Margaret Little

In this paper, I have tried to develop a critique of committee procedures and conflict of interest within research advisory committees and ethical review committees (ERCs). There are specific features of conflict of interest in medical research. Scientists, communities and the subjects of research all have legitimate stakeholdings. The interests of medical scientists are particularly complex, since they are justified by the moral and physical welfare of their research subjects, while the reputations and incomes of scientists depend on the success of their science. Tensions of this kind must at times produce conflict of interest. It is important to recognise that conflicts of interest may unwittingly lead to manipulation of research subjects and their lay representatives on research committees. It is equally important to recognise distinctions between the legal and moral aspects of conflict of interest. Some practical suggestions are made which may go some way towards resolving these difficulties. They indicate what might be needed to ensure the validity of ethical discourse, and to reduce the risks associated with conflict of interest

We argue that it has not been adequately appreciated that there are not one but two types of reasons that have been advanced under the rubric of non-requiring reasons. One camp defends the existence of reasons that play what we call a permissibility-conferring role. These are reasons that function to defuse or neutralize, by a certain degree, the force of requiring reasons. Another camp defends the existence of reasons that play what we call a commendatory role. These are reasons that function to normatively endorse an action without placing one in need of justification to decline. We lay out the two camps – their core claims, animating motivations, and, in final section, why they are sometimes confused for one another.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, not evidence.

A striking feature of the life of practical agency is the substantial latitude it includes. One suggestion for how to explain this latitude is that such latitude points to pluralism in the very way that reasons favor: some reasons favor deontically, and other reasons only commend. However, there is a critical question about the comparative lives of such reasons. They presumably admit of different strengths, and are thus capable of ordering options. While one might agree that we have latitude to decline following the direction of a reason that merely commends, it seems that once we face two or more such reasons that offer competing recommendations, only the action supported by the better reason is a candidate for action. Against this challenge, this chapter argues that commendatory reasons have the ability to defend, in the cases we care about, the moral and rational acceptability of doing the less worthy.

When a woman is pregnant, how should we understand the moral status of the life within her? How should we understand its status as conceptus, as embryo, when an early or again matured fetus? According to some, human life in all of these forms is inviolable: early human life has a moral status equivalent to a person from the moment of conception. According to others, such life has no intrinsic status, even late in pregnancy. According to still others, moral status emerges when sentience does. Until the fetus is conscious - a point somewhere at the end of the second trimester, it has no moral status at all; after it is conscious, it does.

I defend moral objectivism against charges that it cannot plausibly preserve or explain morality's action-guiding nature. I take as my starting point the intuitive view that morality has a special connection to motivation: one who genuinely accepts a moral verdict must have a motivating reason to follow its dictates and, indeed, must often enough be motivated to act as it recommends. ;Many have argued that this connection vindicates subjectivism. Some argue that there can be no universally accessible truths whose acknowledgements necessarily give one reason to act, because all reasons for action are based on desires that vary across rational agents. I argue against the Humean doctrine, implicit in this claim, that beliefs alone cannot move rational agents. The 18th-century metaphors of "passive" belief and "active" desire rest on arguments which either beg the question, equivocate, or misunderstand what would be involved in attributing the appropriate motivational power to belief. Others ground their objection in morality's holistic tie to desire, claiming that desires distort truth, rather than reveal it to us. I argue that there is nothing mysterious about the idea that possession of certain desires can be preconditions to seeing how things are.

A timely and penetrating investigation, this book seeks to transform moral philosophy. In the face of continuing disagreement about which general moral principles are correct, there has been a resurgence of interest in the idea that correct moral judgements can be only about particular cases. This view--moral particularism --forecasts a revolution in ordinary moral practice that has until now consisted largely of appeals to general moral principles. Moral particularism also opposes the primary aim of most contemporary normative moral theory that attempts to show that either one general principle, or a set of general principles, is superior to all its rivals

Though much progress has been made on inclusion of non-pregnant women in research, thoughtful discussion about including pregnant women has lagged behind. We outline resulting knowledge gaps and their costs and then highlight four reasons why ethically we are obliged to confront the challenges of including pregnant women in clinical research. These are: the need for effective treatment for women during pregnancy, fetal safety, harm from the reticence to prescribe potentially beneficial medication, and the broader issues of justice and access to benefits of research participation. Going forward requires shifting the burden of justification from inclusion to exclusion and developing an adequate ethical framework that specifies suitable justifications for excluding pregnant women from research.