Bias in Medicine: From Evidence Based Medicine to Artificial Intelligence (University of Toronto, 2021)
Offre de post-doctorat 1 an
Chers toutes et tous,
Dans le cadre du projet ANR Epancopi portant sur “Les questions éthiques de la pandémie de Covid-19 et leurs enjeux épistémologiques”, le Laboratoire Philosophie et Rationalités (PHIER – EA 3297) recrutera un ou une post-doctorant-e pour une durée de onze à douze mois à partir de février 2021 jusqu’à fin janvier 2022 (le contrat ne pouvant être prolongé au-delà de ce terme), au sein de l’Université Clermont Auvergne à Clermont-Ferrand.
Ce post-doctorat consistera pour une part à conduire des travaux de recherches philosophiques originaux sur la pandémie de Covid-19 en rapport avec les thématiques du projet, et pour une autre part à coordonner avec les porteurs du projet un certain nombre d’événements : organisation d’un colloque international, d’une publication collective, et mise en ligne ponctuelle de contenus (sur un ratio approximatif de 70% pour les activités de recherche et 30% pour les activités organisationnelles). Le salaire minimum devrait se situer autour de 2100 euros nets/mois.
Le ou la candidat-e devra idéalement avoir une spécialisation en épistémologie médicale, ou en éthique appliquée à la médecine, ou de façon plus générale en philosophie des sciences de la vie. Il ou elle devra également être en mesure de participer activement à l’organisation de la vie du projet.
Pour candidater, merci de nous soumettre les documents suivants :
– Un curriculum vitae
– Un projet de recherche de 1000 mots en rapport avec les thématiques abordées dans le projet Epancopi (voir texte ci-dessous).
Les dossiers seront évalués à la fois sur la nature et la pertinence du projet de recherche proposé ainsi qu’en fonction de l’adéquation du profil du ou de la candidate avec les différents aspects du projet Epancopi.
La date limite pour soumettre une candidature est le 15 janvier 2021.
Les dossiers doivent être transmis en version électronique à l’adresse suivante: firstname.lastname@example.org
Pour le projet Epancopi, les organisateurs,
Juliette Ferry-Danini, Cédric Paternotte, et Samuel Lepine
Epancopi project : « Ethical issues of the Covid-19 pandemic and their epistemological aspects »
Context of the proposal and state of the art:
The Covid-19 pandemic brings out numerous ethical issues that are closely related to epistemological ones: the ethics of clinical trials, of decisions whether to quarantine regions or countries, of vaccination policies or of case traceability. Indeed, it seems difficult to ask whether these different practices are morally acceptable and justifiable without at the same time questioning the scientific knowledge underlying them. Clinical trials thus seem justified only in a situation of objective uncertainty about the effectiveness of treatments, and the decision to quarantine at least part of the population is a legitimate deprivation of freedoms only if there are serious reasons to believe that this will have an effect on the spread of the virus, which could not be obtained by simple measures of physical distancing or hygiene. The question of who should receive vaccines first depends on considerations concerning the populations most at risk, but also on the modes of transmission of the virus. And the question of the traceability of the virus depends on our capacity to develop tracking devices that do not threaten the individual freedoms of citizens. These few examples give an overview of the ethical questions that have arisen so far since the start of the pandemic. They highlight how intertwined ethical and epistemological issues are, and how our knowledge of the disease intersects with our ability to implement measures likely to contain the pandemic.
On all these points, it seems that French philosophical research has been discreet until now. This discretion is first revealed by lack of substantial French-language debates on some of the ethical issues of the pandemic and on the different ways of tackling them. For instance, there is no standard philosophical debate on whether we should defend (or contest) the obligation to get vaccinated – an issue that soon will become all the more crucial as France counts as one of the countries whose citizens are the most resistant to vaccines (Wellcome, 2018). There is also no French debate on the question of the necessary rationing of medical resources, in contrast to the numerous concerns regarding the availability of beds in intensive care units or of mechanical ventilators. There is a need for more scholarly discussions about these issues in the French context. Unfortunately, ethical research has been overshadowed in the public eye by columns in major newspapers, which help maintain the picture of philosophy and ethics as essentially an essayist activity, which is widespread in France, or as mere legal procedures.
However, there is currently a large number of papers on each of these points in the English-speaking literature. The ethics of clinical trials, especially in pandemic times, has been the subject of a rich literature (Freedman 1978; London 2009, 2019; London & Kimmelman 2020). The rationing of mechanical ventilators (Patrone & Resnik, 2011), of vaccines (Emanuel & Wertheimer, 2006), and of antivirals (Arinaminpathy, N., Savulescu, J. & Mclean, 2009) has been the subject of discussions for at least twenty years in texts which have strived to anticipate the probable consequences of future pandemics. Similarly, the obligation to get vaccinated has been defended on the basis of numerous arguments (Giubilini, 2019; Giubilini & Savulescu, 2019). Finally, containment has been the subject of recent discussions, whether they legitimate (Bramble, 2020) or contest it on the basis of the fragility of the scientific epidemiological models on which it was based (Brennan, Surprenant & Winsberg, 2020), or even propose modulations according to the populations most at risk (Savulescu & Cameron, 2020). We should be worried about this contrast between the existence of an abundant English-speaking philosophical literature on questions of applied ethics, and the near absence of French texts devoted to these questions. In effect, this favours a damaging vacuum in the public debate, which should ideally be focused on solid arguments.
The relative lack of French-speaking philosophical debates on the covid-19-related ethical questions has unfortunately allowed philosophically unqualified people to seize them in the public space; it has also favoured the appearance of cavalier positions regarding the value of randomized controlled clinical trials, or of the scientific method in general (Raoult 2020). Such speeches have largely led to a form of mistrust regarding official speeches about the reality of the pandemic, its social effects, and the methods by which it may be countered. By interfering with the reception of scientific data and by favouring a form of medical conspiracy, these speeches have also had regrettable effects, in particular by spreading the idea that Covid-19 is an unremarkable disease, against which the distancing measures or the wearing of face masks might be too demanding.
Based on this assessment, the goal of this research project is clear: it aims to gather a number of researchers whose speciality is epistemology, applied ethics, and more generally philosophy of medicine and health, in order to produce in the French-speaking literature a body of texts and arguments likely to fuel a healthy public debate. In this regard, this project falls fully within the “Social and economic dynamics, ethical issues” theme of the AAP. In particular, it targets the “Ethics of research and care and human rights” and “Representations, perceptions, attitudes, behaviors relating to the epidemic ” subthemes. In order to carry out this project, we would intend, on the one hand, to organize an international philosophical congress within the Université Clermont Auvergne (UCA) during the month of June 2021, devoted to its general theme, which would then lead to the publication of a collective work gathering the communications of the speakers. At the same time, we plan to communicate regularly the results of our work through a website, with texts, videos, and podcasts. On the other hand, we would like to finance a postdoctoral position over a period of one year within the UCA, which would be responsible for organizing this website, the congress, and the publication of the papers, jointly with this project’s primary investigator.
The goal of the congress, as well as the website, will be to focus on each of these aspects of the pandemic in which ethical and epistemological questions are closely connected. We shall address at least the topics mentioned above, and particularly the ethics of clinical trials during a pandemic, the rationing of medical resources, and the ethics of vaccination, quarantine and tracing.
First, ethical and epistemological considerations should be situated in context, here the French context and, more precisely, the French legal context. Indeed, since the beginning of the Covid-19 pandemic, several laws have been implemented in order to tackle the crisis (see Pitcho, 2020; Pitcho & Petkova, 2020). These “emergency” laws are closely related to epistemological and ethical matters: they have explicitly impacted clinical research and uses of medications outside evidence-based medicine. Doing so, the French government seems to have implemented what has been called “pandemic research exceptionalism” (London & Kimmelman, 2020), the idea that a crisis justifies changing the rules of research and the rules of ethics. Pandemic research exceptionalism is an issue that should be discussed both at the epistemological and ethical levels. This is the most crucial question regarding the ethics of clinical trials in a pandemic. Although CNRS’s sections’ presidents have warned against research exceptionalism in an open letter in the French journal Libération, a scholarly discussion is needed in order to understand better what impact research exceptionalism can have on medical research and clinical care.
The rationing of medical resources first requires that we know which resources are particularly effective on which population. If we have to distribute treatments which are becoming scarce, we need to know how to optimize these treatments. But this raises another issue: is the effectiveness and instrumental value of a treatment the only way to approach the question of distributive justice in medicine, or should we not also take in consideration other values such as equality or giving priority to the worst off (Emanuel et al., 2020)? Similarly, if triage is also to be done among patients, one needs to know which model is more likely to be morally justified: a utilitarian model or an egalitarian one (Tabery and Mackett, 2008) ?
The ethics of vaccination raises many other questions. The first one is related to the testing process of vaccines, a process which usually takes a long time. In order to accelerate this process, it has been proposed to test the vaccine candidates on volunteers and then to expose these volunteers directly to the virus, provided that they are fully informed about the risks they are taking (Chappell & Singer, 2020; Eyal, Lipsitch, & Smith, 2020). But even among volunteers, one may wonder whether testing should not be prioritized on certain populations, like healthcare workers, or those who are working on areas which may be considered as essentials to societies, such as food and transports, or maybe those who are the most vulnerable to Covid-19. These are pressing questions, and we need clear criteria for deciding such priorities. A second issue regards the moral grounds for compulsory vaccination. Some people refuse to be vaccinated, seeing this obligation as an unjustified deprivation of freedom, or even as a danger. Leaving aside the influence of conspiracy theories on this kind of choice and ideology, one still has to provide a clear justification for this obligation, whether in utilitarian, contractual, or even libertarian terms. We should also be able to explain why this kind of obligation is not really a form of moral paternalism. Some have argued, for instance, that we shall precisely distinguish moral paternalism and public health issues (Walker, 2016).
The ethics of quarantine and tracing, finally, is closely connected to sciences such as epidemiology and modelling. While the pandemic continues, some are still discussing the appropriateness of lockdown and tracing measures. Admittedly, scientific data on these topics are far from perfect, and models are fragile, especially when they are carried out in such a short period of time. But an important question is precisely whether we can rely on anything other than epidemiological modelling. More precisely, the question arises as to what value should be given to models in political decisions. In this respect, there is an ongoing discussion on how modelling should be carried out to “serve society” (Saltelli et al., 2020). But beyond the question of the impact of epidemiological models on political decisions to lockdown, the question remains of the conditions under which a lockdown can be considered legitimate. Here again, one needs a moral criterion to define under what conditions exactly public health should involve a restriction of individual liberties. Some have also argued that contact tracing could be a real alternative to lockdown (White & van Basshuysen). But contact tracing, especially digital contact tracing, can be a satisfactory alternative to lockdown only if it can be argued that it is perfectly safe and that our personal data is well protected. So that once-again ethical questions and epistemological ones remain closely intertwined.
More broadly, this project shall tackle ethical questions which are peculiarly acute in the time of a pandemic. For instance, one might wonder whether healthcare workers have a special duty to treat during a pandemic (Malm et al., 2008). Considering the fact that these workers are primarily exposed to the pandemic and its dangers, and that they may have to work for many more hours, possibly in quarantine, we should at least ask on what moral grounds such a duty can be legitimated. A closely connected issue concerns the right to be treated during a pandemic, and more generally the moral right to health. Since healthcare is a limited resource, and even more during a pandemic, one might ask on what grounds we should consider healthcare as a right (Rumbold, 2015). And if it is really a right, we would still have to ask about the modalities of its implementation. These are pressing questions: even if we have a long-lasting attachment to a universal right to healthcare in France for instance, it is a lively possibility that such a right might be questioned and challenged during a severe pandemic. Thus, we need to be particularly clear about the moral foundations of such a right. Conversely, one might think that the mere possibility of a future pandemic is itself a strong argument in favor of universal health coverage, given that we need to organize the protection of citizens against a health disaster that could potentially destroy a country’s economy.
The state of the art on all these topics is at best rudimentary in the French literature (it should be noted, though, that the “Espace éthique” in various cities in France have tried to tackle part of the questions mentioned above), and it is precisely a central part of this project to remedy this worrying situation. Many members of the team involved in this project have already published papers either related to the Covid-19 crisis (particularly on the methodology of ethical trials), either related to various topics in philosophy of medicine (see section 2), but we think that through this project a structured philosophical approach of the pandemic could be organized, in order to meet what seems to be a real social need.
Program and methodology:
This one-year project aims to bring together the skills of researchers in epistemology, ethics, and in philosophy of medicine, in order to develop interdisciplinary works likely to enrich the French debate on the pandemic, and also wishes to give rise to quality international publications. In order to achieve this goal, we plan to organize a four days international congress in the Université Clermont Auvergne, which is the center part of this project. Indeed, this congress will promote interaction between French researchers in various areas of epistemology and ethics, as well as with foreign researchers, and will thus allow the emergence of quality debates on the philosophical issues related to the Covid-19 pandemic. We will also communicate regularly, and from the beginning of this project, the results of our work through a website, updated with texts, videos, and podcasts. As a second step, we also plan to organize the publication of a collective volume following the congress. A postdoctoral researcher will be recruited to carry out all of these tasks, with the leader of this project.
Arinaminpathy, N., Savulescu, J. & Mclean, A.R. (2009). “Effective use of a Limited Antiviral Stockpile for Pandemic Influenza.” Bioethical Inquiry, 6, 171–179.
Bramble, B. (2020). Pandemic Ethics – 8 Big Questions of COVID-19. Sydney: Bartleby books.
Brennan, J., Surprenant, C. & Winsberg, E. (2020). “How Government Leaders Violated Their Epistemic Duties During the SARS-CoV-2 Crisis.” Kennedy Institute Journal of Ethics. Available at SSRN: https://ssrn.com/abstract=3605981
Chappell, R.Y., & Singer P. (2020). “Pandemic ethics: the case for risky research.” Research Ethics, 16(3-4), 1-8.
Emanuel, E., & Wertheimer, A. (2006). “Who should get influenza vaccine when not all can?” Science, 312, 854–855.
Emanuel, E., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., Phillips, J.P. (2020). “Fair Allocation of Scarce Medical Resources in the Time of Covid-19”. New England Journal of Medicine, 382(21), 2049-2055.
Eyal, N., Lipsitch, M., Smith, P.G. (2020). “Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure.” The Journal of Infectious Diseases, 221(11), 1752–1756.
Giubilini, A. (2019). “An Argument for Compulsory Vaccination: The Taxation Analogy.” Journal of Applied Philosophy, 37(3), 446–66.
Giubilini, A., & Savulescu, J. (2019). “Vaccination, Risks, and Freedom: The Seat Belt Analogy.” Public Health Ethics, 12(3), 237–249.
London, A. J., & Kimmelman, J. (2020), Against pandemic research exceptionalism, Science, 476-477.
London, A. J.., (2019), “Social value, clinical equipoise, and research in a public health emergency” dans Bioethics, 33:326–334.
London, A., J., (2009), “Clinical Research in a Public Health Crisis: The Integrative Approach to Managing Uncertainty and Mitigating Conflict,” Seton Hall
Malm, H., May, T., Francis, LP., Omer, S.B., Salmon, D.A., Hood, R. (2008). “Ethics, pandemics, and the duty to treat”. American Journal of Bioethics, 8(8), 4-19.
Patrone, D., & Resnik, D. (2011). “Pandemic ventilator rationing and appeals processes.”Health Care Anal, 19(2),165–179.
Pitcho, B., (2020, “Fébrilité, incertitudes et hésitations au temps du COVID-19”, Revue Générale de Droit Médicale, n° 75, 2020, p. 27-46.
Pitcho, B., & Petkova, M. (2020), “L’état d’urgence sanitaire : Comment ? Pourquoi ?”, Tribune, 20 mars 2020, Village de la Justice, https://www.village-justice.com/articles/etat-urgence-sanitaire-comment-pourquoi,34216.html
Raoult, D., (2020), “L’éthique du traitement contre l’éthique de la recherche”, Contribution, Quotidien du médecin, 4 avril 2020, https://www.lequotidiendumedecin.fr/specialites/infectiologie/lethique-du-traitement-contre-lethique-de-la-recherche-le-pr-didier-raoult-critique-les-derives-de
Rumbold, B.E. (2015). “The moral right to health: a survey of available conceptions”. Critical Review of International Social and Political Philosophy, 20(4), 508-528.
Saltelli, A., Bammer, G., Bruno, I., Charters, E., Di Fiore, M., Didier, E., Nelson Espeland, W., Kay, J., Lo Piano, S., Mayo, D., Pielke, R. Jr., Portaluri, T., Porter, T.M., Puy, A., Rafols, I., Ravetz, J.R., Reinert, E., Sarewitz, D., Stark, P.B., Stirling, A., van der Sluijs, J., Vineis, P. (2020). “Five ways to ensure that models serve society: a manifesto.” Nature, 582(7813), 482-484.
Savulescu J., & Cameron J. (2020). “Why lockdown of the elderly is not ageist and why levelling down equality is wrong.” Journal of Medical Ethics.
Tabery J., & Mackett, C.W. 3rd (2008). “Ethics of triage in the event of an influenza pandemic.” Disaster Medicine and Public Health Preparedness, 2(2):114-118.
Walker, T. (2016). “Paternalism and Populations.” Public Health Ethics, 9(1), 46–54.
Wellcome (2018). Wellcome global monitor 2018 : How does the world feel about science and health? (https://wellcome.org/sites/default/files/wellcome-global-monitor-2018.pdf).
White, L., & van Basshuysen, P. (2020). “How to overcome lockdown: selective isolation versus contact tracing”. Journal of Medical Ethics, 1-2.
Mon DM de L3 sur la barbe de Gandalf (pour le lol) :
Gandalf porte-il une barbe ? (fautes comprises)
Mon mémoire de M2 sur la douleur (en anglais, fautes d’orthographes comprises) :