Zahra Keshavarz Moraveji, Yunping Liang, Ursula Eicker, Tian Li
No abstract is available for this record.
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Zahra Keshavarz Moraveji, Yunping Liang, Ursula Eicker, Tian Li
No abstract is available for this record.
Ervin Goci, Suzanne Harris-Brandts
Amidst a global surge in urban development foregrounding smart, sustainable, and now pandemic-proof design, new forms of longstanding hazard and health discourse are being deployed to justify dispossession, particularly in self-built districts. Looking at a case in Tirana, Albania, we examine how this discourse is being contemporized and paired with diverse digital media as it overlaps within a single project – the Tirana Riverside Project. As expressions of authoritative knowledge, architectural visualizations, social media posts, state-backed news broadcasts, and international design blogs work to validate this underlying ideology driving demolition. Such imagery and discourse, we contend, thus need to be read as artifacts of power that entrench government authority while substantiating mass dispossession. We argue that these processes are not only about the real estate profits demolition-based urban renewal generates but also – in Albania’s flawed democratic context – their ability to support the ruling elite. Using content analysis, we identify four hazard and health imaginaries overlapping within the project: 1) pandemic-proof design; 2) design for seismic emergencies; 3) zero-emission sustainable design; and 4) smart city technologies. We show how these imaginaries join longer traditions of normative discourse around hazard and health in urban renewal yet scrutinize their distinct contemporized and localized expressions.
Manuel Díáz, Enrique Soler, Luis Llopis, Joaquín Trillo
Safety-Critical Systems (SCSs) often manage sensible data that must be trustworthy, especially in many cases in which different actors participate whose interests may not coincide. Blockchain is a disruptive technology that has emerged to ensure the trustfulness of data. The nuclear industry incorporates many SCSs where blockchain can be applied. This paper focuses on the use of blockchain for the inspection of steam generators of a nuclear power plant. This is a critical process where different actors participate: plant property, external companies in charge of the inspection itself and different administrations. It typically consists of a number of processes that explore the state of different components of the plant in order to find any kind of failure or defect and it generates a great amount of data that must be verifiable and trustworthy. A distributed blockchain-based system is presented where all the nodes share the information and it cannot be altered. As a novelty, automatic inspection algorithms are stored in the blockchain itself by means of smart contracts. The benefits of blockchain are studied for the nuclear industry in general and for the inspection process in particular. In order to explore the possible drawbacks of a blockchain-based system for data management, a simulator has been implemented to recreate the scenario of an inspection. The results obtained show that blockchain architectures are a good alternative to traditional information repositories for nuclear power plant inspections.
Philip A. Ebert, Martin Smith, Ian Durbach
The notion of risk plays a central role in economics, finance, health, psychology, law and elsewhere, and is prevalent in managing challenges and resources in day-to-day life. In recent work, Duncan Pritchard (2015, 2016) has argued against the orthodox probabilistic conception of risk on which the risk of a hypothetical scenario is determined by how probable it is, and in favour of a modal conception on which the risk of a hypothetical scenario is determined by how modally close it is. In this article, we use Pritchard's discussion as a springboard for a more wide-ranging discussion of the notion of risk. We introduce three different conceptions of risk: the standard probabilistic conception, Pritchard's modal conception, and a normalcy conception that is new (though it has some precursors in the psychological literature on risk perception). Ultimately, we argue that the modal conception is ill-suited to the roles that a notion of risk is required to play and explore the prospects for a form of pluralism about risk, embracing both the probabilistic and the normalcy conceptions. We take the view that a risk judgment always implicates a body of evidence, which we refer to as the background evidence. In cases where the background evidence is not made explicit, we take it to be supplied by the context of utterance and, in typical cases, to be the evidence possessed by the one making the judgment. That is, we are inclined towards a contextualist semantics for utterances such as 3 and 4, on which their truth conditions feature an evidence parameter, the value of which is fixed by the context. The semantics of such utterances is not, however, our primary concern here. As well as making categorical risk judgments such as the above, we often make comparisons. While we may judge that the risk of a plane crash is very low, we may also judge that there is a higher risk of a car crash on the way to the airport. As well as judging that there's a high risk of food poisoning at a particular restaurant, we might also judge that there is a lower risk of food poisoning at the restaurant next door. Moreover, while we often speak about the riskiness of feared events, such as plane crashes, food poisoning, etc., we can also assess the risk of states of affairs. For instance, before drilling into the wall of a 1970s West Australian house, one might assess the risk that the wall contains asbestos, or jurors in a criminal trial, when contemplating a guilty verdict, might consider the risk that the defendant is innocent, or a mountaineer may ponder the risk that the snow conditions are unfavourable for a climb. Here, we treat propositions as the primary bearers of risk, with the riskiness of an event or state of affairs corresponding to the riskiness of the proposition that the event occurs, or the state of affairs obtains. As well as making judgments about the risk of specific events and states of affairs, people also assess the risk of activities or decisions, saying things like ‘Drilling into this wall is risky’, ‘It would be risky to attempt a climb under these conditions’. These judgments are important to understanding the connections between risk and decision making but we put them to one side here. According to the probabilistic of risk, the risk of a proposition is determined by the of higher the the higher the risk. this the risk of is higher the risk of in is more probable is. The be as the background evidence. We Pritchard in the probabilistic as the orthodox of risk is important to however, that this is different to the of risk that has standard in risk and in some this risk is with the of an by a of how or it would is some evidence to that this is as a a recent which with our risk judgments In our be on risk made in cases where is and the of risk the is that the risk judgments that people are inclined to make always with the probabilistic would In to at the 1970s a of in which judgments the probabilistic would These not as evidence against the probabilistic as important and which our judgments about risk and For a of that risk such as the and which in cases to the probabilistic would to be for an about risk are to in take into As a about risk and risk often of the as a to risk judgments some risk judgments be the of a and determined by such as while judgments be by a more and by the or with which the can be and by with the That risk judgments can the probabilistic is to be on a has a which has in a the people is way of the before the it is to The however, a of specific between and on the next The of these is to is not to with this as above, the a of three events obtains. the in the at the the by at the in the the by at the of to speak a of next The of this of events are to According to is and, to we to to We there may be some to judge as Pritchard but would be in about the of the probabilistic this judgment is on this this would to put Pritchard's in the as in which risk judgments to the probabilistic Pritchard with an as on the probabilistic of risk, a or which can our of and that into play in the of cases Pritchard that we might is that the conditions for a in to the conditions in that the in the by at or that the in the the by at or that the to speak a of next the of a In to particular in the next particular In a of that there is a between the with which an event can be or and how probable we the event to as the or the one might that of may an on risk judgments when are made That is, one might that the with which one can the scenario as in might one to it a higher risk the are to be to the to when the are can on how and people take to be with to the in that to take on events on events, when judge the to be in the would be to and as to that is a scenario in which or is to to be about the conditions in may be to that In the event that a in that may to some is the the of about the in The of a can be the of the it is how to the of the conditions in Pritchard a value for the of an in but it is to take this as more and the corresponding value in and a of in which in an scenario are by in about the In a that is for the and that when to between under conditions a or is in some where the are to be a for a for some the might well that the in are The that the in the by at and the in the the by at and the to speak a of next might be to be lower the value of in a more of this the probabilistic that the risk in is lower in for the These are of Pritchard's judgment about the scenario in a way that is with the probabilistic of risk. In as Pritchard to the probabilistic as a of risk of this to be Moreover, as above, it is also in this that Pritchard's judgment is this we put a the Pritchard The of our can be in the which a more discussion of the to the while the that people to our the that people judge to be risky is not with the of judging that the risk of the in the is These on their that Pritchard's judgment about the cases is and against the probabilistic Pritchard that to be by We in a about more we that the is in the of cases to which Pritchard the probabilistic a as to how people judge to to work, there are in which be the car or in a The risk of the car is car is new and it the risk of in a is on the at this and there are of the risk of to is the is this an but in it may be that this is is for instance, in the of risk on which that are to be are for risk in of their risk and a low, but of risk to as the which the are while which are the are to a risk in to be to against may by the and in the and is in the of and and both the risk one the of and against and the of and against one has in the of and against is there is that the risk of is the the the risk of a car and of a are both to be the the both of these are and are against these are the in which be for the are against this the risk that be for the may well be the in which the that we take against or at consider the of the of it is that this to risk is in which to play a role is in the context of of the of criminal are to the risk of an The high standard of for criminal to that a defendant be the risk that or is innocent, the evidence, is very criminal a of and the is to the standard to for For instance, to be guilty of in a defendant defendant be of one of these conditions is not a defendant be of these conditions is this that there is a risk that the defendant not take the there is a risk that the defendant not to the of that and there is a risk that the defendant the this that there is a risk that the defendant is in of the the probabilistic of risk, however, is an The of can be higher both the of and the of a the that a is and the that a is The that a or a is According to the probabilistic of risk, the risk of is and the risk of is low, it that the risk of is are which are at with the probabilistic of risk. we to that such are we are to the that may to however, that the of these to consider of risk that may make different about We to such a notion in As above, Pritchard the not to put on the probabilistic of risk, but to an which the modal of risk. 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While we attempt a or of risk in we the of such a view and for the of view that we to the probabilistic and of our notion of risk, or on different of that While we to the of of risk, it is not our that such In our the of the modal notion of risk for instance, that it as a of our view of this a of the of and in making risk a we different for making risk we are to that one of these a which is a while it is for risk judgments to be by and we that are at play we for making such it may be that the are different of risk, of which can be our the the to use of as a way of judging risk is to an but for a however, this can be as an for is in our notion of risk. also a new on the which to an on risk For the of a has as a of in risk on the that it can people to or probabilistic the which our about risk, to or of the notion of risk. there are a of about on the view we we about the notion of risk and to the probabilistic and is to the notion of risk as a in the of by which to and In this the probabilistic and of risk be as which can be the and which it for a of be not as at but as the of also As more be required to our form of risk We by three our for and psychological discussion the notion of risk and the of risk our Pritchard's While a judge the as with the probabilistic is that one in three and judge to be risky as by the For a one in three a judgment which would to be and For the on the it might be that some of these are by the very of the to the by a notion of risk. the important of how and when such for of this to be an Ultimately, such may to more when a or probabilistic notion a of risk the be with the to judgment about risk. the by that there to be in our risk an which is a probabilistic is to risk pluralism with a by risk and probabilistic risk as the by the and may in a of the as one of the prospects for such a it is that in the role of such as and when making risk judgments be by the role that normalcy plays in judgment about risk. our discussion a new take on the in In a of and and of and as or judgment on them In that the of judgment against the of an probabilistic is often it to take into the of judgment and We not to into the of this but it is important to that it with one of our primary of a probabilistic the for risk The conception of risk a different on about the of risk According to the there are different of our notion of risk, of which their which in some cases but in judge in a way that against the the probabilistic this their judgment may be judging in with the for the notion of risk. may be a in which this the one we that there are with the different of risk, we might these are always or there are in which one of them be as the of and judgment. a we the of of that are to the about the of risk the of to the of a and the of to the standard in a context. the of which standard to be in in a to be to We for our which is to be to in an of and well in the the specific of the we to and for In we and we one background in We the of for this We the which is to the in Pritchard has a which has in a the people is way of the before the it is to The a of in a The of these is in is not to with this The a of three events obtains. the in the at the the by at the in the the by at the of to speak a of next The of this of events are in is not to with the of of the events in this We about their are the by the We them about their risk judgment to the judge The of our are as with to the While both the of scenario is scenario or the a for scenario more the when it to risk judgments to judge both to be judgment more the We with to both their and risk judgments In our we the and the risk on the and, while the before the risk both to the while to a risk judgment in of their judgment some for scenario to with the risk and judge the as risky of we not this for a for one of the and of a for and the to be challenges the in Pritchard's in these cases risk judgments are determined or by a on the a for scenario in one would this to a between the of people made the risk judgment that scenario is more and the the to be however, is not the to a for scenario in of evidence not the of an with is required when these is that these made by that with judge to be may a for a is to judgments and risk judgments in some cases but not in and there are for risk and
Pierce Greenberg, Dylan Bugden
No abstract is available for this record.
Mark J. Cherry
The United Nations Educational, Scientific, and Cultural Organization's (UNESCO) Universal Declaration on Bioethics and Human Rights announces a significant array of welfare entitlements--to personal health and health care, medicine, nutrition, water, improved living conditions, environmental protection, and so forth--as well as corresponding governmental duties to provide for such public health measures, though the simple expedient of announcing that such entitlements are "basic human rights." The Universal Declaration provides no argument for the legitimacy of the sweeping governmental authority, taxation, and regulation to create and impose such "rights." As this paper explores that some action promotes a purported good, such as "health," does not thereby make the action morally permissible. Just as there are moral limits on legitimate personal actions, there are also moral limits on legitimate governmental actions to promote purported goods, including health. A core question of any governmental regulation, therefore, is whether it is a legitimate application of moral political authority or an unauthorized act of state coercion. Pace UNESCO's wide-ranging assertions, this paper argues that promoting health only falls within the legitimate authority of governments in very narrowly defined circumstances. As the paper critically explores, at stake are foundational moral and political questions concerning the limits of governmental authority to intervene in the consensual interaction of persons. Imposing such duties on others, including citizens of a state through regulatory activity and taxation, must be justified, nonarbitrary, and demonstrably within the limits of moral political authority. UNESCO's assertions do not meet this burden of proof.
Authors unavailable
The past decade has been a period of introspection in the radiological protection community. The International Commission on Radiological Protection (ICRP) has set out to produce a new set of recommendations; a draft document has been produced and made available on the ICRP web site. That draft has been widely reviewed and support for the proposed recommendations has been muted to say the least [1]. A subsequent draft is now being reviewed. As we wait for the final version it seems worthwhile to reaffirm the fundamental base for radiological protection as we practise it. The base is the set of three principles; justification, protection of the individual, and optimization of protection (the ALARA principle). Their importance seemed to be lost in the detail of the initial draft recommendations. I feel that without a clear statement of their primacy in the protection system we are in danger of the minutiae of the recommendations being applied in a far too arbitrary and restrictive way. There was a hint of this in the draft ICRP document on optimization that was available for review earlier this summer, in which it was argued that the so-called precautionary principle had been the driver for the evolution of the ICRP's thinking [2]. Some argue, correctly I believe, that this is not really a principle; it is more a poorly-defined and open-ended method of handling or reacting to uncertainties in our knowledge of risk. We see the precautionary principle rather loosely invoked in some risk management decisions as justifying arbitrary safety factors. `Applying the precautionary principle' sounds more substantial and scientific than just saying `to be on the safe side'. The influence of the principle is far more widespread though. The idea behind the precautionary principle originated in Germany in the 1960s but it was not until 1982 that it was endorsed internationally when the UN included it in the World Charter for Nature. It gained prominence in European treaties and was advocated by the UN Rio Declaration on Environment and Development in 1992. Initially the idea was that `uncertainty does not justify inaction'. The idea evolved and precaution began to take the place of science-based risk assessment and management. By the late 1990s the idea was that uncertainty also required shifting the burden and standard of proof [3]. The principle became `When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context, the proponent of an activity, rather than the public, should bear the burden of proof.' [4,5] In other words, uncertain risk requires forbidding the potentially risky activity until the proponent of the activity demonstrates that it poses no (or acceptable) risk. We are all aware of the impossibility of proving a zero but this wording may sound reasonable provided that the parenthetic `or acceptable' is the operative qualifier. For many though, it is not. Adams has described what he calls the {\it environmentalist paradigm}, in which possibility replaces probability as a criterion for protection regulation, and any agent harmful at high doses is considered harmful at exceedingly low doses [6]. Only zero risk is then acceptable when the precautionary principle is applied. This is a stultifying situation. Morris comments, in a broad-ranging critique, that the precautionary principle not only lacks any clear guidance on when and how it does apply, but perhaps more importantly it is devoid of any limitations of when it does apply [7]. Without such limitations, he notes, the precautionary principle will be a vacuum that can consume any and all products and technologies, since some risk and uncertainty is associated with every human activity. We could conclude that in radiological protection we would have no optimizing; no applying the ALARA principle. Radiation regulations based on the three fundamental ICRP principles have achieved an acceptable level of protection for decades. We should not abandon them to the arbitrariness of the precautionary principle when we have a sound basis for radiological protection in the clearly-enunciated principles of justification, individual dose limitation and optimization of protection. Radiological protection based on these principles includes elements of precaution. Why do we need a precautionary principle? This has been indirectly answered by asking: What if we were to apply the precautionary principle to itself? Its application carries the burden of untold risks and uncertainties. Thus, by its own definition, it should be abandoned [4]. This is not to argue that we should throw caution to the wind. The key is reasonableness. As Nilsson points out, though it is certainly better to be safe than sorry, it is important to distinguish unjustified precautionary action from justifiable precautionary action based on sound science and an appropriate assessment of the costs and benefits of taking action [8]. The precautionary principle fails to distinguish between the two, by elevating to the status of universal `principle' a notion that is only narrowly applicable. In Canada we are fortunate that we have sensible wording in the Federal Nuclear Safety and Control Act that provides the framework for many of the radiological protection regulations in Canada [9]. Part of its stated purpose is the limitation, to a reasonable level , of the risks to the health and safety of persons and the environment. The ICRP principle of dose limitation and the ALARA principle are coherent with this. Further, the Federal Government's Privy Council Office (PCO) has published guidance for its agencies on the application of precaution in science-based decision-making that reinforces the approach we have been taking in radiological protection and, in particular, emphasizes the importance of what is in essence the ALARA principle [10]. It notes that sound scientific information and its evaluation must be the basis for applying precaution. Peer review represents a concrete test for the practical application of precaution to decision making. A peer-review process can assess the soundness of the scientific evidence and its inherent credibility within the scientific community. Scientific advisors should give weight to peer-reviewed science and aim at sound and reasonable evidence on which to base their judgments. Moreover, the science function can be further supplemented by formal, structured and, where warranted, independent advisory processes that include widely recognized and credible individuals. I believe we can heartily subscribe to this. The guidance document lays out five principles that should guide the application of precautionary measures. They should be: Subject to reconsideration, on the basis of the evolution of science, technology and society's chosen level of protection. Proportional to the potential severity of the risk being addressed and to society's chosen level of protection. Non-discriminatory and consistent with measures taken in similar circumstances. Cost-effective, with the goal of generating an overall net benefit for society at least cost, and efficiency in the choice of measures. Finally, where more than one option reasonably meets the above characteristics, then the least trade-restrictive measure should be applied. We can see all three radiological protection principles reflected in this guidance. Particularly important is the emphasis on the link to scientific knowledge, rather than the whims of activist groups, together with the exhortation to assess the real and potential impacts of making a precautionary decision (whether to act or not to act), including social, economic and other relevant factors and risk-risk trade-offs. Apply the ALARA principle in other words. The guidance concludes with the expectation that Canadian agency officials will consider its guiding principles in decision-making and will work together in developing, in consultation with their stakeholders, guidance for the application of precaution in t
Jonathan D. Moreno
In 1986, the German sociologist Ulrich Beck published the first edition of his book, Risk Society.1 Beck's book has attained wide popularity, especially in Europe, for his analysis of the distance between scientific expertise and popular opinion in the understanding of potential harms. Time and again, Beck points out, the public complains that there is a harmful process at work, while the scientists who are appointed by authorities to assess the complaints conclude that there is no objective basis for concern. Too often, though, the scientific conclusions are advanced without involving the public and without taking into account conditions outside of the laboratory. Subsequent experiences, such as the Mad Cow disaster in British livestock, have only reinforced the problem. Public skepticism about genetically modified organisms and the food supply can be traced to the same roots. On both sides of the Atlantic, the example of HIV in the blood supply, the halting management of the crisis, and the resulting loss of public confidence in the system, constitute an all-too-familiar case for readers of this journal. These kinds of examples and the conditions that Beck describes and explicates helped lead to the development of a policy standard, again especially in Europe, called the precautionary principle. In a 1992 statement, the European Environment Agency gave a succinct statement of the principle: [I]n order to protect the environment, a precautionary approach should be widely applied, meaning that where there are threats of serious or irreversible damage to the environment, lack of full scientific certainty should not be used as a reason for postponing cost-effective measures to prevent environmental degradation. Further, The precautionary principle permits a lower level of proof of harm to be used in policy-making whenever the consequences of waiting for higher levels of proof may be very costly and/or irreversible (emphasis added).2 Paradoxically, technologic advancement itself is the source of the risks that concern us. In other words, scientific expertise has created the very conditions that society now doubts the experts fully appreciate. In Risk Society, Beck defines risk as “a systematic way of dealing with hazards and insecurities induced and introduced by modernization itself.” He goes on, “Risks, as opposed to older dangers, are consequences which relate to the threatening force of modernization and to its globalization of doubt.” The social and political conditions that affect current issues in transfusion medicine are thus part of a much larger “globalization of doubt” about expertise. Although he does not allude to transfusion medicine per se, it is a paradigm case of risk in the sense that Beck writes about, for it has been a modernizing development in medical care and the risks it brings about would not exist without that modernization. The tensions within a “risk society” are brought to the surface when a new incident reignites doubt, such as concerns about West Nile virus in the summer of 2002. Sensitized by previous failures to satisfy public concern, responsible officials leap into action, often shifting their attention and energy away from known and measurable risks to persuade society that the unknown and often nonmeasurable risk is being taken seriously. This reaction, while understandable in light of the critique leveled by Beck and many others, should give us pause. Along with policies intended to drastically reduce risk, it is an example of the way that the precautionary principle has been both transformed into a dogma and taken out of its original context. I call these tendencies “creeping precautionism” because the adoption of a precautionary stance may not even be noticed until it is too late, and because a reasonable principle can easily be turned into a self-defeating ideology. Consider two recent policies that public health and blood industry experts have cited in conversation as examples that might reflect creeping precautionism: p24 antigen testing for HIV, which may have prevented one case per year at a cost of tens of millions a year; and deferral of donors who have been European residents, when the risk of CJD risk remains highly theoretical with no documented case of transmission, and hundreds of thousands of units have been lost as a result. I am no authority on the complex medical and public health issues involved, but suppose for the sake of argument that these policies raise valid questions. How did they come to pass? Clearly many elements came into play in these policy decisions. One that has not previously been identified is the fact that, as these policies were being formed, the precautionary principle came to have a great deal of influence in environmental health circles. In fact, I believe that we live in a period in which the principle has, without argument and often without conscious awareness, both been taken out of context, applied to problems other than catastrophic health concerns, and misinterpreted. The original context was environmentalism, where ecologic complexities and uncertainties present risks that, for all intents and purposes, may truly be inestimable and irreversible. Those conditions may not apply in other policy contexts. The misinterpretation has been to suppose that precautionism requires that only zero risk is acceptable, or at least something quite close to zero risk. Even advocates of the principle would recognize these subtle shifts in thinking as errors. In particular, it is clear that no action or inaction is risk free, and that any decision has opportunity costs. The opportunity costs of precautionism in the blood industry are, among others, the loss of many usable units of blood and the alienation of potential donors. I am not arguing that the policies in question are without merit nor that they should be repealed. Rather, I urge that a discussion begin in the blood services community about whether unwarranted precautionism has in fact crept into policymaking. This discussion should also take into account the peculiar stresses upon the role of expertise in a modern democracy. To step back for a moment, it is useful to recall the classical origins of the idea of expertise. In his seminal work, The Republic, Plato uses an allegory to characterize the situation of the truly knowledgeable person. He spins a tale about a group of slaves bound to their places since birth, unable to turn their heads, and only able to view a wall in front of them. Behind them are carried ordinary objects, whose shadows fall upon the wall. Knowing nothing better, the slaves assume that the shadows are the real objects. Now suppose, Plato continues, a slave manages to break his bonds and escape to the mouth of the cave. Unaccustomed to the light, he will at first be blinded by the sun, then realize to his horror that all his life what he has thought was reality was merely illusion. He tries to enlighten (pun intended) his comrades, but they mock him as mad. Discouraged, he takes his place among the slaves again. The allegory implies that knowledge is painful, hard to achieve, and subject to ridicule by the ignorant. This is the uncomfortable position of the expert. The problem is especially grave in medicine, whose practitioners are supposed to be sensitive to the uninitiated. Yet, too much sensitivity is incompatible with the detachment and decorum that the physician requires to be effective. Sir William Osler, generally regarded as the father of internal medicine, commented on this dilemma of the health care expert over a century ago. Imperturbability. . . . It is the quality which is most appreciated by the laity though often misunderstood by them; and the physician who has the misfortune to be without it, who betrays indecision and worry, and who shows that he is flustered and flurried in ordinary emergencies, loses rapidly the confidence of his patients.3 I write as a product and professor of the bioethical revolution in medicine, which is characterized by a deep suspicion of expertise, manifested as the insistence on informed consent and truth telling by doctors. This revolution is only about 30 years old in practice and would have shocked my father, a 1917 graduate of the University of Vienna medical school. The emergence of bioethics in the 1970s (my father died in 1974, too soon to experience the sweeping changes in medical ethics) is of a piece with the appearance of the precautionary principle of the 1980s. Both are rooted in skepticism of professional authority, and both have advocated lay involvement in medical decisions. I do not advocate repudiating the new medical ethics. As the Yale University psychiatrist and law professor Jay Katz has long pointed out, the doctor-patient relationship was for eons characterized by a doctor-dominated paradigm that is best left behind. Yet, I worry that the critique of modernism, of expertise, has swung too far. In the clinical setting, I have seen this phenomenon manifested as the reluctance of physicians to give advice to patients who are facing a complex treatment decision. Often I hear complaints that doctors respond to patients’ requests for guidance with the demurrer that it is their decision, that they must exercise their self-determination. This is a case of turning patient autonomy into a shield behind which doctors can hide. The ethical principle of autonomy should not be an excuse for abandoning the counseling that patients crave. Similarly, in the long run I think it is bad for the profession to give up the moral authority that comes with expertise. Perhaps those with expertise in public health and blood should open a conversation about whether they have succumbed to creeping protectionism in an honest attempt to learn from the horrors of the HIV experience. I cannot say whether this is the case, only that the signs point to this possibility. On the importance of a philosophical view of scientific expertise, consider Osler again. A rare and precious gift is the Art of Detachment, by which a man may so separate himself from a life-long environment as to take a panoramic view of the conditions under which he has lived and moved: it frees him from Plato's den long enough to see the realities as they are, the shadows as they appear. Could a physician attain to such an art he would find in the state of his profession a theme calling as well for the exercise of the highest faculties of description and imagination as for the deepest philosophic insight.4 In our time, scientists have learned about the pitfalls of an aristocratic attitude. The challenge is to balance those lessons with society's continuing need for unshackled expertise. To this end, efforts should be made to develop evidence that quantifies, or at least aids in prioritizing risks, with the goal of evidence-based risk assessment. Scientists and physicians should then recognize their social obligation to participate in policy debates in which their expert opinions can help the public balance imminent and more remote risks and evaluate the costs associated with risk-minimizing initiatives. In this way, perhaps we can all meet the Platonic challenge of doing science in a democracy.
Carrie L. Hull
This paper is centred around a debate taking place among environmental scientists. One camp argues that proof of a causal connection between a chemical and a biological anomaly must be demonstrated in the laboratory. The other contends that actual damage is underestimated in the lab, and that it is therefore necessary to conduct supplemental ecoepidemiological research in order to determine the full impact of toxic chemicals. Members of the former contingent – claiming to be defending scientific rigour – sometimes accuse their peers of practising an inferior science. This paper argues that this contention is supported by a philosophical tradition tending to favour abstract and formal analysis over the close examination of material detail. To the extent that this preference has been adopted by the media, industry, policy analysts, and regulatory bodies, more is at stake than an intellectual squabble. The paper provides a brief overview of the history of the formalist tendency in philosophy, followed by an illustration of the ways in which advocates of a strict laboratory methodology implicitly rely on this foundation. The work and ideas of contemporary ecoepidemiologists are then compared to this imposing edifice of traditional science.