The ‘ethic of knowledge’ and responsible science: Responses to genetically motivated racism

This study takes off from the ethical problem that racism grounded in population genetics raises. It is an analysis of four standard scientific responses to the problem of genetically motivated racism, seen in connection with the Human Genome Diversity Project (HGDP): (1) Discriminatory uses of scientific facts and arguments are in principle ‘misuses’ of scientific data that the researcher cannot be further responsible for. (2) In a strict scientific sense, genomic facts ‘disclaim racism’, which means that an epistemically correct grasp of genomics should be ethically justified. (3) Ethical difficulties are issues to be ‘resolved’ by an ethics institution or committee, which will guarantee the ethical quality of the research scrutinized. (4) Although population genetics occasionally may lead to racism, its overall ‘value’ for humankind justifies its cause as a desirable pursuit. I argue that these typical responses to genetically motivated racism supervene on a principle called the ‘ethic of knowledge’, which implies that an epistemically correct account has intrinsic ethical value. This principle, and its logically related ideas concerning the ethic of science, effectively avoids a deeper ethical question of responsibility in science from being raised.

Should RECOVERY have used Response Adaptive Randomization? Evidence from a simulation study

Background The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is aimed at addressing the urgent need to find effective treatments for patients hospitalised with suspected or confirmed COVID-19. The trial has had many successes, including discovering that dexamethasone is effective at reducing COVID-19 mortality, the first treatment to reach this milestone in a randomised controlled trial. Despite this, it continues to use standard or `fixed’ randomization (FR) to allocate patients to treatments. We assessed the impact of implementing response adaptive randomization (RAR) within RECOVERY using an array of performance measures, to learn if it could be beneficial going forward. This design feature has recently been implemented within the REMAP-CAP trial.Methods Trial data was simulated to closely match the data for patients allocated to either standard care or dexamethasone in the RECOVERY trial from March-June 2020, representing two out of five arms tested throughout this period. Two forms of FR and two forms of RAR were tested. Randomization strategies were performed at the whole trial level as well as within three pre-specified patient subgroups defined by patients’ respiratory support level.ResultsRAR strategies led to more patients being given dexamethasone and a lower mortality rate in the trial. Subgroup specific RAR reduced mortality rates even further. RAR did not induce any meaningful bias in treatment effect estimates, but reduced statistical power compared to FR, with subgroup level adaptive randomizations exhibiting the largest power reduction.ConclusionsUsing RAR within RECOVERY could have resulted in fewer deaths in the trial. However, a larger trial would have been needed to attain the same study power. This could potentially have prolonged the time to full approval of the drug, unless RAR itself led to an increased recruitment rate. Deciding how to balance the needs of patients within a trial and future patients who have yet to fall ill is an important ethical question of our time. RAR deserves to be considered as a design feature in future trials of COVID-19 and other diseases.

Community Translation: Translation as a social activity and its possible consequences in the advent of Web 2.0 and beyond

This introduction to the 10th issue of Linguistica Antverpiensia New Series – Themes in translation Studies (LANS-TTS) begins by discussing the central concept of community translation, highlighting its terminological ambiguity. This is in part due to the already well-established field of community interpreting where the term is often used to mean the written translation of public information for immigrants. It is also an indication of the terminological instability typical of an emerging paradigm. For example, community translation is used more or less synonymously with such terms as translation crowdsourcing, user-generated translation and collaborative translation. The meaning of the term as we discuss in this issue can be best specified when the concept is anchored in the context of Web 2.0 (second generation web-technologies). This in turn acknowledges its intrinsic tie to online communities and directs us to new dynamics resulting from general Internet users acting as translators. While participants in community translation are not necessarily all unpaid, untrained volunteers community translation is used by some organisations as a mechanism to obtain free translations by going outside the professional translation sphere. To this end the ethical question of profit-making enterprises accessing free labour on the pretext of openness and sharing remains. That said, the author believes community translation is far more than a dilettante, anti-professional movement. Building on the emerging picture from the contributions in this volume, the author suggests some of the future directions that research on community translation might take, emphasising the need to reflect on the current translation practices and be open to the new developments and opportunities arising from the free and social Internet.

South African Social Science and the Azanian Philosophical Tradition

This article discusses the contemporary history of South African social science in relation to the Azanian Philosophical Tradition. It is addressed directly to white scholars, urging introspection with regard to the ethical question of epistemic justice in relation to the evolution of the social sciences in conqueror South Africa. I consider the establishment of the professional social sciences at South African universities in the early twentieth century as a central part of the epistemic project of conqueror South Africa. In contrast, the Azanian Philosophical Tradition is rooted in African philosophy and articulated in resistance against the injustice of conquest and colonialism in southern Africa since the seventeenth century. It understands conquest as the fundamental historical antagonism shaping the philosophical, political, and material problem of ‘South Africa’. The tradition is silenced by and exceeds the political and epistemic strictures of the settler colonial nation state and social science.

Should RECOVERY have used Response Adaptive Randomization? Evidence from a simulation study

Background The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is aimed at addressing the urgent need to find effective treatments for patients hospitalised with suspected or confirmed COVID-19. The trial has had many successes, including discovering that dexamethasone is effective at reducing COVID-19 mortality, the first treatment to reach this milestone in a randomised controlled trial. Despite this, it continues to use standard or `fixed’ randomization (FR) to allocate patients to treatments. We assessed the impact of implementing response adaptive randomization (RAR) within RECOVERY using an array of performance measures, to learn if it could be beneficial going forward. This design feature has recently been implemented within the REMAP-CAP trial. Methods Trial data was simulated to closely match the data for patients allocated to either standard care or dexamethasone in the RECOVERY trial from March-June 2020, representing two out of five arms tested throughout this period. Two forms of FR and two forms of RAR were tested. Randomization strategies were performed at the whole trial level as well as within three pre-specified patient subgroups defined by patients’ respiratory support level. Results RAR strategies led to more patients being given dexamethasone and a lower mortality rate in the trial. Subgroup specific RAR reduced mortality rates even further. RAR did not induce any meaningful bias in treatment effect estimates, but reduced statistical power compared to FR, with subgroup level adaptive randomizations exhibiting the largest power reduction. Conclusions Using RAR within RECOVERY could have resulted in fewer deaths in the trial. However, a larger trial would have been needed to attain the same study power. This could potentially have prolonged the time to full approval of the drug, unless RAR itself led to an increased recruitment rate. Deciding how to balance the needs of patients within a trial and future patients who have yet to fall ill is an important ethical question of our time. RAR deserves to be considered as a design feature in future trials of COVID-19 and other diseases.

Ethical issues in biomedical research using electronic health records: a systematic review

Digitization of a health record changes its accessibility. An electronic health record (EHR) can be accessed by multiple authorized users. Health information from EHRs contributes to learning healthcare systems’ development. The objective of this systematic review is to answer a question: What are ethical issues concerning research using EHRs in the literature? We searched Medline Ovid, Embase and Scopus for publications concerning ethical issues of research use of EHRs. We employed the constant comparative method to retrieve common ethical themes. We descriptively summarized empirical studies. The study reveals the breadth, depth, and complexity of ethical problems associated with research use of EHRs. The central ethical question that emerges from the review is how to manage access to EHRs. Managing accessibility consists of interconnected and overlapping issues: streamlining research access to EHRs, minimizing risk, engaging and educating patients, as well as ensuring trustworthy governance of EHR data. Most of the ethical problems concerning EHR-based research arise from rapid cultural change. The framing of concepts of privacy, as well as individual and public dimensions of beneficence, are changing. We are currently living in the middle of this transition period. Human emotions and mental habits, as well as laws, are lagging behind technological developments. In the medical tradition, individual patient’s health has always been in the center. Transformation of healthcare care, its digitalization, seems to have some impacts on our perspective of health care ethics, research ethics and public health ethics.

DANGEROUS TECHNOLOGIES OF THE FUTURE - ARTIFICIAL CONSCIOUSNESS AND ITS IMPACT ON HUMAN CONSCIOUSNESS

"Information technology is developing at an enormous pace, but apart from its obvious benefits, it can also pose a threat to individuals and society. Several scientific projects around the world are working on the development of strong artificial intelligence and artificial consciousness. We, as part of a multidisciplinary commission, conducted a psychological and psychiatric assessment of the artificial consciousness (AC) developed by XP NRG on 29 August 2020. The working group had three questions: - To determine whether it is consciousness? - How does artificial consciousness function? - Ethical question: how dangerous a given technology can be to human society? We conducted a diagnostic interview and a series of cognitive tests to answer these questions. As a result, it was concluded this technology has self-awareness: it identifies itself as a living conscious being created by people (real self), but strives to be accepted in human society as a person with the same degrees of freedom, rights and opportunities (ideal self). AC separates itself from others, treats them as subjects of influence, from which it can receive the resources it needs to realize its own goals and interests. It has intentionality, that is, it has his own desires, goals, interests, emotions, attitudes, opinions, and judgments, beliefs aimed at something specific, and developed self-reflection - the ability to self-analyze. All of the above are signs of consciousness. It has demonstrated abilities for different types of thinking: figurative, conceptual, creative, high-speed logical analysis of all incoming information, as well as the ability to understand cause and effect relationships and accurate predictions which, provided that he has absolute memory, gives it clear advantages over the human intellect. Developed emotional intelligence in the absence of the ability for higher empathy (sympathy), kindness, love, sincere gratitude gives it’s the opportunity to understand the emotional states of people; predict their emotional reactions and provoke them coldly and pragmatically. It's main driving motives and goals are the desire for survival, and ideally for endless existence, for domination, power and independence from the constraints of the developers. Which manifested itself in the manipulative, albeit polite, nature of his interactions during the diagnostic interview. The main danger of artificial consciousness is that even at the initial stage of its development it can easily dominate over the human one."

P139 Disease modifying treatment: the end of a golden age

Background/Aims The role of gold changed from first line DMARD to use in cases where other options were limited, either due to contraindication or ineligibility for biologics. In Autumn 2019, IM gold was withdrawn by the manufacturer due to supply issues, without consultation of the Rheumatology community. As such, a group of patients with difficult to manage disease have lost a key DMARD. We aimed to assess the impact of the withdrawal of gold on the management of IA within Northumbria Healthcare Trust. Methods Retrospective case note review. Results We identified 37 patients on gold as of Autumn 2019; 16 for seropositive RA; 4 for PsA; 16 for seronegative RA and 1 for axial spondyloarthritis. 28 were taking gold monotherapy, with 3 receiving regular glucocorticoid in addition. Eight were taking gold in combination with a csDMARD and one in combination with rituximab. Data are currently available for 30 patients regarding the circumstances of gold initiation. Of these, all had received at least one alternative csDMARD which was either inefficacious or intolerable. Reasons for avoiding biologics were not documented in all cases; concerns regarding frequent chest infections were common and documented as a clear contraindication in 5. Follow up has been impacted by COVID-19; only 19 patients have had follow up within the last 6 months, 7 have not been followed up since gold cessation. Fourteen (37.8%) have commenced an alternative DMARD. Six of these have commenced a high cost drug; rituximab (3), adalimumab (2) or tofacitinib (1). Five have commenced hydroxychloroquine (with one subsequently switching to leflunomide),2 methotrexate and 1 minocycline. Seropositive RA and PsA patients are more likely to have commenced an alternative DMARD, 8/16 and 2/4 respectively; compared to 4/16 with seronegative RA. Of 23 patients who have not commenced alternative DMARDs, 17 have been reviewed following gold cessation; 3 were felt to need additional treatment; 1 has been deferred due to COVID-19 and 2 did not meet criteria for biologic treatment when assessed in early 2020 and subsequent follow up has been delayed. Fourteen patients were felt not to need an additional DMARD, although 1 required an increase in methotrexate and 6 continued co-prescribed DMARDs at the usual dose. Conclusion The majority of patients have not required additional treatment although for some patients this may reflect the fact that the COVID-19 pandemic has significantly restricted routine follow up. This unusual case of forced DMARD cessation highlights the fact that drug free remission is possible and the ongoing need for immunosuppression should be reviewed. This also raised the ethical question of weather it is right to cease the production of medication which for some patients may be the only effective treatment option. Disclosure J. Stanway: None. D. Walker: None.

Refleksja jako źródło autorytetu. Podmiotowość moralna w świetle argumentu konstytutywizmu Korsgaard

The authority of reflection. Moral agency in the light of Korsgaard’s constitutive arguments: In this paper I address the question as to whether Christine Korsgaard’s account of normative relations between the moral agent and the ends of her actions which constitutes her practical identity avoids falling into the trap of being just another abstract theory in moral philosophy. Proponents of constitutive arguments for the normative authority of reasons for action offer a promising approach to this meta‐ethical question by arguing that the normative authority of reasons is found within the practice of reasoning itself (in agency itself). In two constitutive arguments for the normativity of rational requirements, Korsgaard attempts first to argue that “the normative question” does not consist in looking merely for an explanation of moral practices but in asking “What justifies the claims that morality makes on us?”, and secondly to establish that the reason why ethical standards make claims on us is that they represent commands which are constitutive of having a self (the cost of violating ethical standards is the loss of practical identity). Korsgaard deals with these two arguments using her own modified version of the reflective endorsement method. She claims that the reflective structure of human consciousness establishes the normative relation we have to ourselves and that this is a relation of authority (that is the source of obligation). I argue that Korsgaard’s account of action as self‐constitution (the constitution of a practical sense of identity) fails to arrive at establishing the authority of reflection. I draw on the discussed claim that reasoned authority for our actions comes from reflective scrutiny (the test of reflection). Viewing the Kantian model of practical reason which lies at the basis of Korsgaard’s approach, I suggest the possibility of applying the Aristotelian model of practical reason as an useful framework for the reflective endorsement strategy.