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

For decades, worries about undue inducement have Pervaded clinical research, and are especially common when research is accompanied by payment or conducted in developing countries. Few ethical judgments carry as much moral opprobrium or are thought to undermine the ethical soundness of a clinical trial as thoroughly as undue inducement. Indeed, the admonition to prevent undue inducement is one of the few explicit instructions in the Common Rules requirements for informed consent.Despite their long history and pervasiveness, charges of undue inducement (...) in clinical research are almost always mistaken. Indeed, I will advance an even more radical claim: Aresearch trial that otherwise fulfills the fundamental ethical requirements for human subjects research inherently cannot create the possibility of undue inducement because substantial risk of serious harm isprecluded. Charges of undue inducement tend to express displaced and mislabeled ethical concerns about other aspects of human subjects research. Consequently, claims of undue inducement should rarely be made, and when they are advanced should be treated with skepticism, placing a heavy burden of proofon those advancing such charges. (shrink)

The challenges of the 21st century are examined as Zimbabwe’s modern theological views are discussed, and responses are given and analysed in this study. In Zimbabwe, theology is changing quickly to meet the demands of the country’s people in the face of persistent socioeconomic difficulties, political unrest and cultural changes. Contemporary theological debate is structured by the historical background of Zimbabwean theology, which is characterised by colonial influences and the freedom movement. These days, the discussion tackles several urgent issues: gender (...) justice, seen through the prism of feminist theology that seeks to demolish patriarchal structures; political unrest, highlighted by a prophetic theology that challenges corruption and fosters governance; the ongoing economic crisis, arguing for economic justice and ethical leadership; and the significance of interfaith dialogue and cultural integration in a pluralistic society. This study also emphasises how important it is to address the specific issues that young people face, include contemporary digital platforms in religious activities, and involve them in theological conversation. To make theology relevant and transformational, theological views in modern Zimbabwe are distinguished by their receptivity to regional and global shifts. This study makes an overview and analysis of theological responses in Zimbabwe – the case for a theology that is both prophetic and practical one that offers long-term remedies for social change in addition to criticism.Contribution: This study examines contemporary theological approaches in Zimbabwe, highlighting the adaptation of theology to address issues such as gender justice, political integrity and economic crises. It advocates for a responsive and transformative role for the church in promoting societal change. (shrink)

Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.

Commentators often claim that medical research subjects are coerced into participating in clinical studies. In recent years, such claims have appeared especially frequently in ethical discussions of research in developing countries. Medical research ethics is more important than ever as we move into the 21st century because worldwide the pharmaceutical industry has grown so much and shows no sign of slowing its growth. This means that more people are involved in medical research today than ever before, and in the future (...) even more will be involved. However, despite the pressing need for reflection on research ethics, it is important to carefully identify the concerns we have about research. Otherwise we run the risk that the moral language we use, and which we hear other people use, may do our moral thinking for us. We argue that many recent claims about the occurrence of coercion in medical research are misguided and misuse the word "coercion." We try to identify the real problems, and urge people to attend carefully to the implications of their descriptions of moral problems in research. (shrink)

Poetic Fragments is the second collection of writings by the neglected German poet, dramatist and philosopher Karoline von Günderrode (1780–1806), which she published in 1805. This bilingual English-German edition is the first volume of Günderrode’s work to appear with an English translation. An introduction and three essays argue for the philosophical significance and originality of the pieces included in Poetic Fragments and relate Günderrode’s thought to its Romantic and German Idealist context. This critical material argues that in Poetic Fragments Günderrode (...) presents a radical and unique consideration of the nature of the universe, death, religion, agency, power, and gender roles, which deserves to be included in the academic study of German Romanticism and post-Kantian Idealism. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of current (...) practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

Debates about what constitutes benefits in human research continue to be less informed due to a lack of empirical evidence from the developing world. This study aimed to explore what constitutes benefits in HIV vaccine trials in Tanzania and examine inherent ethical implications. A qualitative case study design was deployed and a total of 29 purposively selected study participants comprising of experienced researchers, institutional review board members and community advisory board members were included. Collected data were analyzed by thematic analysis (...) aided by computer software: MAXQDA version 20.4.0. The study findings indicate that there is a growing appreciation of benefits beyond actual vaccines to include 1) capacity building at individual, community, institutional and regulatory levels; and 2) non‐capacity building related benefits such as strengthened collaborations, ancillary care and employment opportunities. So, as the struggle for viable HIV vaccines continues, other benefits that have accrued from such trials are not to be blindsided especially for developing countries like Tanzania. (shrink)

This article describes the daunting challenge of precarious housing in Salvokop located in the southern part of inner City of Tshwane, Gauteng Province. Insecure tenure, unmaintained dwellings, overcrowding, mushrooming of backyard shacks and the rise of the informal settlement, all that led to deep levels of vulnerability and neighbourhood deterioration. Current conditions show that life in that neighbourhood is fraught as substandard housing degenerated into slum and squalor. This concern emerged among other salient pressing issues of poverty and vulnerability from (...) the World Café and Focus Groups with the inner city churches including those from Salvokop. The article set out to describe precarious housing, unpleasant living conditions owing to the fact that human beings stay in unsuitable dwellings while the environment deteriorates. Taking into account their circumstances, the article’s aim was to recapture the extent to which the residents suffer as a result of living in dwellings unfit for human habitation, rethinking an alternative model to respond. A theological agenda for future ecclesiological engagement was discerned forthwith recommendations. The article makes a contribution towards the theology of the city in that it stimulates church practices and housing of poor people in Tshwane. It does so by engaging in a unique way grassroots knowledge from the different inner city congregations. This process used the platform of surveys, World Café style gatherings and Focus Groups. In conversation with the primary source, this article also contributed with original data generated with the Salvokop residents whose stories helped to expend on horizons of housing, which is acknowledged. All the inner city church contributors of the realisation of the study objectives are also recognised. (shrink)

In The Law of Peoples, John Rawls sets out his normative conception of global justice. The book remains a foundational text for scholars in the field. In recent years, however, new issues have arisen in the global justice literature, which Rawls did not consider. Moreover, his view has been rejected by many. So, as we move forward, does Rawls’ The Law of Peoples deserve to retain this foundational status? I argue that we have two weighty reasons to afford it this (...) status. As we consider the future directions of global justice, we should do so by returning to The Law of Peoples. (shrink)

INTRODUCTION The Questions of Medical Ethics Call him Andrew. His face is gaunt and unshaven but peaceful. His eyelids are gently closed. ...

ABSTRACT This paper adds to efforts to retrieve the long-neglected philosophical contributions of Karoline von Günderrode, and is one of the first to seriously address the political commitments in Günderrode’s work, especially regarding revolution. This idea gains an unusual status in the context of Günderrode’s metaphysics, and is key to understanding the connections between Günderrode’s more obviously philosophical writings and her literary work. I argue that Günderrode’s concept of revolution resembles, in some respects, the ideas of other thinkers of her (...) time, but has ramifications for conceiving of human individuals and their relationships to society and nature that are unique to Günderrode. First, I use a comparison with the work of contemporaries on revolution to justify interpreting Günderrode’s metaphysics in relation to her thought on politics. Günderrode often masks her political thought in the form of plays, and the paper next considers the theme of revolution in her plays Muhammad, the Prophet of Mecca, and Udohla. Lastly, the paper contrasts Günderrode’s position on revolution to claims by Herder and Fichte, arguing that Günderrode’s conception of a cycle of enhancement and decay of natural forces, political power and social cohesion differs from androcentric models that emphasize the development of consciousness. (shrink)

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

The African intelligentsia played a pivotal role in the anti-colonial and anti-apartheid struggle in Africa. Not only did it provide intellectual resources to the political struggle leaders but also took active part in the political leadership. Since independence, this role has diminished tremendously, as some of the intelligentsia are ‘silenced’ and others become ‘captured’ by the newly independent states. As a result, a wedge is driven between the intelligentsia and the political leadership. However, given that there is a deficit in (...) efforts to reconstruct Africa, the pan-African intelligentsia are called upon to reinvigorate and reposition themselves to assist in developing organisations and institutions to serve African people worldwide. This call challenges them to take a creative, innovative role in the reconstructive task of Africa, thereby bidding farewell to intellectual isolationism. The article draws from Kwame Nkrumah’s ideas, thereby affirming the relevance of his political ideas in contemporary Africa. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public (...) health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

Comprehensive in scope and research, this book will be a crucial resource for researchers in the medical sciences, as well as teachers and students alike.

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

The current prevailing view is that participation in biomedical research is above and beyond the call of duty. While some commentators have offered reasons against this, we propose a novel public goods argument for an obligation to participate in biomedical research. Biomedical knowledge is a public good, available to any individual even if that individual does not contribute to it. Participation in research is a critical way to support an important public good. Consequently, all have a duty to participate. The (...) current social norm is that individuals participate only if they have a good reason to do so. The public goods argument implies that individuals should participate unless they have a good reason not to. Such a shift would be of great aid to the progress of biomedical research, eventually making society significantly healthier and longer lived. (shrink)

1. The opinions expressed are the author's own. They do not reflect any position or policy of the National Institutes of Health, Public Health Service, Department of Health and Human Services, or any of the authors affiliated organizations.

The understanding of appropriate ethical protections for participants of biomedical research has not been static. It has evolved over time, with the evolution of biomedical research as well as social values. Since World War II, there have been four major paradigms of research and research oversight operative in the United States. These paradigms incorporate different values and provide different approaches to research oversight and the protection of research participants.

In a pluralistic society, the “best interests” standard is an inadequate criterion for determining what level of medical care to provide incompetent patients. Instead, the standard of care should be derived from the deliberations of particular communities. A “community‐federated” plan would enhance individual choice and diminish family and physician uncertainty.

In this chapter, Gerda Walther weds her interest in political and social questions with phenomenological approaches and concerns, homing in on the nature of a social community. By posing and responding to a series of questions regarding the nature and structure of a community, Walther distinguishes community from society and argues that community is crucially connected to subjective feeling. In addition, she contends—contra Edith Stein and Edmund Husserl—that the feeling of community both differs from and precedes the feeling of empathy.

In this chapter, Lou Andreas-Salomé explores the erotic (widely conceived), as it discloses a pre-reflective and foundational aspect of life. The erotic, for Salomé, is prior to the split between mind and body, even between the individual and nature, as a totality. In her view, the erotic is related to sexuality but also to art, creativity, and even religion. The chapter establishes Salomé as a philosopher who carves out an independent intellectual space between Nietzsche and Freud.

An article publicising the philosophical contributions of German women writers in the late 18th and 19th centuries.

All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the (...) trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)

This chapter presents selections from Bettina Brentano von Arnim’s 1840 Günderode. Günderode is based on a correspondence between Brentano von Arnim and her friend Karoline von Günderrode. In its attempt to convey an intimate and engrossing dialogue between the two friends, Günderode is an exemplary realization of the romantic ideals of sym-philosophy and sociability. A hit in Germany and the United States, Günderode delves into fundamental philosophical questions, including the value of philosophy and its potential to grasp and describe human (...) experience, and the relationship between philosophy and art. (shrink)

In her essays and speeches, Clara Zetkin argues that the workers’ movement and the women’s movement are co-dependent, and that it is only if male and female workers cooperate that they will be able to overcome economic and social injustices and inequalities. Furthermore, she analyzes different forms of oppression, explains how they relate to and enable one another, and makes appeals for international solidarity with oppressed people everywhere.

In this chapter, Edith Stein offers an analysis of empathy with others, which she sees as a fundamental trait of the human being. In her view, empathy is a condition of possibility for sociality and sympathy, rather than the other way around. She grounds empathy in human embodiment, more precisely in the way in which the human being is embodied mind and minded body. Stein’s work on empathy represents a pathbreaking contribution to phenomenology and shows how she makes active use (...) of and goes beyond the works of Edmund Husserl, Alexander Pfänder, and others. (shrink)

An encyclopedia entry on this often-overlooked but central concept in the work of Romantic writer and philosopher Karoline von Günderrode.

This chapter considers the philosophical contributions of German writer Karoline von Günderrode (1780–1806). Günderrode is an original, though neglected, thinker engaged with German Idealism and Romanticism, whose writings reflect on the same problems that preoccupied other philosophers working in these traditions. Her work participates in debates regarding the question of free will, the nature of the self, the nature of consciousness, what happens to us after we die, the vocation of humankind, the relationship between the self and nature and between (...) these and the Absolute or the divine, the role of gender in social life, ideals for political arrangements, and the pursuit of virtue and beauty. Günderrode’s writings provide a rich and relatively unexplored perspective on these topics. After a biography and overview of Günderrode’s writings, the chapter summarizes key areas of Günderrode’s thought. These include Günderrode’s metaphysical claims, unique accounts of love and death, models of consciousness and identity, political theory (especially regarding revolution), contributions to early nineteenth century understandings of gender, and nascent ethics and aesthetics. The last section of the chapter considers ways that Günderrode might have influenced several well-known nineteenth century thinkers, notably Clemens Brentano, Georg Friedrich Creuzer, and Bettina Brentano-von Arnim – and, through the latter, the Young Hegelians and American Transcendentalism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Blossoming of Bioethics at NIHEzekiel J. Emanuel (bio)The establishment of the Department of Clinical Bioethics at the Warren G. Magnuson Clinical Center of the National Institutes of Health (NIH) has coincided with a burgeoning of interest and activity related to bioethical issues at NIH. The department has precipitated a reexamination and revitalization of existing bioethics activities in the Clinical Center and has launched new programs especially in the (...) areas of education and research. In addition, the department contributes to the work of others throughout NIH who address bioethical issues.The Organizational Location of the Department of Clinical BioethicsBefore describing the history and current activities of the Department of Clinical Bioethics, I will say something about it administrative location. Comprehension of the department’s organizational location is essential to understanding its history, role, and function. Prior to interviewing for the position of chair of the department, I did not—and, if truth be told, still do not fully—understand the details of the organizational structure of NIH. I therefore assume that many other bioethicists outside of the Institutes, especially those who do not regularly receive NIH funding, may not fully grasp its organizational intricacies.The Department of Clinical Bioethics is a department within the Warren G. Magnuson Clinical Center, which is NIH’s “hospital.” Hospital is in quotes because all of the patients at the Clinical Center must be enrolled in a research protocol and, therefore, are research subjects. The Clinical Center is where NIH’s clinical researchers admit their research subjects or see them in the out-patient setting. The Department of Clinical Bioethics reports directly to the Director of the Clinical Center, John I. Gallin, M.D., and receives its finances, space, and other resources from the Clinical Center.In this way, the department is part of NIH’s intramural (“inside”) program. People employed by NIH conduct intramural research, training, and other initiatives. The extramural program, which receives approximately 87 percent of NIH’s budget, funds research at institutions outside NIH. The extramural program awards grants and contracts for research, training, and conferences conducted [End Page 455] by investigators who are not affiliated with NIH. The National Human Genome Research Institute’s ELSI (Ethical, Legal, and Social Implications) program, for example, is part of NIH’s extramural program. As part of the NIH intramural program, the Department of Clinical Bioethics is not empowered to fund independent initiatives of people outside of NIH through grants and contracts. However, the department can collaborate with bioethicists and others on research, educational, and other programs outside of NIH and has some funds to support these collaborations.In addition, it is important for bioethicists to understand that NIH is a collection of 24 institutes and centers. Although there is coordination and collaboration between the institutes and centers, each is funded separately, and each has its own scope, programs, administrative structures, research agendas, training priorities, boards of advisors, and so forth. In this sense, NIH is more like a university that has many distinct schools, each with its own dean, faculty, budget, and fund raising office, than one that is tightly integrated and centrally-administered. Within NIH’s diffuse administrative structure, the Department of Clinical Bioethics is located within one of the centers (the Clinical Center) and has defined authority and responsibility only for bioethics within that center; in addition, because the Clinical Center’s mission is to support clinical research at other institutes, the department’ mission includes supporting the work of those institutes as well. Intellectual exchanges and relationships with other institutes and centers are neither pre-ordained nor administratively established; such relationships must be developed case-by-case, topic-by-topic, and initiative-by-initiative.The History and the Development of the Department of Clinical BioethicsThe Department of Clinical Bioethics was launched in late 1996. Although the department’s creation marked a major commitment to bioethics by the Clinical Center, and especially by its director, Dr. Gallin, it was formed on a pre-existing foundation of bioethics activities at NIH. 1In 1977, John Fletcher, Ph.D., was appointed by then Director Mortimer Lipsett as the bioethicist at the Clinical Center; his official title was Assistant for Bioethics... (shrink)

In this chapter, Rosa Luxemburg examines the basic structure of wage labor. For Luxemburg, wage labor is a condition for the systemic, economical exploitation of one free human being by another. Luxemburg analyzes the capitalists’ thinking about wages, their interest in extending the workday and in lowering the pay, and the conflict of interest between the worker and the owner of capital. She also discusses the role of trade unions in keeping not only the real wages but also the social (...) wages above the level of mere sustenance for the individual worker. (shrink)

This chapter considers the philosophical contributions of German writer Karoline von Günderrode (1780–1806). Günderrode's work participates in debates regarding the question of free will, the nature of the self, the nature of consciousness, what happens to us after we die, the vocation of humankind, the relationship between the self and nature and between these and the Absolute or the divine, the role of gender in social life, ideals for political arrangements, and the pursuit of virtue and beauty. Günderrode’s writings provide (...) a rich and relatively unexplored perspective on these topics. After a biography and overview of Günderrode’s writings, the chapter summarizes key areas of Günderrode’s thought. These include Günderrode’s metaphysical claims, unique accounts of love and death, models of consciousness and identity, political theory (especially regarding revolution), contributions to early nineteenth century understandings of gender, and nascent ethics and aesthetics. The last section of the chapter considers ways that Günderrode might have influenced several well-known nineteenth century thinkers, notably Clemens Brentano, Georg Friedrich Creuzer, and Bettina Brentano-von Arnim – and, through the latter, the Young Hegelians and American Transcendentalism. (shrink)

An article publicising the philosophical contributions of German writer Rahel Varnhagen (1771–1833).

This chapter presents three unpublished works by Karoline von Günderrode. In them, Günderrode discusses and assesses the moral philosophy of Johann Gottlieb Fichte and Friedrich Schelling’s philosophy of nature, while also developing her own ethical account of the human relation to the earth in the essay “Idea of the Earth.” Widely regarded as her most important and radical contribution, “Idea of the Earth” distinguishes Günderrode among her contemporaries and places her in proximity to current environmental thought.

An article publicising the philosophical importance of Early German Romantic writer Dorothea Veit-Schlegel (1764–1839).

This article traces the French construction and demonization of American feminism by a segment of the women's movement and by public left-wing intellectuals. The joining of anti-American and anti-feminist traditions produces a new entity, dubbed French anti-amér-féminisme. The development is traced in the writings of one women's group, Psychanalyse et Politique, and in the debates around a so-called political correctness. Defending the image of a France distinguished by harmonious gender rapport and relations of seduction, this entity is used as a (...) mechanism to encourage French women to reject feminism or to define a different, homegrown heterosocial version. Using the examples of debates in women's studies, parity democracy and sexual harassment, the author demonstrates how anti-amér-féminisme has had material repercussions on French women's lives, such as limiting the scope of sexual harassment law. (shrink)