Can quite different values be rationally weighed against one another? Can the value of one thing always be ranked as greater than, equal to, or less than the value of something else? If the answer to these questions is no, then in what areas do we find commensurability and comparability unavailable? And what are the implications for moral and legal decision making? This book struggles with these questions, and arrives at distinctly different answers.".

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

Joel Feinberg was a brilliant philosopher whose work in social and moral philosophy is a legacy of excellent, even stunning achievement. Perhaps his most memorable achievement is his four-volume treatise on The Moral Limits of the Criminal Law, and perhaps the most striking jewel in this crowning achievement is his passionate and deeply insightful treatment of paternalism.1 Feinberg opposes Legal Paternalism, the doctrine that “it is always a good reason in support of a [criminal law] prohibition that it is necessary (...) to prevent harm (physical, psychological, or economic) to the actor himself.” Against this doctrine Feinberg asserts that when an agent’s sufficiently voluntary choice causes harm to herself or risk of harm to herself, this category of harm-to-self is never a good reason in support of criminal law prohibition of that type of conduct. (shrink)

This article defends Richard Titmuss''s argument, and PeterSinger''s sympathetic support for it, against orthodoxphilosophical criticism. The article specifies thesense in which a market in blood is ``dehumanising'''' ashaving to do with a loss of ``imagined community'''' orsocial ``integration'''', and not with a loss of valued or``deeper'''' liberty. It separates two ``domino arguments''''– the ``contamination of meaning'''' argument and the``erosion of motivation'''' argument which support, indifferent but interrelated ways, the claim that amarket in blood is ``imperialistic.'''' Concentrating onthe first domino argument (...) the article considers theview that monetary and non-monetary meanings of thesame good can co-exist given the robustness of certainkinds of relationship and joint undertakings withinwhich gifts can figure. It argues that societalrelationships are vulnerable or permeable to theeffects of the market in a way that those constitutiveof the personal sphere are not.General, more broadly political questions remainunanswered but the core of Titmuss''s original andchallenging argument remains and can be presented ina defensible form. (shrink)

Two recent cases raise the question: Should the body be considered a form of property? Patients generally do not share in the profits derived from the applications of research on their body parts and products. Nor is their consent for research required so long as the body part is unidentified and is removed in the course of treatment. A market in body parts and products would require consent to all categories of research and ensure that patients are protected from coercion (...) and given the chance to be paid fairly for their contributions. Such a market might force us to rethink our policies prohibiting organ sales. Donors, recipients, and society will benefit from a market in body parts so long as owners—and no one else—retain control over their bodies. (shrink)

In 'Stakes and Kidneys' the author discusses various ethical issues surrounding the international trade in human organs.

Opposition to inducement payments for research subjects is an international orthodoxy amongst writers of ethics committee guidelines. We offer an argument in favour of these payments. We also critically evaluate the best arguments we can find or devise against such payments, and except in one very limited range of circumstances, we find these unconvincing.

Living donor kidney transplantation has increased significantly in the past 10 years. Currently it accounts for 41% of all kidney transplants in the USA.1 While the percentage is lower in the United Kingdom and other European countries, the number of living compared with cadaveric kidney donors will probably continue to increase globally. Mortality associated with surgery on live donors is low, thanks largely to the success of laparoscopic nephrectomy. Kidney transplantation from a living donor is preferable to that from a (...) cadaveric, or deceased, donor because of its superior graft and patient survival outcomes. It also preempts the need for or reduces the duration of dialysis for individuals with end-stage renal disease and therefore greatly improves their quality of life.Some who donate kidneys to anonymous recipients are motivated by altruism, with no direct benefit and only an indirect psychological benefit as a consequence of donating. Those who donate may be motivated by prudential reasons involving shared interests, or by a sense of obligation grounded in emotional relations. This includes donations between spouses, siblings, parents and children and may also include donations between intimate friends. Others may be motivated to donate by the prospect of financial gain. In a recent article on kidney markets, The Economist claimed that those who donate one of their healthy kidneys do so at “very little risk to their health”.2 Presumably, this provides support for these markets. In 2004, Zell Kravinsky, an American in his early 40s, gave away one of his healthy kidneys to a stranger as part of a utilitarian obligation to help other people and maximise the good by saving or improving the quality of their lives.3 He estimated that this entailed a statistically insignificant risk to his health. In a lecture to an ethics class at …. (shrink)

Organ transplantation is at once a technology that raises new ethical problems and a good testing ground for various moral principles. It has become a common procedure in some countries and, at least in the United States, promises to become even more so. It poses questions about costs and benefits as well as the very large question of whether we should try to renew human life indefinitely and, if so, at what cost. It raises the problem of whether organs are (...) the property of their possessors – at least when the possessors are competent adults. It raises issues of organ sales, of what might be called donor recruitment, of informed consent, of reparations when transplant fails, of eligibility for transplant, and of competition for medical time and expertise between transplantation and other, less dramatic kinds of medical care. This essay touches on all of these topics, with the aim of identifying the broad dimensions of the ethical problems of organ transplantation and some of the moral principles that may help us solve them. (shrink)

From all points of the political compass, from widely different groups, have come indignant outcries against the trade in human organs from live vendors. Opponents contend that such practices constitute a morally outrageous and gross exploitation of the poor, inherently coercive and obviously intolerable in any civilized society. This article examines the arguments typically offered in defense of these claims, and finds serious problems with all of them. The prohibition of organ sales is derived not from the principles and argument (...) usually invoked in support of prohibition, but rather, from strong feelings of repugnance which exert an invisible but powerful influence on the debate, distorting the arguments [and working] to the detriment of the [very] people most in need of protection. (shrink)

This paper argues against paying people to participate in research. Volunteering to participate as a subject in a research program is not like taking a job. The main difference is to do with the risks inherent in research. Experimentation on human beings is, by definition, trying out something with an unknown consequence and exposes people to risks of harm which cannot be known in advance. This is the main reason for independent review by committee of research programs. It is based (...) on a recognition that researchers are not always capable of putting the interests of their subjects ahead of their research objectives. It is not simply a matter of individual autonomy. Society has an obligation, prior to the protection of individual freedom and autonomy, to establish basic safeguards that are equitable in their operation. Any inducement for participating in research would add to the difficulty subjects have in adequately assessing the risks of participating in research. An acceptance of inducement to participate in research would further increase the inequity of research conducted on the impecunious for the benefit of the well‐off. (shrink)

It is almost universally acknowledged that risks have to be weighed against benefits, but there are different ways to perform the weighing. In conventional risk analysis, collectivist risk-weighing is the standard. This means that an option is accepted if the sum of all individual benefits outweighs the sum of all individual risks. In practices originating in clinical medicine, such as ethical appraisals of clinical trials, individualist risk-weighing is the standard. This implies a much stricter criterion for risk acceptance, namely that (...) the risk to which each individual is exposed should be outweighed by benefits for that same individual. The different choices of risk-weighing methods in different policy areas seem to have emerged from traditional thought patterns and social relations, rather than from explicit deliberations on possible justifications for the alternative ways to weigh risks against benefits. It is not obvious how the prevalent differences in risk-weighing practices can be reconstructed in terms of consistent underlying principles of preventive health or social priority-setting. (shrink)

: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

This paper argues against paying people to participate in research. Volunteering to participate as a subject in a research program is not like taking a job. The main difference is to do with the risks inherent in research. Experimentation on human beings is, by definition, trying out something with an unknown consequence and exposes people to risks of harm which cannot be known in advance. This is the main reason for independent review by committee of research programs. It is based (...) on a recognition that researchers are not always capable of putting the interests of their subjects ahead of their research objectives. It is not simply a matter of individual autonomy. Society has an obligation, prior to the protection of individual freedom and autonomy, to establish basic safeguards that are equitable in their operation. Any inducement for participating in research would add to the difficulty subjects have in adequately assessing the risks of participating in research. An acceptance of inducement to participate in research would further increase the inequity of research conducted on the impecunious for the benefit of the well‐off. (shrink)

This paper challenges the view that bans on kidney sales are unjustifiably paternalistic, that is, that they unduly deny people the freedom to make decisions about their own bodies in order to protect them from harm. I argue that not even principled anti-paternalists need to reject such bans. This is because their rationale is not hard paternalism, which anti-paternalists repudiate, but soft paternalism, which they in principle accept. More precisely, I suggest that their rationale is what Franklin Miller and Alan (...) Wertheimer call ‘group soft paternalism’. Group soft paternalistic policies restrict the freedom of autonomous individuals, not for their own good (hard paternalism), but as an unavoidable consequence of seeking to protect other, non-autonomous individuals from harms that they have not voluntarily chosen (soft paternalism). Group soft paternalism supports prohibiting kidney sales on three conditions: (1) that such sales are potentially harmful to vendors, (2) that many vendors would suffer impaired autonomy, and (3) that distinguishing between autonomous and non-autonomous vendors and interfering only with the latter is unfeasible. I provide reasons for thinking that these conditions will often hold. (shrink)

In late August 2002, a general practitioner in London, Dr Bhagat Singh Makkar, 62, was struck off the medical register after he was discovered to have bragged to an undercover journalist about being able to obtain a kidney from a live donor in exchange for a fee. He told the journalist, who posed as the son of a patient with renal failure: “No problem, I can fix that for you. Do you want it done here, do you want it done (...) in Germany or do you want it done in India?” The price he quoted included payment to the donor and “my administration costs”. Dr Makkar said he regretted giving “stupid answers” to the journalist. He had been “tired, confused, and upset after a long day dealing with emotional patients”.1Deliberation about ethics is often muddied by the personalities involved in a particular issue. Many people are uninspired by Richard Seed or Jack Kevorkian. This contaminates their view about the much broader and important issues such as cloning or euthanasia that Seed and Kevorkian, whom some people might describe as mavericks, have shoved their finger in.Discussion of the sale of organs is …. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

I take as my starting point the “one very simple principle” proclaimed by Mill in On Liberty … “That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. He cannot rightfully be compelled to do (...) or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right.”. (shrink)

This is the third volume of Joel Feinberg's highly regarded The Moral Limits of the Criminal Law, a four-volume series in which Feinberg skillfully addresses a complex question: What kinds of conduct may the state make criminal without infringing on the moral autonomy of individual citizens? In Harm to Self, Feinberg offers insightful commentary into various notions attached to self-inflicted harm, covering such topics as legal paternalism, personal sovereignty and its boundaries, voluntariness and assumptions of risk, consent and its counterfeits, (...) coercive force, incapacity, and choice of death. (shrink)

Some of the most difficult and wrenching social and political issues in U.S. society today are about the relationship between strongly held moral values and the laws of the land. There is no consensus about whether the law should deal with morality at all, and if it is to do so, there is no agreement over whose morality is to be reflected in the law.In this compact and carefully edited anthology, Gerald Dworkin presents the readings necessary for an understanding of (...) these issues. The volume contains classical and contemporary philosophical statements as well as a generous sampling of legal cases and opinions, including such topics of current interest as flag-burning, nude dancing, the sale of human organs, and sexual behavior. The volume represents the best in applied legal and moral philosophy. (shrink)

In this retitled and revised version of Harris's original text Wonderwoman and Superman, the author discusses the ethics of human biotechnology and its implications relative to human evolution and destiny.

In Why Some Things Should Not Be for Sale, philosopher Debra Satz takes a penetrating look at those commodity exchanges that strike most of us as problematic. What considerations, she asks, ought to guide the debates about such markets? What is it about a market involving prostitution or the sale of kidneys that makes it morally objectionable? How is a market in weapons or pollution different than a market in soybeans or automobiles? Are laws and social policies banning the more (...) noxious markets necessarily the best responses to them? Satz contends that categories previously used by philosophers and economists are of limited utility in addressing such questions because they have assumed markets to be homogenous. Accordingly, she offers a broader and more nuanced view of markets--one that goes beyond the usual discussions of efficiency and distributional equality--to show how markets shape our culture, foster or thwart human development, and create and support structures of power. (shrink)

Do we have the right to deny others access to our body? What if this would harm those who need personal services or body parts from us? Ccile Fabre examines the impact that arguments for distributive justice have on the rights we have over ourselves, and on such contentious issues as organ sales, prostitution, and surrogate motherhood.

In recent years, the free market position has been gaining strength. In this book, Radin provides a nuanced response to its sweeping generalization.

_Bodies for Sale: Ethics and Exploitation in the Human Body Trade _explores the philosophical and practical issues raised by activities such as surrogacy and organ trafficking. Stephen Wilkinson asks what is it that makes some commercial uses of the body controversial, whether the arguments against commercial exploitation stand up, and whether legislation outlawing such practices is really justified. In Part One Wilkinson explains and analyses some of the notoriously slippery concepts used in the body commodification debate, including exploitation, harm and (...) consent. In Part Two he focuses on three controversial issues outlining contemporary regulation and investigating both the moral issues and the arguments for legal prohibition. (shrink)