The Return of Quarantinism and How to Keep It in Check: From Wishful Regulations to Political Accountability

Concerns about emerging and re-emerging infectious diseases have given a new lease of life to quarantinist measures: a series of time-honoured techniques for controlling the spread of infectious diseases through breaking the chain of human contagion. Since such measures typically infringe individual rights or privacy their use is subject to legal regulations and gives rise to ethical and political worries and suspicions. Yet in some circumstances they can be very effective. After considering some case studies that show how epidemics are unique, fluid and affected by a multitude of contingent factors, it is argued that the legal and ethical guidelines may not always be the best approach to discipline the use of quarantinist measures. An alternative model based on ex-post political accountability for reasonableness is proposed. This model restores the centrality of political decision and expert judgement in situations characterized by high risk, uncertainty and contingency. It is argued that such alternative model affords quicker and more flexible responses to serious outbreaks of infections, while providing adequate protection against abuses

The Rise (and Fall?) of Normative Ethics. A Critical notice of Sergio Cremaschi’s L’etica del Novecento

Sergio Cremaschi’s L’etica del Novecento offers a clear and careful account of the development of ethical theory in English-language and German Philosophy. The focus on meta-ethics and normative concerns allows the author to offer a very concise, reliable and comprehensive overview of philosophical ethics. In this respect the book effectively fills the gap left by the lack of a good, updated history of ethics. Although those qualities establish Cremaschi’s work as a valuable reference book, a few doubts are raised about the highly theoretical approach adopted. On the one hand this choice proves not to be very hospitable to some traditions (like most of French philosophy, Marxism, Virtue ethics etc.) and overlooks the connections between ethics and the socio-historical world, with the effect of giving a picture of moral philosophy as a very abstract and academic discipline. On the other hand it is not clear whether the emergence of applied ethics is to be greeted as the culmination of the resurgence of normative ethics, or whether it is conspiring with other trends to undermine the whole enterprise of constructing normative theories. If, as I suspect, the latter is the case, the moral of Cremaschi’s narrative may be different from the one he suggests

Un maquillage molto leggero. Considerazioni sulla riformulazione della giustizia come equità di John Rawls.

In this review of Rawls’ last publication two aims are pursued. First, an attempt is made to clarify how this new work makes the deep structure of the theory emerge, thus indicating the way the different arguments, assumptions and conceptions are strictly intertwined. The main point is to show that the overlapping consensus does not bear a foundational role, since justification rests on the combined work of reflective equilibrium and of the original position. The possibility of an overlapping consensus simply shows that the theory is neither utopian nor pointless. Second, an assessment is made about the supposed new features of the book. It is argued that, rather than real novelties, improvements and clarifications are to be found. Moreover, some interesting topics never thoroughly explored before are not satisfyingly developed. The conclusion is that the book may be of some help to the interpretation of the scope and frame of Rawls’ political liberalism, but however it does not add any particularly significant development or novelty to his theory

Measuring Openness and Evaluating Digital Academic Publishing Models: Not Quite the Same Business

In this article we raise a problem, and we offer two practical contributions to its solution. The problem is that academic communities interested in digital publishing do not have adequate tools to help them in choosing a publishing model that suits their needs. We believe that excessive focus on Open Access (OA) has obscured some important issues; moreover exclusive emphasis on increasing openness has contributed to an agenda and to policies that show clear practical shortcomings. We believe that academic communities have different needs and priorities; therefore there cannot be a ranking of publishing models that fits all and is based on only one criterion or value. We thus believe that two things are needed. First, communities need help in working out what they want from their digital publications. Their needs and desiderata should be made explicit and their relative importance estimated. This exercise leads to the formulation and ordering of their objectives. Second, available publishing models should be assessed on the basis of these objectives, so as to choose one that satisfies them well. Accordingly we have developed a framework that assists communities in going through these two steps. The framework can be used informally, as a guide to the collection and systematic organization of the information needed to make an informed choice of publishing model. In order to do so it maps the values that should be weighed and the technical features that embed them. Building on our framework, we also offer a method to produce ordinal and cardinal scores of publishing models. When these techniques are applied the framework becomes a formal decision–making tool. Finally, the framework stresses that, while the OA movement tackles important issues in digital publishing, it cannot incorporate the whole range of values and interests that are at the core of academic publishing. Therefore the framework suggests a broader agenda that is relevant in making better policy decisions around academic publishing and OA

Conceptual and terminological confusion around Personalised Medicine: a coping strategy

The idea of personalised medicine (PM) has gathered momentum recently, attracting funding and generating hopes as well as scepticism. As PM gives rise to differing interpretations, there have been several attempts to clarify the concept. In an influential paper published in this journal, Schleidgen and colleagues have proposed a precise and narrow definition of PM on the basis of a systematic literature review. Given that their conclusion is at odds with those of other recent attempts to understand PM, we consider whether their systematic review gives them an edge over competing interpretations. We have found some methodological weaknesses and questionable assumptions in Schleidgen and colleagues’ attempt to provide a more specific definition of PM. Our perplexities concern the lack of criteria for assessing the epistemic strength of the definitions that they consider, as well as the logical principles used to extract a more precise definition, the narrowness of the pool from which they have drawn their empirical data, and finally their overlooking the fact that definitions depend on the context of use. We are also worried that their ethical assumption that only patients’ interests are legitimate is too simplistic and drives all other stakeholders’ interests—including those that are justifiable—underground, thus compromising any hope of a transparent and fair negotiation among a plurality of actors and interests. As an alternative to the shortcomings of attempting a semantic disciplining of the concept we propose a pragmatic approach. Rather than considering PM to be a scientific concept in need of precise demarcation, we look at it as an open and negotiable concept used in a variety of contexts including at the level of orienting research goals and policy objectives. We believe that since PM is still more an ideal than an achieved reality, a plurality of visions is to be expected and we need to pay attention to the people, reasons and interests behind these alternative conceptions. In other words, the logic and politics of PM cannot be disentangled and disagreements need to be tackled addressing the normative and strategic conflicts behind them

Practical Integration: the Art of Balancing Values, Institutions and Knowledge. Lessons from the History of British Public Health and Town Planning.

The paper uses two historical examples, public health (1840-1880) and town planning (1945-1975) in Britain, to analyse the challenges faced by goal-driven research, an increasingly important trend in science policy, as exemplified by the prominence of calls for addressing Grand Challenges. Two key points are argued. (1) Given that the aim of research addressing social or global problems is to contribute to improving things, this research should include all the steps necessary to bring science and technology to fruition. This need is captured by the idea of practical integration, which brings this type of research under the umbrella of collective practical reason rather than under the aegis of science. Achieving practical integration is difficult for many reasons: the complexity of social needs, the plurality of values at stake, the limitation of our knowledge, the elusive nature of the skills needed to deal with uncertainty, incomplete information and asymmetries of power. Nevertheless, drawing from the lessons of the case studies, it is argued that (2) practical integration needs a proper balance between values, institutions and knowledge: i.e. a combination of mutual support and mutual limitation. Pursuing such a balance provides a flexible strategy for approximating practical integration

Pharmacogenomic Inequalities: Strategies for Justice in Biomedical Research and Healthcare

The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus propose two provisos that would prevent the most offensive outcomes and moderate the scope of the produced inequalities. The first proviso rejects pharmacogenomics innovations that worsen existing group inequalities and aggravate the disadvantage of communities with a history of discrimination. The second proviso requires that there is a strategy in place to even out as much as possible the distribution of benefits in the future and that a system of compensations (in terms of healthcare services) is in place for pharmacogenomic orphans. Given that only one moral problem generated by pharmacogenomics has been tackled, the list of provisos might be expanded when other issues are considered

Rescuing Solidarity from Its Carers. A Response to Professor ter Meulen

The paper points out three serious problems in Ruud ter Meulen’s view of solidarity and of its role in healthcare ethics. First, it is not clear whether and to what extent ter Meulen expects normative concepts to be rooted in existing social practices: his criticism of liberal theories of justice seems to imply a different view on this issue than his implicit assumption that normative concepts are independent from social and historical trends. Second, it is not clear at which level his notion of solidarity is meant to be applied: does it provide principles for individuals or for institutions? Nor is it clear at what level of generality it should work: is it meant for healthcare institutions or for states, for citizens or for healthcare practitioners? Third, it is not at all clear how the communitarian and the universalist aspirations in his conception of solidarity can be reconciled. In light of such difficulties it is argued that within philosophical discourse solidarity can be a useful notion only if it can be clearly distinguished from existing and commonly used ethical concepts. Three examples of such narrow and specific uses of solidarity are presented. Finally, a sceptical view of confining the work of applied philosophers to articulating normative concepts is put forward and an alternative view of blending empirical and philosophical analysis is proposed. This vision of field philosophy requires serious attention and careful understanding of the circumstances and constraints within which normative recommendations operate. It is suggested that such a modest and empirically grounded understanding of normative work is a better way of honouring the belief that philosophy is rooted in social institutions and in complex webs of relations

Is regulatory innovation fit for purpose? A case study of adaptive regulation for advanced biotherapeutics

The need to better balance the promotion of scientific and technological innovation with risk management for consumer protection has inspired several recent reforms attempting to make regulations more flexible and adaptive. The pharmaceutical sector has a long, established regulatory tradition, as well as a long history of controversies around how to balance incentives for needed therapeutic innovations and protecting patient safety. The emergence of disruptive biotechnologies has provided the occasion for regulatory innovation in this sector. This article investigates the regulation of advanced biotherapeutics in the European Union and shows that it presents several defining features of an adaptive regulation regime, notably institutionalized processes of planned adaptation that allow regulators to gather, generate, and mobilize new scientific and risk evidence about innovative products. However, our in-depth case analysis highlights that more attention needs to be paid to the consequences of the introduction of adaptive regulations, especially for critical stakeholders involved in this new regulatory ecosystem, the capacity and resource requirements placed on them to adapt, and the new tradeoffs they face. In addition, our analysis highlights a deficit in how we currently evaluate the performance and public value proposition of adaptive regulations vis-à-vis their stated goals and objectives

When is a Techno-Fix Legitimate? The Case of Viticultural Climate Resilience

Climate change is an existential risk reinforced by ordinary actions in afuent societies—often silently present in comfortable and enjoyable habits. This silence is sometimes broken, presenting itself as a nagging reminder of how our habits fuel a catastrophe. As a case in point, global warming has created a state of urgency among wine makers in Spain, as the alcohol level has risen to a point where it jeopardises wine quality and thereby Spanish viticulture. Eforts are currently being made to solve this problem technologically by developing (non-GMO) strains of yeast that produce less alcohol. If successful, this could help save Spanish viticulture. This kind of technological solution is routinely criticised for ofering simplistic “techno-fx” solutions to solve complex societal problems. However, it is not clear what features are criticised by the notion of techno-fx and hence how to avoid this criticism. In our interpretation, the techno-fx notion is not exclusively used as a dismissive term. The notion points to a general virtue of engineering: to create technological solutions that work silently in the background. This asset of technological solutions might sometimes be problematic and sometimes not. Hence, it needs to be analysed case-by-case by paying attention to the moral relevance of the hidden implications of the technology and of the unrefective actions and habits that they facilitate. Such moral analysis will in turn inform strategies for foregrounding this technology to counteract silencing. We discuss what this means in the case of modifying yeast as a viticultural climate resilience strategy