Should the precautionary principle guide our actions or our beliefs?

Pediatric Sport-Related Concussion: Recommendations From the Amsterdam Consensus Statement 2023

The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research.

Ethics of resource allocation in a public health emergency context

Resource allocation under non-emergency conditions is often challenging. Within the context of a Public Health Emergency (PHE), allocation decisions become significantly more difficult as decisions are often necessary on very short timelines, where relevant information (either evidence or information "on the ground") is changing or incomplete, there is significant potential for harm, and resources are scarce, in unpredictable supply, and likely in high demand. An intentional value-based decision-making approach in such circumstances can clarify the values that ought to guide decisions, offering transparency and consistency, among other benefits. We use the example of vaccine allocation during the COVID-19 pandemic to explore value-based decision-making within a PHE context. We describe several core values that are relevant to PHE decision-making and outline their implications for approaches to vaccine allocation. While we focus on vaccine allocation, the values discussed are relevant to other system-level decisions in both emergency and non-emergency situations. Tips for leaders wishing to adopt a value-based approach to decision-making are offered.

The Precautionary Principle and Expert Disagreement

The Precautionary Principle is typically construed as a conservative decision rule aimed at preventing harm. But Martin Peterson (JME 33: 5-10, 2007; The ethics of technology: A geometric analysis of five moral principles, Oxford University Press, Oxford, 2017) has argued that the principle is better understood as an epistemic rule, guiding decision-makers in forming beliefs rather than choosing among possible acts. On the epistemic view, he claims there is a principle concerning expert disagreement underlying precautionary-based reasoning called the ecumenical principle: all expert views should be considered in a precautionary appraisal, not just those that are the most prominent or influential. In articulating the doxastic commitments of decision-makers under this constraint, Peterson precludes any probabilistic rule that might result in combining expert opinions. For combined or consensus probabilities are likely to provide decision-makers with information that is more precise than warranted. Contra Peterson, I argue that upon adopting a broader conception of probability, there is a probabilistic rule, under which expert opinions are combined, that is immune to his criticism and better represents the ecumenical principle.

Risk Science Contributions: Three Illustrating Examples

This article aims to demonstrate that risk science is important for society, industry and all of us. Rather few people today, including scientists and managers, are familiar with what this science is about-its foundation and main features-and how it is used to gain knowledge and improve communication and decision making in real-life situations. The article seeks to meet this challenge, by presenting three examples, showing how risk science works to gain new generic, fundamental knowledge on risk concepts, principles, and methods, as well as supporting the practical tackling of actual risk problems.

On the Limits of the Precautionary Principle

The precautionary principle (PP) is an influential principle of risk management. It has been widely introduced into environmental legislation, and it plays an important role in most international environmental agreements. Yet, there is little consensus on precisely how to understand and formulate the principle. In this article I prove some impossibility results for two plausible formulations of the PP as a decision-rule. These results illustrate the difficulty in making the PP consistent with the acceptance of any tradeoffs between catastrophic risks and more ordinary goods. How one interprets these results will, however, depend on one's views and commitments. For instance, those who are convinced that the conditions in the impossibility results are requirements of rationality may see these results as undermining the rationality of the PP. But others may simply take these results to identify a set of purported rationality conditions that defenders of the PP should not accept, or to illustrate types of situations in which the principle should not be applied.

Is the Precautionary Principle Really Incoherent?

The Precautionary Principle has been an increasingly important principle in international treaties since the 1980s. Through varying formulations, it states that when an activity can lead to a catastrophe for human health or the environment, measures should be taken to prevent it even if the cause-and-effect relationship is not fully established scientifically. The Precautionary Principle has been critically discussed from many sides. This article concentrates on a theoretical argument by Peterson (2006) according to which the Precautionary Principle is incoherent with other desiderata of rational decision making, and thus cannot be used as a decision rule that selects an action among several ones. I claim here that Peterson's argument fails to establish the incoherence of the Precautionary Principle, by attacking three of its premises. I argue (i) that Peterson's treatment of uncertainties lacks generality, (ii) that his Archimedian condition is problematic for incommensurability reasons, and (iii) that his explication of the Precautionary Principle is not adequate. This leads me to conjecture that the Precautionary Principle can be envisaged as a coherent decision rule, again.

Yes, The Precautionary Principle Is Incoherent

This article is a reply to Thomas Boyer-Kassem's discussion of my criticism of the precautionary principle published in this journal about a decade ago. Boyer-Kassem does not question the logical validity of the theorem proved in my original article, but he brings up important questions about its scope. He also challenges the plausibility of some of the assumptions on which it is based. In this comment, I argue that each objection can be adequately dealt with. As a decision rule, the precautionary principle is (still) incoherent.

Risk, Uncertainty and Precaution in Science: The Threshold of the Toxicological Concern Approach in Food Toxicology

Environmental risk assessment is often affected by severe uncertainty. The frequently invoked precautionary principle helps to guide risk assessment and decision-making in the face of scientific uncertainty. In many contexts, however, uncertainties play a role not only in the application of scientific models but also in their development. Building on recent literature in the philosophy of science, this paper argues that precaution should be exercised at the stage when tools for risk assessment are developed as well as when they are used to inform decision-making. The relevance and consequences of this claim are discussed in the context of the threshold of the toxicological concern approach in food toxicology. I conclude that the approach does not meet the standards of an epistemic version of the precautionary principle.

Analyzing precautionary regulation: do precaution, science, and innovation go together?

In this article we argue that the precautionary principle, as applied to the regulation of science and technology, cannot be considered in any general manner inconsistent with the norms and methods of scientific knowledge generation and justification. Moreover, it does not necessarily curtail scientific-technological innovation. Our argument flows from a differentiated view of what precaution in regulation means. We first characterize several of the most relevant interpretations given to the precautionary principle in academic debate and regulatory practice. We then use examples of actual precaution-based regulation to show that, even though science can have varying functions in different circumstances and frames, all of those interpretations recur to scientific method and knowledge, and tend to imply innovation in methods, products, and processes. In fact, the interplay of regulation and innovation in precautionary policy, at least in the case of the interpretations of precaution that our analysis takes into account, could be understood as a way of reconciling the two fundamental science and technology policy functions of promotion and control.

The principle of proportionality revisited: interpretations and applications

The principle of proportionality is used in many different contexts. Some of these uses and contexts are first briefly indicated. This paper focusses on the use of this principle as a moral principle. I argue that under certain conditions the principle of proportionality is helpful as a guide in decision-making. But it needs to be clarified and to be used with some flexibility as a context-dependent principle. Several interpretations of the principle are distinguished, using three conditions as a starting point: importance of objective, relevance of means, and most favourable option. The principle is then tested against an example, which suggests that a fourth condition, focusing on non-excessiveness, needs to be added. I will distinguish between three main interpretations of the principle, some primarily with uses in research ethics, others with uses in other areas of bioethics, for instance in comparisons of therapeutic means and ends. The relations between the principle of proportionality and the precautionary principle are explored in the following section. It is concluded that the principles are different and may even clash. In the next section the principle of proportionality is applied to some medical examples drawn from research ethics and bioethics. In concluding, the status of the principle of proportionality as a moral principle is discussed. What has been achieved so far and what remains to be done is finally summarized.

Choosing for the child with cochlear implants: a note of precaution

Recent contributions to discussions on paediatric cochlear implantation in Norway indicate two mutually exclusive doctrines prescribing the best course of post-operative support for a child with cochlear implants; bilingually with sign language and spoken language simultaneously or primarily monolingually with speech only. This conflict constitutes an ethical problem for parents responsible for choosing between one of the two alternatives. This article puts forth the precautionary principle as a possible solution to this problem. Although scientific uncertainty exists in the case of both doctrines, there exists a scenario of possible irreversible harm to some of the children habilitated monolingually. An application of the precautionary principle may hence suggest that it is rational to agree on the bilingual approach, at least for the time-being.