Visiting Speakers - Fall 2007
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“Further lessons from ECMO: The ethics and epistemology of clinical research”
Dr. Robyn Bluhm, Postdoctoral Fellow in Neuropsychiatry , Department of Psychiatry, University of Western Ontario
Date: Friday, September 14, 2007
Time: 3:30 pm
Place: UC, Shiloh
Evidence-based medicine (EBM) posits a hierarchy of evidence on which the “best” evidence for the efficacy of a therapy comes from randomized controlled trials (RCTs). Moreover, there is an ethical obligation to conduct the best possible research in order both to provide the best care to future patients and to make sure that the efforts of current research participants are put to the best possible ends. On this view, exceptions to a randomized study are justifiable only when stronger ethical reasons exist for not randomizing participants to study groups, generally when the balance of benefits and harms is very different in the two groups. Thus, it is ethically justifiable to sacrifice methodological rigor when stronger ethical concerns demand it.
A rare exception to the general rule that both ethical and methodological concerns support the use of RCTs is described in Robert Truog’ analysis of the controversial RCTs of extracorporeal membrane oxygenation (ECMO) therapy in newborns. Truog offers both epistemological and ethical reasons in support of his claim that ECMO should not have been tested using RCTs, but that a long-term, large-scale observational study should have been conducted. Central to Truog’s argument, however, is the idea that ECMO is an unusual case. Thus, it is an open question whether Truog’s conclusions can be extended to other areas of medical research. In this talk, I look at epistemological and ethical issues arising in the care of patients with chronic diseases, using ECMO as a starting point. Both the similarities and the dissimilarities of these two cases highlight important issues in biomedical research and support a conclusion similar to Truog’s. Research on the treatment of chronic disease should rest primarily, not on RCTs, but on observational studies of the type described by Truog. I conclude by examining the implications of this claim for EBM.
“Property Rights and the Resource Curse”
Dr. Leif Wenar, Professor of Philosophy, University of Sheffield, Visiting Professor Princeton Center for Human Values
Date: Friday, October 19, 2007
Time: 3:30 pm
Place: AA 111
The resource curse afflicts poor countries with valuable resources like oil and diamonds. Such countries are prone to repressive governments, civil wars, and slower growth. This talk argues that the resource curse often results from a
failure to enforce property rights: the property rights of each country's people in that country's natural resources. This right is widely affirmed in international law, but violated when dictators and civil warriors sell off a territory's resources in circumstances where the people could not possibly authorize those sales. Firms that buy resources from repressive regimes are therefore receiving stolen goods, and passing these stolen goods on to consumers. Using a widely accepted metric, this talk shows that at least one in every eight barrels of oil currently entering the United States has been stolen from its country of origin.
Previous proposals to address the resource curse have focused on trying to convince kleptocratic regimes to behave better, or on creating novel international institutions. This talk describes two property rights enforcement mechanisms that use existing national institutions to sanction those who buy resources from the worst regimes. The first mechanism is litigation in rich-country courts against the international corporations that receive stolen resources. The second mechanism is an "anti-theft" trade policy that enables rich countries to penalize states that buy resources from
disqualified regimes.
The talk shows that authoritarianism, civil conflict, and slow growth in less developed countries can result from a failure to enforce the property rights of the poor. This flaw in global commerce can be corrected by ensuring that all
international resource sales respect the rules of legitimate trade.
"Distributive Justice at Home and Abroad"
Dr. Jon Mandle, Associate Professor of Philosophy and Department Chair, The University at Albany (SUNY)
Date: Friday, November 2,2007
Time: 3:30 pm,
Place: UC, Shiloh
Over the last decade, many philosophers addressing issues of global justice have considered whether the reasons that support egalitarian principles of distributive justice in the domestic sphere also support similar or identical principles globally. Strong cosmopolitans say yes—state boundaries and citizenship are morally arbitrary and cannot themselves legitimate differences in life prospects. Others say that although some cosmopolitan duties are owed to all, egalitarian duties hold only in the presence of certain types of institutions or relationships. Within this group, there is disagreement concerning which relationships trigger egalitarian duties and whether such relationships currently obtain on a global scale.
In this paper, I argue that there is no generalized egalitarian demand of justice in the absence of certain types of special relationships. Specifically, participation in a shared political order with a system of legitimate law triggers special egalitarian demands of justice. These egalitarian duties apply to the design of the basic structure of society, and not directly to acts of private individuals (when the basic structure is not at stake).
The position takes its cue from a reading of Kant’s political philosophy and Rousseau’s claim that “the fundamental pact, rather than destroying natural equality, on the contrary substitutes a moral and legitimate equality for whatever physical inequality nature may have placed between men, and that while they may be unequal in force or in genius, they all become equal by convention and by right.”
“On the Rhetoric of Failure and the Maintenance of Trust: Toward a Public Understanding of Ignorance in Public Science”
Dr. Alan Richardson, Professor and Distinguished University Scholar, Department of Philosophy, University of British Columbia
Date: Monday, November 12, 2007
Time: 3:30 pm
Place: UC, Shiloh
The SARS crisis in Toronto in the spring of 2003 led to a general wringing of hands in Canadian public health circles and to a desire to expose and correct the “failure” of the public health system in Ontario. The consensus view, as offered in detail in the Naylor Report (“Learning from SARS,” Health Canada, October 2003), was that the failure was not scientific but systemic; the public health system was unable properly to respond to the crisis. The operative terms, both at the time of the crisis and also in the wake of it, were taken from emergency and risk management: preparedness, threat containment, risk assessment, etc. I will argue that an STS perspective can help us ask different questions. For example, why is there a rhetoric of failure surrounding the health care system, one so easily mobilized and exploited when a deadly infectious disease claims a few dozen lives? What are the costs to health care workers, health researchers, and the public when the health care system operates under this discourse of failure? Moreover, I will provide an argument that emergency and risk management cannot deal with the most salient locus of public skepticism during the SARS crisis, which was a problem not of risk management but of ignorance management. During the SARS crisis, Ontario public health officials and health researchers appeared at daily press conferences and on the nightly news. These officials had to convince the Toronto (and Canadian) populace that they were the relevant experts who should be listened to even as they admitted that (a) there was no clear case definition for SARS; (b) no clear causative agent was known; and, thus, (c) there was no clear understanding of probabilities of getting ill with SARS. All decisions, public and private, made during the SARS crisis were, in the language of statistics, decisions made under ignorance, not under risk. This form of ignorance management—scientists and government officials managing their own ignorance in public—is a prior and more complicated problem than is the problem of simply and clearly communicating risk. Failure in ignorance management is failure of credibility, a failure to create a sense of trustworthiness. The problem for the experts was to maintain their status as experts while publicly managing their ignorance and exposing their internal controversies; STS, which has focused considerable attention on scientific controversy and on the establishment, maintenance, and dissolution of expert status, can here play both a critical and policy-oriented role.
(Co-sponsored by the Howard Baker Center for Public Policy)
For more information contact: hdouglas@utk.edu