Broadly speaking, my research addresses lacuna in three different areas of applied ethics and applied political philosophy. The first is research ethics, broadly construed: what ethical and methodological standards ought to govern the behavior of researchers and research sponsors who conduct research involving human subjects, and how ought participants to be treated before, during, and after the conduct of research? The second is global justice, with a more specific focus on exploitation: what kinds of responsibilities do privileged individuals, states, or organizations have to low- and middle-income individuals or populations when they interact with them in various ways, and in particular how should obligations grounded in a principled objection to exploitation be balanced against welfare considerations that often make exploitation appear better than non-interaction? Finally, democracy and group-decision making: how ought groups structure decision-making so as to best make use of the epistemic diversity of their comprising members, and how ought epistemic obligations be distributed among them? Although these are three distinct areas of research, in practice there is significant overlap between them. For example, many of the questions of research ethics that I seek to address are also questions of justice and exploitation. Similarly, analyses of group decision-making can be usefully applied to problems in clinical research oversight. Below, I outline some of my projects in more detail.
Global Justice, Exploitation, and International Research
A significant portion of clinical research is now conducted in low- and middle-income (LMI) populations, including a large portion of that funded by research institutes from high-income countries and multinational pharmaceutical corporations. The communities in which such research is conducted ("host communities") frequently suffer from lack of access to adequate healthcare, lack of healthcare and research infrastructure, and significant disease burdens. Conducting research in such populations is attractive to research funders for a number of reasons, most of which add up to the fact that it is often cheaper and faster. The prevalence of need (both health-related and otherwise) in these populations also makes them more vulnerable to potential exploitation.
There are many competing accounts of exploitation; one prominent account suggests that a transaction is exploitative when one party leverages its greater bargaining power to generate an agreement in which the social surplus created in the transaction is distributed in an unfair way. The most interesting cases of exploitation are those in which both parties fully consent and both parties benefit relative to their pre- or no-transaction baseline. In international research, host communities benefit in various ways from hosting research, participants in that research (usually) provide valid consent to researchers, but often the kind or amount of benefits that devolve to host communities are dwarfed by the benefits to researchers, research sponsors, and the health systems of high-income countries. This raises important questions about how to balance deontic concerns about the exploitation of vulnerable populations against consequentialist considerations regarding the benefits they may receive from research interactions.
A view that I characterize as "liberal about exploitation" claims that interference with voluntary transactions between research sponsors, investigators, and host communities in the form of regulatory interventions or ethical standards governing international research will ultimately result in the diversion of benefits: needy communities will receive fewer benefits from hosting research than they otherwise would, as research sponsors lose the financial incentive to conduct research in those settings. I reject this position, and argue that outside parties would be justified in imposing restrictions on the kinds of research agreements that can be entered into by LMI host communities and research sponsors. Specifically, I argue that it is a mischaracterization to construe such regulatory interference as unjustly paternalistic, and demonstrate that harmonized regulatory measures that were imposed and enforced in a uniform manner would significantly mitigate worries about diversion effects.
A further claim made by some liberals about exploitation is that diversion effects are or would be counter-productive as assessed against the putative aims of international research ethics. In a rejection of this position, I argue that the claim that the promulgation of international research ethics standards is self-defeating rests on a mischaracterization of both the research enterprise as well as the goals that are pursued by those promulgating ethical standards for research. I go on to argue that the absence of such standards may serve to generate incentives that would only exacerbate existing disparities in access to health services.
Vulnerability to exploitation also has implications for the question what, if any, limits there should be on the kinds of research questions that are addressed by clinical research conducted in LMI communities. In previous and ongoing research, I argue that the justification for subjecting human participants to risks of harm in clinical research is the potential for generating socially valuable knowledge, and that this social function of research grounds what is known as the "social value requirement" in research: In order to be ethical, clinical research must hold out the prospect of producing socially valuable knowledge. I have used decision theory to formalize this requirement. But I also take the social value requirement further, and argue that the social value of research-generated knowledge is importantly context-dependent in a way that ought to inform which research is conducted in which populations. A contextualized version of the social value requirement is therefore the best candidate to fill in what is known as "the responsiveness requirement" - the idea that in order to be ethical, research conducted in LMI host communities must be responsive to local health needs.
Non-Domination and the Limits of Autonomy
Worries about exploitation and how best to protect vulnerable populations are often in tension with the principle of respect for autonomy. In several ongoing projects, I explore that tension. Feminist theorists have demonstrated significant problems with traditional conceptions of autonomy that rely on an overly-individualistic understanding of the person. However, the conception of autonomy that is proposed to replace these liberal understandings (so-called "relational autonomy") is also problematic in its inability to give clear, unambiguous answers to important questions about the nature of moral agency and the kinds of influences on preferences that undermine or donít undermine authenticity. I argue across several, related papers that the goals promoted by the principle of respect for autonomy may be better served by the promotion of freedom as non-domination. This overarching project (the basis of a 2018 Brocher Institute summer residency) also includes papers on clinical research, public health, and sweatshop labor. A final, more theoretical paper, uses these individual cases to argue that the conceptual framework of freedom as non-domination (as developed in neorepublican political theory) may be better suited to resolving a variety of applied questions than either liberal or relational conceptions of autonomy.
Democracy and Group Decision-Making
An account of democratic legitimacy must provide normative grounding for the claim that citizens are obligated to respect and obey the outcomes of political decision-making, or alternatively, an account of why the state is justified in using its monopoly on coercive power to enforce the rules that it does. The deliberative turn in democratic theory was driven largely by the difficulties that aggregative accounts had in playing this role: aggregation's vulnerability to strategic behaviors and cyclic majorities suggested that it was neither procedurally fair nor somehow more likely to produce substantively better outcomes. Deliberative democrats sought to fill this gap by emphasizing the idea that collective political decision-making should involve a process of deliberation, conducted among equals who offer reasons in support of their positions. By ensuring full and equal access to deliberation and selecting outcomes on the basis of discussion aimed at rational consensus rather than inequalities of power or bargaining position, the process of collective decision-making could once again regain a legitimating function. But the legitimacy-conferring aspects of deliberation are lofty ideals. If it turns out that the ideal is unreachable, because predicated on unrealistic assumptions about democratic societies and the citizens within them, the relevance of ideal deliberative theory for existing political institutions is unclear.
I use social scientific data to interrogate the value of deliberative processes in joint decision-making. I leverage a substantial body of research about the ways in which groups deliberations can function to silence or diminish the impacts of some voices to argue that deliberative theorists claims regarding deliberation's legitimacy-conferring role in political decision-making are at best overstated, and at worst miss the mark. But there is another upshot of this analysis, which is that defenses of decision-making procedures that are grounded in idealized assumptions about the way individuals and groups reason and make decisions will be unable to lend legitimacy to those procedures when they are undertaken under non-ideal circumstances. I have also applied such analyses to the decision-making procedures used in research oversight committees tasked with reviewing the ethical and methodological bona fides of clinical trials.
More recently I've become interested in how epistemic responsibility for collective decision-making is distributed in a democracy. Motivated by clear breakdowns in the communication of political knowledge in contemporary democracies (social media bubbles, echo chambers of so-called "fake news", etc.), I am interested in two seeming tensions in political liberalism: that between the desire to leave room for a robust personal autonomy over the kind of life one wants to lead, and the need for a relatively demanding level of specialized knowledge to effectively contribute to political decision-making; and that generated by wanting a distribution of the responsibility for effective political decision-making that is both as undemanding as possible for the worst off in society (a basic tenet of Rawlsian liberalism) but simultaneously responsive to the needs of that worst off population. Similar worries have also motivate an exploration of how to conceive of responsibility for collective harms generated by political decisions made in communities with widely diffuse political power.