Health care reform proposals threaten to exacerbate tensions physicians already face in trying to balance traditional duties to individual patients against increasing pressure to serve broader societal and institutional goals. To cope with reform, medical ethics must clarify physicians' moral obligations, change existing ethical codes, and develop an ethics of institutions.

Both bioethics and law have governed human genomics by distinguishing research from clinical practice. Yet the rise of translational genomics now makes this traditional dichotomy inadequate. This paper pioneers a new approach to the ethics of translational genomics. It maps the full range of ethical approaches needed, proposes a “layered” approach to determining the ethics framework for projects combining research and clinical care, and clarifies the key role that return of results can play in advancing translation.

From the foregoing discussion we can note that whilst Marx transcends the fact-value distinction he embraces neither a scientistic approach nor a moral theory. Rather he gives a sociological account of morality, illustrating that description and evaluation cannot be separated and that juridical conceptions need to be understood in relation to the mode of production in which they arise.30 In the absence of an absolute notion of justice it is mistaken to see Marx as offering a critique of capitalism based (...) on moral principles. Of course Marx had reasons for attacking capitalism but these are contained within his account of the capitalist mode of production. Yet whilst this theory is not a moral theory it cannot be described as a descriptive theory either. In Marx's work description and evaluation cannot be meaningfully separated.In portraying Communist society as the solution to problems generated within capitalist society Marx is not sketching out a picture of a morally superior society but rather considering the possibilities of an alternative way of life with its own moral and judicial standards. Indeed the fact that Marx did not provide blueprints for future Communist society is itself symptomatic of his awareness of the difficulties involved in the attempt to describe in detail a form of social life based upon principles different from our own. (shrink)

Kant objects on principle to any duty of moral self-perfection that would aim at the moral self-perfection of another person. Yet, despite the apparent barrier posed by the introspective technique of self-perfecting effort, I argue that such a duty is both possible and desirable as a part of moral friendship. Through mutual sincere efforts at self-disclosure, we escape the prison of mutual distrust which otherwise characterizes social life and consolidate the very sincerity necessary for moral improvement.

Participant-driven research is a burgeoning domain of research innovation, often facilitated by mobile technologies. Return of results and data are common hallmarks, grounded in transparency and data democracy. PDR has much to teach traditional research about these practices and successful engagement. Recommendations calling for new state laws governing research with mHealth modalities common in PDR and federal creation of review mechanisms, threaten to stifle valuable participant-driven innovation, including in return of results.

Genetic testing poses fundamental questions for insurance. Testing can predict a low probability of future illness and disability, which can help promote the insurability of individuals with a family history of genetic risk, but it can also invite insurers to reject applicants, increase premiums, exclude people with certain illnesses and disabilities, and otherwise adjust the underwriting processes for individuals with certain genotypes. In the workplace, these issues may cause employers who offer or pay for insurance to alter their hiring behavior, (...) either by selecting those with desirable genetic makeup or rejecting, dismissing, or reassigning those who carry an unwanted risk, ultimately threatening employability and the safety net that insurance is intended to provide. (shrink)

Adrienne Asch pioneered a way of doing bioethics that few are brave enough to attempt. In addition to summoning logic, arguing values, and applying reasoning to cases, Adrienne lived bioethics. Without compromising the strength of her analysis, she grounded that analysis explicitly in her own lived experience of disability. Hers was the view from somewhere—a deep invitation to others to rethink everything from embryo selection to end‐of‐life decisions through the lens of lived disability.

In this paper I examine the particularist attack on deductive uses of moral principles, reviewing the critiques of the uniformity of moral reasons and impartiality in ethics, looking principally at arguments from Larry Blum, Jonathan Dancy, and Margaret Walker. I defend the action-guiding-ness of moral principles themselves, but consider various ways to accommodate the objections coming fromparticularism. I conclude that one objection to the impartialist theory of value must be conceded without qualification: generalism is unable to account for the unique (...) and irreplaceable value of individual persons. I present an example which supports my view andshows that, in the context of lived experience, replaceability is contradicted. Indeed there may be few constants of value in the narrative of one’s life, as experiences overlay supposed constants with continual new shading, and create even deeper sorts of transformation in valuing. In the end, both particularized moral judgment and the articulation of fact with principle contribute to moral discernment. (shrink)

Using the infamous research studies in Tuskegee and Guatemala, the article examines the difference between victims and bystanders. The victims can include families, sexual partners, and children not just the participants. There are also the bystanders in the populations who are affected, even vaguely, decades after the initial studies took place. Differing reparations for victims and bystanders through lawsuits and historical acknowledgments has to be part of broader discussions of historical justice, and the weighing of the impact of racism and (...) imperial research endeavors. (shrink)

This paper explores definitions of death from the perspectives of several world and indigenous religions, with practical application for health care providers in relation to end of life decisions and organ and tissue donation after death. It provides background material on several traditions and explains how different religions derive their conclusions for end of life decisions from the ethical guidelines they proffer.

Evolutionary theory assumed that mutations occur constantly, gradually, and randomly over time. This formulation from the “modern synthesis” of the 1930s was embraced decades before molecular understanding of genes or mutations. Since then, our labs and others have elucidated mutation mechanisms activated by stress responses. Stress‐induced mutation mechanisms produce mutations, potentially accelerating evolution, specifically when cells are maladapted to their environment, that is, when they are stressed. The mechanisms of stress‐induced mutation that are being revealed experimentally in laboratory settings provide (...) compelling models for mutagenesis that propels pathogen–host adaptation, antibiotic resistance, cancer progression and resistance, and perhaps much of evolution generally. We discuss double‐strand‐break‐dependent stress‐induced mutation in Escherichia coli. Recent results illustrate how a stress response activates mutagenesis and demonstrate this mechanism's generality and importance to spontaneous mutation. New data also suggest a possible harmony between previous, apparently opposed, models for the molecular mechanism. They additionally strengthen the case for anti‐evolvability therapeutics for infectious disease and cancer. (shrink)

This paper examines Hutcheson’s moral sense theory’s attack on internalism and his defense of an innovative version of externalism. I show that Hutcheson’s distinction between exciting and justifying reasons supports a type of externalist theory not anticipated by Brink, Smith, or McDowell. In Moral Sense Externalism, moral judgment relies upon the perceptions of a moral sense, and the felt quality of these perceptions introduces to judgment an affective dimension. Thus feeling is a constituitive part of what it is to have (...) a justifying reason for a moral act even when it is not the direct motive to action. (shrink)

Moral debate over vegetarianism forms the backdrop to a preliminary consideration of the questions: Is it ethical to produce, sell and eat faux meat? Is it ethical to produce, sell and wear fake animal skin? Is it ethical to sell or wear secondhand or thriftshop genuine animal skin? If vegetarianism is morally required, the question of just what uses of nonhuman animals are ethical or unethical and on what grounds is always on tap. In this piece, I examine the above (...) questions in light of deontological then utilitarian reasons for vegetarianism. I conclude deontological or animal rights grounds entail the moral condemnation of faux meat and fake and secondhand animal skin. I conclude utilitarian or animal welfare grounds entail, with some qualification, the moral acceptability of faux meat and fake animal skin but the clear moral unacceptability of secondhand animal skin. (shrink)

This paper considers feministperspectives on the Human Rights Act. Itdiscusses the reasons why many feminists aresceptical regarding the impact the Act willhave on women''s lives, including theimplications for anti-discrimination law,problems with the framework of rights in theEuropean Convention and deeper difficulties facingfeminism in negotiating rights discourse. Whileacknowledging these problems, it is argued thatthere are grounds for a more positiveinterpretation of incorporation. Questions arethen raised about the nature and scope of rightsand the role of the state in challenging genderinequality.

Mouse models of human genetic disorders provide a valuable resource for investigating the pathogenesis of genetic disease and for testing potential therapies. The high degree of resolution of linkage mapping in the mouse allows mutant phenotypes to be mapped precisely which, combined with the accurate definition of areas of homology between the mouse and human genomes, greatly facilitates the identification of mouse models. We describe here mouse models of human single gene disorders dividing them into three categories depending on the (...) information available; phenotypic similarities, comparative mapping and identification of the underlying genetic lesion. (shrink)

A Skeptical View of the Liberal Peace reflects on the place of democracy in the global community. The article pays particular attention to the widespread assumption that there is an inherent relationship between democracy and peace, and that peace most assuredly is derived from democracy itself. I find these assertions to be highly questionable and overstated. Reflection on the philosophy which underpins these claims can only be helpful for international relations. In particular, given the United States’ apparent imperialistic urge to (...) force democracies on other nations as Iraq, the article seems especially timely. (shrink)

Hutchesonʹs theories offer an objective referent for beauty linked with a subjective determination to be pleased. As Kenneth Winkler’s terminology suggests, Hutcheson is an eighteenth‐century aesthetic realist, a beauty realist, because the aesthetic object need not be identified with the natural object. I argue that this aesthetic realism helps to settle key disputes concerning moral qualities in the moral sense theory. The natural and automatic operation of the aesthetic and moral senses allows a role for new experiences of beauty and (...) virtue beyond their root forms, and permits a cultural refinement that remains true to a widely held, even if not universal, set of moral parameters for virtuous motivation. (shrink)

In museum settings, caregivers support children's learning as they explore and interact with exhibits. Museums have developed exhibit design and facilitation strategies for promoting families' exploration and inquiry, but these strategies have rarely been contrasted. The goal of the current study was to investigate how prompts offered through staff facilitation vs. labels printed on exhibit components affected how family groups explored a circuit blocks exhibit, particularly whether children set and worked toward their own goals, and how caregivers were involved in (...) children's play. We compared whether children, their caregivers, or both set goals as they played together, and the actions they each took to connect the circuits. We found little difference in how families set goals between the two conditions, but did find significant differences in caregivers' actions, with caregivers in the facilitation condition making fewer actions to connect circuits while using the exhibit, compared to caregivers in the exhibit labels condition. The findings suggest that facilitated and written prompts shape the quality of caregiver-child interactions in distinct ways. (shrink)

A critical difference between 1978, the first time the U.S. Supreme Court heard on its merits a case involving affirmative action policies (AAPs), and its 2003 revisiting of the issue was that the context for hearing the issue had significantly changed from that of medical education to that of undergraduate and law school programs. This shift in context mattered. I argue here that medicine has particular interests and insights into the problem of race, and in this, its participation in the (...) debate is critical not only for medical education and practice but for the development of sound judicial approaches to AAPs. (shrink)

The myelin basic proteins are a set of peripheral membrane polypeptides which play an essential role in myelination. Their most well‐documented property is the unique ability to ‘seal’ the cytoplasmic aspects of the myelin membrane, but this is probably not the only function for these highly charged molecules. Despite extensive homology, the individual myelin basic proteins (MBPs) exhibit different expression patterns and biochemical properties, and so it is now believed that the various isoforms are not functionally equivalent in myelinating cells. (...) We now think that while the major MBPs are intracellular adhesion molecules, some of the quantitatively less abundant isoforms that are expressed very early in development may have regulatory effects on the myelination program. (shrink)