Broadly speaking, my research seeks to bring frameworks and insights from political philosophy to bear on questions in applied ethics, and in particular on questions in the ethics of scientific and technological progress. The bulk of my work addresses what I see as two, often overlapping, themes. The first theme concerns how to think about the value of research - so far, primarily clinical research - and how such considerations should inform what research is conducted, where, and why. I am currently working to expand this work to address the value of research of other kinds, such as the development of AI and the rapid proliferation of algorithmic decision-making into all facets of life. The second theme concerns what I think is a problematic tendency in applied ethics to address questions in these areas in a manner that focuses on the ethics of individual interactions, often in ways that obscure the relevance of background relationships and structural injustice. These two themes are largely intertwined in my work; below I discuss them separately to the extent that I can.
The Social Value of Research-Generated Knowledge & Priority-Setting in Research
In an early paper ("The Social Value of Knowledge and International Clinical Research"), I argued that the justification for subjecting human participants to risks of harm in clinical research is the potential for generation of socially valuable knowledge, and that the social value of research-generated knowledge is importantly context-dependent in a way that ought to inform which research should be conducted in which populations. This work was further developed in a second paper ("The Social Value of Knowledge and the Responsiveness Requirement for International Research"). This paper uses decision theory to formalize what is often referred to in the literature as "the social value requirement" (SVR) - the idea that in order to be ethical, clinical research must be capable of generating socially valuable knowledge. The paper goes on to argue that a contextualized version of the SVR is the best candidate to fill in what is known as "the responsiveness requirement" - the idea that in order to be ethical, research conducted in low- and middle-income host communities must be responsive to local health needs.
More recently, some ethicists have questioned the basis for asserting the SVR in research, and in particular have put pressure on the idea that research sponsored by private entities (as opposed to publicly-funded research institutes) should be bound by it. In a recent paper ("The Social Value Requirement in Research: From the Transactional to the Basic Structure Model of Stakeholder Obligations"), I argue that much of this debate is conducted against the background of an often unacknowledged commitment to what I call the "transactional model of stakeholder obligations." This model takes clinical research to be primarily comprised of voluntary interactions between consenting parties, typically including (although maybe not limited to) research sponsors, investigators, and research participants. I argue that a more adequate model of research stakeholder obligations is what I call the "basic structure model." This model takes clinical research to be one component of an institutional structure governing the health systems that are available to individuals - an institutional structure from which they cannot opt out, and which will have deep and lasting impacts on their life prospects. Using John Rawls's arguments regarding the central importance of what he called the "basic structure of society," I contend that this model of research places it squarely within the purview of basic justice considerations. As such, stakeholders in the research enterprise have obligations not only to those with whom they directly interact as sponsors, investigators, and participants, but also to all of those who are governed by the institutional structure of which clinical research is a central part and whose lives it aims to fundamentally impact.
The basic structure model serves as the jumping off point for a 2019-2022 Greenwall Foundation Fellowship. This project seeks to unpack the practical implications of viewing research as a basic structure institution, in particular for the ethics of health research priority-setting, the just distribution of research results, and how intellectual property rights to research results are conceptualized. The shift in grounds for the social value requirement away from a transactional and towards a basic structure model impacts both the content and scope of the social value requirement, and importantly is inconsistent with some recent attempts in the literature to enunciate the ethics of health research priority-setting. My arguments for the basic structure model also have implications for the proliferation of algorithms and artificial intelligence into society. An expansion of this project is thus an application of the basic structure argument to the governance of the development of a range of new technologies.
Towards Structural Accounts in Applied Ethics
My work on the basic structure model also reflects a second theme of problematizing the tendency in applied ethics to focus on individual interactions to the neglect of structural forces. In putting forward the basic structure model of research stakeholder obligations, I am effectively arguing that the traditional focus of research ethics on the protection of human subjects is too narrow. While human subjects protection has historically been an important driver of advances in research ethics, this focus fails to adequately capture the social role of clinical research. This suggests a significant widening of the ethical lens by highlighting the role that research plays in both ensuring either just or unjust background conditions against which individual interactions occur, and in circumscribing the kinds of lives that members of society are able to have. And this shift in perspective is significant: once research ceases to be construed as primarily comprised of interactions between researchers, research sponsors, and individual research participants, we can better understand how and why even private, for-profit research entities have ethical obligations to science and society that should inform not only health research priority-setting but also how the knowledge gained in health research should go on to be leveraged.
I also seek to put pressure on transactional approaches in applied ethics from a different direction. The dialectic underlying much discussion about exploitation within bioethics takes the same form as that addressed in two early papers I wrote about exploitation in clinical research ("Against Permitted Exploitation in Developing World Research Agreements" and "Diversion Effects, Incentive Effects, and the Goals of Research Ethics Promulgations"): Many recognize that not all exploitative interactions are non-consensual, and that in fact the most philosophically interesting, and most difficult to assess, cases of exploitation are precisely those instances that are both fully consensual and mutually beneficial. Aside from questioning what might be wrong about such interactions, the question also remains what to do about them from the perspectives of ethics and policy-making. A common refrain is that even if there is something morally wrong with such mutually-beneficial exploitation, it would nevertheless also be wrong to interfere with it - by promulgating ethical norms, for example, or regulating it to try and increase benefits to exploited parties. This is because such intervention both runs the risk of depriving those who are exploited of a net benefit that is desperately needed, and also disrespects the autonomy of those who are exploited by interfering with their ability to make fully-informed decisions to enter into certain kinds of transactions.
In a project developed during a 2018 Brocher Institute summer residency, I seek to expand the conceptual toolbox that bioethicists use to analyze interactions that are often discussed under the rubric of exploitation. I argue across several, related papers that the goals of non-exploitation and respect for autonomy may be better served by the promotion of freedom as non-domination. For example, in "Non-Domination and the Limits of Relational Autonomy," I argue that the conceptual framework of freedom as non-domination may be better suited to resolving a variety of applied questions than either liberal or relational conceptions of autonomy while also better serving the goals of feminist theorists who seek to identify, problematize, and combat oppression. Other manuscripts in this line are either under review or in preparation. Importantly, one of the major upshots of this work is that it is possible to be unfree because dominated even while not being exploited, and this should push us to consider background context in our assessment of interactions, rather than focusing solely on the discrete parties to a contract.