Ben Almassi

Ghostwriting in its various forms has received critical scrutiny from medical ethicists, journal editors, and science studies scholars trying to explain where ghostwriting goes wrong and ascertain how to counter it. Recent analyses have characterized ghostwriting as plagiarism or fraud, and have urged that it be deterred through stricter compliance with journal submission requirements, conflict of interest disclosures, author-institutional censure, legal remedies, and journals' refusal to publish commercially sponsored articles. As a supplement to such efforts, this paper offers a critical assessment of medical ghostwriting as contrary to good patient care, on the grounds that it contradicts established general principles guiding clinical ethics. Specifically, I argue that ghostwriting undermines trust relationships between authors and their readers, and between these readers and their trusting patients, and in so doing contradicts the duty of respect for patient autonomy by obstructing informed consent. For this reason, complicity in ghostwriting practices should be understood as a violation of the professional ethical duties of physicians and other healthcare workers

Throughout his work on the rationality of epistemic dependence, John Hardwig makes the striking observation that he believes many things for which he possesses no evidence (1985, 335; 1991, 693; 1994, 83). While he could imagine collecting for himself the relevant evidence for some of his beliefs, the vastness of the world and constraints of time and individual intellect thwart his ability to gather for himself the evidence for all his beliefs. So for many things he believes what others tell him, as we all do. Epistemic dependence is the responsible choice, he argues, because he can be reasonably sure that those on whom he depends know more about the subject than he does. Epistemic dependence on experts is a smarter bet than epistemic autonomy: after all, Hardwig reasons, “if I were to pursue epistemic autonomy across the board, I would succeed in holding relatively uninformed, unreliable, crude, untested, and therefore irrational beliefs” (1985, 340) [...] In this paper I argue against what I call Hardwig’s no-evidence thesis: that knowledge and belief based on testimony are knowledge and belief for which the knower possesses no evidence. Against the no-evidence thesis, I propose we recognize that layperson B’s good reason to believe that expert A has good reason to believe proposition p constitutes evidence for B for p. I argue that the reasons Hardwig gives for the no-evidence thesis are inconclusive at best; at worst the no-evidence thesis coupled with his recognition of expert interdependence exposes him to recent criticisms by Stella Gaon and Stephen Norris. By rejecting the no-evidence thesis, we can recognize with Hardwig the importance of expert epistemic interdependence while avoiding the paradoxical implications of his position.

Several recent publications in biomedical ethics argue that organ donation is generally morally obligatory and failure to do so is morally indefensible. Arguments for this moral conclusion tend to be of two kinds: arguments from fairness and arguments from easy rescue. While I agree that many of us have a duty to donate, in this article I criticize these arguments for a general duty of organ donation and their application to organ procurement policy. My concern is that these arguments neglect the role that trust plays in contemporary organ transplant policies and in differential rational attitudes toward donation. Recognizing donation as an achievement of trust, and acknowledging the warrant of many people's rational distrust or withheld trust in medicine, I argue, should have significant implications for the ethics of organ procurement

The evidence most of us have for our beliefs on global climate change, the extent of human contribution to it, and appropriate anticipatory and mitigating actions turns crucially on epistemic trust. We extend trust or distrust to many varied others: scientists performing original research, intergovernmental agencies and those reviewing research, think tanks offering critique and advocating skepticism, journalists transmitting and interpreting claims, even social systems of modern science such as peer-reviewed publication and grant allocation. Our personal experiences and assessments of evidential indicators themselves may be buttressed significantly by trust, not just in.