A sufficiency threshold is not a harm principle: A better alternative to best interests for overriding parental decisions

Douglas Diekema influentially argues that interference with parental decisions is not in fact guided by the child’s best interests, but rather by a more permissive standard, which he calls the harm principle. This article first seeks to clarify this alternative position and defend it against certain existing criticisms, before offering a new criticism and alternative. This ‘harm principle’ has been criticized for (i) lack of adequate moral grounding, and (ii) being as indeterminate as the best interest standard that it seeks to replace. I argue that these are not serious problems. I take Diekema’s negative point to be right—our actual standard for intervention is not literally the best interests of the child—but I disagree with his proposed replacement. First, Diekema’s proposed harm threshold should be more carefully distinguished from Mill’s harm principle. Second, there is no reason to assume that the standard for permissible intervention coincides with the threshold for harm (or serious harm). Thus, I propose that the best alternative to the best interests standard is not a harm principle, but rather a sufficiency threshold between adequate (or ‘good enough’) and inadequate (or ‘substandard’) parenting.     

THE NON-IDENTITY PROBLEM AND GENETIC HARMS – THE CASE OF WRONGFUL HANDICAPS

The Human Genome Project will produce information permitting increasing opportunities to prevent genetically transmitted harms, most of which will be compatible with a life worth living, through avoiding conception or terminating a pregnancy. Failure to prevent these harms when it is possible for parents to do so without substantial burdens or costs to themselves or others are what J call "wrongful handicaps". Derek Parfit has developed a systematic difficulty for any such cases being wrongs — when the harm could be prevented only by preventing the existence of the individual who would have a worthwhile life even with the handicap, then bringing him into existence with the handicap does not make him worse off and so does not wrong him. I argue that a non "person-affecting" principle requiring the avoidance of suffering and limited opportunity correctly accounts for cases of wrongful handicaps without requiring that the individuals with the handicap have been made worse off and therefore wronged. It is an advantage, not a difficulty, of this account that it does not imply that the person with the handicap has been wronged or is a victim with a special moral complaint.     

The harm principle as a mid-level principle?: three problems from the context of infectious disease control

Effective infectious disease control may require states to restrict the liberty of individuals. Since preventing harm to others is almost universally accepted as a legitimate (prima facie) reason for restricting the liberty of individuals, it seems plausible to employ a mid-level harm principle in infectious disease control. Moral practices like infectious disease control support - or even require - a certain level of theory-modesty. However, employing a mid-level harm principle in infectious disease control faces at least three problems. First, it is unclear what we gain by attaining convergence on a specific formulation of the harm principle. Likely candidates for convergence, a harm principle aimed at preventing harmful conduct, supplemented by considerations of effectiveness and always choosing the least intrusive means still leave ample room for normative disagreement. Second, while mid-level principles are sometimes put forward in response to the problem of normative theories attaching different weight to moral principles, employing a mid-level harm principle completely leaves open how to determine what weight to attach to it in application. Third, there appears to be a trade-off between attaining convergence and finding a formulation of the harm principle that can justify liberty-restrictions in all situations of contagion, including interventions that are commonly allowed. These are not reasons to abandon mid-level theorizing altogether. But there is no reason to be too theory-modest in applied ethics. Morally justifying e.g. if a liberty-restriction in infectious disease control is proportional to the aim of harm-prevention, promptly requires moving beyond the mid-level harm principle.     

The Harm of Bioethics: A Critique of Singer and Callahan on Obesity

Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of resource allocation or clinical procedures such as bariatric surgery. However, prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences. This article critically examines two problematic aspects of Singer and Callahan's respective approaches. First, there is an uncritical assumption that individuals are autonomous agents responsible for health‐related effects associated with food choices. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, this view alone does not justify intervention. Both Singer and Callahan recognize that individuals are free to make foolish choices so long as they do not harm others. It is at this point that the second problematic aspect arises. To interfere legitimately in the liberty of individuals, they invoke the harm principle. I contend, however, that in making this move both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. I argue that the mobilization of the harm principle and corresponding focus on individual behaviours without careful consideration of the empirical research is itself a form of harm that needs to be taken seriously.     

Comparison of Bayesian-Utilitarian and Maximin Principle Approaches

The Precautionary Principle implies the adoption of a set of rules aimed at avoiding possible future harm associated with suspected, but not ascertained, risk factors. Several philosophical, economical and societal questions are implied by precaution-based public health decision making. The purpose of the present paper is to specify the scope of the principle examining the notion of uncertainty involved, and the implication of different approaches to the decision making process. The Bayesian-utilitarian approach and the approach based on the maximin principle will be considered, and the different meaning of prudence in the two settings will be discussed. In a Bayesian-utilitarian approach the small number of attributable cases will end up in a low average expected value, easily regarded as acceptable in a cost-benefit analysis. In a maximin approach, on the other hand, the issue will be to consider the high etiologic fraction of a rare disease in the highest category of exposure. In the light of the aforementioned cautions in interpretation, the core difference between the two approaches has to do with the choice between averaging knowledge or equitably distributing technological risks.     

气流控制农业害虫的发展与利用

气流控制技术工作原理是利用流动的空气消灭农作物上的害虫。利用气流控制技术原理制造产生流动的空气清除、杀死和收集农作物上害虫的机械装置称捕虫机或称吸虫机。应用捕虫机防治马铃薯、甘薯、茄子、香葱、草莓、茶树等农作物上的害虫方法,具有不污染环境、无残留、对人体健康无伤害、对土壤微生物影响较小等优点。本文从气流控制农业害虫的基本原理、发展和利用、局限性以及展望四个方面出发,阐述了国内外昆虫学者利用气流控制农业害虫研究的进展,目的是为我国研发和利用其技术防治农业害虫提供参考。     

The Concept of Risk in Biomedical Research Involving Human Subjects

An established ethical principle of biomedical research involving human subjects stipulates that risk to subjects should be proportionate to an experiment's potential benefits. Sometimes this principle is imprecisely stated as a requirement that 'risks and benefits' be balanced. First, it is noted why this language is imprecise. Second, the persistence of such language is attributed to how it functions as a rhetorical trope. Finally, an argument is made that such a trope is infelicitous because it may not achieve its intended persuasive purposes. More importantly, it should be avoided because it masks the important role that chance plays in clinical research. Risk is the possibility of harm. As a precondition of harm it is unintended and undesirable in projects of biomedical research. It requires ethical vigilance. As a vehicle of chance, however, it is both intended and desirable. It requires methodological appreciation.     

Wrongs, preferences, and the selection of children: a critique of Rebecca Bennett's argument against the principle of procreative beneficence

Rebecca Bennett, in a recent paper dismissing Julian Savulescu's principle of procreative beneficence, advances both a negative and a positive thesis. The negative thesis holds that the principle's theoretical foundation - the notion of impersonal harm or non-person-affecting wrong - is indefensible. Therefore, there can be no obligations of the sort that the principle asserts. The positive thesis, on the other hand, attempts to plug an explanatory gap that arises once the principle has been rejected. That is, it holds that the intuitions of those who adhere to the principle are not genuine moral intuitions, but instead simply give voice to mere (non-moral) preferences. This paper, while agreeing that Savulescu's principle does not express a genuine moral obligation, takes issue with both of Bennett's theses. It is suggested that the argument for the negative thesis is either weak or question-begging, while there is insufficient reason to suppose the positive thesis true.     

Nutritional immunity: transition metals at the pathogen-host interface

Transition metals occupy an essential niche in biological systems. Their electrostatic properties stabilize substrates or reaction intermediates in the active sites of enzymes, and their heightened reactivity is harnessed for catalysis. However, this heightened activity also renders transition metals toxic at high concentrations. Bacteria, like all living organisms, must regulate their intracellular levels of these elements to satisfy their physiological needs while avoiding harm. It is therefore not surprising that the host capitalizes on both the essentiality and toxicity of transition metals to defend against bacterial invaders. This Review discusses established and emerging paradigms in nutrient metal homeostasis at the pathogen-host interface.     

Misusing uteruses? Childrearing capacity and access to transplantable wombs

In light of recent successful uterus transplantations, it is reasonable to expect that womb transplants will become more commonplace in the future. If this happens, important questions emerge about who should receive the donated wombs. Some arguments have been advanced that suggest that potential recipients should be screened for their anticipated childrearing capacity, as one component of a comprehensive process for determining eligibility. The main arguments provided in support of this position have to do with the presumed responsibility of the state to protect future children from harm, and with avoiding complicity for any resulting harm experienced by the child born through the transplanted uterus. The purpose of this paper is to reject this position, based on two main criticisms: (1) screening potential uterus recipients for anticipated childrearing ability, but not also screening other kinds of morally equal family builders, is unjustly discriminatory; and (2) with respect to actions performed in good faith (e.g. providing a transplantable uterus to someone for the purpose of having a child), one is not morally blameworthy for the consequences of those actions (a) that one did not intend, and (b) that were directly caused by someone else, and (c) where others are directly responsible for making sure that those consequences do not come about. These criticisms are sufficient for concluding that the state is not justified in assessing the anticipated childrearing capacity of potential uterus recipients, and this is so regardless of whether or not there is a scarcity of transplantable uteruses available.     

A response to Dodds and Jones

In response to "Surrogacy and Autonomy," by Susan Dodds and Karen Jones in this issue of Bioethics, the author concedes that only a surrogacy practice stringently regulated by good counseling, escape clauses for pregnant women, and the prohibition of profit-making agencies will save women from exploitation, but she objects to singling out women for paternalistic "protection against themselves," and to defending women's autonomy to the extent of their right to behave in ways known to harm a fetus. Dodds and Jones' concerns about attitudes toward women, genetic bias, the concept of children as property, and the harm principle generated by surrogacy contracts are answered with arguments for why surrogacy should not be illegal.     

Conceptual challenges to the harm threshold

Children are presumptively regarded as incompetent to make their own medical decisions, and the responsibility for making such decisions typically falls to parents. Parental authority is not unlimited, however, and ethical guidelines identifying appropriate bounds on this authority are needed. One proposal currently gaining support is the harm threshold (HT), which asserts that the state may only legitimately intervene in parental decision-making when serious and preventable harm to children is likely. This paper considers two questions: in virtue of what underlying principle or property does the HT gain its purported justification?; and does this underlying principle or property ground the HT as its proponents conceive of it? I identify two separate grounds represented in the literature: (a) J.S. Mill’s Harm Principle; and (b) the liberty interests of parents. I find that the HT is not sufficiently grounded in either of these, revealing a substantial conceptual difficulty for its advocates.     

The Precautionary Principle,Epidemiology and the Ethics of Delay

Ethics tells us: do good and do no harm and invokes the norms of justice, equity and respect for autonomy in protecting and promoting health and well-being. The Precautionary Principle, a contemporary re-definition of Bradford Hill's case for action, gives us a common sense rule for doing good by preventing harm to public health from delay: when in doubt about the presence of a hazard, there should be no doubt about its prevention or removal. It shifts the burden of proof from showing presence of risk to showing absence of risk, aims to do good by preventing harm, and subsumes the upstream strategies of the DPSEEA (Driving Forces Pressure Stress Exposure Effect Action) model and downstream strategies from molecular epidemiology for detection and prevention of risk. The Precautionary Principle has emerged because of the ethical import of delays in detection of risks to human health and the environment. Ethical principles, the Precautionary Principle, the DPSEEA model and molecular epidemiology all imply re-emphasizing epidemiology's classic rôle for early detection and prevention. Delays in recognizing risks from past exposures and acting on the findings (e.g., cigarette smoking and lung cancer, asbestos, organochlorines and endocrine disruption, radiofrequency, raised travel speeds) were examples of failures that were not only scientific, but ethical, since they resulted in preventable harm to exposed populations. These may delay results from, among other things, external and internal determinants of epidemiologic investigations of hazard and risk, including misuse of tests of statistical significance. Furthermore, applying the Precautionary Principle to ensure justice, equity, and respect for autonomy raises questions concerning the short-term costs of implementation to achieve long-term goals and the principles that guide compensation.     

Implicit normativity in scientific advice: values in nutrition scientists' decisions to give public advice

This paper focuses on implicit normative considerations underlying scientific advice -- those normative questions, decisions, or issues that scientific advisers and the general public are not fully aware of but that nevertheless have implications for the character of the advice given. Using nutritional science as an example, we identify three such implicit normative issues. The first concerns the aim of scientific advice: whether it is about avoiding harm or promoting good. The second concerns the intended beneficiaries of the advice: whether advice should be framed to benefit the society as a whole or with special concern for the most vulnerable members of the population. The third consideration involves scientific advisers' attempts to balance the strengths of the scientific evidence with the expected consequences of scientific advice. We hope to promote more explicit discussion of these issues among scientific advisers and a wider public.     

The Ebbeson-Tang formula. Theoretical background of an alternative to the disector in stereologic cell count studies

OBJECTIVE: To evaluate the formula of Ebbeson and Tang (FET) with respect to the disector (DS) principle. STUDY DESIGN: The DS principle has been proposed for avoiding cell count bias. DS is a slice of tissue, and from it those cells by area are counted in microscopy; the cells are not in contact with one of the surfaces of the slice. The resulting number divided by the thickness of the DS gives an accurate figure for cell number by volume. FET applies two sections of different thickness, usually cut adjacent. Cells seen in the sections are counted by area, the figures are subtracted from each other, and the difference is divided by the difference between the thicknesses of the sections. The result is cell number by volume: NV = (NA1 - NA2)/(t1 - t2). RESULTS: FET and the DS principle superficially appear different. However, from a geometric point of view they are based on the same principle. When the thickness of the thinner section of FET approaches zero, the situation is in all respects equal to the DS principle. The formula for DS can thus be written: NV = (NA1 - NA2)/t1. CONCLUSION: The result proves that in principle DS and FET are equivalent methods of counting cell numbers by volume in tissues. FET may be more easily applied in histopathology practice because visual comparison of the sections is not necessary. Section thickness, however, has to be measured from vertically embedded sections or with scanning laser confocal microscopy. FET shares the stereologically unbiased character of the DS principle and is independent of the size and shape of structures counted.     

Prevención cuaternaria en ancianos

Quaternary prevention is a group of measures taken to prevent, decrease and/or alleviate the harm caused by health activities.     

The threat premium in economic bargaining

Costly punishment is thought to have evolved because it promotes cooperation and the equitable sharing of resources, but the costs associated with punishment – for both the punisher and the punished – limit the efficiency of this enforcement system in economic interactions. Reputation may also guide decision-making, but this information is not always available (e.g., in interactions involving strangers). Across several bargaining studies, we provide evidence of an efficient and flexible “threat-based” bargaining system that can influence the division of resources without the need for costly punishment and reputational information. We found that participants, without prompting, dynamically adjusted bargaining based on the perceived threat-potential (resource holding power and aggressiveness) of the bargaining partner, giving larger offers to individuals who appeared more threatening. These effects of perceived threat-potential were strongest among participants who were most vulnerable to harm in physical contests (women vs men and weaker men vs stronger men), despite that offers were made on-line and anonymously to photographs of the individuals rather than in face-to-face interactions. These results may reflect an overgeneralization of a real-world threat heuristic that allows low threat individuals to extract resources when possible, while avoiding physical retaliation and harm, and high threat individuals to appropriate larger shares of a resource through static facial cues of threat rather than by physically expressing their propensity to punish. Previously, researchers have highlighted the monetary advantages of attractiveness (the “beauty premium”), but the effects of threat either trumped, devalued, or were equivalent to those of attractiveness.     

藏经楼粉螨综合防治案例

应用电热器升温 ,CaCl2 吸湿 ,NaHCO3 和草酸晶粉释放CO2 ,磷化铝熏蒸 ,DDVP乙醇混合液综合防治某寺院藏经楼的粉螨 ,杀虫效果显著 ,且对藏经楼的文物没有危害。     

A room for reflection: self-observation and transformation in participatory HIV prevention work

This article looks at HIV prevention projects in which established stigmatized and stigmatizing roles were actively reversed and manipulated in pursuit of HIV harm reduction. In two Norwegian projects, sex workers and drug users carried out harm-reduction activities with other drug users and sex workers. Although HIV-related harm reduction was the aim of the projects, termination or reduction of drug use or sex work was not. Such changes nevertheless occurred among the sex workers and drug users who took active part in the project. The article considers these changes in order to reflect on the meanings and roles of participation in HIV prevention work. In particular, the discussion theorizes on possible ways in which alteration of roles and subject positions may produce self-reflective effects with transformative potentials.     

Mass-dependent predation risk and lethal dolphin-porpoise interactions

In small birds, mass-dependent predation risk (MDPR) is known to make the trade-off between avoiding starvation and avoiding predation dependent on individual mass. This occurs because carrying increased fat reserves not only reduces starvation risk but also results in a higher predation risk due to reduced escape flight performance and/or the increased foraging exposure needed to maintain a higher body mass. In principle, the theory of MDPR could also apply to any animal capable of storing energy reserves to reduce starvation and whose escape performance decreases with increasing mass. We used a unique situation along certain parts of coastal Britain, where harbour porpoises (Phocoena phocoena) are pursued and killed but crucially not eaten by bottlenose dolphins (Tursiops truncatus), to investigate whether a MDPR effect can occur in non-avian species. We show that where high levels of dolphin 'predation' occur, porpoises carry significantly less energy reserves than would otherwise be expected and this equates to reducing by approximately 37% the length of time that a porpoise could survive without feeding. These results provide the first evidence that a mass-dependent starvation-predation risk trade-off may be a general ecological principle that can apply to widely different animal types rather than, as is currently thought, only to birds.