Gopal Sreenivasan

Does informed consent to research require comprehension

It consists of two parts: a duty to obtain the voluntary agreement of patients or trial participants before treatment or enrolment; and a duty to disclose adequate information to the patient or participant before seeking this agreement. 1 The two parts evolved separately. 1–3 Indeed, the first is centuries old, 10 whereas the second is a relatively recent development. 11 Yet, according to the standard view of informed consent, they are best understood, morally, as closely integrated parts of a single requirement. 3–7 This interpretation has an ethically weighty implication; that the validity of an individual’s consent depends on him or her actually comprehending the information disclosed. 3–7 To remove doubt, comprehension or understanding is often listed in addition to disclosure, voluntary participation, and competence as an explicit requirement of informed consent. 3–7

Health Care and Equality of Opportunity

One widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity. But the evidence on the social determinants of health undermines this argument.

Duties and Their Direction

As said in Lake Shore & M.S.R. Co. v. Kurtz: “A duty or a legal obligation is that which one ought or ought not to do. ‘Duty’ and ‘right’ are correlative terms. When a right is invaded, a duty is violated.” In other words, if X has a right against Y that he shall stay off the former’s land, the correlative (and equivalent) is that Y is under a duty toward X to stay off the place. If, as seems desirable, we should seek a synonym for the term “right” in this limited and proper meaning, perhaps the word “claim” would prove best.

The situationist critique of virtue ethics

Traditional philosophical theories of virtue define a “virtue” as a species of character trait. Many contemporary philosophical theories of virtue follow suit, though not all do. Adopting this traditional definition exposes a theory of virtue to what has come to be known as the “situationist” critique of virtue ethics. To explain this critique, and to keep track of the ensuing debate, it helps to distinguish philosophical situationism from psychological situationism (see Snow 2010). Psychological situationists are not philosophers and they make no philosophical claims. Rather, they belong to a particular experimental tradition within social psychology, a tradition that is opposed to traditional personality theory or “personology” (for an accessible introduction, see Ross and Nisbett 1991). Since they are the original situationists, I shall henceforth refer to psychological situationists as “situationists” tout court. Philosophical situationists – principally, Gilbert Harman (1999, 2000) and John Doris (1998, 2002) – reject theories of virtue that employ the traditional philosophical definition of ‘virtue.’ Specifically, they claim that such theories are “empirically inadequate” and their argument for this claim centrally appeals to the experimental results of situationism. It is their argument that constitutes the “situationist critique.” The philosophical situationists’ argument can be framed as a pair of inferences, which take us from the original situationist data to their own bottom-line conclusion. Their bottom-line conclusion is that traditional theories of virtue are “empirically inadequate.”

Does the Gats Undermine Democratic Control over Health

This paper examines the General Agreement on Trade in Services (GATS), which is one of the World Trade Organisation’s free trade agreements. In particular, I examine the extent to which the GATS unduly restricts the scope for national democratic choice. For purposes of illustration, I focus on the domestic health system as the subject of policy choice. I argue that signatories to the GATS effectively acquire a constitutional obligation to maintain a domestic health sector with a certain minimum degree of privatisation. Like constitutional obligations, the restrictions the GATS imposes on the freedom of future generations to structure their domestic health sector are (i) very difficult, though not strictly impossible, to alter; and (ii) not chosen in any ordinary sense by the subject generation. To gain democratic legitimacy, therefore, the relevant provisions of the GATS must pass some higher standard of democratic scrutiny, such as ratification by a super-majority. Ordinary legislative ratification does not suffice.

Equality, opportunity, ambiguity

I distinguish four different interpretations of ‘equality of opportunity.’ We get four interpretations because a neglected ambiguity in ‘opportunity’ intersects a well-known ambiguity in ‘equality.’ The neglected ambiguity holds between substantive and non-substantive conceptions of ‘opportunity’ and the well-known ambiguity holds between comparative and non-comparative conceptions of ‘equality.’ Among other things, distinguishing these four interpretations reveals how misleading ‘equal opportunity for advantage’ formulations of luck egalitarianism can be. These formulations are misleading in so far as they obscure the difference between two separate claims about which inequalities are consistent with true equality. Luck egalitarianism claims that inequalities that have been chosen in some suitable sense are consistent with true equality, while the traditional ideal of equality of opportunity only claims that inevitable inequalities that have been determined through fair competitions are consistent with true equality. Obscuring the difference between these two claims therefore serves both to arrogate the rhetorical advantages of the traditional ideal to luck egalitarianism and to cover over a limitation to luck egalitarianism’s ambition to provide a comprehensive principle of distributive justice.

Health care and human rights: against the split duty gambit

There are various grounds on which one may wish to distinguish a right to health care from a right to health. In this article, I review some old grounds before introducing some new grounds. But my central task is to argue that separating a right to health care from a right to health has objectionable consequences. I offer two main objections. The domestic objection is that separating the two rights prevents the state from fulfilling its duty to maximise the health it provides each citizen from its fixed health budget. The international objection is that separating a human right to health care fails the moral requirement that, for any given moral human right, the substance to which any two right-holders are entitled be of an equal standard.