Do pharmaceutical companies have a moral obligation to expand access to investigational drugs to patients outside the clinical trial? One reason for thinking they do not is that expanded access programs might negatively affect the clinical trial process. This potential impact creates dilemmas for practitioners who nevertheless acknowledge some moral reason for expanding access. Bioethicists have explained these reasons in terms of beneficence, compassion, or a principle of rescue, but their arguments have been limited to questions of moral permissibility, leaving (...) for future research the question of whether expanded access is morally obligatory. We take up this further question and argue that pharmaceutical companies have a moral obligation to expand access. Our defense is not based on beneficence, compassion, or rescue, but instead on a reciprocal moral expectation resulting from existing social commitments that help ensure a robust pharmaceutical practice within the broader healthcare system. Our aim is to give this obligation, along with several others, a coherent and plausible structure within the wider clinical trial process so that one might better explain the sources of the dilemmas and their possible resolutions. (shrink)

This article aims to provide some insight into the nature and content of the theory of associative political obligation. It does this by first locating the view in the wider debate on political obligation, analyzing the view in terms of four central elements that are shared by many of its versions, and then discussing important criticisms that have been made of each of these, as well as some rejoinders by defenders of the theory.

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from (...) it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics. (shrink)

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why the medical (...) profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach. (shrink)

Judicial obligation to enforce the law is typically regarded as both unproblematic and important: unproblematic because there is little reason to doubt that judges have a general, if prima facie, obligation to enforce law, and important because the obligation gives judges significant reason to limit their concern in adjudication to applying the law. I challenge both of these assumptions and argue that norms of political legitimacy, which may be extra-legal, are irretrievably at the basis of responsible judicial reasoning.

Those of us who are not pacifists face an obvious challenge. Common-sense morality contains a stringent constraint on intentional killing, yet war involves homicide on a grand scale. If wars are to be morally justified, it needs be shown how this conflict can be reconciled. A major fault line running throughout the contemporary just war literature divides two approaches to attempting this reconciliation. On a ‘reductivist’ view, defended most prominently by Jeff McMahan, the conflict is largely illusory, since such killing (...) can be justified by aggregating individuals’ ordinary permissions to use force in self- and other-defence. In opposition, a rival ‘nonreductivist’ approach holds that these considerations are insufficient for the task. One prominent version of non-reductivism grounds the permission to kill in combatants’ membership in certain kinds of group or association. The key claim is that participation in certain morally important relationships can provide an independent source of permission for killing in war. This paper argues that non-reductivism should be rejected. It does so by pushing a dilemma onto non-reductivists: if they are successful in showing that the relevant relationships can generate permissions to kill in war, they must also jettison the most intuitive restrictions on conduct in war—the constraint on intentionally killing morally innocent non-combatants most saliently. Since this conclusion is unacceptable, non-reductivism should be rejected. (shrink)

Solidarity is a significant but poorly understood feature of political life. It is typically conceived, in “associative and teleological” terms, as working together for common political aims. But this conception misses the fact that solidarity requires individuals to will collective ends despite incompletely shared interests. Careful consideration of these elements reveals four “dynamics of solidarity”: its characteristic duties, the durability of commitments made in solidarity, the deference it involves, and its effects over time on agents’ habits and capacities. In this (...) article I describe these dynamics, first contrasting solidarity-given duties with duties of beneficence, justice, and loyalty. These contrasts lay bare the distinctive durability of solidarity, which differs from both the liberal’s commitment to justice and the loyalist’s commitment to the group. I then discuss deference, a feature of solidarity that has implications for individual engagement in political life more generally. Finally, I discuss the effects of solidarity on agents’ intellectual and physical capacities. I conclude by drawing out implications of these dynamics, challenging Tommie Shelby’s influential conception and justification of black solidarity and buttressing Philip Soper’s rejection of the Principle of Autonomy. (shrink)

Most of us accept that we have special obligations to our family members: to, e.g., our parents, our siblings, and our grandparents. But it is extremely difficult to offer a plausible grounding for such obligations, given the apparent fact that familial relationships are not voluntarily entered. I did not choose to be my mother's daughter or my brother's sister, so why suppose that such facts about me are morally significant? Why suppose that I owe more to my mother or to (...) my brother than natural duty requires that I do for all and any persons? Special obligations appear more problematic the less the relationships that supposedly generate them are akin to the relationship between promiser and promisee, a voluntarily assumed relationship. Thus, for example, special obligations to friends might appear less problematic than do those to family members, because it seems that we voluntarily choose our friends, and, thus, voluntarily choose to bear more for them than natural duty requires. (shrink)