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.

Abortion is one of the great moral debates of the epoch. Is there a rational method by which the debate can be resolved? Can bioethics' promise of such a method be fulfilled? Surely, a strictly rational approach can establish solid grounds for our beliefs once and for all. We would then be justified in deeming as unreasonable anyone who does not accept the perfectly rational conclusions. I present two scenarios to show that there can be no such philosophically grounded method (...) and therefore no such facts to which everyone must agree. This does not mean that it is in fact impossible for people to reach agreement. It simply means that there is no incontrovertibly rational means by which they must do so. (shrink)

In the United States, disturbing concerns pertaining to both how putative bioethicists are perceived and the potential for the abuse of their power in connection with these perceptions compel close examination. This paper addresses these caveats by examining two fundamental and interrelated components in the image-construction of the ethicist: definitional and contextual. Definitional features reveal that perceptions and images of the ethicist are especially subject to distortion due to a lack of clarity as to the nature and qualifications of the (...) ethicist. Furthermore, the clinical, professional, political, academic, and linguistic contexts in which these ethicists are engaged are contexts of disquieting degrees of power. I argue that the lack of definitional clarity as to what constitutes an ethicist combined with the above volatile contexts together set the stage for the abuse of power on the part of ethicists. Throughout, I question the extent of self-critical analyses among ethicists, and, in view of these components in image-construction and their relationship to power, I challenge the degree of integrity within the field. In conclusion, I propose some areas for further investigation. (shrink)

This note examines the British case of Broidy v. St Helen's andKnowsley Health Authority in which Margaret Broidy was unsuccessful in anegligence action against the defendant Health Authority following an emergency caesareanoperation in which a hysterectomy had been performed as `essential'. Of particularfeminist interest is the fact that Broidy's claim for, inter alia, the costs of asurrogacy arrangement to be carried out in California was refused on the basis that it wasnot reasonable – the chances of success of the surrogacy (...) arrangement being deemed tooremote. Set within the context of an increasingly prolific number ofworld-wide surrogacy stories, the Broidy decision is analysed as providing a recentillustration of some of the difficult implications of the reproductive option which surrogacyhas now become. (shrink)

The role that the first-person perspective is allowed to play in moral reasoning is a major source of contemporary debate between partialists and impartialists. The discussion usually revolves around the question of partiality’s justification when it is intended to benefit our loved ones. Surprisingly, the issue of partiality to oneself is rarely addressed directly and its link with egoism is left unexplored. This is a gap that this paper attempts to fill by focusing on some of the difficulties raised by (...) the idea of justified partiality to oneself. (shrink)

Moral and political philosophers no longer condemn harm inflicted on nonhuman animals as self-evidently as they did when animal welfare and animal rights advocacy was at the forefront in the 1980s, and sentience, suffering, species-typical behavior, and personhood were the basic concepts of the discussion. The article shows this by comparing the determination with which societies seek responsibility for human harm to the relative indifference with which law and morality react to nonhuman harm. When harm is inflicted on humans, policies (...) concerning negligence and duty of care and principles such as the ‘but for’ rule and the doctrine of double effect are easily introduced. When harm is inflicted on nonhumans, this does not happen, at least not any more. As an explanation for the changed situation, the article offers a shift in discussion and its basic terminology. Simple ethical considerations supported the case for nonhuman animals, but many philosophers moved on to debate different views on political justice instead. This allowed the creation of many conflicting views that are justifiable on their own presuppositions. In the absence of a shared foundation, this fragments the discussion, focuses it on humans, and ignores or marginalizes nonhuman animals. (shrink)

Since the 70s of last century, people started to talk about philosophy for children in order to improve students’ ability to think through the philosophical dialogue. Nowadays we wonder whether it makes sense to talk about ethics and bioethics for positively influencing the civil life of pupils. It is certainly right, in fact, that the public school is secular, but it cannot be totally deprived of values. This problem cannot be solved with the study of Religion in school, but perhaps (...) include activities of ethics and bioethics in the daily teaching can become a good habit. In the second part of the article, a teaching about environmental education is described. We tried a new protocol for the teaching of bioethics at school: we have combined the discussion, typical of “Philosophy for Children” to “Life skills teaching.” In “Life skills teaching” the boys are faced with challenging situations in order to increase their skills. This activity was aimed to excite students about acquired many skills and to develop and share the lessons learned during the discussions of bioethics. The document on which these discussions were based is “The Earth Charter”, an official document written at the invitation of the World Commission of the United Nations. (shrink)

Anti-theory is a multi-faceted critique of moral theory which, it appears, is undergoing something of reassessment. In a recent paper Hämäläinen discusses the relevance of an anti-theoretical perspective for the activity of applied ethics. This paper explores her view of anti-theory. In particular I examine its relevance for understanding the formal guidance on pandemic flu planning issues by the Department of Health in the UK and some subsequent discussions around triage and reverse triage decisions which may be considered by both (...) Primary and Secondary Care Trusts. in setting their own policies and which may face clinicians in the eventuality of a pandemic. Following Hämäläinen in contrasting reflective equilibrium with her anti-theory inspired suggestion of an instrumental approach to moral theory in practice I demonstrate how this understanding complements the diversity of our intuitive moral judgements. Consequentially I suggest that this anti-theoretical instrumental approach is in greater accord with the conditions under which such policy planning and decision making is, or will be, made. Furthermore, on the grounds of keeping open the ethical dimensions of medical practice in conditions of uncertainty, i.e. during a pandemic, I suggest that the anti-theoretical instrumental perspective is, ethically, the preferable approach to producing such policies and guidelines. (shrink)

ABSTRACT In his paper ‘The Survival Lottery’John Harris suggested that there could be situations where the rational thing to do would be to kill a healthy person and harvest his organs for transplantation, thereby saving several lives at the cost of one. Anne Maclean claims that such a proposal, far from being rational, does not qualify as a moral proposal at all since what it suggests is ‘plain murder’. I argue that she is correct to claim that the proposal is (...) not uniquely rational and that doctors could quite rationally reject it, but that she overreaches herself when she holds it not to be a moral proposal at all. (shrink)

This paper examines ethical concerns of the utilitarian paradigm, the greatest good for the greatest number, advocated by many proponents and consultants in siting landfills. The implications of the consequentialist utilitarian approach are considered through the examination of a landfill-site-search case study in Ontario, Canada. Limitations to such an approach, in terms of differing values, equal consideration, equitable participation, distributive justice and the emphasis on non-quantifiable factors are discussed. Recommendations to improve the process are made based on the ethical analysis (...) of the case study. (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?

This paper is motivated by Davis’ [14] theory of the individual in economics. Davis’ analysis is applied to health economics, where the individual is conceived as a utility maximiser, although capable of regarding others’ welfare through interdependent utility functions. Nonetheless, this provides a restrictive and flawed account, engendering a narrow and abstract conception of care grounded in Paretian value and Cartesian analytical frames. Instead, a richer account of the socially embedded individual is advocated, which employs collective intentionality analysis. This provides (...) a sound foundation for research into an approach to health policy that promotes health as a basic human right. (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from research interviews and observations in two (...) London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

What is the place of vulnerability in our lives? The current debate about the ethics of enhancement technologies provides a context in which to think about this question. In my view, the current debate is likely to be fruitless, largely because we bring the wrong ethical resources to bear on its questions. In this article, I recall an important, but currently neglected, role that moral concepts play in our thinking, a role they should especially play in relation to the introduction (...) of new technologies. I call this the ‘contemplative role of moral concepts’. I then contrast two approaches to the contemplative role of moral concepts which are found in the current literature, and show why it is important to keep in mind both of these approaches when thinking about human vulnerability. (shrink)

This series of articles have explored the need that society has for clinical research to be done and the consequent sets of duties that call on the one hand upon investigators to carry it out and on the other upon patients to be subjects of it. The purpose of the discussions has been to understand what should be the relationship between investigators and patient-subjects in order that both might meet their obligations effectively, efficiently, safely and with mutual respect. Here I (...) reach my conclusions. (shrink)

(2001). The Question of Method in Ethics Consultation: Transforming a Career into a Profession? The American Journal of Bioethics: Vol. 1, No. 4, pp. 42-43.

Anne Maclean has written a book which purports to identify and then definitively to reject the claims which she perceives to be the claims of bioethics. If she is right, then the enterprise to which this journal is dedicated is misconceived and worthless. In this paper, I attempt to show why so far from being not right she is comprehensively wrong, both in her understanding of the nature of bioethics and in the specific moral claims she makes about those she (...) terms 'bioethicists'. Since much of her book-length study is devoted to a criticism of my own work, this paper analyses the extent to which Maclean's criticisms of me, and by extension, of other bioethicists, are sustainable. (shrink)

Here are some kinds of reasons for taking an action to have been morally right. It was done out of a good intention or a pure good will on the part of the agent, or was owed to a virtue of hers. It issued from the agent's moral perception or intuition with respect to a situation, not from the application of a general principle or from calculation of the consequences of possible actions. Although it would give rise to distress or (...) worse, the action was one of integrity, autonomy, or self-concern, perhaps in accord with the agent's aversion to killing by her own hand, or true to her life-hope to achieve a success on her own. (shrink)