In financial disputes involving research, the parties are traditionally individual researchers and their institutions, biotech and pharmaceutical companies, and other entities engaged in the commercial development of biomedical research. Occasionally, research subjects claim that researchers have misled them or misappropriated their biological materials to derive financial gain. The best known example is the case of Moore v. Regents of the University of California, decided in 1990.With new developments in genomics, large-scale repositories of tissue and other biological specimens are increasingly important. (...) Biobanks have been established by various researchers, commercial entities, health-care institutions, and even entire countries. Individuals who contribute specimens almost always retain no commercial interest in any resulting research and language to that effect is now customarily included in informed consent documents signed at the time the specimen is given. Suppose, however, that the research subjects actually collect the specimens themselves, recruit the researcher, and provide financial support for the research. (shrink)

Este artigo tem por objetivo investigar de que forma a ética se relaciona com o processo de construção de conhecimentos no âmbito da educação por meio da reflexão sobre três eixos fundamentais: a ética e sua relação com a moral, a bioética e as ciências do comportamento social e psíquico do ser humano. O estudo foi norteado pela seguinte questão: se quisermos reforçar a excelência nas relações, de maneira que toda a estrutura de ensino possa ser paulatinamente reforçada, por onde (...) começar? A fundamentação teórica pautou-se nos estudos de Morin, Santi, Rovighi, Ringer, Singer, Kolakowski, Harris entre outros, a qual indica que os paradigmas sustentados na história, articulados aos estudos interdisciplinares, favorecem o aprofundamento sobre a ética nas relações humanas com foco na valorização do ser humano. (shrink)

I examine the familiar criterial view of personhood, according to which the possession of personal properties such as self-consciousness, emotionality, sentience, and so forth is necessary and sufficient for the status of a person. I argue that this view confuses criteria for personhood with parts of an ideal of personhood. In normal cases, we have already identified a creature as a person before we start looking for it to manifest the personal properties, indeed this pre-identification is part of what makes (...) it possible for us to see and interpret the creature as a person in the first place. This pre-identification is typically based on biological features. Except in some interesting special or science-fiction cases, some of which I discuss, it is human animals that we identify as persons. (shrink)

Animals, in the age of biotechnology, are the subjects of a myriad of scientific procedures, interventions, and modifications. They are created, altered, and experimented upon—often with highly beneficial outcomes for humans in terms of knowledge gained and applied, yet not without concern also for the effects upon the experimental subjects themselves: consideration of the use of animals in research remains an intensely debated topic. Concerns for animal welfare in scientific research have, however, been primarily directed at harm to and suffering (...) of animal subjects and their prevention. Little attention has been paid to the benefits research might potentially produce for animals themselves and the interests that some animals may therefore have in the furtherance of particular avenues of science. (shrink)

Bioethicists often present ‘saving lives’ as a goal distinct from, and competing with, that of extending lives by as much as possible. I argue that this usage of the term is misleading, and provides unwarranted rhetorical support for neglecting the magnitudes of the harms and benefits at stake in medical allocation decisions, often to the detriment of the young. Equal concern for all persons requires weighting equal interests equally, but not all individuals have an equal interest in ‘life-saving’ treatment.

The philosophical debate surrounding the moral status of the embryo has reached the public arena. The author of this paper examines some of the common arguments against embryo experimentation, including an influential article by Professor Ian Kennedy. He concludes that these arguments do not succeed in demonstrating that the intentional creation of embryos for research purposes is wrong, unless they also succeed in demonstrating that contemporary liberal abortion laws are also wrong. The author also criticises the conclusions of the Warnock (...) Report, and suggests that the reasons for permitting embryo research must be given a wider public audience. (shrink)

In debates about human cloning, a distinction is frequently drawn between therapeutic and reproductive uses of the technology. Naturally enough, this distinction influences the way that the law is framed. The general consensus is that therapeutic cloning is less morally problematic than reproductive cloning — one can hold this position while holding that both are morally unacceptable — and the law frequently leaves the way open for some cloning for the sake of research into new therapeutic techniques while banning it (...) for reproductive purposes. We claim that the position adopted by the law has things the wrong way around: if we accept a moral distinction between therapeutic and reproductive cloning, there are actually more reasons to be morally worried about therapeutic cloning than about reproductive cloning. If cloning is the proper object of legal scrutiny, then, we ought to make sure that we are scrutinising the right kind of clone. (shrink)

Longevity is valuable. Most of us would agree that it’s bad to die when you could go on living, and death’s badness has to do with the value your life would have if it continued. Most of us would also agree that it’s bad if life expectancy in a country is low, it’s bad if there is high infant mortality and it’s bad if there is a wide mortality gap between different groups in a population. But how can we make (...) such judgments more precise? How should we evaluate the harm of mortality in a population? Although philosophers have written a lot about the harm of death for individuals, very little work has been done on the harm of mortality for populations. In this article, I take the first steps towards developing a theory of the harm of population mortality. Even these first steps, I argue, lead to surprising results. (shrink)

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: (...) age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation. (shrink)

Where a decision has been made to stop futile treatment of critically ill patients on an intensive care unit – what is termed withdrawal of treatment in the UK – yet no doctor is available to perform the actions of withdrawal, nurses may be called upon to perform key tasks. In this paper I present two moral justifications for this activity by offering answers to two major questions. One is to ask if it can be in patients' best interests for (...) nurses to be the key actors in withdrawal of life‐sustaining treatment. The other is to ask if there is any reason that the nursing profession should not undertake such tasks if this is so. Both these questions require the resolution of weighty moral and philosophical issues. Thus, while offering a serious attempt to provide moral justifications for nurses undertaking withdrawal, this paper also invites debate over both the aim of task division between nurses and doctors, and how we might decide what is in the best interests of patients. (shrink)

The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. According to the principle of double effect, sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a (...) means to bringing about the same good end. Does the principle of double effect play the important explanatory role that has been claimed for it? To consider this question, one must be careful to clarify just what the principle is supposed to explain. Three misinterpretations of the principle’s force or range of application are common. 1. To ensure that Double Effect is not misunderstood as principle issuing a blanket permission on causing any unintended harm that yields a benefit, applications must require that the agent seek to minimize the harm involved. 2. Since it is widely accepted that it is wrong to aim to produce harm to someone as an end, to rule this out is not part of double effect’s distinctive content. 3. Harms that were produced regretfully and only for the sake of producing a good end may be prohibited by double effect because they were brought about as part of the agent’s means to realizing the good end. (shrink)

Surrogacy involves a private agreement whereby a woman who gestates a child attempts to surrender her (putative) moral right to become the parent of that child such that another person (or persons), of the woman’s choice, can acquire it. Since people lack the normative power to privately transfer custody, attempts to do so are illegitimate, and the law should reflect this fact.

When attempting to determine which of our acts affect future generations and which affect the identities of those who make up such generations, accounts of personal identity that privilege psychological features and person affecting accounts of morality, whilst highly useful when discussing the rights and wrongs of acts relating to extant persons, seem to come up short. On such approaches it is often held that the intuition that future persons can be harmed by decisions made prior to their existence is (...) mistaken as identity is a most fragile thing with even the smallest differences in the conditions under which we procreate affecting not the interests of distinct future persons, but the identities of those who will come to exist in the future. Within this paper I reject this view, holding that a subscription to these two accounts need not result in the conclusion that virtually all acts relating to possible persons are permitted. Further, I argue that such accounts may in fact allow a great deal more scope for the determination of prenatal harms than accounts of personal identity that privilege physical features. Finally, by interpreting claims regarding causal identity such as Parfit’s Time Dependence Claim in terms of Counterpart Theory I suggest that a solution to the non-identity problem can be found in the acceptance of, as relevant in prenatal cases, three kinds of objective similarity relations: Biological, Environmental and Decisional counterpart relations. (shrink)

The commercial trading of human organs, along withvarious related activities (for example, advertising)was criminalised throughout Great Britain under theHuman Organ Transplants Act 1989.This paper critically assesses one type of argumentfor this, and similar, legal prohibitions:commodification arguments.Firstly, the term `commodification' is analysed. Thiscan be used to refer to either social practices or toattitudes. Commodification arguments rely on thesecond sense and are based on the idea that having acommodifying attitude to certain classes of thing(e.g. bodies or persons) is wrong. The commodifyingattitude consists (...) of three main elements: denial ofsubjectivity, instrumentality, and fungibility.Secondly, in the light of this analysis, the claimthat organ sale involves commodifying the human bodyis examined. This claim is found to be plausible butinsufficient to ground an argument against organ sale,because the very same commodifying attitude is likelyto be present in cases of (unpaid) organ donation. Itis also argued that commodifying bodies per semay not be wrong.Thirdly, the view that organ sale involvescommodifying persons is examined. Although this andthe claim that it is wrong to commodify persons areprobably true, there is – it is argued – littlereason to regard organ sale as worse in this respectthan other widely accepted practices, such as thebuying and selling of labour.The conclusion is that although commodification is auseful ethical concept and although commodificationarguments may sometimes be successful, thecommodification argument against organ sale is notpersuasive. This is not to say, though, that thereare no arguments for prohibition – simply that thisparticular justificatory strategy is flawed. (shrink)

BackgroundThe assessment of patients’ decision-making capacity is ubiquitous in contemporary healthcare. This paper examines the ethics of undisclosed probing of capacity by psychiatrists. The discussion will refer to the law in England and Wales, though the highlighted issues are likely to be relevant in similar jurisdictions.Main textDecision-making capacity is a private attribute, and patients may not necessarily be aware that one of their personal abilities is being explored. Routine exploration of capacity has not historically been a part of psychiatric examination, (...) but it is now difficult to avoid during psychiatric interview.Ethical practice and shared decision-making require patients to be aware that their decision-making may be evaluated by the doctor at some point, and the potential implications of an objective professional conclusion of incapacity. Case law directs that patients should be informed about any assessment of their decision-making ability, though the extent to which this has translated into practice is unclear. However, explanation about the assessment may cause a patient to react negatively, which may impede therapeutic engagement and constitute an ethical dilemma. It is argued that in the absence of systemic measures, professionals should retain the discretion to decide whether a particular patient should be informed about the impending probe into their decision-making ability, or not. In the latter instance, concealment of information about the assessment or its purpose should be subject to the caveats and safeguards associated with any recourse to therapeutic exception.ConclusionThe necessity to mandatorily inform patients about assessment of their capacity introduces a novel ethical dilemma for psychiatrists. The negotiation of this dilemma should not be the prerogative of the clinician, and requires systemic initiatives to ensure universal awareness of patients about the possibility of their capacity being assessed during their journeys through healthcare systems. (shrink)

In the first five of these articles I have questioned the justice, and effectiveness, of total dependence in clinical research on willing volunteers. I have explored ways that might better and more equitably spread the burden of participating in clinical research as subjects of it. Here I consider this question: if consent is the barrier, must we regard consent as indispensable?

What relationship between investigators and subjects of clinical research would best meet the needs and wants of both – and of society, which has an interest not only in clinical research being done but also in its being done well? This series of articles argues that investigators and subjects should work together in a partnership based in shared aims. Other relationships are possible, however, and here I examine two.

In a series of articles, I set out my belief that investigators and subjects of research should work together in a partnership based in shared aims. Such a relationship – quite different from what is usual today – would impose duties on both partners. In earlier papers I explored the origin and nature of the duties that would fall on patients; here I examine their limits.

This series of articles argues for a different relationship between investigators and subjects of clinical research based on partnership in shared aims and recognition, by each, of their duties within this partnership. This second essay describes how those duties arise and explores the basis on which, and by and to whom, they are owed. The conclusion that patients have duties in research raises a number of moral issues which, ultimately, question the concept of consent. Discussion of these will be continued (...) in future articles. (shrink)

This article explores conceptions of moral status in the work of American thriller author Dean Koontz. It begins by examining some of the general theories of moral status used by philosophers to determine whether particular entities have moral status. This includes both uni-criterial theories and multi-criterial theories of moral status. After this examination, the article argues for exploring bioethics conceptions in popular fiction. Popular fiction is considered a rich source for analysis because it provides not only a good approximation of (...) the beliefs of ordinary members of the moral community, but also explores important issues in a context where ordinary individuals are likely to encounter them. Following on from this, the article then explores theories of moral status in the context of Koontz’s novels. In particular, the article focuses on the novel Watchers and Koontz’s Frankenstein series. Through these works, Koontz indicates that entities have moral status for a variety of reasons and thus presumably, he is a proponent of multi-criterial theories of moral status. The article concludes with an examination of what this might mean for our understanding of moral status claims generally. (shrink)

Ethics, Policy & Environment, Volume 14, Issue 3, Page 329-344, October 2011.

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for—as though health care is a commodity that needs no examination—or what health outcomes should receive priority in a just society, i.e., rationing. I present a rationing proposal, consistent with U.S. culture and traditions, that deals not with “health care,” the terminology used in the current debate, but with the more modest and limited topic of (...) medical care. Integral to this rationing proposal—which allows scope to individual choice and at the same time recognizes the interdependence of the individual and society—is a definition of a “decent minimum,” the basic package of medical treatments everyone should have access to in a just society. I apply it to a specific example, diabetes mellitus, and track it through a person's life span. (shrink)

Im Zeichen steigender Lebenserwartung, individualisierter Lebensentwürfe und wachsender medizinischer Eingriffsmöglichkeiten ist die Ethik herausgefordert, sich ausdrücklich und systematisch mit der Bedeutung der zeitlichen Erstreckung, Verlaufsstruktur und Einteilung unseres Lebens auseinanderzusetzen. Einen ersten Ansatzpunkt dazu bietet die im entwicklungspsychologischen und sozialwissenschaftlichen Bereich ausgebildete Lebensverlaufsperspektive. Am Beispiel des Alterns wird zunächst das Desiderat einer angemessenen ethischen Auseinandersetzung mit den normativen Aspekten menschlicher Zeitlichkeit aufgezeigt. Vor diesem Hintergrund werden die theoretischen Grundzüge der Lebensverlaufsperspektive umrissen und in ihrer Leistungsfähigkeit für die ethische Theoriebildung erörtert. (...) Das Hauptaugenmerk liegt auf drei Konzepten: Altersnormen als normative Standards altersgemäßen Verhaltens, Phasenideale als evaluative Maßstäbe der Lebensabschnittsgestaltung sowie Ablaufpläne als diachrone Schemata lebensgeschichtlicher Vorgänge. Abschließend werden Anwendungsmöglichkeiten und Grenzen einer solchen Lebensverlaufsperspektive in der Ethik erörtert. (shrink)

This paper discusses two paradigms of risk communication that guide strategies for communicating food safety issues. Built on the principles of social utility and paternalism, the first paradigm heavily relies on science and technical experts to determine food safety regulations and policies. Risk communication, in this context, is a unidirectional process by which experts from the industry or government regulatory agencies inform or alert potentially affected publics about the hazards they face and the protective actions they can take. However, public (...) trust and confidence in government and industry have considerably declined. Experts are being questioned about the objectivity of their assessments of risks. Policy makers are being challenged on such risk management decisions as tolerance guidelines, food labeling laws, and emergency warning systems. Concomitantly, some segments of the public, especially consumer advocates and environmental groups, are demanding increased input into the decision making process as they call for the recognition of lay perceptions and interpretations of risk as a legitimate counterpart to technically-assessed risk. Hence, instead of the linear, persuasion-oriented communication process, there are evolving efforts to shape risk communication into a more dialogical, interactive, and democratic exchange of information among different stakeholders (i.e., technical experts, government policy makers, industry, interest groups, and the general public). Reflecting a more Jeffersonian approach, this second paradigm argues that decisions about food safety are so complex and multi-dimensional that they must not be left to experts alone.However, both paradigms present ethical dilemmas. Determining the risks and relative safety of foods is not a totally objective and concise process. Since it involves social, economic, political, and personal values, how can the public not be involved in the exchange of ideas and information concerning food risks and safety? On the other hand, can we afford to let public opinion govern decisions pertaining to food risks and safety without consideration for the merits of scientific risk assessment? This paper raises questions regarding some assumptions of these two risk communication paradigms, and explores and discusses some of the salient ethical questions inherent in each framework. (shrink)

The 2009 pandemic of influenza A was relatively mild, but a subsequent outbreak of pandemic influenza could be much worse. According to projections from the Department of Health and Human Services, the potential health consequences of a severe influenza pandemic in the United States could be literally overwhelming: up to 1.9 million deaths; 90 million people sick; 45 million people needing outpatient care; 9.9 million people hospitalized, of whom 1.485 million would need treatment in an intensive care unit ; and (...) 742,500 patients needing mechanical ventilators. Even a less cataclysmic, moderate pandemic would result in 209,000 deaths; 90 million people sick; 45 million people needing outpatient care; 865,000 people hospitalized, of whom 128,750 would need treatment in an ICU; and 64,875 patients needing mechanical ventilators. (shrink)

Two contemporary strategies in cadaver organ transplantation, both with the potential to affect significantly expanding organ transplant waiting list sizes, have evolved: elective ventilation and use of nonheart-beating donors. Both are undergoing a period of critical review. It is not clear how widely EV is practiced around the world. In Great Britain, the Royal Devon and Exeter Hospital was the first hospital to develop an EV protocol, in 1988, after which other British hospitals followed suit. In the 1980s, new NHBD (...) protocols of two distinct types were implemented worldwide, although both rely on death confirmed by traditional cardiopulmonary criteria. The first type involves the removal of organs immediately after death, the preeminent example being the University of Pittsburgh Medical Center Protocol. The second involves the perfusion and cooling of kidneys immediately following death and subsequent organ removal. Protocols of this type have sprung up in Holland, Great Britain, Italy, France, Spain, Japan, and the United States. (shrink)

Two contemporary strategies in cadaver organ transplantation, both with the potential to affect significantly expanding organ transplant waiting list sizes, have evolved: elective ventilation and use of nonheart-beating donors. Both are undergoing a period of critical review. It is not clear how widely EV is practiced around the world. In Great Britain, the Royal Devon and Exeter Hospital was the first hospital to develop an EV protocol, in 1988, after which other British hospitals followed suit. In the 1980s, new NHBD (...) protocols of two distinct types were implemented worldwide, although both rely on death confirmed by traditional cardiopulmonary criteria. The first type involves the removal of organs immediately after death, the preeminent example being the University of Pittsburgh Medical Center Protocol. The second involves the perfusion and cooling of kidneys immediately following death and subsequent organ removal. Protocols of this type have sprung up in Holland, Great Britain, Italy, France, Spain, Japan, and the United States. (shrink)

Drugs used to provide improvement of cognitive functioning have been shown to be effective in healthy individuals. It is sometimes assumed that the use of these drugs constitutes cheating in an academic context. We examine whether this assumption is ethically sound. Beyond providing the most up-to-date discussion of modafinil use in an academic context, this contribution includes an overview of the safety of modafinil use in greater depth than previous studies addressing the issue of cheating. Secondly, we emphasize two crucial, (...) but hitherto nearly overlooked, nuances to the issues: the potential for modafinil to decrease inequality and disadvantage in academic settings, and the fact that how modafinil is used dramatically impacts its effects on health, coercion, fairness, authenticity and effort. Finally, we explicitly defend the position that there are no qualitatively morally relevant differences between modafinil use and other enhancement modalities; any such differences are in degree,... (shrink)

The aim of this paper is to critically examine David Shaw, Wybo Dondorp, and Guido de Wert’s arguments in favour of the procurement of human organs from human/nonhuman-primate chimeras, specifically from great-ape/human chimeras. My main claim is that their arguments fail and are in need of substantial revision. To prove this I first introduce the topic, and then reconstruct Shaw et al.’s position and arguments. Next, I show that Shaw et al.: failed to properly apply the subsidiarity and proportionality principles; (...) neglected species overlapping cases in their ethical assessment; ignored the ethics literature on borderline persons; and misunderstood McMahan’s two-tiered moral theory. These mistakes render an important part of their conclusions either false or problematic to the point that they would no longer endorse them. Finally I will briefly mention a possible multipolar solution to the human organ shortage problem that would reduce the need for chimeras’ organs. (shrink)

Recent breakthroughs in stem cell differentiation and reprogramming suggest that functional human gametes could soon be created in vitro. While the ethical debate on the uses of in vitro generated gametes (IVG) was originally constrained by the fact that they could be derived only from embryonic stem cell lines, the advent of somatic cell reprogramming, with the possibility to easily derive human induced pluripotent stem cells from any individual, affords now a major leap in the feasibility of IVG derivation and (...) in the scope of their potential applications. In this paper we develop an ethical framework, rooted in recent scientific evidence, to support a robust experimental pipeline that could enable the first-in-human use of IVG. We then apply this framework to the following objectives: (1) a clarification of the genetic parenting options afforded by IVG, along with their ethical underpinnings; (2) a defence of the use of IVG to remedy infertility, broadening their scope to same-sex couples; (3) an assessment of the most far-reaching implications of IVG for multiplex parenting. These include, first, the liberation of parenting roles from the constraints of biological generations in vivo, allowing multiple individuals to engage in genetic parenting together, thus blurring the distinction between biological and social generations. Second, we discuss the conflation of IVG with sequencing technology and its implications for the possibility that prospective parents may choose among a hitherto unprecedented number of potential children. In view of these perspectives, we argue that, contrary to the exhausted paradigm according to which society lags behind science, IVG may represent instead a salient and most visible instance where biotechnological ingenuity could be used in pursuit of social experimentation. (shrink)

In this paper I explore some of the moral issues that could emerge from the creation of human–nonhuman chimeras capable of human gamete production and human pregnancy. First I explore whether there is a cogent argument against the creation of HNH-chimeras that could produce human gametes. I conclude that so far there is none, and that in fact there is at least one good moral reason for producing such types of creatures. Afterwards I explore some of the moral problems that (...) could emerge from the fact that a HNH-chimera could become pregnant with a human conceptus. I focus on two sets of problems: problems that would arise by virtue of the fact that a human is gestated by a nonhuman creature, and problems that would emerge from the fact that such pregnancies could affect the health of the HNH-chimera. (shrink)

Within contemporary philosophy of religion there are three main ways in which God is conceptualised in relation to personhood:God is a person and so personal. God is non-personal, and so is not a person. God is a personal non-person. The first two of these options will be familiar to many, with held by most contemporary monotheist philosophers of religion and mainly by those who are pantheists., however, is a view some may not have come across, despite its proponents claiming it (...) was the view of great philosophical theologians from the past. However, within recent times has become more popular. On the face of it, it might not be clear what the difference between and is, and whether debate had between the two positions is substantive. The goal of this paper is therefore to clarify the debate and assess whether the many claims advocates of make as to why God cannot be a person stand up to scrutiny or are persuasive. My suggestion will be that on the whole they do and are not. As such, defenders of will either need to defend these reasons in more detail or focus on the area I suggest the debate really rests on. (shrink)

In this article I will address the question of determining the moral limits of reproductive decisions. In so doing I will examine the contributions made by John Harris, who has over the years consistently addressed the ethical implications of advancing reproductive technologies. In addressing these matters, Harris has centred his arguments on the principle of harm and with this in mind has set out a specific theoretical framework from which decisions about disability and causing harm, as in the case of (...) reproductive decisions, can be rationally addressed. This discussion will attempt to question the conceptual scheme that he proposes. The aim here is not to present an alternative theoretical contribution to the morality of reproductive choice. Rather, in the attempt to follow some of the directives in Wittgenstein’s later philosophy, the aim is to demonstrate some of the pitfalls of what Wittgenstein has described as the “craving for generality” in contemporary philosophy. I propose that this craving can distort, in this instance, our ordinary usage of concepts such as harm, suffering and disability and their role in the moral vocabulary of reproductive decision making. (shrink)

That we are morally responsible for what we do willingly and knowingly is a commonplace. That our moral responsibility extends as far as to cover at least the intended consequences of our voluntary actions and perhaps also the ones we did not intend, but could or did foresee, is equally beyond dispute. But what about omissions? Are we, or can we be, (equally) morally responsible for the harm that has occured because we did not prevent it, even though we could (...) have done so? Say, for all the enormous suffering, caused daily by famine, deprivation and curable diseases in the Third World countries? Moral intuitions and practices that one could consult in this matter seem to leave us in the dark. We regularly ascribe responsibility to people for harms resulting from their negligence or failure to fulfill professional duties. On the other hand, we tend to think that unless there is some evidence of the causal contribution that agents made to a harmful event and/or state, it is not really fair to blame it on them. And finally, to complicate things even more, most of us deny that omissions could effect anything (any change) in the world and consequently regard them as causally impotent (as well as possibly harmless). (shrink)

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming (...) neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. (shrink)

Background: Existing ethical guidelines recommend that, all else equal, past receipt of a medical resource (e.g. a scarce organ) should not be considered in current allocation decisions (e.g. a repeat transplantation).DiscussionOne stated reason for this ethical consensus is that formal theories of ethics and justice do not persuasively accept or reject repeated access to the same medical resources. Another is that restricting attention to past receipt of a particular medical resource seems arbitrary: why couldn't one just as well, it is (...) argued, consider receipt of other goods such as income or education? In consequence, simple allocation by lottery or first-come-first-served without consideration of any past receipt is thought to best afford equal opportunity, conditional on equal medical need. There are three issues with this view that need to be addressed. First, public views and patient preferences are less ambiguous than formal theories of ethics. Empirical work shows strong preferences for fairness in health care that have not been taken into account: repeated accessto resources has been perceived as unfair. Second, while difficult to consider receipt of many other prior resources including non-medical resources, this should not be used a motive for ignoring the receipt of any and all goods including the focal resource in question. Third, when all claimants to a scarce resource are equally deserving, then use of random allocation seems warranted. However, the converse is not true: mere use of a randomizer does not by itself make the merits of all claimants equal.SummaryMy conclusion is that not ignoring prior receipt of the same medical resource, and prioritizing those who have not previously had access to the medical resource in question, may be perceived as fairer and more equitable by society. (shrink)

In this paper I analyse who should be able to control the use of human embryonic stem cell lines. I distinguish between different kinds of control and analyse a set of arguments that purport to show that the donors of gametes and embryos should not be able to control the use of stem cell lines derived from their embryos. I show these arguments to be either deficient or of so general a scope that they apply not only to donors but (...) also to those who derived the stem cell lines. Since we normally think that stem cell derivers have the right to control the use of the cell lines they derived, we have no justification for denying donors similar rights of control. In the final section I briefly discuss why informed consent is not an appropriate vehicle for transferring or alienating control rights. (shrink)

Whenever embryo experimentation is discussed the question of whether it is preferable to use spare or specifically produced (‘research’) embryos for destructive embryo experimentation always enters the debate at some stage. This question is analysed, and it is suggested that the distinction is morally uninteresting, but rhetorically useful for both sides in the debate. It is further suggested that part of the force of this distinction is caused by the fact that it is parasitic on a real moral distinction based (...) on the degree to which the gametes used in the experiment are obtained by explicit or implicit coercion. (shrink)

Die Frage nach der Gerechtigkeit im Gesundheitswesen wird aus der Perspektive einer allgemeinen Theorie der Gerechtigkeit betrachtet. Diese Theorie ist ein Befähigungsansatz, der zwischen 1) der Grundversorgung aller Bürger mit Grundbefähigungen, 2) einem gerechten Anteil an den Früchten gesellschaftlicher Kooperation und 3) individuell erstrebten Gütern und Leistungen differenziert. Die Anwendung dieser Theorie reagiert auf charakteristische Probleme der Allokation im Gesundheitssektor: den prinzipiell ungedeckten Bedarf, die mangelnde Zurechenbarkeit des Bedarfes und die asymmetrische Informationsstruktur zwischen Patienten und Leistungserbringern.

ZusammenfassungDie Frage nach der Gerechtigkeit im Gesundheitswesen wird aus der Perspektive einer allgemeinen Theorie der Gerechtigkeit betrachtet. Diese Theorie ist ein Befähigungsansatz, der zwischen 1) der Grundversorgung aller Bürger mit Grundbefähigungen, 2) einem gerechten Anteil an den Früchten gesellschaftlicher Kooperation und 3) individuell erstrebten Gütern und Leistungen differenziert. Die Anwendung dieser Theorie reagiert auf charakteristische Probleme der Allokation im Gesundheitssektor: den prinzipiell ungedeckten Bedarf, die mangelnde Zurechenbarkeit des Bedarfes und die asymmetrische Informationsstruktur zwischen Patienten und Leistungserbringern.

A principle claiming equal entitlement to continued life has been strongly defended in the literature as a fundamental social value. We refer to this principle as ‘equal value of life'. In this paper we argue that there is a general incompatibility between the equal value of life principle and the weak Pareto principle and provide proof of this under mild structural assumptions. Moreover we demonstrate that a weaker, age-dependent version of the equal value of life principle is also incompatible with (...) the weak Pareto principle. However, both principles can be satisfied if transitivity of social preference is relaxed to quasi-transitivity. Footnotes1 The authors are grateful to Luc Bovens, Kristian Schultz Hansen, Søren Holm, Franz Huber, Wiebke Kuklys, Gabriella Pigozzi, and two anonymous referees for detailed and very helpful comments on earlier versions of this paper. Any errors and shortcomings are the responsibility of the authors alone. (shrink)

In his ‘Moral Enhancement, Freedom, and What We Value in Moral Behaviour’,1 David DeGrazia sets out to defend moral bioenhancement from a number of critics, me prominently among them. Here he sets out his stall: "Many scholars doubt what I assert: that there is nothing inherently wrong with MB. Some doubt this on the basis of a conviction that there is something inherently wrong with biomedical enhancement technologies in general. Chief among their objections are the charges that biomedical enhancement is (...) unnatural, use of biomedical enhancements evinces an insufficient appreciation for human “giftedness”, and biomedical enhancements pose a threat to personal identity. Elsewhere I have attempted to neutralize these objections. Here I will address a set of concerns that are directed at MB in particular and appeal to the nature and value of human freedom."Let me make clear at once that I do not believe there is anything inherently wrong with MB. I have been an advocate for human enhancement for over 30 years writing four books defending such enhancements.2–⇓4 The most recent of these published in 2007 covers much the same ground as Allen Buchanan's 2011 book cited by DeGrazia,5 but, unlike Buchanan, I do not define enhancements in terms of the intention or the motivation of those who produce them but rather in terms of their effect. I must also make clear that, like DeGrazia, I have also, for a very long time, attempted to neutralise objections 1–3 listed in the above passage.2–⇓4DeGrazia introduces his critique of my approach like this: "I will construe Harris’ argument and similar arguments as directed entirely at motivation-based MB—though I will hereafter omit the qualifier, “motivation-based.” (Certainly, these arguments do not apply to embryo selection, which … ". (shrink)