Alex Voorhoeve

Clinical researchers should help respect the autonomy and promote the well-being of prospective study participants by helping them make voluntary, informed decisions about enrollment. However, participants often exhibit poor understanding of important information about clinical research. Bioethicists have given special attention to “misconceptions” about clinical research that can compromise participants’ decision-making, most notably the “therapeutic misconception.” These misconceptions typically involve false beliefs about a study’s purpose, or risks or potential benefits for participants. In this article, we describe a misconception involving false beliefs about a study’s potential benefits for non-participants, or its expected social value. This social value misconception can compromise altruistically motivated participants’ decision-making, potentially threatening their autonomy and well-being. We show how the social value misconception raises ethical concerns for inherently low-value research, hyped research, and even ordinary research, and advocate for empirical and normative work to help understand and counteract this misconception’s potential negative impacts on participants.

In cases where the claims of different groups of people compete, the Relevance View occupies a middle ground between aggregation and nonaggregation. It allows weaker claims to aggregate to outweigh a stronger claim just when the competing claims, compared pairwise, are sufficiently close in strength. The view has strong intuitive appeal when applied to simple binary choices, but I argue that attempts to extend it to nonbinary choices have been unsuccessful. I propose a new extension of the Relevance View to nonbinary choices based on a “binary contrastive” account of the moral reasons that obtain in the cases of interest.

It is well known that there is a conflict between three intuitive principles for the evaluation of risky prospects in distributional contexts, Ex-Post Egalitarianism, Ex-Ante Pareto and Dominance. In this paper, I return to Peter Diamond’s suggestion that we reject Dominance as a principle of rationality in distributional contexts and present a new argument in support of this position. The argument is based on an observation regarding the right way for a distributor to weigh reasons for actions. In some cases, I argue, reasons for action that are grounded in the interests of one of the patients ought to be disregarded by the distributor. These cases share the following property: it is in the patient’s overall interest that the distributor disregards them. I show that Dominance does not permit distributors to disregard such reasons and use this observation to argue against the claim that Dominance is a principle of rationality in distributional contexts.