All major western countries today contain groups that differ in their religious beliefs, customary practices or ideas about the right way in which to live. How should public policy respond to this diversity? In this important new work, Brian Barry challenges the currently orthodox answer and develops a powerful restatement of an egalitarian liberalism for the twenty-first century. Until recently it was assumed without much question that cultural diversity could best be accommodated by leaving cultural minorities free to associate in (...) pursuit of their distinctive ends within the limits imposed by a common framework of laws. This solution is rejected by an influential school of political theorists, among whom some of the best known are William Galston, Will Kymlicka, Bhikhu Parekh, Charles Taylor and Iris Marion Young. According to them, this 'difference-blind' conception of liberal equality fails to deliver either liberty or equal treatment. In its place, they propose that the state should 'recognize' group identities, by granting groups exemptions from certain laws, publicly 'affirming' their value, and by providing them with special privileges or subsidies. In Culture and Equality, Barry offers an incisive critique of these arguments and suggests that theorists of multiculturism tend to misdiagnose the problems of minority groups. Often, these are not rooted in culture, and multiculturalist policies may actually stand in the way of universalistic measures that would be genuinely beneficial. (shrink)

In this classic work of feminist political thought, Iris Marion Young challenges the prevailing reduction of social justice to distributive justice.

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

This book provides an analysis of the debate surrounding cultural diversity, and attempts to reconcile the seemingly opposing views of "ethical imperialism," the belief that each individual is entitled to fundamental human rights, and cultural relativism, the belief that ethics must be relative to particular cultures and societies. The author examines the role of cultural tradition, often used as a defense against critical ethical judgments. Key issues in health and medicine are explored in the context of cultural diversity: the physician-patient (...) relationship, disclosing a diagnosis of a fatal illness, informed consent, brain death and organ transplantation, rituals surrounding birth and death, female genital mutilation, sex selection of offspring, fertility regulation, and biomedical research involving human subjects. Among the conclusions the author reaches are that ethical universals exist, but must not be confused with ethical absolutes. The existence of ethical universals is compatible with a variety of culturally relative interpretations, and some rights related to medicine and health care should be considered human rights. Illustrative examples are drawn from the author's experiences serving on international ethical review committees and her travels to countries in Africa, Asia, and Latin America, where she conducted educational workshops and carried out out her own research. (shrink)

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 ...

Bioethics has paid surprisingly little attention to the special problems faced by women and to feminist analyses of current health care issues other than ...

In this paper I argue that a global bioethicsis possible. Specifically, I present the viewthat there are within feminist approaches tobioethics some conceptual and methodologicaltools necessary to forge a bioethics thatembraces the health-related concerns of bothdeveloping and developed nations equally. Tosupport my argument I discuss some of thechallenges that have historically confrontedfeminists. If feminists accept the idea thatwomen are entirely the same, then feministspresent as fact the fiction of the essential``Woman.'' Not only does ``Woman'' not exist,``she'' obscures important racial, ethnic,cultural, (...) and class differences among women. However, if feminists stress women'sdifferences too much, feminists lose the powerto speak coherently and cogently about genderjustice, women's rights, and sexual equality ingeneral. Analyzing the ways in which the ideaof difference as well as the idea of samenesshave led feminists astray, I ask whether it ispossible to avoid the Scylla of absolutism(imperialism, colonialism, hegemony) on the onehand and the Charybdis of relativism(postmodernism, fragmentation, Balkanization)on the other. Finally, after reflecting uponthe work of Uma Narayan, Susan Muller Okin, andMartha Nussbaum, I conclude that there is a wayout of this ethical bind. By focusing onwomen's, children's, and men's common humanneeds, it is possible to lay thefoundation for a just and caring globalbioethics. (shrink)

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers strong counter-arguments to (...) this view that enable us to think in terms of universal standards. (shrink)

This volume contains essays which cover a range of aspects in the debate over genetic testing. It looks at both the advantages and disadvantages involved in knowing or not knowing whether one is a carrier of certain genetic traits.

One effect of late capitalism – the commodification of practically everything – is to knock down the Chinese walls between the natural and productive realms, to use a Marxist framework. Women's labour in egg extraction and ‘surrogate’ motherhood might then be seen as what it is, labour which produces something of value. But this does not necessarily mean that women will benefit from the commodification of practically everything, in either North or South. In the newly developing biotechnologies involving stem cells, (...) the reverse is more likely, particular given the shortage in the North of the egg donors who will be increasingly necessary to therapeutic cloning.Although most of the ethical debate has focused on the status of the embryo, this is to define ethics with no reference to global or gender justice. There has been little or no debate about possible exploitation of women, particularly of ovum donors from the South. Countries of the South without national ethics committees or guidelines may be particularly vulnerable: although there is increasing awareness of the susceptibility of poorer countries to abuses in research ethics, very little has been written about how they might be affected by the enormously profitable new technologies exploiting human tissue. Even in the UK, although the new Medical Research Council guidelines make a good deal of the ‘gift relationship’, what they are actually about is commodification. If donors believe they are demonstrating altruism, but biotechnology firms and researchers use the discourse of commodity and profit, we have not ‘incomplete commodification’ but complete commodification with a plausibly human face. (shrink)

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or theories, (...) these approaches are consistent with and should not be considered adversaries of a principle-based account. (shrink)

Medical issues affecting health care have become everyday media events. In response to mounting public concern, growing numbers of bioethicists are being appointed to medical school faculties and public policy panels. However the ideas voiced in these forums are seldom informed by feminist perspectives. In this important book, a distinguished group of feminist scholars and activists discuss crucial bioethics topics in a feminist light. Among the subjects explored are the care/justice debates, transforming bioethics, practice, and reproduction. The book also covers (...) less commonly discussed issues, such as culturally appropriate responses to reproductive health problems in developing countries. (shrink)

There is an urgent need for reconstructing models of property to make them more women-friendly. However, we need not start from scratch: both ‘canonical’ and feminist authors can sometimes provide concepts which we can refine and apply towards women’s propertylessness. This paper looks in particular at women’s alienation from their reproductive labour, building on Marx and Delphy. Developing an economic and political rather than a psychological reading of alienation, it then considers how the refined and revised concept can be applied (...) to concrete examples in global justice for women: in particular, the commercialisation of embryonic and fetal tissue in the new stem cell technologies. (shrink)

: he commercialization of biotechnology, especially research and development by transnational pharmaceutical companies, is already excessive and is increasingly dangerous to distributive justice, human rights, and access of marginal populations to basic human goods. Focusing on gene patenting, this article employs the work of Margaret Jane Radin and others to argue that gene patenting ought to be more highly regulated and that it ought to be regulated with international participation and in view of concerns about solidarity and the common good. (...) The mode of argument called for on this issue is more pragmatic than logical, emphasizing persuasion based on evidence about the reality and effects of control of genetic research by profit-driven biotech companies. (shrink)

Both communitarianism and casuistry have sought to restore ethics as a practical science—the former by incorporating various traditions into a shared definition of the common good, the latter by considering the circumstances of each situation through critical reasoning. Mark G. Kuczewski analyzes the origins and methods of these two approaches and forges from them a new unified approach. This approach takes the communitarian notion of the person as its starting point but also relies upon the narrative and analogical tools of (...) case-based reasoning. He separates out the rhetoric that is incongruent with the Aristotelian aspirations of each method to show that the two are complementary, and that consensus can emerge from fragmentation. He then applies his resulting method to three major problems in bioethics: the difficulties that the issue of personal identity poses for advance directives, the role of the family in medical decision making, and the refusal of treatment because of religious beliefs. He analyzes the need to assume a communitarian notion of the person as a starting point for the application of casuistic insights. Combining theoretical, practical, and scholarly insights, this book will be of interest to philosophers, political and social scientists, and bioethicists. (shrink)

Bioethicists’ attraction to principlism is rooted in a Western view of how matters that affect the public ought to be deliberated and decided: their resolution ought to be so structured and constrained that it can be understood and verified even by those at a remove from the circumstances of the problem. That view of deliberation, itself fostered by the Western view of government, has encouraged principlism to spread from its source in human subjects research into other areas of bioethics discourse.