In this work, the author has fashioned out of the logical and linguistic theses of his earlier books a full-scale but readily intelligible account of moral argument.

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)

In non-technical contexts, the word “risk” refers, often rather vaguely, to situations in which it is possible but not certain that some undesirable event will occur. In technical contexts, the word has many uses and specialized meanings. The most common ones are the following.

This paper investigates the nature and foundation of duties to oneself in Kant's moral theory. Duties to oneself embody the requirement of the formula of humanity that agents respect rational nature in them-selves as well as in others. So understood, duties to oneself are not subject to the sorts of conceptual objections often raised against duties to oneself; nor do these duties support objections that Kant's moral theory is overly demanding or produces agents who are preoccupied with their own virtue. (...) Duties to oneself emerge as an essential and compelling part of Kant's moral theory. (shrink)

Many people take for granted an absolute conception of property rights. According to this conception, if I own a piece of property I have a moral right to do with it as I please, irrespective of the needs of others.This paper articulates an argument against this conception of property rights. First, it shows that there are many possible conceptions of property rights, and that there are significant differences among the models of ownership which have prevailed in different societies. Then, it (...) argues that there are decisive grounds to refuse to grant that property owners have a moral right to exercise absolute control over their property, and that ownership implies not only rights but also duties and limits. (shrink)

An argument against the participation of physicians in capital punishment by means of lethal injection.

Using the example of an unconsented mouth swab I criticise the view that an action of this kind taken in itself is wrongful in respect of its being a violation of autonomy. This is so much inasmuch as autonomy merits respect only with regard to ‘critical life choices’. I consider the view that such an action is nevertheless harmful or risks serious harm. I also respond to two possible suggestions: that the action is of a kind that violates autonomy; and, (...) that the class of such actions violates autonomy. I suggest that the action is wrongful in as much as it is a bodily trespass. I consider, and criticise, two ways of understanding how morally I stand to my own body: as owner and as sovereign. In respect of the latter I consider Arthur Ripstein's recent defence of a sovereignty principle. Finally I criticise an attempt by Joel Feinberg to explain bodily trespass in terms of personal autonomy. (shrink)

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

Our lives are such that moral wrongdoing is sometimes inescapable for us. We have moral responsibilities to persons which may conflict and which it is wrong to violate even when they do conflict. Christopher W. Gowans argues that we must accept this conclusion if we are to make sense of our moral experience and the way in which persons are valuable to us. In defending this position, he critically examines the recent moral dilemmas debate. He maintains that what is important (...) in this debate is not whether there are irresolvable moral conflicts, but whether there are moral conflicts in which wrongdoing is unavoidable. Though it would be incoherent to conclude moral deliberation by deciding to perform incompatible actions, he argues that there is nothing incoherent in supposing that we have conflicting moral responsibilities. In this way, he shows that it is possible to capture the intuitions of those who have defended the idea of moral dilemmas while meeting the objections of those who have rejected this idea. Gowans carefully evaluates utilitarian and Kantian analyses of moral dilemmas. He argues that these approaches eliminate genuine moral conflict only by displacing persons as direct objects of moral concern. As an alternative, he develops a more concrete account in which moral responsibilities to persons are central. The book also includes discussions of Melville's Billy Budd, methodology in moral philosophy, moral pluralism, moral tragedy, and "dirty hands" in politics. (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)

These four volumes address the question of the kinds of conduct may the state make criminal without infringing on the moral autonomy of individual citizens.

Cost–benefit analysis (CBA) is much more philosophically interesting than has in general been recognized. Since it is the only well-developed form of applied consequentialism, it is a testing-ground for consequentialism and for the counterfactual analysis that it requires. Ten classes of philosophical problems that affect the practical performance of cost–benefit analysis are investigated: topic selection, dependence on the decision perspective, dangers of super synopticism and undue centralization, prediction problems, the indeterminateness of our control over future decisions, the need to exclude (...) certain consequences for moral reasons, bias in the delimitation of consequences, incommensurability of consequences, difficulties in defending the essential requirement of transferability across contexts, and the normatively questionable but equally essential assumption of interpersonal compensability. (Published Online July 31 2007). (shrink)

Gerald Dworkin has argued that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. He does this by proposing a principle by which we are to judge whether an action is consistent with the proper ends of medicine. I argue: (a) that this principle, if valid, does not show that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection; (...) and (b) that this principle is not valid, and this is because it mistakenly views the promotion of patient autonomy as one of the proper ends of medicine. Rather, I propose, we should view respect for a patient's autonomy as a constraint on the pursuit of the proper ends of medicine, rather than as one of the proper ends itself. With this revised understanding of the proper ends of medicine, we can conclude that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. (shrink)

Several attempts have been made to transfer the concept of informed consent from medical and research ethics to dealing with affected groups in other areas such as engineering, land use planning, and business management. It is argued that these attempts are unsuccessful since the concept of informed consent is inadequate for situations in which groups of affected persons are dealt with collectively (rather than individually, as in clinical medicine). There are several reasons for this. The affected groups from which informed (...) consent is sought cannot be identified with sufficient precision. Informed consent is associated with individual veto power, but it does not appear realistic to give veto power to all individuals who are affected for instance by an engineering project. Most importantly, the concept of informed consent puts focus on the public’s acceptance of ready-made proposals rather than on its participation in the decision-making process as a whole, which includes the development of alternatives for the decision. Therefore, the concept of informed consent is not applicable to a company’s relations with groups and collectives. It may, however, be applicable to a company’s relations with individual persons such as customers and employees. (shrink)

The principle that each person is his own property occupies an almost axiomatic status in right-wing liberal thought as well as in some egalitarian theories. I reject any, full or partial, notion of property with respect to oneself by showing that any appeal and any justifiability which may be associated with self-ownership can at most serve to ground rights which are demonstrably non-property rights. As a contrast to self ownership, I introduce the non-proprietarian notion of Original Freedom. I compare the (...) two with respect to the control, income, and transfer aspects of ownership and suggest that Original Freedom is the more intuitively acceptable. (shrink)

Given the increasing need for solid organ and tissue transplants and the decreasing supply of suitable allographic organs and tissue to meet this need, it is understandable that the hope for successful xenotransplantation has resurfaced in recent years. The biomedical obstacles to xenotransplantation encountered in previous attempts could be mitigated or overcome by developments in immunosuppression and especially by genetic manipulation of organ source animals. In this essay we consider the history of xenotransplantation, discuss the biomedical obstacles to success, explore (...) recent developments in transgenic sourcing of organs and tissues, and analyze the problem of infectious disease resulting from xenotransplantation (xenosis). We then apply a model of risk analysis to these risks. The conclusions of this risk analysis are used in an ethical evaluation of informed consent in xenotransplantation, with an ethical foundation in Kantian autonomy and Levinasian heteronomic alterity. Our conclusion is that individual and collective informed consent to the infectious disease risks of xenotransplantation requires an open, participatory and dialogical public policy process not yet seen in the United States and Europe. Until that process is created, we propose caution in xenotransplantation in general and a postponement of solid organ xenotransplants in particular. (shrink)