Jonathan Herington

We explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention.

Efforts to promote responsible conduct of research (RCR) should take into consideration how scientists already conceptualize the relationship between ethics and science. In this study, we investigated how scientists relate ethics and science by analyzing the values expressed in interviews with fifteen science faculty members at a large midwestern university. We identified the values the scientists appealed to when discussing research ethics, how explicitly they related their values to ethics, and the relationships between the values they appealed to. We found that the scientists in our study appealed to epistemic and ethical values with about the same frequency, and much more often than any other type of value. We also found that they explicitly associated epistemic values with ethical values. Participants were more likely to describe epistemic and ethical values as supporting each other, rather than trading off with each other. This suggests that many scientists already have a sophisticated understanding of the relationship between ethics and science, which may be an important resource for RCR training interventions.

Measures of algorithmic bias can be roughly classified into four categories, distinguished by the conditional probabilistic dependencies to which they are sensitive. First, measures of "procedural bias" diagnose bias when the score returned by an algorithm is probabilistically dependent on a sensitive class variable (e.g. race or sex). Second, measures of "outcome bias" capture probabilistic dependence between class variables and the outcome for each subject (e.g. parole granted or loan denied). Third, measures of "behavior-relative error bias" capture probabilistic dependence between class variables and the algorithmic score, conditional on target behaviors (e.g. recidivism or loan default). Fourth, measures of "score-relative error bias" capture probabilistic dependence between class variables and behavior, conditional on score. Several recent discussions have demonstrated a tradeoff between these different measures of algorithmic bias, and at least one recent paper has suggested conditions under which tradeoffs may be minimized. In this paper we use the machinery of causal graphical models to show that, under standard assumptions, the underlying causal relations among variables forces some tradeoffs. We delineate a number of normative considerations that are encoded in different measures of bias, with reference to the philosophical literature on the wrongfulness of disparate treatment and disparate impact. While both kinds of error bias are nominally motivated by concern to avoid disparate impact, we argue that consideration of causal structures shows that these measures are better understood as complicated and unreliable measures of procedural biases (i.e. disparate treatment). Moreover, while procedural bias is indicative of disparate treatment, we show that the measure of procedural bias one ought to adopt is dependent on the account of the wrongfulness of disparate treatment one endorses. Finally, given that neither score-relative nor behavior-relative measures of error bias capture the relevant normative considerations, we suggest that error bias proper is best measured by score-based measures of accuracy, such as the Brier score.

Computer scientists have made great strides in characterizing different measures of algorithmic fairness, and showing that certain measures of fairness cannot be jointly satisfied. In this paper, I argue that the three most popular families of measures - unconditional independence, target-conditional independence and classification-conditional independence - make assumptions that are unsustainable in the context of an unjust world. I begin by introducing the measures and the implicit idealizations they make about the underlying causal structure of the contexts in which they are deployed. I then discuss how these idealizations fall apart in the context of historical injustice, ongoing unmodeled oppression, and the permissibility of using sensitive attributes to rectify injustice. In the final section, I suggest an alternative framework for measuring fairness in the context of existing injustice: distributive fairness.

Many instances of scientific research impose risks, not just on participants and scientists but also on third parties. This class of social risks unifies a range of problems previously treated as distinct phenomena, including so-called bystander risks, biosafety concerns arising from gain-of-function research, the misuse of the results of dual-use research, and the harm caused by inductive risks. The standard approach to these problems has been to extend two familiar principles from human subjects research regulations—a favorable risk-benefit ratio and informed consent. We argue, however, that these moral principles will be difficult to satisfy in the context of widely distributed social risks about which affected parties may reasonably disagree. We propose that framing these risks as political rather than moral problems may offer another way. By borrowing lessons from political philosophy, we propose a framework that unifies our discussion of social risks and the possible solutions to them.

Scientific research that could cause grave harm, either through accident or intentional malevolence, is known as dual-use research. Recent high-profile cases of dual-use research in the life sciences have led to debate about the extent to which restrictions on the conduct and dissemination of such research may impede scientific progress. We adapt formal models of scientific networks to systematically explore the effects that different regulatory schemes may have on a community’s ability to learn about the world. Our results suggest that, contrary to common wisdom, some restrictions on the conduct and dissemination of dual-use research do not inhibit scientific progress and may actually aid communities in learning.

Do unknown and unrealized risks of harm diminish an individual’s well-being? The traditional answer is no: that the security of prudential goods benefits an individual only instrumentally or by virtue of their subjective sense of security. Recent work has argued, however, that the security of prudential goods non-instrumentally benefits an individual regardless of whether or not they enjoy subjective security. In this paper, I critically examine three claims about the way in which unknown and unrealized risks of harm might diminish individual well-being: it frustrates a desire to be secure, it frustrates the enjoyment of modally-robust goods, and it undermines the ability to make reasonable plans. Ultimately, I argue that all three of these hypotheses are mistaken, but that they deepen our understanding of the ways in which subjective security is an important constituent of individual well-being.

In a recent paper, I argued that the mere risk of climate-related harm was itself a harm, since it undermined the security of individuals subject to that risk. In his commentary, Mintz-Woo argues that my account of the value of security is mistaken. On his view, the value of belief-relative security is already well captured by standard theories of wellbeing, and the value of fact-relative security is illusory. In the following, I attempt to respond to his concerns. First, I argue contrary to Mintz-Woo that the literature on the cognitive effect on poverty is relevant to an assessment of the value of belief-relative security. Second, I introduce a distinction between ex ante and ex post perspectives on justice, and show that straightforward prioritarian commitments motivate an ex ante concern for fact-relative security.

In 2009, health authorities from Taiwan formally attended the 62nd World Health Assembly of the World Health Organization as observers, marking the country’s participation for the first time since 1972. The long process of negotiating this breakthrough has been cited as an example of successful global health diplomacy. This paper analyses this negotiation process, drawing on government documents, formal representations from both sides of the Taiwan Strait, and key informant interviews. The actors and their motivations, along with the forums, practices and outcomes of the negotiation process, are detailed. While it is argued that non-traditional diplomatic action was important in establishing the case for Taiwan’s inclusion at the WHA, traditional concerns regarding Taiwanese sovereignty and diplomatic representation ultimately played a decisive role. The persistent influence of these traditional diplomatic questions illustrates the limits of global health diplomacy.

Many argue that consumers possess a “right to know” when products contain ingredients derived from genetically modified organisms, on the grounds that it would protect consumer autonomy. In this paper, I critically evaluate that claim. I begin by providing a version of the “consumer autonomy” argument, showing that its success relies on ambiguities in the notion of autonomy. I then distinguish four approaches to autonomy and articulate the circumstances under which they would support active disclosure of a product property. I argue that none of these conceptions would support active disclosure of the presence of ingredients derived from genetically modified organisms.

The harms of climate change are deeply uncertain. Though climate change will render most individuals more vulnerable to harm, many individuals will not actually suffer climate-related harms. In this paper, I argue that vulnerability to harms is itself a harm, because it undermines our enjoyment of the good of security. After some brief remarks on the concept of security, I give three reasons for thinking that depriving an individual of the security of basic goods harms them: it has a strong contingent connection to fear and anxiety, it directly undermines their ability to make reasonable plans, and security may reasonably be valued as an end in itself. This suggests that one of our goals in determining climate policy ought to be mechanisms which ensure the security of basic goods.

This paper discusses the views of 17 healthcare practitioners involved with transplantation on the ethics of live liver donations . Donations between emotionally related donor and recipients increased the acceptability of an LLD compared with those between strangers. Most healthcare professionals disapproved of altruistic stranger donations, considering them to entail an unacceptable degree of risk taking. Participants tended to emphasise the need to balance the harms of proceeding against those of not proceeding, rather than calculating the harm-to-benefits ratio of donor versus recipient. Participants’ views suggested that a complex process of negotiation is required, which respects the autonomy of donor, recipient and HCP. Although they considered that, of the three, donor autonomy is of primary importance, they also placed considerable weight on their own autonomy. Our participants suggest that their opinions about acceptable risk taking were more objective than those of the recipient or donor and were therefore given greater weight. However, it was clear that more subjective values were also influential. Processes used in live kidney donation were thought to be a good model for LLD, but our participants stressed that there is a danger that patients may underestimate the risks involved in LLD if it is too closely associated with LKD

Academic freedom is an important good, but it comes with several responsibilities. In this commentary we seek to do two things. First, we argue against Francesca Minerva's view of academic freedom as presented in her article ‘New threats to academic freedom’ on a number of grounds. We reject the nature of the absolutist moral claim to free speech for academics implicit in the article; we reject the elitist role for academics as truth-seekers explicit in her view; and we reject a possible more moderate re-construction of her view based on the harm/offence distinction. Second, we identify some of the responsibilities of applied ethicists, and illustrate how they recommend against allowing for anonymous publication of research. Such a proposal points to the wider perils of a public discourse which eschews the calm and careful discussion of ideas

Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of obesity than does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior. To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one.

Health security has become a popular way of justifying efforts to control catastrophic threats to public health. Unfortunately, there has been little analysis of the concept of health security, nor the relationship between health security and other potential aims of public health policy. In this paper I develop an account of health security as an aversion to risky policy options. I explore three reasons for thinking risk avoidance is a distinctly worthwhile aim of public health policy: that security is intrinsically valuable, that it is necessary for social planning and that it is an appropriate response to decision-making in contexts of very limited information. Striking the right balance between securing and maximizing population health thus requires a substantive, and hitherto unrecognized, value judgment. Finally, I critically evaluate the current health security agenda in light of this new account of the concept and its relationship to the other aims of public health policy.

Whilst security seems central to many moral and political problems, sustained examination of the concept by contemporary philosophers is rare. In this chapter I seek to re-ignite philosophical interest in security by uncovering some of the ways in which the concept has been both understood and misunderstood. I begin by exploring the scarce historical understandings of security within the Western philosophical canon, from the Epicureans through Hobbes and on to contemporary political philosophy, identifying the key themes which arise within the literature. I then provide an account of the structure of the concept of security, which lays bare its relationship to contemporary debates on the distinction between “natural” and “social” threats, on the political significance of fear, and on the nature of rights. Finally, I identify four key problems in moral and political philosophy – the balance between state and individual security, between liberty and security, the status of moral principles during emergencies and the trade-off between privacy and public safety – where a finer grained understanding of security can benefit normative theorising.

This chapter provides a philosophical analysis of the different meanings of “security” and, by so doing, identifies some key features of the concept of security. I begin by establishing a number of qualities which this chapter’s conceptual analysis should ideally possess. I then make an important distinction between security as a practice and security as a state of being, and argue that more attention should be paid to the latter if our goal is to interrogate the justifiability of using security practices in the context of infectious disease emergencies. The latter half of the chapter investigates three common features of contemporary accounts of security: (1) the referent object, (2) the conditions that object must satisfy to be secure, and (3) the distinction between the objective and subjective realisation of those conditions. I argue that accounts of the meaning of “security” identify a referent object and a set of conditions which must be reliable for that referent. I conclude by suggesting that a deeper engagement by moral philosophers with the concept and value of security (as a state of being) is required if we are to get very far in evaluating the justifiability of treating infectious disease emergencies as security issues.