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Joseph Millum [42]Joseph R. Millum [1]
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Joseph Millum
National Institutes of Health
  1. How Payment For Research Participation Can Be Coercive.Joseph Millum & Michael Garnett - 2019 - American Journal of Bioethics 19 (9):21-31.
    The idea that payment for research participation can be coercive appears widespread among research ethics committee members, researchers, and regulatory bodies. Yet analysis of the concept of coercion by philosophers and bioethicists has mostly concluded that payment does not coerce, because coercion necessarily involves threats, not offers. In this article we aim to resolve this disagreement by distinguishing between two distinct but overlapping concepts of coercion. Consent-undermining coercion marks out certain actions as impermissible and certain agreements as unenforceable. By contrast, (...)
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  2. Health Research Priority Setting: The Duties of Individual Funders.Leah Pierson & Joseph Millum - 2018 - American Journal of Bioethics 18 (11):6-17.
    The vast majority of health research resources are used to study conditions that affect a small, advantaged portion of the global population. This distribution has been widely criticized as inequitable and threatens to exacerbate health disparities. However, there has been little systematic work on what individual health research funders ought to do in response. In this article, we analyze the general and special duties of research funders to the different populations that might benefit from health research. We assess how these (...)
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  3.  47
    Setting Priorities Fairly in Response to Covid-19: Identifying Overlapping Consensus and Reasonable Disagreement.David Wasserman, Govind Persad & Joseph Millum - 2020 - Journal of Law and the Biosciences 1:doi:10.1093/jlb/lsaa044.
    Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...)
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  4. Global Bioethics and Political Theory.Joseph Millum - 2012 - In Joseph Millum & Ezekiel J. Emanuel (eds.), Global Justice and bioethics. Oxford University Press. pp. 17-42.
    Most bioethicists who address questions to which global justice matters have not considered the significance of the disputes over the correct theory of global justice. Consequently, the significance of the differences between theories of global justice for bioethics has been obscured. In this paper, I consider when and how these differences are important. I argue that certain bioethical problems can be resolved without addressing disagreements about global justice. People with very different views about global justice can converge on the existence (...)
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  5. Lies, Control, and Consent: A Response to Dougherty and Manson.Danielle Bromwich & Joseph Millum - 2018 - Ethics 128 (2):446-461.
    Tom Dougherty argues that culpably deceiving another person into sex is seriously wrong no matter what the content about which she is deceived. We argue that his explanation of why deception invalidates consent has extremely implausible implications. Though we reject Dougherty’s explanation, we defend his verdict about deception and consent to sex. We argue that he goes awry by conflating the disclosure requirement for consent and the understanding requirement. When these are distinguished, we can identify how deceptive disclosure invalidates consent. (...)
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  6. First Come, First Served?Tyler M. John & Joseph Millum - 2019 - Ethics 130 (2):179-207.
    Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there (...)
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  7. How to Allocate Scarce Health Resources Without Discriminating Against People with Disabilities.Tyler M. John, Joseph Millum & David Wasserman - 2017 - Economics and Philosophy 33 (2):161-186.
    One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...)
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  8. The Social Value of Health Research and the Worst Off.Nicola Barsdorf & Joseph Millum - 2017 - Bioethics 31 (2):105-115.
    In this article we argue that the social value of health research should be conceptualized as a function of both the expected benefits of the research and the priority that the beneficiaries deserve. People deserve greater priority the worse off they are. This conception of social value can be applied for at least two important purposes: in health research priority setting when research funders, policy-makers, or researchers decide between alternative research projects; and in evaluating the ethics of proposed research proposals (...)
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  9. Putting a Number on the Harm of Death.Joseph Millum - 2019 - In Espen Gamlund & Carl Tollef Solberg (eds.), Saving People from the Harm of Death. Oxford University Press. pp. 61-75.
    Donors to global health programs and policymakers within national health systems have to make difficult decisions about how to allocate scarce health care resources. Principled ways to make these decisions all make some use of summary measures of health, which provide a common measure of the value (or disvalue) of morbidity and mortality. They thereby allow comparisons between health interventions with different effects on the patterns of death and ill health within a population. The construction of a summary measure of (...)
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  10. Informed Consent to HIV Cure Research.Danielle Bromwich & Joseph R. Millum - 2017 - Journal of Medical Ethics 43 (2):108-113.
    Trials with highly unfavourable risk–benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants’ motivations for enrolling in potentially high risk research with no prospect of direct benefit; and (...)
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  11. Rescuing the Duty to Rescue.Tina Rulli & Joseph Millum - 2014 - Journal of Medical Ethics:1-5.
    Clinicians and health researchers frequently encounter opportunities to rescue people. Rescue cases can generate a moral duty to aid those in peril. As such, bioethicists have leveraged a duty to rescue for a variety of purposes. Yet, despite its broad application, the duty to rescue is under-analyzed. In this paper, we assess the state of theorizing about the duty to rescue. There are large gaps in bioethicists’ understanding of the force, scope, and justification of the two most cited duties to (...)
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  12. The Foundation of the Child's Right to an Open Future.Joseph Millum - 2014 - Journal of Social Philosophy 45 (4):522-538.
    It is common to cite the child’s “right to an open future” in discussions of how parents and the state may and should treat children. However, the right to an open future can only be useful in these discussions if we have some method for deriving the content of the right. In the paper in which he introduces the right to an open future Joel Feinberg seems to provide such a method: he derives the right from the content of adult (...)
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  13. Prioritarianism for Global Health Investments: Identifying the Worst Off.Daniel Sharp & Joseph Millum - 2018 - Journal of Applied Philosophy:112-132.
    The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource (...)
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  14.  21
    Response to Open Peer Commentaries on “How Payment for Research Participation Can Be Coercive”.Joseph Millum & Michael Garnett - 2020 - American Journal of Bioethics 20 (8):W8-W11.
    Volume 20, Issue 8, August 2020, Page W8-W11.
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  15. Post‐Trial Access to Antiretrovirals: Who Owes What to Whom?Joseph Millum - 2011 - Bioethics 25 (3):145-154.
    ABSTRACTMany recent articles argue that participants who seroconvert during HIV prevention trials deserve treatment when they develop AIDS, and there is a general consensus that the participants in HIV/AIDS treatment trials should have continuing post‐trial access. As a result, the primary concern of many ethicists and activists has shifted from justifying an obligation to treat trial participants, to working out mechanisms through which treatment could be provided. In this paper I argue that this shift frequently conceals an important assumption: that (...)
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  16. Disclosure and Consent to Medical Research Participation.Danielle Bromwich & Joseph Millum - 2013 - Journal of Moral Philosophy 10 (4):195-219.
    Most regulations and guidelines require that potential research participants be told a great deal of information during the consent process. Many of these documents, and most of the scholars who consider the consent process, assume that all this information must be disclosed because it must all be understood. However, a wide range of studies surveying apparently competent participants in clinical trials around the world show that many do not understand key aspects of what they have been told. The standard view (...)
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  17. Understanding, Communication, and Consent.Joseph Millum & Danielle Bromwich - 2018 - Ergo: An Open Access Journal of Philosophy 5:45-68.
    Misconceived Consent: Miguel has stage IV lung cancer. He has nearly exhausted his treatment options when his oncologist, Dr. Llewellyn, tells him about an experimental vaccine trial that may boost his immune response to kill cancer cells. Dr. Llewellyn provides Miguel with a consent form that explains why the study is being conducted, what procedures he will undergo, what the various risks and benefits are, alternative sources of treatment, and so forth. She even sits down with him, carefully talks through (...)
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  18. Stillbirths: Economic and Psychosocial Consequences.Alexander E. P. Heazell, Dimitros Siassakos, Hannah Blencowe, Zulfiqar A. Bhutta, Joanne Cacciatore, Nghia Dang, Jai Das, Bicki Flenady, Katherine J. Gold, Olivia K. Mensah, Joseph Millum, Daniel Nuzum, Keelin O'Donoghue, Maggie Redshaw, Arjumand Rizvi, Tracy Roberts, Toyin Saraki, Claire Storey, Aleena M. Wojcieszek & Soo Downe - 2016 - The Lancet 387 (10018):604-16.
    Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are (...)
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  19. Age and Death: A Defence of Gradualism.Joseph Millum - 2015 - Utilitas 27 (3):279-297.
    According to standard comparativist views, death is bad insofar as it deprives someone of goods she would otherwise have had. In The Ethics of Killing, Jeff McMahan argues against such views and in favor of a gradualist account according to which how bad it is to die is a function of both the future goods of which the decedent is deprived and her cognitive development when she dies. Comparativists and gradualists therefore disagree about how bad it is to die at (...)
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  20. Consent Under Pressure: The Puzzle of Third Party Coercion.Joseph Millum - 2014 - Ethical Theory and Moral Practice 17 (1):113-127.
    Coercion by the recipient of consent renders that consent invalid. But what about when the coercive force comes from a third party, not from the person to whom consent would be proffered? In this paper I analyze how threats from a third party affect consent. I argue that, as with other cases of coercion, we should distinguish threats that render consent invalid from threats whose force is too weak to invalidate consent and threats that are legitimate. Illegitimate controlling third party (...)
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  21. Valuing Stillbirths.John Phillips & Joseph Millum - 2015 - Bioethics 29 (6):413-423.
    Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life years and disability-adjusted life years. These measures typically do not include stillbirths among the negative health outcomes they count. Priority-setting decisions that rely on these measures are therefore likely to place little value on preventing the more than three million stillbirths that occur annually worldwide. In contrast, neonatal deaths, which occur in comparable numbers, have a (...)
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  22.  32
    Emergency Care Research Ethics in Low- and Middle-Income Countries.Joseph Millum, Blythe Beecroft, Timothy C. Hardcastle, Jon Mark Hirshon, Adnan A. Hyder, Jennifer A. Newberry & Carla Saenz - 2019 - BMJ Global Health 4:e001260.
    A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research to improve emergency (...)
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  23. Manipulation in the Enrollment of Research Participants.Amulya Mandava & Joseph Millum - 2013 - Hastings Center Report 43 (2):38-47.
    In this paper we analyze the non-coercive ways in which researchers can use knowledge about the decision-making tendencies of potential participants in order to motivate them to consent to research enrollment. We identify which modes of influence preserve respect for participants’ autonomy and which disrespect autonomy, and apply the umbrella term of manipulation to the latter. We then apply our analysis to a series of cases adapted from the experiences of clinical researchers in order to develop a framework for thinking (...)
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  24.  61
    Sharing the Benefits of Research Fairly: Two Approaches.Joseph Millum - 2012 - Journal of Medical Ethics 38 (4):219-223.
    Research projects sponsored by rich countries or companies and carried out in developing countries are often described as exploitative. One important debate about the prevention of exploitation in research centres on whether and how clinical research in developing countries should be responsive to local health problems. This paper analyses the responsiveness debate and draws out more general lessons for how policy makers can prevent exploitation in various research contexts. There are two independent ways to do this in the face of (...)
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  25. The Tortured Patient: A Medical Dilemma.Chiara Lepora & Joseph Millum - 2011 - Hastings Center Report 41 (3):38-47.
    Torture is unethical and usually counterproductive. It is prohibited by international and national laws. Yet it persists: according to Amnesty International, torture is widespread in more than a third of countries. Physicians and other medical professionals are frequently asked to assist with torture. -/- Medical complicity in torture, like other forms of involvement, is prohibited both by international law and by codes of professional ethics. However, when the victims of torture are also patients in need of treatment, doctors can find (...)
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  26. Are Indirect Benefits Relevant to Health Care Allocation Decisions?Jessica Du Toit & Joseph Millum - 2016 - Journal of Medicine and Philosophy 41 (5):540-557.
    When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. First, we (...)
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  27. The Ethics of Placebo-Controlled Trials: Methodological Justifications.Joseph Millum & Christine Grady - 2013 - Contemporary Clinical Trials 36 (2):510-14.
    The use of placebo controls in clinical trials remains controversial. Ethical analysis and international ethical guidance permit the use of placebo controls in randomized trials when scientifically indicated in four cases: (1) when there is no proven effective treatment for the condition under study; (2) when withholding treatment poses negligible risks to participants; (3) when there are compelling methodological reasons for using placebo, and withholding treatment does not pose a risk of serious harm to participants; and, more controversially, (4) when (...)
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  28. Natural Goodness and Natural Evil.Joseph Millum - 2006 - Ratio 19 (2):199–213.
    In Natural Goodness Philippa Foot gives an analysis of the concepts we use to describe the characteristics of living things. She suggests that we describe them in functional terms, and this allows us to judge organisms as good or defective depending on how well they perform their distinctive functions. Foot claims that we can judge intentional human actions in the same way: the virtues contribute in obvious ways to good human functioning, and this provides us with grounds for making moral (...)
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  29. Introduction: The Fogarty International Research Ethics Education and Curriculum Development Program in Historical Context.Joseph Millum, Christine Grady, Gerald Keusch & Barbara Sina - 2013 - Journal of Empirical Research on Human Research Ethics: An International Journal 8 (5):3-16.
    In response to the increasing need for research ethics expertise in low and middle income countries (LMICs), the NIH's Fogarty International Research Ethics Education and Curriculum Development Program has provided grants for the development of training programs in international research ethics for LMIC professionals since 2000. This collection of papers draws upon the combined expertise of Fogarty grantees, trainees, and other experts to assess the state of research ethics in LMICs, and the lessons learned over 12 years of international research (...)
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  30.  34
    Stillbirth Should Be Given Greater Priority on the Global Health Agenda.Zeshan U. Qureshi, Joseph Millum, Hannah Blencowe, Maureen Kelley, Joy E. Lawn, Anthony Costello & Tim Colbourn - 2015 - British Medical Journal 351:h4620.
    Stillbirths are largely excluded from international measures of mortality and morbidity. Zeshan Qureshi and colleagues argue that stillbirth should be higher on the global health agenda.
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  31.  77
    How Should the Benefits of Bioprospecting Be Shared?Joseph Millum - 2010 - Hastings Center Report 40 (1):24-33.
    The search for valuable new products from among the world’s stock of natural biological resources is mostly carried out by people from wealthy countries, and mostly takes place in developing countries that lack the research capacity to profit from it. Surely, the indigenous people should receive some compensation from it. But we must build a robust defense for this intuition, rooted in the Western moral traditions that are widely accepted in wealthy countries, if we are to put it into practice (...)
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  32. When Should Genome Researchers Disclose Misattributed Pahentage?Amulya Mandava, Joseph Millum & Benjamin E. Berkman - 2015 - Hastings Center Report 45 (4):28-36.
    Research studies increasingly use genomic sequencing to draw inferences based on comparisons between the genetic data of a set of purportedly related individuals. As use of this method progresses, it will become much more common to discover that the assumed biological relationships between the individuals are mistaken. Consequently, researchers will have to grapple with decisions about whether to return incidental findings of misattributed parentage on a much larger scale than ever before. In this paper we provide an extended argument for (...)
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  33.  22
    Allocation of Scarce Biospecimens for Use in Research.Leah Pierson, Sophia Gibert, Benjamin Berkman, Marion Danis & Joseph Millum - forthcoming - Journal of Medical Ethics:medethics-2019-105766.
    Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...)
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  34. How Do We Acquire Parental Rights?Joseph Millum - 2010 - Social Theory and Practice 36 (1):112-132.
    In this paper I develop a theory of the acquisition of parental rights. According to this investment theory, parental rights are generated by the performance of parental work. Thus, those who successfully parent a child have the right to continue to do so, and to exclude others from so doing. The account derives from a more general principle of desert that applies outside the domain of parenthood. It also has some interesting implications for the attribution of moral parenthood. In particular, (...)
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  35. Preventing Sin: The Ethics of Vaccines Against Smoking.Sarah R. Lieber & Joseph Millum - 2013 - Hastings Center Report 43 (3):23-33.
    Advances in immunotherapy pave the way for vaccines that target not only infections, but also unhealthy behaviors such as smoking. A nicotine vaccine that eliminates the pleasure associated with smoking could potentially be used to prevent children from adopting this addictive and dangerous behavior. This paper offers an ethical analysis of such vaccines. We argue that it would be permissible for parents to give their child a nicotine vaccine if the following conditions are met: (1) the vaccine is expected to (...)
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  36. How Do We Acquire Parental Responsibilities?Joseph Millum - 2008 - Social Theory and Practice 34 (1):71-93.
    It is commonly believed that parents have special duties toward their children—weightier duties than they owe other children. How these duties are acquired, however, is not well understood. This is problematic when claims about parental responsibilities are challenged; for example, when people deny that they are morally responsible for their biological offspring. In this paper I present a theory of the origins of parental responsibilities that can resolve such cases of disputed moral parenthood.
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  37.  85
    Response to Open Peer Commentaries on “Health Research Priority Setting: The Duties of Individual Funders”.Leah Pierson & Joseph Millum - 2019 - American Journal of Bioethics 19 (1):W5-W7.
    We respond to open peer commentaries on our target article, "Health Research Priority Setting: The Duties of Individual Funders".
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  38. The Duty to Rescue and Randomized Controlled Trials Involving Serious Diseases.Joseph Millum & David Wendler - 2018 - Journal of Moral Philosophy 15 (3):298-323.
    During the recent Ebola epidemic, some commentators and stakeholders argued that it would be unethical to carry out a study that withheld a potential treatment from affected individuals with such a serious, untreatable disease. As a result, the initial trials of experimental treatments did not have control arms, despite important scientific reasons for their inclusion. In this paper, we consider whether the duty to rescue entails that it would be unethical to withhold an experimental treatment from patient-participants with serious diseases (...)
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  39. Controlling Ebola Trials.Joseph Millum - 2015 - American Journal of Bioethics 15 (4):36-37.
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  40. A Third Way: Ethics Guidance as Evidence-Informed Provisional Rules.Kirstin Borgerson & Joseph Millum - 2010 - American Journal of Bioethics 10 (6):20-22.
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  41. A Biological Alternative to Moral Explanations.Joseph Millum - 2008 - Southern Journal of Philosophy 46 (3):385-407.
    Some moral realists claim that moral facts are a species of natural fact, amenable to scientific investigation. They argue that these moral facts are needed in the best explanations of certain phenomena and that this is evidence that they are real. In this paper I present part of a biological account of the function of morality. The account allows the identification of a plausible natural kind that could play the explanatory role that a moral kind would play in naturalist realist (...)
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  42.  62
    The Global Forum for Bioethics in Research: Past Present and Future.Katherine Littler, Joseph Millum & Douglas Richard Wassenaar - 2014 - South African Journal of Bioethics and Law 7 (1):5.
    The Global Forum on Bioethics in Research (GFBR) served as a global platform for debate on ethical issues in international health research between 1999 and 2008, bringing together research ethics experts, researchers, policy makers and community members from developing and developed countries. In total, nine GFBR meetings were held on six continents. Work is currently underway to revive the GFBR. This paper describes the purpose and history of the GFBR and presents key elements for its reinstatement, future functioning and sustainability. (...)
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  43.  78
    Are Pharmaceutical Patents Protected by Human Rights?Joseph Millum - 2008 - Journal of Medical Ethics 34 (11):e25-e25.
    The International Bill of Rights enshrines a right to health, which includes a right to access essential medicines. This right frequently appears to conflict with the intellectual property regime that governs pharmaceutical patents. However, there is also a human right that protects creative works, including scientific productions. Does this right support intellectual property protections, even when they may negatively affect health? -/- This article examines the recent attempt by the Committee on Economic, Social and Cultural Rights to resolve this issue (...)
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