What does it mean to be truthful? What role does truth play in our lives? What do we lose if we reject truthfulness? No philosopher is better suited to answer these questions than Bernard Williams. Writing with his characteristic combination of passion and elegant simplicity, he explores the value of truth and finds it to be both less and more than we might imagine.Modern culture exhibits two attitudes toward truth: suspicion of being deceived and skepticism that objective truth exists at (...) all. This tension between a demand for truthfulness and the doubt that there is any truth to be found is not an abstract paradox. It has political consequences and signals a danger that our intellectual activities, particularly in the humanities, may tear themselves to pieces.Williams's approach, in the tradition of Nietzsche's genealogy, blends philosophy, history, and a fictional account of how the human concern with truth might have arisen. Without denying that we should worry about the contingency of much that we take for granted, he defends truth as an intellectual objective and a cultural value. He identifies two basic virtues of truth, Accuracy and Sincerity, the first of which aims at finding out the truth and the second at telling it. He describes different psychological and social forms that these virtues have taken and asks what ideas can make best sense of them today. Truth and Truthfulness presents a powerful challenge to the fashionable belief that truth has no value, but equally to the traditional faith that its value guarantees itself. Bernard Williams shows us that when we lose a sense of the value of truth, we lose a lot both politically and personally, and may well lose everything. (shrink)

To what risks may children participating in research be subjected? Institutional review boards can stand surrogate for parents by filtering out studies whose risk is unacceptably high.

Bioethics represents a dramatic revision of the centuries-old professional ethics that governed the behavior of physicians and their relationships with patients. This venerable ethics code was challenged in the years after World War II by the remarkable advances in the biomedical sciences and medicine that raised questions about the definition of death, the use of life-support systems, organ transplantation, and reproductive interventions. In response, philosophers and theologians, lawyers and social scientists joined together with physicians and scientists to rethink and revise (...) the old standards. Governments established commissions to recommend policies. Courts heard arguments and legislatures passed laws. This book is the first broad history of the growing field of bioethics. Covering the period 1947-1987, it examines the origin and evolution of the debates over human experimentation, genetic engineering, organ transplantation, termination of life-sustaining treatment, and new reproductive technologies. It assesses the contributions of philosophy, theology, law and the social sciences to the expanding discourse of bioethics. Written by one of the field's founders, The Birth of Bioethics is based on extensive archival research into sources that are difficult to obtain and on interviews with many of the leading figures in the moral debates in medicine. A very readable and comprehensive account of the evolution of bioethics, this book stresses the history of ideas but does not neglect the social and cultural context and the people involved. It will serve the information needs of philosophers, ethicists, social historians, and everyone interested in the origins of some of today's most hotly debated issues. (shrink)

Autonomy generally is a valued condition for persons in liberal cultures such as the United States. We uphold autonomous agents as the exemplar of persons who, by their judgment and action, authenticate the social and political principles and policies that advance their interests. But questions about the value of autonomy are often problematic. They are problematic because they concern the kind of value autonomy has and not just how much value autonomy has when weighed against competing goods. The two questions (...) are frequently conflated. For example, in asking what happens when the putative right to autonomy is tested against competing goods, such as personal contentment or political security, we might overlook the fact that we are comparing goods that are valued for different reasons. My aim in this paper is to explore in a very general way some of the issues surrounding these questions about the value of autonomy. I plan to do so by focusing on the phenomenon of being “blinded” by an inarticulate ideal of the value of autonomy. (shrink)

Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician''s responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient''s decisions and a surrogate''s and the professional responsibilities implied by that distinction. In every case involving a patient who lacks decisional (...) capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate''s decision. They have to assess the surrogate''s decisional capacity and attitude toward the patient as well as the reasons that support the surrogate''s decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment. (shrink)

Some are concerned about the possibility that offering money for research participation can constitute coercion or undue influence capable of distorting the judgment of potential research subjects and compromising the voluntariness of their informed consent. The author recognizes that more often than not there are multiple influences leading to decisions, including decisions about research participation. The concept of undue influence is explored, as well as the question of whether or not there is something uniquely distorting about money as opposed to (...) a chance for treatment or medical care. An amount of money that is not excessive and is calculated on the basis of time or contribution may, rather than constitute an undue inducement, be an indication of respect for the time and contribution that research subjects make. (shrink)

Written from the combined perspectives of a physician, lawyer, and social scientist, this book is the first reference work to provide a concise and practical overview of informed consent. Topics include the ethical theories and history of the principle of informed consent, all legal requirements for practitioners, and suggesions for making the interaction between doctor and patient clinically meaningful.

Scientific research and ethics -- Ethical theory and decision making -- Data acquisition and management -- Mentoring and professional relationship -- Collaboration in research -- Authorship -- Publication and peer review -- Misconduct in research -- Intellectual property -- Conflicts of interest and scientific objectivity -- The use of animals in research -- The use of human subjects in research -- The use of vulnerable subjects in research -- Genetics, cloning, and stem cell research -- International research.

An updated and expanded successor to Culver and Gert's Philosophy in Medicine, this book integrates moral philosophy with clinical medicine to present a comprehensive summary of the theory, concepts, and lines of reasoning underlying the ...

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)

Justice at Nuremberg traces the history of the Nuremberg Doctors' Trial held in 1946-47, as seen through the eyes of the Austrian bliogemigrbliogé psychiatrist Leo Alexander. His investigations helped the United States to prosecute twenty German doctors and three administrators for war crimes and crimes against humanity. The legacy of Nuremberg was profound. In the Nuremberg code--a landmark in the history of modern medical ethics--the judges laid down, for the first time, international guidelines for permissible experiments on humans. One of (...) those who helped to formulate the code was Alexander. Justice at Nuremberg provides a detailed insight into the origins of human rights in medical science and into the changing role of international law, ethics and politics. (shrink)

A broad critical review of national policies on biomedical research - human, epidemiologic, clinical trials, genetic, reproductive, etc.

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

For the past three decades philosophical discussions of both personal autonomy and what it is for a person to “identify” with her desires have been dominated by the “hierarchical” analyses of these concepts developed by Gerald Dworkin and Harry Frankfurt. The longevity of these analyses is owed, in part, to the intuitive appeal of their shared claim that the concepts of autonomy and identification are to be analyzed in terms of hierarchies of desires, such that it is a necessary condition (...) for a person to be autonomous with respect to a desire that moves her to act, that she desires that this desire so move her. Despite the intuitive appeal of these analyses, however, Irving Thalberg has argued that they should be rejected. This is because, he argues, a person who is forced to perform an action by being subjected to duress of a certain degree of harshness will desire to be moved by her desire to submit. Thus, he continues, the proponents of hierarchical analyses of autonomy and identification will be forced to hold that such a person acted willingly, and did not suffer from any impairment in her autonomy. This, Thalberg concludes, is so counterintuitive as to justify rejecting hierarchical analyses. (shrink)

(2001). The Fiction of 'Undue Inducement': Why Researchers Should Be Allowed to Pay Participants Any Amount of Money for Any Reasonable Research Project. The American Journal of Bioethics: Vol. 1, No. 2, pp. 1g-3g.

(2001). Justice and Healthcare: The Right to a Decent Minimum, Not Equality of Opportunity. The American Journal of Bioethics: Vol. 1, No. 2, pp. 1a-3a.

ABSTRACT A complex problem exists about how to promote the best interests of children as a group through research while protecting the rights and welfare of individual research subjects. The Nuremberg Code forbids studies without consent, eliminating most children as subjects, and the Declaration of Helsinki disallows non-therapeutic research on non-consenting subjects. Both codes are unreasonably restrictive. Another approach is represented by the Council for the International Organizations of Medical Science, the U.S. Federal Research Guidelines, and many other national policies. (...) They allow research ethics committees or institutional review boards to authorize studies with acceptable balances of likely benefits and harms, but neither clarify how to balance them nor explain the meaning of pivotal concepts, like “minimal risk.” Paths to the improvement of balancing or consequentialist approaches include improving standardizing of risk assessment, rejecting crude utilitarianism, identifying and justifying normative or moral judg-ments, and acknowledging extra-regulatory thresholds and deontological or non-negotiable duties to children. (shrink)

The basic principles of scientific research from the great French physiologist whose contributions in the 19th century included the discovery of vasomotor nerves; nature of curare and other poisons in human body; more.

Most recent thinking about thevulnerability of research subjects uses a``subpopulation'' focus. So conceived, theproblem is to work out special standards forprisoners, pregnant women, the mentally ill,children, and similar groups. In contrast, an``analytical'' approach would identifycharacteristics that are criteria forvulnerability. Using these criteria, one couldsupport a judgment that certain individuals arevulnerable and identify needed accommodationsif they are to serve as research subjects.Seven such characteristics can be evident inchildren: they commonly lack the capacity tomake mature decisions; they are subject to theauthority of (...) others; they (and their parents)may be deferential in ways that can maskunderlying dissent; their rights and interestsmay be socially undervalued; they may haveacute medical conditions requiring immediatedecisions not consistent with informed consent;they may have serious medical conditions thatcannot be effectively treated; and they (andtheir parents) may lack important sociallydistributed goods. Each of thesevulnerabilities can call for special care inthe design and implementation of researchprotocols. (shrink)

Happiness, then, is the best, noblest, and most pleasant thing in the world.'In the Nicomachean Ethics Aristotle's guiding question is: what is the best thing for a human being? His answer is happiness, but he means, not something we feel, but rather a specially good kind of life. Happiness is made up of activities in which we use the best human capacities, both ones that contribute to our flourishing as members of a community, and ones that allow us to engage (...) in god-like contemplation. Contemporary ethical writings on the role and importance of the moral virtues such as courage and justice have drawn inspiration from this work, which also contains important discussions on responsibility for actions, on the nature of practical reasoning, and on friendship and its role in the best life. This new edition retains David Ross's justly admired translation while updating certain key terms. It also includes a valuable introduction to this seminal work, and notes designed to elucidate Aristotle's arguments. (shrink)