Philip J. Nickel

In this paper, I examine the ethics of e - trust and e - trustworthiness in the context of health care, looking at direct computer-patient interfaces (DCPIs), information systems that provide medical information, diagnosis, advice, consenting and/or treatment directly to patients without clinicians as intermediaries. Designers, manufacturers and deployers of such systems have an ethical obligation to provide evidence of their trustworthiness to users. My argument for this claim is based on evidentialism about trust and trustworthiness: the idea that trust should be based on sound evidence of trustworthiness. Evidence of trustworthiness is a broader notion than one might suppose, including not just information about the risks and performance of the system, but also interactional and context-based information. I suggest some sources of evidence in this broader sense that make it plausible that designers, manufacturers and deployers of DCPIs can provide evidence to users that is cognitively simple, easy to communicate, yet rationally connected with actual trustworthiness

Jennifer Lackey’s case “Creationist Teacher,” in which students acquire knowledge of evolutionary theory from a teacher who does not herself believe the theory, has been discussed widely as a counterexample to so-called transmission theories of testimonial knowledge and justification. The case purports to show that a speaker need not herself have knowledge or justification in order to enable listeners to acquire knowledge or justification from her assertion. The original case has been criticized on the ground that it does not really refute the transmission theory, because there is still somebody in a chain of testifiers—the person from whom the creationist teacher acquired what she testifies—who knows the truth of the testified statements. In this paper, we provide a kind of pattern for generating counterexample cases, one that avoids objections discussed by Peter Graham and others in relation to such cases.

This paper advances a new criterion of a vulnerable population in research. According to this criterion, there are consent-based and fairness-based reasons for calling a group vulnerable. The criterion is then applied to the case of people with serious illnesses. It is argued that people with serious illnesses meet this criterion for reasons related to consent. Seriously ill people have a susceptibility to “enticing offers” that hold out the prospect of removing or alleviating illness, and this susceptibility reduces their ability to safeguard their own interests. This explains the inclusion of people with serious illnesses in the Belmont Report’s list of populations needing special protections, and supports the claim that vulnerability is the rule, rather than the exception, in biomedical research

According to assurance views of testimonial justification, in virtue of the act of testifying a speaker provides an assurance of the truth of what she asserts to the addressee. This assurance provides a special justificatory force and a distinctive normative status to the addressee. It is thought to explain certain asymmetries between addressees and other unintended hearers (bystanders and eavesdroppers), such as the phenomenon that the addressee has a right to blame the speaker for conveying a falsehood but unintended hearers do not, and the phenomenon that the addressee may deflect challenges to his testimonial belief to the speaker but unintended hearers may not. Here I argue that we can do a better job explaining the normative statuses associated with testimony by reference to epistemic norms of assertion and privacy norms. Following Sanford Goldberg, I argue that epistemic norms of assertion, according to which sincere assertion is appropriate only when the asserter possesses certain epistemic goods, can be ‘put to work’ to explain the normative statuses associated with testimony. When these norms are violated, they give hearers the right to blame the speaker, and they also explain why the speaker takes responsibility for the justification of the statement asserted. Norms of privacy, on the other hand, directly exclude eavesdroppers and bystanders from an informational exchange, implying that they have no standing to do many of the things, such as issue challenges or questions to the speaker, that would be normal for conversational participants. This explains asymmetries of normative status associated with testimony in a way logically independent of speaker assurance.