Research led by participants: a new social contract for a new kind of research.

In recent years, there have been prominent calls for a new social contract that accords a more central role to citizens in health research. Typically, this has been understood as citizens and patients having a greater voice and role within the standard research enterprise. Beyond this, however, it is important that the renegotiated contract specifically addresses the oversight of a new, path-breaking approach to health research: participant-led research. In light of the momentum behind participant-led research and its potential to advance health knowledge by challenging and complementing traditional research, it is vital for all stakeholders to work together in securing the conditions that will enable it to flourish.

Historical trends and human futures.

Kant's essay Idea for a universal history with a cosmopolitan purpose differs in deep ways from standard Enlightenment views of human history. Although he agrees with many contemporaries that unsocial sociability can drive human progress, he argues that we know too little about the trends of history to offer either metaphysical defence or empirical vindication of the perfectibility of man or the inevitability of progress. However, as freely acting beings we can contribute to a better future, so have grounds for committing ourselves to human progress even if we cannot guarantee or know that it will continue indefinitely. As Kant sees, it, human progress is better seen as a practical assumption--an Idea of Reason--than as a theoretical claim.

Accountability, trust and informed consent in medical practice and research.

During the last 25 years public policy in the UK has aimed to replace 'club' cultures and their supposedly suspect reliance on trust between professionals and public with a new public culture based on accountability and 'transparency'. These transformations have changed both clinical practice and public health policy in deep ways. Are the new conceptions of accountability adequate? Are obligations to be 'transparent' any more than requirements to disclose information which overlook the need for genuine communication? Can demands for ever fuller informed consent improve accountability to individual patients and research subjects? Could we devise more intelligent conceptions of accountability that support more intelligent placing and refusal of trust? What might intelligent conceptions of accountability suggest about proper clinical practice, public health medicine and professional responsibilities?

'Reproductive autonomy' versus public good?

Hitherto sex selection could be achieved only by destroying any fetus or child of the unwanted sex. Sperm selection may change that. The technology could be used to 'balance' families. However its use in certain developing countries might 'unbalance' populations, with serious, if unintended, consequences.

Informed consent and public health.

During the past 25 years, medical ethics has concentrated largely on clinical medicine and the treatment of individual patients. This focus permits a view of medical provision as a (quasi-) consumer good, whose distribution can be or should be contingent on individual choice. The approach cannot be extended to public health provision. Public health provision, including measures for limiting the spread of infectious diseases, is a public good and can be provided for some only if provided for many. The provision or non-provision of public goods cannot be contingent on individual informed consent, so must be in some respects compulsory. An adequate ethics of public health needs to set aside debates about informed consent and to consider the permissible limits of just compulsion for various types of public good. It will therefore gain more from engaging with work in political philosophy than with individualistic work in ethics.