This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Women Are Up to Something: How Elizabeth Anscombe, Philippa Foot, Mary Midgley, and Iris Murdoch Revolutionized Ethics by Benjamin J. B. LipscombAmy Gilbert RichardsLIPSCOMB, Benjamin J. B. The Women Are Up to Something: How Elizabeth Anscombe, Philippa Foot, Mary Midgley, and Iris Murdoch Revolutionized Ethics. New York: Oxford University Press, 2022. xxx + 326 pp. Cloth, $27.95In The Women Are Up to Something, (...) Lipscomb demonstrates in form and content the inextricable link between philosophical theory and personal story and character. The book tells two stories: "first, a story [End Page 148] about four women, their overlapping friendships, and their struggle to establish themselves as philosophers in an often-hostile context; second, a story about two conflicting approaches to ethics." These two stories connect through the role these women played in the development of the second of the conflicting approaches—a challenge to the mid-twentieth-century Oxbridge orthodoxy in metaethics, what Lipscomb later calls a "minority report."Chapter 1 centers on the fact–value divide. The consequence of this divide for ethics lies in its banishment of all evaluative terms from the realm of possible facts, thereby demoting them to matters of "opinion." Lipscomb here offers a genealogy of the divide. He also introduces the insight that will become the seed of the minority report: The picture of the world offered by the fact-value divide is just that, a picture. Bringing to light the deep background pictures that undergird our understanding of the world is one of the most difficult intellectual tasks. But the picture rooted in the fact–value divide includes the claim that the divide itself is simply a "fact"—not a picture at all, and therefore not contestable. Lipscomb labels this view "the Dawkins' sublime."The next three chapters continue the work of stage-setting. Chapter 2 immerses us in the Oxford of the women's undergraduate years—an Oxford temporarily but dramatically altered by World War II, where female students made up a much larger percentage of the undergraduate population than was usual, and where professors were in a new way open to mentoring women. Chapter 3 briefly recounts all four childhoods, lived in the aftermath of the first World War. Chapter 4 returns to Oxford and narrates the graduate degrees of the four women. It also offers a perceptive primer on the history of analytic ethics, culminating in the state of the field at the point when the women were on the cusp of entering it—the precise shape of the approach to ethics the women would eventually abjure.Each of the next four chapters traces the development of the mature philosophy of one of the four women—in order: Murdoch, Anscombe, Foot, and Midgley. Despite deep differences among their philosophical and theological outlooks, they all four came to defend a version of the thesis, commonplace in ancient and medieval philosophy, that there are things that are good for human beings qua human being, that our moral lives are largely a matter of seeing and responding—well or poorly—to these elements of the human good that are given as part of our nature. In other words, there are facts about values. We in crucial ways discover rather than invent morality.The last chapter serves as an epilogue to both stories: It traces the ways in which the writing and lives of these four women produced a decisive change in the landscape of Anglo-American philosophy. Lipscomb notes which strains in contemporary Anglo-American philosophy owe their existence to the minority report. Figures like Korsgaard feature as contemporary representatives of an ethics grounded in the fact–value [End Page 149] divide. Figures like MacIntyre and Hursthouse feature as inheritors of the philosophical legacy of the book's heroines.In this final chapter Lipscomb also offers brief portraits of the later life and death of each of the women in turn. At the end of the final portrait, the book rounds to a poetic close—not offering a final philosophical statement but reflecting on the fruits of friendship and the power of its legacy for those who come after.It is difficult to pin down Lipscomb's precise philosophical... (shrink)

Examines ethics as a discipline from which knowledge may be derived, which offers guidance for practical understanding and moral decision making, and which underlies methods of effecting such moral decisions.

This is the first of two essays concerned to specify in what sense "ought" and "value" are genuine characteristics of reality serving as data that help us empirically verify the truth and falsity of our moral judgments. This, the first, essay discusses the significance of the ought/is question for moral philosophy and theological ethics, giving reasons for the inadequacy of current views on the relation between "ought" and "is." Building on the perceptual theories of Gestalt psychologists yields a phenomenological (...) description of the nature of "ought" and "value" as unique experiences of gap-induced demands or requiredness. These moral experiences of requiredness are delineated in such a way that they are distinguishable from aesthetic, logical, and causal forms of requiredness. (shrink)

This book focuses on justice and its demands in the way of providing people with medical care. Building on recent insights on the nature of moral perceptions and motivations from the neurosciences, it makes a case for the traditional medical ethic and examines its financial feasibility. The book starts out by giving an account of the concept of justice and tracing it back to the practices and tenets of Hippocrates and his followers, while taking into account findings from the neurosciences. (...) Next, it considers whether the claim that it is just to limit medical care for everyone to some basic minimum is justifiable. The book then addresses finances and expenditures of the US health care system and shows that the growth of expenditures and the percentage of the gross national product spent on health care make for an unsustainable trajectory. In light of the question what should be changed, the book suggests that overdiagnosis and medicalizing normal behavior lead to harmful, costly and unnecessary interventions and are the result of unethical behavior on the part of the pharmaceutical industry and extensive ethical failures of the FDA. The book ends with suggestions about what can be done to put the U.S. health care system on the path to sustainability, better medical care, and compliance with the demands of justice. (shrink)

In Joseph Butler, we have an account of human beings as moral beings that is, as this essay demonstrates, being supported by the recently emerging findings of the neurosciences. This applies particularly to Butler's portrayal of our empathic emotions. Butler discovered their moral significance for motivating and guiding moral decisions and actions before the neurosciences did. Butler has, in essence, added a sixth sense to our five senses: this is the moral sense by means of which we perceive what we (...) ought or ought not do. The moral sense yields relatively reliable moral perceptions when we love our neighbors as ourselves, and when our love for ourselves is genuine. Accurate moral perceptions will be thwarted by self-deceit—that is, by a self-partiality devoid of neighbor love, a condition that thwarts genuine self-love. This essay explores the parallels between Butler's understanding of self-deceit and Robert J. Lifton's understanding of "doubling.". (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of (...) Ethics, Georgetown University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

Contemporary moral philosophy tends to equate what is moral with what is obligatory. Hence, there is a tendency to exclude all virtues from what is moral because they are dispositions other than the one morally good disposition to fulfill obligations out of a sense of obligation. This has the effect of excluding much of what we admire about persons from moral philosophy and from the moral life. This essay argues that there are at least two virtues, both forms of love, (...) moral perceptivity and moral tenacity, which are moral and obligatory. The author explores some of the relationships of these two moral virtues to the traditional theological virtues of faith, hope, and love, and to heroism and saintliness. (shrink)

Part I of this essay described "Ought" and "Value" as forms of moral requiredness. Now in Part II, a description of the ideal conditions for veridical perceptions of moral requiredness are specified. This is done in the form of an ideal observer type of analysis. This analysis is defended against those who oppose naturalism by assuming a bifurcation between 'ought' and 'is' and those who accuse naturalism of a "naturalistic fallacy." It is argued that theistic versions of the ideal observer (...) form of analysis exist in the Christian tradition in logically acceptable and plausible formulations. Specific illustrations are provided. (shrink)

Just below the surface of public life in the United States, a biblically based theory of rights vies with a theory that first appeared in the work of Bentham and Mill, and the latter is gaining increasing dominance. The resolution of this conflict has implications for a host of legal matters and public policy decisions, including life and death issues like physician-assisted suicide. Though the ascendancy of the Millian tradition reflects widespread skepticism concerning the possibility of developing a basis for (...) a common morality or defending a conception of natural inalienable rights, the author argues that a plausible account of common human morality can be developed from attention to the relationships that are requisite for sustaining the communities that are the condition of moral agency. (shrink)

Medical professionals are a community of highly educated individuals with a commitment to a core set of ideals and principles. This community provides both technical and ethical socialization. The ideal physician is confident, empathic, forthright, respectful, and thorough. These ideals allow us to define broadly "the excellence" of being a physician. At the core of these ideals is the ability to be empathic. Empathy exhibits itself in attributes of an individual's moral character and also in actions that actualize and support (...) communal life. Empathy, however, can be diminished or even lost and must be nurtured on an ongoing basis. The development of ethical physicians is strongly linked to experiences in the training period. Moral traits are situation-sensitive psychological and behavioral dispositions. The clinical environment of medical training programs can be so intense as to lead to conditions that may actually deprofessionalize trainees. Creating a clinical environment that is ethically nurturing and sustaining is an indispensable component of practicing medicine. (shrink)

On 18–19 May 2018, a symposium was held in the Research Institute of Irish and Scottish Studies at the University of Aberdeen to commemorate the tenth anniversary of the death of Ronald W. Hepburn (1927–2008). The speakers at this event discussed Hepburn’s oeuvre from several perspectives. For this book, the collection of the revised versions of their talks has been supplemented by the papers of other scholars who were unable to attend the symposium itself. Thus this volume contains contributions from (...) eighteen notable scholars of different disciplines, ranging from contemporary aesthetics and art theory through to philosophical approaches to religion, education and social anthropology. It also includes a bibliography of Hepburn’s writings. The essays were first published in two special issues of the Journal of Scottish Thought, vols. 10–11 (2018–2019). -/- Ronald William Hepburn was born in Aberdeen on 16 March 1927. He went to Aberdeen Grammar School, then he graduated with an M.A. in Philosophy (1951) and obtained his doctorate from the University of Aberdeen (1955). His tutor at Aberdeen was Donald MacKinnon (1913– 1994), a Scottish philosopher and theologian, the author of A Study in Ethical Theory (1957) and The Problem of Metaphysics (1974). Hepburn taught as Lecturer at the Department of Moral Philosophy at Aberdeen (1956–60), and he was also Visiting Associate Professor of Philosophy at New York University (1959–60). He returned from the United States as Professor of Philosophy at Nottingham University. In 1964, he was appointed as a Chair in Philosophy at the University of Edinburgh and between 1965 and 1968 he was also Stanton Lecturer in the Philosophy of Religion at the University of Cambridge. From 1975 until his retirement in 1996, he held the Professorship of Moral Philosophy at Edinburgh. He died in Edinburgh on 23 December 2008. His philosophical interests ranged from theology and the philosophy of religion through moral philosophy and the philosophy of education to art theory and aesthetics. Notably, Hepburn is widely regarded as the founder of modern environmental and everyday aesthetics as a result of the influence of papers in the 1960s which pioneered a new approach to the aesthetics of the natural world. (shrink)

This study explores the impact of mood on individuals’ ethical decision-making processes through the Graham [Graham, J. W.: 1986, Research in Organizational Behavior 8, 1–52] model of Principled Organizational Dissent. In particular, the research addresses how an individual’s mood influences his or her willingness to report the unethical actions of a colleague. Participants’ experienced an affectively charged, unrelated event and were then asked to make a decision regarding whistle-blowing intentions in a public accounting context. As expected, negative mood was associated (...) with lower intentions to report the unethical actions of others to a superior within the organization. The Graham model, which proposes that reporting intentions are impacted by the three determinants of seriousness, personal responsibility and cost, was employed to more clearly understand the nature of the affect–reporting intention relationship. The role of affect was explained by demonstrating that two determinants mediate the relationship between mood and whistle-blowing intentions. Specifically, as seriousness and responsibility have a positive impact on reporting intentions, the reduction of these perceptions by negative mood reduces the intent to report. The negative impact of personal cost on reporting intentions was significant, although not as a mediator of mood. (shrink)

Ethical issues in physician-industry and academia-industry relationships have focused largely on the financial nature of these relationships. It took very little time after solutions to transparenc...

Drawing on social comparison theory, we investigate employees’ ethical and performance comparisons relative to a similar coworker and subsequent emotional and behavioral responses. We test our theoretically driven hypotheses across two studies. Study 1, a cross-sectional field study, reveals that employees who perceive they are more ethical than their coworkers experience negative emotions toward the comparison coworkers and those feelings are even stronger when the employees perceive they are lower performers than their coworkers. Results also reveal that negative emotions mediate (...) the indirect relationship between being more ethical than a coworker, but also being a lower performer than that coworker onto social undermining and ostracism. Study 2, a 2 × 2 between-subjects experimental design, provides further support for our moderated mediation model. Results reveal that participants experience negative emotions when they receive information that they are more ethical than a comparison participant. Negative emotions are amplified if the participant is told they were a lower performer than the comparison participant. Those participants indicate their desire to mistreat and ignore the comparison participant if given the opportunity. Thus, we find support for our hypotheses using a multi-method design. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant (...) step on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:"To make a difference...":Narrative Desire in Global MedicineByron J. Good and Mary-Jo DelVecchio GoodIf, as Arthur Frank (2002) writes, "moral life, for better and worse, takes place in storytelling," this collection of narratives written by physicians working in field settings in global medicine gives us a glimpse of some aspects of moral experience, practice, and dilemmas in settings of poverty and low health care resources. These essays (...) are written from the midst of practice, in diverse settings in Africa, South Asia, Latin America, the Caribbean, and the United States. The majority of the writers are practitioners of contemporary 'global medicine'—physicians from North America or Europe who spend part of their lives flying into settings of poverty or special need to practice medicine and work with on-going collaborative clinical and public health systems—while a smaller number are working in the societies in which they were born. Although a few work for classic humanitarian organizations or have developed their own local NGO's, the great majority are engaged in the 'hybrid life' described by Robert Riviello and noted by Renée Fox, moving between academic medical centers and distant health care systems that are supported by local governments, major international organizations and funding agencies, and international NGO's like Partners in Health. These diverse forms of practice have become a common model for contemporary clinicians engaged in what has emerged as a new discipline of global health or global medicine, and these narratives give us a glimpse of some of the enduring, as well as newly emerging, forms of moral practice and ethical dilemmas characteristic of today's global medicine.Many of these stories are filled with the tension and pathos that makes clinical narratives powerful to read. Physicians are forced to make unfathomable decisions about whether to resuscitate and keep a baby alive, using all means available, or to let the infant die, whether to carry out a procedure that will save an infant in birth but would put the mother at risk, about how to deal with a cancer found in a very advanced state. However, virtually all of the stories transcend these classical stories of the decisions physicians are forced to make by being placed in settings of great scarcity of resources, which stand in particular contrast to the academic medical settings in North America or Europe where many of these global medicine specialists have trained and many continue to practice. The unspeakable inequality of resources emerges throughout these narratives as a kind of master theme, as the underlying moral, as opposed to plot, which gives meaning and sense to the stories. For those who practice medicine in such settings, global inequalities and scarcity of medical resources are deeply felt. They produce the rage that Jeffrey Deal describes. ("I learned to despise American churches during that time, a time when my world encompassed a dying newborn in Sudan, as well as the air conditioned padded seats [End Page 121] of our affluent suburban church.") They produce the distinctive experiences of helplessness and pain felt by clinicians who cannot separate how they would be able to treat such a patient at home from how they have to practice in these settings. For those clinicians working in their own societies, scarcity of resources often produces deep anger at the corrupt governments that fail to support basic human services for the great majority of their population. ("We were temporary actors performing in the cynical play of scarcity on permanent display in Port-au-Prince," writes Haitian physician Paul Pierre about his experience prior to joining Partners in Health.)But for those who regularly travel back and forth across the divide between rich and poor, whether across national boundaries or within their own society, the challenge to live a moral life is unendingly complicated. While becoming a part of a struggle for global justice with colleagues and advocates from both sides of the divide, few of the narrators can avoid personal feelings of ambivalence and guilt at being able to easily move from one side of that divide to the other back home. Many fantasize about giving up their lives in the north to devote themselves... (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about (...) half of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

During the past four decades, the Netherlands played a leading role in the debate about euthanasia and assisted suicide. Despite the claim that other countries would soon follow the Dutch legalization of euthanasia, only Belgium and the American state of Oregon did. In many countries, intense discussions took place. This article discusses some major contributions to the discussion about euthanasia and assisted suicide as written by Nigel Biggar, Arthur J. Dyck, Neil M. Gorsuch, and John Keown. They share (...) a concern that legalization will undermine a society's respect for the inviolability and sanctity of life. Moreover, the Report of the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill is analyzed. All studies use ethical, theological, philosophical, and legal sources. All these documents include references to experiences from the Netherlands. In addition, two recent Dutch documents are analyzed which advocate further liberalization of the Dutch euthanasia practice, so as to include infants and elderly people "suffering from life". (shrink)

Integrating artificial intelligence (AI) into critical domains such as healthcare holds immense promise. Nevertheless, significant challenges must be addressed to avoid harm, promote the well-being of individuals and societies, and ensure ethically sound and socially just technology development. Innovative approaches like Embedded Ethics, which refers to integrating ethics and social science into technology development based on interdisciplinary collaboration, are emerging to address issues of bias, transparency, misrepresentation, and more. This paper aims to develop this approach further to enable (...) future projects to effectively deploy it. Based on the practical experience of using ethics and social science methodology in interdisciplinary AI-related healthcare consortia, this paper presents several methods that have proven helpful for embedding ethical and social science analysis and inquiry. They include (1) stakeholder analyses, (2) literature reviews, (3) ethnographic approaches, (4) peer-to-peer interviews, (5) focus groups, (6) interviews with affected groups and external stakeholders, (7) bias analyses, (8) workshops, and (9) interdisciplinary results dissemination. We believe that applying Embedded Ethics offers a pathway to stimulate reflexivity, proactively anticipate social and ethical concerns, and foster interdisciplinary inquiry into such concerns at every stage of technology development. This approach can help shape responsible, inclusive, and ethically aware technology innovation in healthcare and beyond. (shrink)

Johnson and Stricker published an opinion piece in the Journal of Medical Ethics presenting their perspective on the 2008 agreement between the Infectious Diseases Society of America (IDSA) and the Connecticut Attorney General with regard to the 2006 IDSA treatment guideline for Lyme disease. Their writings indicate that these authors hold unconventional views of a relatively common tick-transmitted bacterial infection caused by the spirochete Borrelia burgdorferi. Therefore, it should come as no surprise that their opinions would clash with the (...) IDSA's evidence-based guidelines for the diagnosis and treatment of Lyme disease. Their allegations of conflict of interest against the IDSA resemble those made against the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control and Prevention in 2000, which were found to be baseless. It is the responsibility of all physicians and medical scientists to stand up to antiscientific, baseless and unethical attacks on those who support an evidence-based approach to caring for patients. (shrink)

But as Harvard ethicist Arthur J. Dyck shows in this powerful work, there are solid moral and practical bases for the existing laws against assisted suicide in ...

The focus of this article is two texts, ‘Advancing Luna – and Ida B. Wells’ (1982) by Alice Walker and Disgrace(1999) by J.M. Coetzee, both of which present ethical problems for the reader. The texts share a common event, an incident of black-on-white, male-on-female rape. In each case the white woman keeps silent about the rape and the narrative is troubled by that silence. I read the dilemma of these texts as at once ethical, political and aesthetic and I explore (...) that multi-faceted problem through three perspectives – the issue of silence, the narrative structures of the texts and the impossibility of resolution. The texts repeatedly question my reading position, not least in that they both suggest that the silence of the white woman might, in certain circumstances, be a condition for political progress. (shrink)

Rapid advances in high throughput genomic technologies and next generation sequencing are making medical genomic research more readily accessible and affordable, including the sequencing of patient and control whole genomes and exomes in order to elucidate genetic factors underlying disease. Over the next five years, the Human Heredity and Health in Africa (H3Africa) Initiative, funded by the Wellcome Trust (United Kingdom) and the National Institutes of Health (United States of America), will contribute greatly towards sequencing of numerous African samples for (...) biomedical research. (shrink)

Public health and service delivery programmes, interventions and policies (collectively, ‘programmes’) are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current (...) ethical guidance and registration procedures make little allowance for scenarios where researchers have played no role in the development or implementation of a programme, but nevertheless plan to conduct a prospective evaluation. We explore the limitations of the guidance and procedures with respect to opportunistic evaluations, providing a number of examples. We propose that one key missing distinction in current guidance is moral responsibility: researchers can only be held accountable for those aspects of a study over which they have control. We argue that requiring researchers to justify an intervention, programme or policy that would occur regardless of their involvement prevents or hinders research in the public interest without providing any further protections to research participants. We recommend that trial consent and ethics procedures allow for a clear separation of responsibilities for the intervention and the evaluation. (shrink)

This book, besides meeting a definite need in the field of Kantian ethical studies, is excellent. Professor Beck treats the Practical Reason as an exemplification of a general Kantian method applied to problems organic to the Kantian system as a whole. His interpretation of the 'Transcendental deduction' of the Principle of Pure Practical Reason is particularly brilliant; the Principle is shown to be established in precisely the form required for a complete resolution of the third antinomy of the Critique (...) of Pure Reason, and the procedure has the further warrant of showing the validity of the "deduction" of chapter III of the "Grundlegung."--J. B. (shrink)

Xenotransplantation has the potential to alter the U.S. transplant system in profound ways. However, this emerging “spare parts” solution spearheaded by biotechnology companies raises concerns about its impact on the organ shortage, healthcare systems, population health, and health inequalities. We contend that xenotransplantation may have limited benefits in improving health, could prove prohibitively expensive for many, and may divert resources away from proven public health measures. Additionally, it carries the risk of perpetuating stigma. Xenotransplantation may thereby exacerbate existing healthcare (...) inequities across racial, ethnic, socio‐economic, and geographic lines. To mitigate these risks, we contend that public health expert input is integral for xenotransplant policy development and outreach and that this underscores the importance of federal government investment in transplant infrastructure. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

Objective Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional precautions. Of particular concern is preventive misconception, or the overestimation of personal protection that is afforded by enrolment in a prevention intervention trial. Methods As part of a larger study of preventive misconception in adolescent HIV vaccine trials, we interviewed (...) 33 male and female 16–19-year-olds who have sex with men. Participants underwent a simulated HIV vaccine trial consent process, and then completed a semistructured interview about their understanding and opinions related to enrolment in a HIV vaccine trial. A grounded theory analysis looked for shared concepts, and focused on the content and process of adolescent participants’ understanding of HIV vaccination and the components of preventive misconception, including experiment, placebo and randomisation. Results Across interviews, adolescents demonstrated active processing of information, in which they questioned the interviewer, verbally worked out their answers based upon information provided, and corrected themselves. We observed a wide variety of understanding of research concepts. While most understood experiment and placebo, fewer understood randomisation. All understood the need for safer sex even if they did not understand the more basic concepts. Conclusions Education about basic concepts related to clinical trials, time to absorb materials and assessment of understanding may be necessary in future biomedical prevention trials. (shrink)

This anthology contains excerpts from some thirty-two important seventeenth- and eighteenth-century moral philosophers. Including a substantial introduction and extensive bibliographies, the anthology facilitates the study and teaching of early modern moral philosophy in its crucial formative period. As well as well-known thinkers such as Hobbes, Hume, and Kant, there are excerpts from a wide range of philosophers never previously assembled in one text, such as Grotius, Pufendorf, Nicole, Clarke, Leibniz, Malebranche, Holbach and Paley. Originally issued as a two-volume edition in (...) 1990, the anthology is now re-issued with a new foreword by Professor Schneewind, as a one-volume anthology to serve as a companion to his highly successful history of modern ethics, The Invention of Autonomy. The anthology provides many of the sources discussed in The Invention of Autonomy and taken together the two volumes will be an invaluable resource for the teaching of the history of modern moral philosophy. (shrink)

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used (...) to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care. (shrink)

John Burdon Sanderson Haldane was a giant among men. He made major contributions to genetics, population biology, and evolutionary theory. He was at once comfortable in mathematics, chemistry, microbiology and animal physiology. But it was his belief in education that led to his preparing his popular essays for publication. In his own words: "Many scientific workers believe that they should confine their publications to learned journals. I think that the public has a right to know what is going on (...) inside the laboratories, for some of which it pays." So begins Haldane's collection of essays, perhaps the most public intellectual communicating science before the writings of Stephen Jay Gould. The first part of the volume emphasizes the important developments in biology and natural science in the first quarter of the century. As such, it provides a benchmark for studies of the next three quarters of the century. In an unusual introduction, Price takes the readers through their paces, discussing the situation then and now in vitamins, oxygen want, disease controls, and the rewards of science as such. This is followed by Haldane's views on society, art, religion and economy as seen through the eyes of a politically alert major scientist. The editor provides readers unfamiliar with Haldane with a carefully rendered chronology of a life that began in 1892 and that spanned much of the present century. Despite ideas on race, class and politics that have seen better times, Haldane was truly exceptional in translating the science of his time into ideas that "everyman" could readily grasp. His predictions on what science would achieve were on target far more often than not. But even his failed predictions are perhaps the most interesting of all. They throw into sharp relief the truly novel and revolutionary developments in science over the past 75 years. J.B.S. Haldane held many positions and received many honors during his lifetime. But for most of the period covered in this volume, he was the William Dunn Reader in Biochemistry at Cambridge University. He simultaneously served as Fellow of New College, in Oxford University's Horticultural Institute. Carl A. Price served until 1999 as professor IIof plant molecular biology in the Waksman Institute of Microbiology at Rutgers, the State University of New Jersey. He also served as the editor of Plant Molecular Biology Reporter from 1983 until 1997. This is the first volume in a new series on the history and theory of science. (shrink)

Background: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – (...) the child – have attracted limited attention. Objective: The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context. Study context: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Methods: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Ethical considerations: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. Findings and discussion: The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion. (shrink)

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases’ powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack (...) on humans by foreign micro‐organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical‐ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.