are you adopting an ethical position where it is wrong for one person to put themselves at risk to benefit others?
No. Volunteers in a clinical trial like this are putting themselves at risk to benefit others, and I feel that is a good thing.
I am concerned about people’s ability to give informed consent. It seems like a hard problem in general to give prospective volunteers a sense of how much risk they are being exposed to—one issue being that people might tend to assume ‘well, whatever they’re saying about risks, it must be pretty safe it they wouldn’t be doing it’. I feel that the ethical thing is to be as good at ensuring consent is informed as is practicable.
I tend to feel that if you continued to admit volunteers to a trial when a potential serious event had occurred, this issue of consent might get trickier. If you don’t tell the next volunteers at all, then it feels like you’re withholding information, meaning their consent is inadequately informed, so I’d be pretty concerned about that. If you do tell them, but continue admitting them, the message of ‘yeah, something bad maybe happened and we want you to know about it before you agree’ might be read by volunteers as having an implicit content of ‘but it’s not that bad or we wouldn’t still be injecting you’.
Of course you might end up with the information putting lots of prospective volunteers off. In that case, you might lose people who would have been volunteers after a pause.
Or are you asserting that there is more suffering and death in the world where the trial continues than in the world where it stops?
I think this is closer to my sense. My guess is that in expectation, a world in which we take pauses (as short as possible) to investigate potential problems with emerging vaccines for a disease like COVID 19, is likely to have less suffering in the long run. Vaccines are not inherently safe, nor are they necessarily trusted by the public even if they are safe. Actions that might let an unsafe vaccine slip through the net have the potential to cause vast harms in terms of the reduced uptake of lots of other vaccines. Even the perception that a vaccine was rushed without taking appropriate safety precautions can result in it getting blamed for things that it doesn’t cause (see the story of the 1976 swine flu vaccine https://www.bbc.com/future/article/20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976 ). Actions that show that care was taken to vet and understand any potential harms will help to improve uptake across all the range of vaccines.
I’m not a philosopher so I won’t say much about your earlier point. It’s worth noting that lots of painful but clearly worthwhile events in history are not worthwhile in your ethical system.
For example, the soldiers at D-Day had much greater uncertainty about their odds of survival than the vaccine trial victims (some beaches were much more dangerous than others). If it’s unethical to allow a volunteer to hurt themselves unless they have total certainty of the risks, the Normandy landings were totally unethical regardless of the suffering in occupied Europe. You can take that ethical system if you want, but it is very distant from conventional ethics.
Excess us deaths are about 10,000 per week. So a one week delay in a vaccine would cost 10,000 deaths. You say a loss of trust in vaccines is possible if the trial is not stopped is possible. But it is also true that if Russia and China start mass Good-enough vaccine distribution long before the US people may lose trust. Can you make an argument that if trials are not suspended a loss of trust in vaccines is more likely than if they are continued? Otherwise the argument isn’t very compelling, no?
My understanding is that there was conscription during WW2, so the comparison is somewhat weakened if we’re not talking about volunteers anyway. But in an armed conflict, I think people have a fair sense that the flying bullets makes it “really rather dangerous”, even if they couldn’t quantify it. My problem with how informed consent can be is around issues like we know there are biases where people have a tendency toward a dichotomy: low risk becomes zero risk in their minds. (To the extent that this applies at the other end of the spectrum, high risk would become near certainty, so further makes the war situation different in nature.)
Can you make an argument that if trials are not suspended a loss of trust in vaccines is more likely than if they are continued?
This seems self evidently true to me. I struggle to envisage a situation where people see caution that they perceive to be excessive and become more reluctant to take vaccines in the future.
Good to have a number for some comparisons. From a quick search, I see the WHO estimates that measles deaths globally fell from 535,600 in 2000 to 124,000 in 2017, but rose to 142,300 in 2018. That seems to show that vaccine uptake can make differences in the tens to hundreds of thousands. Yes, I’m comparing globally to one country, but on the flipside, I’d envisage that negative harms from increased skepticism could aggregate over years-to-decades, and over numerous diseases.
My problem with how informed consent can be is around issues like we know there are biases where people have a tendency toward a dichotomy: low risk becomes zero risk in their minds.
If the changes in risk are very small, in this case of order one in ten thousand, the ethical consequences of people miscalculating that risk are small. We already know that millions of people were willing to take huge risks (<1/100) for altruistic reasons. Why would we assume these volunteers would desist if they “rationally” evaluated the risk at one in ten thousand instead of approximating it at 1 in a hundred thousand?
So for the set of actions that put others in harms way, you believe that the ethics of said action depends on the percent difference between their perceived risk and the actual risk? That is really really weird and far from the point. Say I volunteer for activity A on the assumption that the risk is 1 in a million, but the actual risk is 10 in a million. Then I volunteer for activity B on the assumtion that the risk is 1 in a hundred, but the actual risk is 1 in ten. In both cases the proportion of risk change is a factor of 10, so you would argue they are equally unethical But the change in absolute risk change in activity B was 9%, which is a huge chance of dying! If I am volunteering I am very interested in the absolute change in risk, who cares about the percentage change, because I’m worried about dying not being wrong.
We don’t have to baby people just because they use heuristics to do good.
This seems self evidently true to me. I struggle to envisage a situation where people see caution that they perceive to be excessive and become more reluctant to take vaccines in the future.
People don’t spend that much time thinking about your particular institution’s paricular norms when they assign a trust value (because there are lots of institutions so they don’t have unlimited time). This is the reason courts are built like they are, so people can actually watch the judge deliberate and explain his reasoning. People do not trust courts because juries are statistically good at identifying guilt or because they know the regulations in their jurisdiction in detail. They judge the courts on big noticable surface characteristics that touch their lives and their communities.
They will remember stuff like “did the vaccine work” “did we get it first” and maybe “did people have negative reactions on facebook”. The choices made in one particular trial will be long long forgotten. The UK’s choice to continue the trial gets them more data faster to release a safe vaccine to the genpop. Those are things that touch people. So the UK might experience higher “trust in vaccine institutions” later than the US. It could go the otherway too, but I think the UK choice is stronger in expectation.
Also, the generation who stopped taking measles had forgotten how bad viruses are. I doubt they’ll repeat that mistake after this.
No. Volunteers in a clinical trial like this are putting themselves at risk to benefit others, and I feel that is a good thing.
I am concerned about people’s ability to give informed consent. It seems like a hard problem in general to give prospective volunteers a sense of how much risk they are being exposed to—one issue being that people might tend to assume ‘well, whatever they’re saying about risks, it must be pretty safe it they wouldn’t be doing it’. I feel that the ethical thing is to be as good at ensuring consent is informed as is practicable.
I tend to feel that if you continued to admit volunteers to a trial when a potential serious event had occurred, this issue of consent might get trickier. If you don’t tell the next volunteers at all, then it feels like you’re withholding information, meaning their consent is inadequately informed, so I’d be pretty concerned about that. If you do tell them, but continue admitting them, the message of ‘yeah, something bad maybe happened and we want you to know about it before you agree’ might be read by volunteers as having an implicit content of ‘but it’s not that bad or we wouldn’t still be injecting you’.
Of course you might end up with the information putting lots of prospective volunteers off. In that case, you might lose people who would have been volunteers after a pause.
I think this is closer to my sense. My guess is that in expectation, a world in which we take pauses (as short as possible) to investigate potential problems with emerging vaccines for a disease like COVID 19, is likely to have less suffering in the long run. Vaccines are not inherently safe, nor are they necessarily trusted by the public even if they are safe. Actions that might let an unsafe vaccine slip through the net have the potential to cause vast harms in terms of the reduced uptake of lots of other vaccines. Even the perception that a vaccine was rushed without taking appropriate safety precautions can result in it getting blamed for things that it doesn’t cause (see the story of the 1976 swine flu vaccine https://www.bbc.com/future/article/20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976 ). Actions that show that care was taken to vet and understand any potential harms will help to improve uptake across all the range of vaccines.
I’m not a philosopher so I won’t say much about your earlier point. It’s worth noting that lots of painful but clearly worthwhile events in history are not worthwhile in your ethical system. For example, the soldiers at D-Day had much greater uncertainty about their odds of survival than the vaccine trial victims (some beaches were much more dangerous than others). If it’s unethical to allow a volunteer to hurt themselves unless they have total certainty of the risks, the Normandy landings were totally unethical regardless of the suffering in occupied Europe. You can take that ethical system if you want, but it is very distant from conventional ethics.
Excess us deaths are about 10,000 per week. So a one week delay in a vaccine would cost 10,000 deaths. You say a loss of trust in vaccines is possible if the trial is not stopped is possible. But it is also true that if Russia and China start mass Good-enough vaccine distribution long before the US people may lose trust. Can you make an argument that if trials are not suspended a loss of trust in vaccines is more likely than if they are continued? Otherwise the argument isn’t very compelling, no?
My understanding is that there was conscription during WW2, so the comparison is somewhat weakened if we’re not talking about volunteers anyway. But in an armed conflict, I think people have a fair sense that the flying bullets makes it “really rather dangerous”, even if they couldn’t quantify it. My problem with how informed consent can be is around issues like we know there are biases where people have a tendency toward a dichotomy: low risk becomes zero risk in their minds. (To the extent that this applies at the other end of the spectrum, high risk would become near certainty, so further makes the war situation different in nature.)
This seems self evidently true to me. I struggle to envisage a situation where people see caution that they perceive to be excessive and become more reluctant to take vaccines in the future.
Good to have a number for some comparisons. From a quick search, I see the WHO estimates that measles deaths globally fell from 535,600 in 2000 to 124,000 in 2017, but rose to 142,300 in 2018. That seems to show that vaccine uptake can make differences in the tens to hundreds of thousands. Yes, I’m comparing globally to one country, but on the flipside, I’d envisage that negative harms from increased skepticism could aggregate over years-to-decades, and over numerous diseases.
https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide
If the changes in risk are very small, in this case of order one in ten thousand, the ethical consequences of people miscalculating that risk are small. We already know that millions of people were willing to take huge risks (<1/100) for altruistic reasons. Why would we assume these volunteers would desist if they “rationally” evaluated the risk at one in ten thousand instead of approximating it at 1 in a hundred thousand?
So for the set of actions that put others in harms way, you believe that the ethics of said action depends on the percent difference between their perceived risk and the actual risk? That is really really weird and far from the point. Say I volunteer for activity A on the assumption that the risk is 1 in a million, but the actual risk is 10 in a million. Then I volunteer for activity B on the assumtion that the risk is 1 in a hundred, but the actual risk is 1 in ten. In both cases the proportion of risk change is a factor of 10, so you would argue they are equally unethical But the change in absolute risk change in activity B was 9%, which is a huge chance of dying! If I am volunteering I am very interested in the absolute change in risk, who cares about the percentage change, because I’m worried about dying not being wrong.
We don’t have to baby people just because they use heuristics to do good.
People don’t spend that much time thinking about your particular institution’s paricular norms when they assign a trust value (because there are lots of institutions so they don’t have unlimited time). This is the reason courts are built like they are, so people can actually watch the judge deliberate and explain his reasoning. People do not trust courts because juries are statistically good at identifying guilt or because they know the regulations in their jurisdiction in detail. They judge the courts on big noticable surface characteristics that touch their lives and their communities.
They will remember stuff like “did the vaccine work” “did we get it first” and maybe “did people have negative reactions on facebook”. The choices made in one particular trial will be long long forgotten. The UK’s choice to continue the trial gets them more data faster to release a safe vaccine to the genpop. Those are things that touch people. So the UK might experience higher “trust in vaccine institutions” later than the US. It could go the otherway too, but I think the UK choice is stronger in expectation.
Also, the generation who stopped taking measles had forgotten how bad viruses are. I doubt they’ll repeat that mistake after this.