Group 1: Applied philosophy and practical knowledge
Wednesday, 9th of December
Karla Alex, Heidelberg University Hospital
‘Ethical conceptualization of a sustainable right to health(care)’
Despite a vast amount of ethical discussions on sustainability and on the right to health, it has not been precisely determined how both concepts can be connected. As proposed in this paper, a sustainable right to health (encompassing the right to healthcare) comprises an agent-relative right to health(care); an agent-neutral right to health(care); economic aspects; and (only included in the conceptualization of a sustainable right to health, not to healthcare) environmental aspects.
I argue that from the value of health follows a universal right to health and from the universality of the right follows its sustainability. This approach firstly rests on the assumption of normative realism (Nagel, 1986); I presuppose that the instrumental value of health can be deduced from the objective intrinsic value of a human being. Secondly, the ethical conceptualization of a sustainable right to health is based on the traditional concept of sustainability (WCED, 1987; Elkington, 1999), and on the United Nations’ definition of the right to health (ICESCR, 1966; CESCR, 2000). Thirdly, the concept rests on agent-relative and agent-neutral values, and it is argued that the sustainable right to health is agent-neutral as well as agent-relative because the value of health is agent-neutral as well as agent-relative. Although, according to Nagel, agent- neutral values can be arrived at from the exact same impersonal standpoint, or “view from nowhere,” as agent-relative values, the problem of how to abstract from the agent-relative perspective remains unresolved.
I will briefly discuss this problem by referring to examples of the here proposed concept. For not only is there a conflict between an economic (Porter, 2010) and an ethical (DeCamp, 2019) understanding of value of healthcare that is resolved in my conceptualization by the restriction of economic aspects to those that do not transcend the moral agent-relative and agent-neutral rights to health, but there is also a conflict between the agent-relative and the agent-neutral right to health that cannot be resolved as easily. This conflict becomes apparent when agent-relative rights to a specific type of healthcare conflict with agent-neutral rights of other members of society (including the entire, global society, as well as future generations), e.g. of those to whom the healthcare is not allocated when there is a shortage of resources, or of those who are negatively affected by, but are no direct recipients of the healthcare in question. Examples include assisted reproductive technologies that respect the agent-relative reproductive rights of potential parents, but result in negative effects on future generations either through embryo selection, or through inheritance of unintended consequences (e.g. in germline genome editing). The SARS-CoV2-2019/COVID-19 pandemic is another example where agent-relative and agent-neutral rights may conflict, as allocation guidelines, immunization policies, and triage value the agent-neutral right to health, but may thereby negatively affect agent-relative rights. These and further examples emphasize the importance of the proposed ethical conceptualization of a sustainable right to health(care) for discussions within medical ethics, as well as for applied ethics in general.
Rikke Friis Bentzon, Copenhagen University
‘Wisdom and well-being’
In this talk, I aim to explain how wisdom is a necessary component of living a good life with well-being. I understand wisdom as practical wisdom along the lines of Aristotle’s phronesis. In this view, being wise does not mean that one has good meta cognition, as Socrates thought, or one is book smart, but rather succeeding in living one’s life in a good way (Aristoteles, 2000; Tiberius, 2008). This links wisdom to a process-oriented theory of well-being, as the one presented in The Reflective Life (Tiberius, 2008). When well-being is considered as a process rather than a goal, and wisdom is a necessary component of living a life with well-being, then the notion of wisdom is best explained as a practical knowledge.
Practical knowledge is usually considered in either intellectual or anti-intellectual notions, meaning it is viewed either as a relation between a subject and a propositional content, or as abilities or dispositions to act in a certain way. An intellectualist about practical knowledge will explain my ability to do horseback riding successfully in terms of my familiarity with certain explicit propositions about how one does horseback riding. An anti-intellectualist would say that I have certain abilities or dispositions to act in a certain way when going horseback riding.
I will show how Tiberius bases her notion of wisdom on intellectualistic terms, while explaining her process-oriented theory of well-being. Afterwards, I will argue that wisdom would be better explained in anti-intellectualist notions.
Victor Chidi Wolemonwu, University of Sheffield
‘Exploitation and Servile Relations in Clinical Research’
Abstract: Discussions about the notion of exploitation in clinical research often centre on three key elements, namely, lack of consent, excessive risks and unfair distribution of benefits. Many bioethicists, clinical researchers and policy-makers seem to agree that these elements are essential to provide an adequate explanation of what may be morally wrong about the involvement of human subjects in clinical research (Hans Jonas 1969; WHO-GCP 2002; Howard Brody 2012; CIOMS 2016). The Pfizer, Tuskegee syphilis and Synflorix clinical trials, vividly exemplify morally questionable and exploitative clinical research. In each of these cases, voluntary consent was absent; the studies were excessively risky, and the risks of the research outweighed the benefits offered to the participants, which were mainly food, shelter and transportation. Alan Wertheimer’s account of exploitation seems to show that exploitation may still occur in a consensual interaction. According to Wertheimer, the fundamental element of exploitation is ‘unfair advantage.’ In other words, exploitation occurs if an agent takes unfair advantage of another in other to benefit from the transaction. There are two ways in which an agent can take unfair advantage of another: if an agent benefits from the transaction by harming the other transacting party, or if the agent’s benefit is excessive relative to the benefit of the other transacting party.
Wertheimer’s account is inadequate to account for the moral wrongness in exploitative clinical research cases like the Lily, AstraZeneca and Tenofovir clinical trials for two reasons: First, exploitation may occur even if the exploiter did not receive any benefit. For instance, in the Tenofovir clinical trial, the clinical trial was aborted because some activists claimed that the researchers recruited the research subjects (who were prostitutes) without providing a remedy just in case there were complications. So, the researchers did not achieve the goal of the research, yet, there was something morally wrong about the study. Secondly, it is difficult to determine what counts as excessive benefits in clinical research. The reason is that research subjects consent to trials for different reasons. In non-therapeutic clinical research like the Lily and AstraZeneca experiments, the research subjects agreed to the clinical trials because they needed some money, food and accommodation. There is no gainsaying that addressing these needs by involving in clinical research is the most reasonable thing to do. However, it is difficult to determine what might be morally wrong in these cases if we rely on the size of benefits received, mainly if the benefits received is based on contractual terms. To explain what is morally wrong in the Lily, Tenofovir and AstraZeneca experiments, therefore, we need to invoke the idea exploitation based on the concept of servility. I argue that the Lily, Tenofovir and AstraZeneca experiments are exploitative because the researchers put the research subjects into a position in which they voluntarily enter into servile relations with them. I will attempt a defence of this account against some possible criticisms.