Tuesday, February 10

Meeting 5 (2/17) — Justice and Health

Thanks to Dave McIlroy for an interesting take on the many perils of peer-review. Let's keep the conversation going here (and possibly for the first part of our next class).

In many ways, I think the central problems in research ethics we've seen (and the non-obviousness of any compelling solutions to them) show up again in our next topic: research prioritization and health care justice. It seems that we can ask after the moral properties both of individual agents (researchers, doctors, politicians, citizens, consumers, &c.) and the social social institutions that they (we) collectively compose and utilize. It seems possible that our institutions through no particular dereliction of individual obligations can harm others (or encourage or allow individual harms). In the case of our academic institutions, these harms may be minor (still, we should take care to distinguish, even if vaguely, between regrettable features of a social institution — say, its discouraging people from being friendly — and harms that fall more clearly into the moral realm). But it is far from clear what any solution might look like. Is it more ethics training (as Dave and Dave suggest), greater transparency, more anonymity, standing juries, &c.? Or it may be that this is "as good as it gets": though problematic in this or that way, the institution is, all things considered, optimal.

In a similar vein, we can ask whether the institutions of scientific research are optimally pursuing research projects that they ought to pursue. Take disease research: it features a so-called "90/10 gap": "90% of humanity's burden of disease receives only 10% of the world's health research resources" (Flory and Kitcher 2004, 40). What should we do about that?

So far, you'll notice, we've tackled problems in science ethics that seem (generally) aptly characterized as "negative". Under what conditions is it permissible to utilize animals (including humans) in research? What should you not do as a researcher? It seems to me that the most pressing moral issues in science (and correspondingly, the most difficult) are those which ask whether we have any (positive) duties to adjust our scientific institutions to world need. I can't help feel that we do, but I'm still stuck on what that change should look like.

I'm assigning three articles that I hope will help guide our thinking:
I'm also making available two supplementary (optional) articles on Blackboard concerning more general conceptual questions about health care justice: Brock, "Priority to the Worse Off in Health-Care Resource Prioritization" and Daniels, "Justice, Health, and Health Care". Remember that you need to be logged into Blackboard for these links to work. I'm going to stop reminding you now.

As you'll see, we're starting to bump up against some difficult theoretical issues in ethics and political philosophy. John Rawls is a key figure in discussions about justice. I'll have something to say about the key features of his theory of justice, but if you would like to get a very good overview, head over the Stanford Encyclopedia of Philosophy. I take this meeting to be pivotal for our later discussion: Kitcher's book Science, Truth, and Democracy proposes a way to address questions about how we prioritize our scientific projects.

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