’s The Adventures of Huckleberry Finn as a paradigmatic case of an interrogative artwork that poses an unresolved moral problem, and will contrast my own rejection of the moral appraisal of the novel to Wayne Booth’s attempt to provide a morally informed positive assessment of the novel. (shrink)

The predominant view is that a study using health data is observational research and should require individual consent unless it can be shown that gaining consent is impractical. But recent arguments have been made that citizens have an ethical obligation to share their health information for research purposes. In our view, this obligation is sufficient ground to expand the circumstances where secondary use research with identifiable health information is permitted without explicit subject consent. As such, for some studies the Institutional (...) Review Board/Research Ethics Committee review process should not assess the practicality of gaining consent for data use. Instead the review process should focus on assessing the public good of the research, public engagement and transparency. (shrink)

Nietzsche’s late writings present a value opposition of health and decadence based in his conception of organic life. While this appears to be a moral ideal that risks the naturalistic fallacy of directly deriving norms from facts, it instead describes a meta-ethical ideal: the necessary conditions for any kind of moral agency. Nietzsche’s ideal of health not only evades but also dissolves the naturalistic fallacy by suggesting that the specific content of morality is irrelevant. If health is measured by power (...) over one’s drives rather than the environment, then the source of moral conflict—organic life’s essential tendency toward domination—is surmounted by successful integration of any moral norms, regardless of content. Nietzsche’s concept of health draws on his characterization of organic life as essentially ‘exploitation’: growth through domination of the environment (BGE 259, GM II: 12). In animals, power coincides with happiness, while health and decadence track the correspondence between instinct and happiness (TI II: 11). This simple picture is complicated by the Genealogy, where Nietzsche depicts human nature as an animal illness caused by civilization’s disruption of the natural correspondence of instinct and happiness. Civilization shapes this ‘sick animal’ into the distinctly human ‘sovereign individual’ (GM III: 13, II: 2), restoring the harmony of instinct and happiness in an internal hierarchy of drives. So, sovereign individuality is a distinctly human model of health. Although life is exploitation, human health does not coincide with greater environmental power, but rather an internal qualitative expansion of power: greater variety and tension among drives, greater ‘wholeness in diversity’ in the ‘social structure’ of the self (BGE 212, 12). Nonetheless, health is not a moral criterion, but instead the precondition of moral agency. The subordination of drives to a commanding hierarchy grounds the ability to uphold any moral principles at all, to make and keep promises to oneself and others. Moral agency coincides, in turn, with overcoming the source of moral conflict in organic life’s drive for growth. The unification of opposing drives provides pleasure in power over oneself rather than one’s environment, the ‘happiness of high tension’ among drives (BGE 260), and in environmental resistance, a need for ‘equal opponents’ (TI IX: 38, EH 1: 7). Consequently, Nietzsche’s meta-ethical ideal supports a moral pluralism that supports any moral content. Moral conflicts arise precisely to the degree individuals are incapable of achieving moral agency, but they dissolve as moral agency of any kind is more widely achieved. (shrink)

Nietzsche’s psychological theory of the drives calls into question two common assumptions of ideology critique: 1) that ideology is fetishistic, substituting false satisfactions for true ones, and 2) that ideology is falsification; it conceals exploitation. In contrast, a Nietzschean approach begins from the truth of ideology: that capitalism produces an authentic contentment that makes the concealment of exploitation unnecessary. And it critiques ideology from the same standpoint: capitalism produces pleasures too efficiently, an overproduction of desire that is impossible to sustain (...) indefinitely. Nietzsche’s concept of the drives (Trieben) is grounded in his theory of the will to power. In contrast to Freud’s view that drives aim at satiation, pleasure through stimulus reduction, in Nietzsche’s view, they aim primarily at the “feeling of power” and the “happiness of high tension.” Nietzsche sees the desire for satiation as a symptom of weakness, a secondary, contingent aim that is incompatible with the fundamental drive to sustain and heighten the feeling of tension that accompanies strong desire. While the Freudian subject desires satisfaction, the Nietzschean subject is paradoxically frustrated by satisfaction, finding happiness in desire sustained by resistance and tension. If individuals desire desire as such, then exploitation and immiseration are not necessarily incompatible with their happiness. Consequently, we must reject the view that ideology is fetishistic: capitalism does not depend on an ersatz satisfaction in the commodity, a transferal of value from quality to quantity, use value to exchange value. Capitalism authentically satisfies desire precisely through its exploitative economic structure. The independence and unpredictability of the value of commodities and the immiseration of laborers produces discontents that enhance rather than frustrate desire. By continually introducing new, initially inaccessible commodities, then overcoming their inaccessibility through overproduction, capitalism sustains and intensifies desires. It promotes happiness not by satisfying wants but generating them, feeding the desire for desire, for the intensity of feeling that the brief pleasures of satiation would destroy. The commodity is not, then, a fetish, not a false satisfaction or aim, but a means, a prop that supports and sustains satisfaction as continued desire. Consequently, we must also reject the view that ideology is falsification: capitalism’s efficient production of happiness obviates the need to conceal its nature. Individuals tolerate capitalism not out of ignorance of exploitation but indifference to it; they prefer real happiness to a merely possible justice that might come at its expense. The critique of ideology must begin by acknowledging its truth. Rather than deny the real satisfactions of capitalism, it must demonstrate that they are unsustainable. (shrink)

Nietzsche implicitly endorses a positive value system grounded in his concept of the will to power, a “noble” alternative to the “slavish” and life-denying values that he believes characterize modern European morality. His own power-affirming value system is usually presented amorally: as an alternative to morality, rather than as a competing morality. Most commentators believe this is necessarily so: because Nietzsche founds his values in the affirmation of power, they are incompatible with the concern for the well-being of others that (...) is characteristic of any authentic morality. This paper argues, on the contrary, that Nietzsche’s noble, power-affirming values are fully compatible with morality. It defends this view by rejecting two common misconceptions about Nietzsche’s philosophy: 1) the view that Nietzsche’s concept of the will to power is inseparable from domination, and 2) the view that noble values require and actively promote social hierarchy. (shrink)

In this paper, I directly oppose Nietzsche ’s endorsement of a morality of breeding to all forms of comparative, positive eugenics: the use of genetic selection to introduce positive improvement in individuals or the species, based on negatively or comparatively defined traits. I begin by explaining Nietzsche ’s contrast between two broad categories of morality: breeding and taming. I argue that the ethical dangers of positive eugenics are grounded in their status as forms of taming, which preserves positively evaluated character (...) traits and types through the active de-selection of negatively evaluated ones. The morality of taming is not a form of selection, but de-selection: the production of counter or anti-traits and types. Consequently, in its attempt to improve humanity, it tends necessarily toward violence as the elimination of de-selected forms of human life. In contrast, Nietzsche ’s morality of breeding selects traits and types by protecting them from de-selection—specifically, by attacking moral ideas, values, and practices designed to eliminate them. It tends not towards the destruction but preservation of types; its negativity targets not life but the ideas that disable, disempower, and eradicate forms of life. I argue, further, that the fundamental ethical difference between breeding and taming, and so between Nietzschean morality and eugenics, is found in their attitudes toward the natural world. The violence of eugenics as taming is grounded in its status as anti-natural, while Nietzsche ’s morality of breeding resists violence through its foundational affirmation of the conditions and limitations of the natural world: its resolute moral naturalism. Finally, I apply my interpretation of breeding and taming to two cases of comparative, positive eugenics: the historical case of racial eugenics and the so-called “designer baby” case in contemporary liberal eugenics. Nietzsche must condemn both as forms of the anti-natural morality of taming, to which the morality of breeding is diametrically opposed. (shrink)

The future of health research will be characterised by three continuing trends: rising demand for health data; increasing impracticability of obtaining specific consent for secondary research; and decreasing capacity to effectively anonymise data. In this context, governments, clinicians and the research community must demonstrate that they can be responsible stewards of health data. IRBs and RECs sit at heart of this process because in many jurisdictions they have the capacity to grant consent waivers when research is judged to be of (...) particular value. However, several different terms are used to refer to this value, indicating a lack of conceptual clarity regarding the appropriate test for access to health data for research without consent. In this paper we do three things. First we describe the current confusion and instability in terminology relating to public interest in the context of consent waivers. Second we argue for harmonisation of terminology on the grounds of clarity, transparency and consistency. Third we argue that the term ‘public interest’ best reflects the normative work required to justify consent waivers because it is the broadest of the competing terms. ‘Public interest’ contains within its scope positive and negative implications of a study, as well as welfare, justice and rights considerations. In making this argument, we explain the normative basis for consent waivers, and provide a starting place for further discussion about the precise conditions in which a given study can be said to advance the public interest. Ipsos MORI study found that: … the public would be broadly happy with administrative data linking for research projects provided Those projects have social value, broadly defined. Data are de-identified. Data are kept secure. Businesses are not able to access the data for profit. (shrink)

While much has been made of the similarities between the work of Nietzsche and Freud, insufficient attention has been paid to their differences. Even where they have been noted, the degree of these differences, which sometimes approaches direct opposition, has often been underestimated. In the following essay, I will suggest that on the topic of conscience Nietzsche and Freud have radically opposed views, with profoundly different moral consequences. Despite superficial similarities, Nietzsche’s conception of conscience is opposed to that of Freud (...) in almost every conceivable way. For Freud, conscience is primarily associated with bad will, repression, subordination to social prohibition, and the feeling of guilt. For Nietzsche, conscience is primarily related to affirmation, memory, individual sovereignty, and the feelings of pride and power. To be sure, Freudian “bad conscience” has its parallel in Nietzsche’s philosophy—but only as a modality of conscience, not as its foundation. Freudian conscience is, on the contrary, an essentially bad conscience. (shrink)

In Three Essays on the Theory of Sexuality, Freud rejects the notion of a biologically determined connection of instinct to object, a position which helps him avoid the designation of all variations from heterosexuality as either “degenerate” or “pathological.” However, the gender roles and relations commonly attributed to heterosexuality are already implicit in his understanding of sexual instinct and aim. Consequently, even variations from the normal sexual object and aim exemplify, on his interpretation, the clichéd hierarchical opposition of femininity and (...) masculinity. Freud’s theory of sexuality thus implies that the erotic bond is inevitably one of domination, and that the only possible human relation is one of subject to object, activity to passivity, whole to part, and owner to property. My primary intention in this paper is to explore, in Freud’s analysis of fetishism, traces of an alternate possibility to oppositional hierarchical gender roles and the negative forms of social relation that rely upon them. While Freud---in keeping with common opinion---characterizes sexual fetishism as a distinctly masculine phenomenon, the text also supports a more interesting interpretation: that the non-pathological fetishist evades the construction of gender in terms of sexual roles and that, consequently, fetishism can serve as a critique of Freud’s masculine model of sexual instinct and relation. (shrink)

[English version also available] The Blood of Others begins at the bedside of a mortally wounded Résistance fighter named Hélène Bertrand. We encounter her from the point of view of Jean Blomart, her friend and lover, who recounts the story of their relationship : their first meeting, unhappy romance, bitter breakup, and eventual reunion as fellow fighters for the liberation of occupied France. The novel invites the reader to interpret Hélène and Jean’s story as one of positive ethical development. On (...) this progressive reading, although both characters are initially mired in bad faith and ethical irresponsibility, they ultimately transform themselves into ethically exemplary figures. Through their participation in violent political resistance against the occupation, they recognize their responsibility to humanity and actualize that responsibility in the form of positive political engagement. I will argue, on the contrary, that Jean and Hélène exhibit a unique form of bad faith that Beauvoir identifies in The Ethics of Ambiguity, a dangerous form of bad faith, distinct from the Sartrean conception, that promotes the indiscriminate use of violence for political ends. (shrink)

Eighteenth-century art historian Johann Joachim Winckelmann (1717-1768) shared with Hegel a profound admiration for the art and culture of ancient Greece. Both viewed ancient Greece as, in some sense, an ideal to which the modern world might aspire—a pinnacle of spiritual perfection and originality that contemporary civilization might, through an understanding of ancient Greek culture, one day equal or surpass. This rather competitive form of nostalgia suggests a paradoxical demand to produce an original and higher state of culture through the (...) imitation of another. In Hegel’s writings, this paradox goes beyond the relation of the modern world to the ancient world—he exposes the same paradox in ancient Greece’s relation to its own predecessors. The solution to the latter paradox—the possibility of the realization of ancient Greece as an original and self-contained civilization despite its cultural debts—would also, then, be the key to repeating the success of the ancient world in the modern, the overcoming of modern Europe’s cultural debt to the ancient world. The present essay examines how this paradox is revealed and resolved in the writings of Winckelmann and Hegel, and shows how this strategy of culture production—as imputed to the ancient world and aspired to in the modern—simultaneously attempts to justify and conceal a self-deceptive practice of cultural and political conquest. My focus will be on the two writers’ interpretations of ancient Greek art since, as I will suggest, their solution to the paradox of culture production turns out to be modeled upon the role of ancient Greek art in the invention and actualization of a cultural ideal of beauty, unity, and self-containment. (shrink)