Katharine Browne

The Ebola epidemic that broke out inWest Africa West AfricaAfrica towards the end of 2013 had been brought under reasonable control by 2015. The epidemic had severely affected three countries. This case study is about a phase I/II clinical trial Phase I/II clinical trial of a candidate Ebola virus vaccine in 2015 in a sub-Saharan AfricanSub-Saharan Africa country which had not registered any cases of the Ebola virus disease. The study was designed as a randomized double-blinded trialRandomized double blinded trial. It was sponsored and funded by one of the biggest Northern multinational pharmaceutical companiesPharmaceutical companies. The protocol received ethics clearance from the relevantNational Ethics Committee national ethics committeeEthics committee. The study was coordinated and managed at the local branch of a big Northern diagnostic laboratoryDiagnostic laboratory and a laboratory of a local regional hospital. The overall study was a multi-countryMulti-country, multi-siteMulti-site trial aimed at recruiting a total of 3,000 research participantsResearch participants across four or five sub-Saharan African countries. For this country, the recruitmentRecruitment sites were two big cities, each aiming to recruit 200 participants: adults at the first site and childrenChildren at the second. The target sampleSample size was almost achieved at the first site but, before the study commenced at the second site, some members of raised the alarm that the governmentGovernment was carelessly risking the health, safetySafety and lives of citizens in the cause of an unproven vaccine that could precipitate a public health disaster. The trial was immediately suspended. A commentary on this case, and on the importance of trustTrust, is provided by Katharine Browne and Doris Schroeder at the end of this chapter. It highlights differences between this case and a phase I Ebola vaccine trial in CanadaCanada in 2014.

:Team reasoning is thought to be descriptively and normatively superior to the classical individualistic theory of rational choice primarily because it can recommend coordination on Hi in the Hi-Lo game and cooperation in Prisoner's Dilemma-type situations. However, left unanswered is whether it is rational for individuals to become team members, leaving a gap between reasons for individuals and reasons for team members. In what follows, I take up Susan Hurley's attempt to show that it is rational for an individual to become a team member. I argue that her account fails to show that becoming a team member is necessary to gain the advantages of coordination in Hi-Lo games or cooperation in Prisoner's Dilemma-type situations, and that individuals will often fare better reasoning as individual agents than as members of a team. I argue further that there is a more general problem for team reasoning, specifically that the conditions needed to make it rational for a team member to employ team reasoning make becoming a team member unnecessary.

This paper takes up David Gauthier's most recent defense of the rationality of cooperation in prisoner's dilemmas. In that defense, Gauthier argues for a Pareto-optimizing theory of rational choice. According to Gauthier, rational action should sometimes aim at Pareto-optimization, and cooperation in prisoner's dilemmas is rational because it is Pareto-optimizing. I argue that Pareto-optimization cannot justify cooperation in the prisoner's dilemma in a manner that is also consistent with Gauthier's other desiderata. Either: the rationality of cooperation must derive from what is beneficial for the group rather than what is beneficial for the individual, leaving the individual qua individual without any reason to cooperate, or Gauthier cannot explain why defecting in prisoner's dilemmas is not also rational.

Bill 20, An Act to Enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, was introduced to reduce costs associated with Québec’s healthcare in general and in vitro fertilisation in particular. Passed in November 2015, the new law introduces a number of exclusion criteria for access to and funding for IVF treatment. Remarkably, one exclusion criterion—prior voluntary sterilisation—has prompted little critical commentary. The two justifications offered for restricting funding for IVF on the basis of voluntary sterilisation are that there are cheaper options than IVF for sterilised individuals who want children, and society should not have to pay for IVF for persons who are infertile by choice. I argue that both of these justifications are unsatisfactory, insofar as they contravene the chief value underlying, and current practices of, Canadian healthcare, and rely on problematic ascriptions of personal responsibility for health.

:This article takes up a game-theoretic perspective on California’s recently passed bill that closes all nonmedical exemptions for school-mandated vaccination. Such a perspective characterizes parental decisions to vaccinate their children as a collective action problem and reveals the presence of an incentive to free ride—to enjoy the benefits of others’ efforts to vaccinate their children without vaccinating one’s own. This article defends California’s legislation as a reasonable means of overcoming the free rider problem and of ensuring that the burdens of vaccination are shared equally.