The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that (...) the methods offered for specification and balancing of principles are inadequate. (shrink)

It is hypothesised and argued that “the four principles of medical ethics” can explain and justify, alone or in combination, all the substantive and universalisable claims of medical ethics and probably of ethics more generally. A request is renewed for falsification of this hypothesis showing reason to reject any one of the principles or to require any additional principle(s) that can’t be explained by one or some combination of the four principles. This approach is argued to be compatible with a (...) wide variety of moral theories that are often themselves mutually incompatible. It affords a way forward in the context of intercultural ethics, that treads the delicate path between moral relativism and moral imperialism. Reasons are given for regarding the principle of respect for autonomy as “first among equals”, not least because it is a necessary component of aspects of the other three. A plea is made for bioethicists to celebrate the approach as a basis for global moral ecumenism rather than mistakenly perceiving and denigrating it as an attempt at global moral imperialism. (shrink)

It is commonly held that respect for autonomy is one of the most important principles in medical ethics. However, there are a number of interpretations as to what that respect actually entails in practice and a number of constraints have been suggested even on our self-regarding choices. These limits are often justified in the name of autonomy. In this paper, it is argued that these different interpretations can be explained and understood by looking at the discussion from the viewpoints of (...) positive and negative liberty and the various notions of a “person” that lay beneath. It will be shown how all the appeals to positive liberty presuppose a particular value system and are therefore problematic in multicultural societies. (shrink)

abstract In this paper I consider the nature of the purported vice of moralism by examining two examples that, I suggest, exemplify this vice: the first from Nathaniel Hawthorne's The Scarlet Letter; the second from David Owen's account of his experience as European negotiator between the warring parties in the former Yugoslavia. I argue that in different ways both these examples show the kind of human weakness or failure that is involved in the most extreme version of moralism, a weakness (...) that involves an inability to see or acknowledge those one seeks to judge as real, morally accountable, human beings. (shrink)

This article discusses the suggestion of having the notion of solidarity as the foundational value for welfare scheme reforms. Solidarity is an emerging concept in bioethical deliberations emphasizing the need for value-oriented discussion in revising healthcare structures, and the notion has been contrasted with liberal justice and rights. I suggest that this contrast is unnecessary, flawed, and potentially counterproductive. As necessary as the sense of solidarity is in a society, it is an insufficient concept to secure the goals related to (...) social responsibility. The discussion on solidarity is also based on a questionable sense of nostalgia. Furthermore, solidarity and liberal justice share essential objectives concerning welfare schemes; therefore, the question arises whether the proper comparison should in the first place be within justice and solidarity. (shrink)

In his Tanner Lecture of 1979 called ‘Equality of What?’ Amartya Sen asked what metric egalitarians should use to establish the extent to which their ideal is realized in a given society. What aspect of a person’s condition should count in a fundamental way for egalitarians, and not merely as cause of or evidence of or proxy for what they regard as fundamental?

:This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of (...) this trend have a theoretical background in the responsibility-sensitive egalitarian—or luck egalitarian—tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop. (shrink)

Are there distinctly European values in bioethics, and if there are, what are they? Some Continental philosophers have argued that the principles of dignity, precaution, and solidarity reflect the European ethos better than the liberal concepts of autonomy, harm, and justice. These principles, so the argument goes, elevate prudence over hedonism, communality over individualism, and moral sense over pragmatism. Contrary to what their proponents often believe, however, dignity, precaution, and solidarity can be interpreted in many ways, and it is not (...) clear which reading would, or should, be favored by popular opinion. It is therefore dangerous to think that any one understanding of ``European'', or any other, values could be legitimately imposed on those who have different ideas about morality in health care and related fields. Bioethical principles should be employed to promote discussion, not to suppress it. (shrink)

If genetic diagnosis and preimplantation selection could be employed to produce deaf children, would it be acceptable for deaf parents to do so? Some say no, because there is no moral difference between selecting a deaf embryo and deafening a hearing child, and because it would be wrong to deafen infants. It is argued in this paper, however, that this view is untenable. There are differences between the two activities, and it is perfectly possible to condone genetic selection for deafness (...) while condemning attempts to deafen infants at birth. (shrink)

The association of women with caring dispositions and thinking has become a persistent theme in recent feminist writing. There are a number of reasons for this. One reason is the impetus that has been provided by the empirical work of Carol Gilligan on women’s moral development. The fact that this association is not merely an ideologically or philosophically postulated one, but is argued for on empirical grounds, tends to add to its credibility. Another reason for the resilience of the association (...) is the existence of an increasingly prominent theme in feminist thought and action that focuses on the importance of women’s difference from men, both as a fact and as a goal. Within this theme, there are various views on what the relevant differences are between women and men, and why the differences ought to be emphasized and properly respected. Women’s caring, as will be seen, turns out to have a firm presence in all of these views, and as a result, many women argue that caring should form the basis of a distinctive feminist ethic. On these views, women’s approaches to understanding moral situations, defining selfconceptions, choosing goals and roles, and guiding behaviour, should all be informed by and based upon dispositions of caring. However, if this idea of a feminist ethic of care is to be plausible, it will need to be reconciled with another strong theme in feminism, according to which in fundamental moral respects women ought not be considered or treated differently from men. We will examine the standing of a feminist ethic of care in the context of this tension between the difference theme and the sameness theme in feminism. The discussion begins by re-characterizing the justice and care debate in terms of impartialist and partialist ethical perspectives, and it then goes on to indicate the various ways in which women’s presumed disposition to caring and partialism finds prominence within the difference theme. The central focus of the discussion, however, will be the question of how to reconcile the conflict that exists between impartialist, justice-based moral thinking, and a partialist, caring approach to morality.. (shrink)

In this article, I present what I believe to be the core of Jürgen Habermas’s views on the morality, ethics, and regulation of emerging genetic and reproductive technologies in his bookThe Future of Human Nature.

According to what one might call ‘indirect” forms of utilitarian thinking, the proper end of all human action is the greatest happiness of the greatest number of individuals, but due to the fallibility of moral agents this end cannot, and must not, be directly pursued. Instead, according to at least one version of the indirect theory, moral agents have a duty to act in conformity with a set of general rules which, in their turn, have been designed to promote the (...) greatest happiness of humankind. But acts which conform to such general rules can under exceptional circumstances occasion more suffering than happiness. This is clearly problematical to indirect utilitarians. If they follow the rules regardless of the evil consequences, it can be argued that they have abandoned the basic principles of utilitarianism. If, on the other hand, they refuse to follow the rules which normally promote the general good, their view can be seen to collapse into the direct form of the creed. (shrink)

Two protechnology arguments, the “hopeful principle” and the “automatic escalator”, often used in bioethics, are identified and critically analysed in this paper. It is shown that the hopeful principle is closely related to the problematic precautionary principle, and the automatic escalator argument has close affinities to the often criticised empirical slippery slope argument. The hopeful principle is shown to be really hopeless as an argument, and automatic escalator arguments often lead nowhere when critically analysed. These arguments should therefore only be (...) used with great caution. (shrink)

In this paper I argue that, since institutions must reflect the societies in which they are placed, a socialist health-care system cannot be understood unless democratic socialism—which would assure all of basic necessities of existence, full education and health-care to all members of the community—is not incompatible with a flourishing market for other products. In contrasting single with multiple tiered health care systems, I suggest that a single tiered system in which all have equal access to health care and none (...) can buy more, is most consistent with the ideals of democratic socialism. (shrink)

In a contribution to The Journal of Medicine and Philosophy , Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only (...) in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know. (shrink)

:Justice can be approached from many angles in ethical and political debates, including those involving healthcare, biomedical research, and well-being. The main doctrines of justice are liberal egalitarianism, libertarianism, luck egalitarianism, socialism, utilitarianism, capability approach, communitarianism, and care ethics. These can be further elaborated in the light of traditional moral and social theories, values, ideals, and interests, and there are distinct dimensions of justice that are captured better by some tactics than by others. In this article, questions surrounding these matters (...) are approached with the hermeneutic idea of a distinction between “American” and “European” ways of thinking. (shrink)

The idea of cloning adult human beings often gives rise to objections involving mad dictators producing copies of themselves, or deranged billionaires who want to live forever. But what about situations where we can more readily understand and accept the reasons for creating a clone? Consider, for instance, the case of parents who have simultaneously lost their newly born child and found out that they cannot have any more children of their own by other known methods. Would it be wrong (...) of them to want a new child, a genetic copy of the lost infant, if the child were healthy and could only be produced by cloning the infant who no longer lives? And would it be wrong of genetic engineers to assist them? (shrink)

There is a growing feeling in many Western countries that every human being has a right to health, or a right to health care. This feeling is reflected in a declaration of the World Health Organization (WHO) from 1976, which states: The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. Our intention in the following is to use the WHO (...) declaration as a basis for considering the allocation of resources in health care. We shall first argue that most of the criteria suggested as grounds for fair allocation of scarce medical resources have their difficulties if one tries to apply them one by one to medical practices. We shall then go on to claim that, if we take the right of all human beings to health or health care even moderately seriously, increasing the resources would in most cases be more ethical than attempting to allocate them ‘fairly’. (shrink)

The idea of cloning adult human beings often gives rise to objections involving mad dictators producing copies of themselves, or deranged billionaires who want to live forever. But what about situations where we can more readily understand and accept the reasons for creating a clone? Consider, for instance, the case of parents who have simultaneously lost their newly born child and found out that they cannot have any more children of their own by other known methods. Would it be wrong (...) of them to want a new child, a genetic copy of the lost infant, if the child were healthy and could only be produced by cloning the infant who no longer lives? And would it be wrong of genetic engineers to assist them? (shrink)