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Offers, requests and certainties (in the prevention and treatment of cancer, for example)

Stephen John (Cambridge)

Doctors are sometimes permitted to give patients early detection tests which are not judged safe and effective enough to be used in screening programmes. Pharmaceutical companies are sometimes permitted to give patients drugs which are not yet approved by regulators. On the face of it, these cases seem examples of a more general phenomenon explored in recent philosophy of science under the heading of "inductive risk", where appropriate standards of certainty are fixed by non-epistemic aspects of our situation. However, standard discussions of inductive risk focus on the consequences of different epistemic errors. This doesn't look like a helpful way of thinking through our cases. This paper suggests an alternative: that there is a difference between the ethics of responding to requests and the ethics of making an offer. In the former case, considerations of autonomy are key; in the latter, considerations of nonmaleficence. In turn,these deontic differences have important epistemic implications. This paper develops these ideas, noting their relevance to a range of practices around the prevention, detection and treatment of cancer.