The use of genetic testing has prompted the question of whether insurance companies should be able to use predictive genetic test results (GTRs) in their risk classification of clients. Whilst some jurisdictions have passed legislation to wholly prohibit this practice, the UK has instead adopted a voluntary code of practice that merely restricts the ways in which insurance companies may use GTRs. Critics have invoked various theories of justice to argue that this approach is unfair. However, as well as relying on somewhat idealised assumptions, these analyses have tended to invoke theories that have wide-ranging and highly revisionary implications for insurance. Moreover, they fail to adequately engage with a conception of justice that plausibly undergirds the status quo approach to insurance in the UK. I argue that it is a mistake to simply invoke a single contestable theory in seeking to develop sound policy on the use of GTRs in insurance. To that end, in this paper, I outline three plausible principles of justice that policy on this issue ought to balance: A principle of equity, a principle of equal access, and a principle of need. In doing so, I shall offer a pluralist justice-based argument in support of the spirit, if not the precise letter, of the UK approach.
In response to the SARS-CoV-2 coronavirus pandemic the UK government has passed the Coronavirus Act 2020 (CA). Among other things, this act extends existing statutory powers to impose restrictions of liberty for public health purposes. The extension of such powers naturally raises concerns about whether their use will be compatible with human rights law. In particular, it is unclear whether their use will fall within the public heath exception to the Article 5 right to liberty and security of the person in the European Convention of Human Rights. In this paper, I outline key features of the CA, and briefly consider how the European Court of Human Rights has interpreted the public health exception to Article 5 rights. This analysis suggests two grounds on which restrictions of liberty enforced some under the CA might be vulnerable to claims of Article 5 rights violations. First, the absence of specified time limits on certain restrictions of liberty means that they may fail the requirement of legal certainty championed by the European Court in its interpretation of the public health exception. Second, the Coronavirus Act's extension of powers to individuals lacking public health expertise may undermine the extent to which the act will ensure that deprivations of liberty are necessary and proportionate.
This article critically analyzes the relationships among resource scarcity, conflict, and the transformation of the environment, positing several conceptual tools that provide a nuanced explanation for environmental transformation through human conflict and which overcome some of the limitations of the existing literature of political conflict. After proposing the idea of nonlinear cycles of violent degradation and demonstrating empirically how this has transformed landscapes and societies in the Ecuadorian highlands, the article examines the sociopolitical processes that occur at each of the nodes of the cycle. Specifically, it argues that the political incentives for cooperative environmental management can build confidence and be instrumental in the de-escalation of violence related to natural resource conflicts. When cooperative environmental management and dispute resolution fails, it is frequently the result of a gap between the short-term political incentives for decision makers to intervene and craft institutional solutions and the long-term pay-offs of these institutional measures for their constituents. The article argues that the destructive cycle is not deterministic, and that at each of the nodes of the cycle, opportunities exist to reach a stage of constructive negotiation, either by building on technical cooperation, mobilizing external allies and pressure agents, or by equalizing the gap in political time windows through conflict escalation so that decision makers find it in their interest to engage and help manage the conflict and mitigate global change. ; Este artículo analiza críticamente las relaciones entre la escasez de recursos naturales, los conflictos, y la transformación del medio ambiente. Propone varias herramientas conceptuales que ofrecen una explicación detallada de la transformación ambiental por medio de los conflictos humanos y que superan algunas limitaciones de la literatura sobre los conflictos políticos. Después de proponer la idea de ciclos no-lineales de degradación violenta, y demostrar empíricamente cómo se han transformado los paisajes y sociedades de la Sierra ecuatoriana, el artículo examina los procesos sociopolíticos que ocurren en cada uno de los nodos del ciclo. Específicamente, sostiene que los incentivos políticos para el manejo cooperativo del medio ambiente pueden aumentar la confianza y pueden contribuir decisivamente a la disminución de la violencia que está relacionada a conflictos de recursos naturales. Cuando el manejo cooperativo del medio ambiente y la resolución de disputas fracasan, frecuentemente resulta un desequilibrio entre los incentivos políticos de corto plazo para intervenir con la creación de soluciones institucionales, y los beneficios de largo plazo que vienen de las medidas institucionales para su electorado. Este artículo sostiene que el ciclo destructivo no es determinista, y que en cada nodo del ciclo, existen oportunidades para lograr una negociación constructiva. Esta negociación puede resultar de cooperación técnica, de la movilización de aliados externos y agentes de presión, o de cambiar el desequilibrio en incentivos políticos por medio de un aumento del conflicto para hacer que los líderes políticos tengan interés en involucrarse para ayudar a manejar el conflicto y disminuir el impacto del cambio global.
Once on the periphery of international debate, today small islands are seen by many as key to unlocking new ways of thinking about climate change and developing new practices of adaptation in the epoch of the Anthropocene. These approaches differ starkly from modernist, linear, causal frameworks that construct islands as vulnerable objects that require 'saving' or 'protecting'. Instead, islands become instruments of productive knowledge, laboratories for investigation and learning, fundamental to an alternative, correlational, epistemology. In analysing these approaches, we take the prolific trope of islands as the 'canaries in the coalmine' in order to draw out the ontological implications of instrumentalising islands as 'correlational machines' in the Anthropocene. We raise fundamental problems with this literal instrumentalisation of islands and islanders, drawing out how these logics reduce island life to merely sensing and attuning to the co-relational entanglements of the Anthropocene, rather than offering higher normative aspirations for political change.
The UK government has put Lateral Flow Antigen Tests (LFATs) at the forefront of its strategy to scale up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggests that the test missed over half of the positive cases in the tested population. This raises the question of whether it can it be ethical to use an inaccurate test to guide public health measures. We begin by explicating different dimensions of test accuracy (sensitivity, specificity, and predictive value), and why they matter morally, before highlighting key data from the Liverpool pilot. We argue that the poor sensitivity of the LFAT in this pilot suggests that there are important limitations to what we can expect these tests to achieve. A test with low sensitivity will provide false negative results, and in doing so generate the risk of false assurance and its attendant moral costs. However, we also suggest that the deployment of an insensitive but specific test could identify many asymptomatic carriers of the virus who are currently being missed under existing arrangements. Having outlined ways in which the costs of false reassurance could potentially be mitigated, we conclude that the use of an insensitive LFAT in mass testing may be ethical if (i) it is used predominantly to identify positive cases (ii) it is a cost-effective method of achieving that goal and (iii) if other public health tools can effectively prevent widespread false reassurance.
In response to the COVID-19 pandemic philosophers and governments have proposed scarce resource allocation guidelines. Their purpose is to advise healthcare professionals on how to ethically allocate scarce medical resources. One challenging feature of the pandemic has been the large numbers of patients needing mechanical ventilatory support. Guidelines have paradigmatically focused on the question of what doctors should do if they have fewer ventilators than patients who need respiratory support: which patient should get the ventilator? There is, however, an important higher level allocation problem. Namely, how are we to ethically distribute newly obtained ventilators across hospitals: which hospital should get the ventilator(s)? In this paper, we identify a set of principles for allocating newly obtained ventilators across hospitals. We focus particularly on low and middle income countries, who frequently have limited pre-existing intensive care capacity, and have needed to source additional ventilators. We first provide some background. Second, we argue that the main population healthcare aim during the COVID-19 pandemic should be to save the most lives. Next, we assess a series of potential heuristics or principles that could be used to guide allocation: allocation to the most densely populated cities, random allocation, allocation based on the ratio of patients to ICU personnel, prioritisation in terms of intrahospital mortality, prioritisation of younger populations, and prioritisation in terms of population mortality. We conclude by providing a plausible ranking of the principles, while noting a number of epistemological challenges, in terms of how they best further the aim of increasing the probability of saving the most lives.
