Gabriel Watts

The use of genomic testing in pregnancy is increasing, giving rise to questions over how the information that is generated should be offered and returned in clinical practice. While these tests provide important information for prenatal decision-making, they can also generate information of uncertain significance. This paper critically examines three models for approaching the disclosure of variants of uncertain significance (VUS), which can arise from forms of genomic testing such as prenatal chromosomal microarray analysis (CMA). Contrary to prevailing arguments, we argue that respect for reproductive autonomy does not justify adopting a model on which an offer to disclose VUS is a routine part of genetic counselling. Instead, we contend that a commitment both to solidarity between healthcare providers and pregnant women and to the acceptance of a novel principle of caution under normative uncertainty means that we should instead adopt a model of VUS disclosure that imposes a strong presumption against offering to disclose VUS. The upshot of this is that it should be standard practice to only offer to disclose VUS when this is requested by the woman undergoing CMA. We defend our position against claims that arise from an alleged right to such information and that a presumption against an offer will lead to inequity.

In this paper I set out what I call a ‘conquest’ conception of Hume's experimental science of man. It is notable, I claim, that Hume regards what he calls the ‘capital’ of the sciences – ‘the science of MAN’ – as occupied territory, and that he views his ‘direct’ method of approach upon the science of human nature as a ‘conquest’. I expand upon such statements by leveraging the comparison that Hume draws between experimental moral philosophy and the experimental tradition in natural philosophy inaugurated by Francis Bacon. Overall, I suggest that Hume's decision to ground his science of human nature upon experience and observation is as much about overthrowing the epistemic authority of speculative dogmas as it is about establishing a secure foundation for his system of the sciences, and I contend that Hume's application of his hypotheses to animals is central to this conception of his philosophical project in the Treatise.

Abstract:In this paper I argue that Hume’s decision to include an account of curiosity within his theory of the passions is what gives Book 2 of the Treatise its distinctive shape, in which an account of what Hume calls “indirect” passions precedes an account of the nature of the will, which is itself followed by an account of the “direct” passions, then curiosity. On my reading, Hume concludes his theory of the passions with an account of curiosity because this is where it ought to go, given how Hume understands the love of truth to arise in human nature. Not only this, but I contend that Hume’s need to account for the nature of curiosity within his theory of the passions can explain his decision to open Book 2 with a discussion of the indirect passions, rather than the direct passions.

This paper provides a reception history of Book Two of the Treatise-Of the passions-as well as an attempt to reconcile Hume's ambitions to systematicity in Book Two with the distracted and distracting nature of the text. We currently have, I think, a good sense of the philosophical importance of Book Two within Hume's science of human nature. Yet we have not made much progress on understanding Book Two on its own terms, and especially why Book Two so often seems on the verge of falling into an explanatory heap. I aim to rectify this situation by giving a reading of Book Two that makes sense of the philosophical importance of Hume's system of the passions, yet also explains why he encounters so many difficulties in setting out his system; such that he is often forced to stretch his explanations to the very edge of the credible. I contend that Hume's system of the passions is best viewed as an unstable explanatory compound, one that progressively dissolves as Hume's explanatory intentions become increasingly ambitious.

Multiple studies show that periodic reanalysis of genomic test results held by clinical laboratories delivers significant increases in overall diagnostic yield. However, while there is a widespread consensus that implementing routine reanalysis procedures is highly desirable, there is an equally widespread understanding that routine reanalysis of individual patient results is not presently feasible to perform for all patients. Instead, researchers, geneticists and ethicists are beginning to turn their attention to one part of reanalysis—reinterpretation of previously classified variants—as a means of achieving similar ends to large-scale individual reanalysis but in a more sustainable manner. This has led some to ask whether the responsible implementation of genomics in healthcare requires that diagnostic laboratories routinely reinterpret their genomic variant classifications and reissue patient reports in the case of materially relevant changes. In this paper, we set out the nature and scope of any such obligation, and analyse some of the main ethical considerations pertaining to a putative duty to reinterpret. We discern and assess three potential outcomes of reinterpretation—upgrades, downgrades and regrades—in light of ongoing duties of care, systemic error risks and diagnostic equity. We argue against the existence of any general duty to reinterpret genomic variant classifications, yet we contend that a suitably restricted duty to reinterpret ought to be recognised, and that the responsible implementation of genomics into healthcare must take this into account.

The results of tests carried out using next-generation genomic sequencing (NGS) possess a peculiar and perhaps unique ‘diagnostic durability’. Unlike most other forms of testing, if genomic results or data are stored over time, then it remains possible to interrogate that information indefinitely, without having to retest the patient. Another peculiar property of genomic results is that their interpretations are subject to change within relatively short time frames. For instance, a genomic variant that is of uncertain significance (VUS) at the time of testing may shortly afterwards come to be understood as pathogenic (P) or benign (B). Moreover, variant classifications might be downgraded from likely pathogenic to VUS or B, or regraded from B to VUS. These two properties of genomic testing have important implications for the responsible implementation of genomic testing in healthcare. One of these is that they prompt the question whether diagnostic laboratories are morally required to routinely reinterpret their genomic variant classifications and reissue patient reports in the case of materially relevant changes. We take up this question in our paper, in which we argue against the existence of any general duty to reinterpret genomic variant classifications (as had been argued for by Appelbaum et al 1). Still, we maintain that a restricted duty to reinterpret ought to be recognised.2 We thank the authors of the commentaries on our paper for their attention to our argument and for their thoughtful responses to (and expansions of) our position. Oerlemans et al address …

Innovation is a key driver of care provision in assisted reproductive technologies (ART). ART providers offer a range of add‐on interventions, aiming to augment standard in vitro fertilization protocols and improve the chances of a live birth. Particularly in the context of commercial provision, an ever‐increasing array of add‐ons are marketed to ART patients, even when evidence to support them is equivocal. A defining feature of ART is hope—hope that a cycle will lead to a baby or that another test or intervention will make a difference. Yet such hope also leaves ART patients vulnerable in a variety of ways. This article argues that previous attempts to safeguard ART patients have neglected how the use of add‐ons in commercial ART can exploit patients’ hopes. Commercial providers of ART should provide add‐ons only free of charge, under a suitable research protocol.