Conventional and well-established guidelines for the ethical conduct of clinical research are necessary but not sufficient for addressing research dilemmas related to public health research. There is a particular need for a public health ethics framework when, in the face of an epidemic, research is urgently needed to promote the common good. While there is limited experience in the use of a public health ethics framework, the value and potential of such an approach is increasingly being appreciated. Here we use (...) two examples of adolescent women as potential candidates for participation in microbicide trials to illustrate how ethical decisions for public health research can be enhanced by drawing on both traditional research ethics guidance, and the emerging framework for public health ethics. (shrink)

The blinkered debate on organ donation neglects the widening gap between the developed and developing worldsThe current debate about organ donation and the associated advocacy for selling kidneys, while laudable for its concern about increasing the ability to save the lives of some people with chronic renal failure, is characterised by four features that locate the reasoning process within a narrow and inadequate framework. Firstly, the focus on saving lives is myopic, with the lives of the most privileged in the (...) world receiving most attention. Secondly, the debate is firmly set within a value system in which market values dominate. Thirdly, health is considered from a highly individualistic perspective with little understanding of the importance of social solidarity in health. Finally, a constricted moral vocabulary is used to discuss the ethics of organ sales.MYOPIC CONCERN FOR SAVING LIVESMany articles making pleas for more organs begin by describing the number of people waiting for donated organs, the number of donors who could give organs but are not doing so, and how many lives could be saved if more organs could be made available. Great concern is expressed about a few thousand …. (shrink)

I am very pleased to see the response by J S Taylor to my critique of the “organs debate”. He makes some notable and important points, but also some errors to which attention should be drawn.Taylor erroneously attributes to me concern that the organ debate excessively focuses on saving the lives of a few people. My concern was about the narrow framework within which the debate is embedded and that it focuses on the lives of a few privileged people—those who (...) can pay—while largely neglecting the lives of those who cannot. The fact that some attention has been paid to such issues in some journals does not negate the importance of my claim. Moreover, it is not that the question of millions of premature deaths has …. (shrink)

Following promulgation of the Nuremberg code in 1947, the ethics of research on human subjects has been a challenging and often contentious topic of debate. Escalation in the use of research participants in low-income countries over recent decades , has intensified the debate on the ethics of international research and led to increasing attention both to exploitation of vulnerable subjects and to considerations of how the 10:90 gap in health and medical research could be narrowed. In 2000, prompted by the (...) discussions over several years that led to the US NIH launching a capacity building programme on research ethics for members of research ethics committees in developing countries, we advanced a ‘new look’ for the ethics of international research.1 Since then progress has been made on several fronts.First, our ideas—considered somewhat radical and impractical at the time—have been provocatively addressed by scholars who have either contested them or advanced similar conceptions of what obligations international researchers have to research participants and communities in low income countries before, during and after clinical trials. Second, those researchers who have been sympathetic to our ideas have either endeavoured to put these into practice or have investigated the feasibility of doing so. Third, the intractability of the 10/90 gap and the escalation of interest in global health have sensitised many to the need to amplify the uptake of these ideas in practice.Here, we briefly review the conceptual and practical developments in international research ethics. While much conceptual progress has been made (and the concepts are now appearing …. (shrink)

Disturbing international inequalities in health abound. Life expectancy in Swaziland is half that in Japan. A child unfortunate enough to be born in Angola has 73 times as great a chance of dying before age 5 as a child born in Norway. A mother giving birth in southern sub-Saharan Africa has 100 times as great a chance of dying from her labor as one birthing in an industrialized country. For every mile one travels outward toward the Maryland suburbs from downtown (...) Washington, DC on its underground rail system, life expectancy rises by a year – reflecting the race and class inequities in American health. Are the glaring, even larger, international health inequalities also unjust? -/- All of us no doubt think they are grossly unfortunate. Many of us think they are unfair or unjust. Why should some people be at such a health disadvantage through no fault of their own, losers in a natural and social lottery assigning them birth in an unhealthy place? Others of us are troubled by the absence of the kinds of human relationships that ordinarily give rise to the claims of egalitarian justice that we make on each other – for example, being fellow citizens or even interacting in a cooperative scheme. Who has obligations of justice to reduce these international inequalities? And do those obligations hold regardless of how the inequalities came about? What institutions are accountable for addressing them? (shrink)

Clinical research has become a burgeoning activity in recent years, largely stimulated by the pharmaceutical industry's interest in new drugs with high marketing profiles. Several other forces fuel this thrust: the increasing dependence of academic medical institutions on research funding from industry; the need for large, efficient multicenter trials to obtain reliable and statistically significant results in the shortest possible time for drug registration purposes; and access to research subjects in countries. The intense interest in HIV/AIDS research and recent controversies (...) about revisions to the Helsinki Declaration, which have been seen by some to be motivated by the desire to facilitate exploitative research in countries, have stimulated renewed interest in the ethics of clinical research. (shrink)

Are our lives meaningless? Is death bad? Would immortality be better? Alternatively, should we hasten our deaths by acts of suicide? Many people are tempted to offer comforting optimistic answers to these big questions. The Human Predicament offers a less sanguine assessment, and defends a substantial, but not unmitigated, pessimism.

The military might of the modern era poses devastating threats to humankind. Wars result from struggles for material or ideological power. In this context the probability of flouting agreements made during peaceful times is great. The rights of victims and the rights of medical personnel are vulnerable to State and military momentum in the quest for sovereignty. Scholars, scientists and physicians enjoy little enough influence during times of peace and we should be sanguine about their influence during war. But we (...) also must avoid becoming co-opted by partisan political forces. The universal ideals for which we strive, need to be cherished and kept central in our field of vision if we are to rise above man's basest instincts and if we are to preserve professional integrity, individuality and humanitarian concern for the sanctity of life — even the lives of our foes who are engaged in battle against us. Such compassion also recognizes the coercion implicit in recruiting persons into wars they detest and which pits them against their own image. Man's inhumanity to man, most evident during war, must not be allowed to pervade the sanctuary of medical care. Health professionals must constantly be encouraged to serve humankind with empathy and compassion and great social effort needs to be expended to facilitate this role globally and under all conditions. (shrink)

This series of responses was commissioned to accompany the article by Singer et al, which can be found at http://www.biomedcentral.com/1472-6939/2/1. If you would like to comment on the article by Singer et al or any of the responses, please email us on [email protected].

In a recent paper, Rob Lawlor argues that moral theories should not be taught in courses on applied ethics. The author contends that Dr Lawlor’s arguments overlook at least two important roles that some attention to ethical theories may play in practical ethics courses. The conclusion is not that moral theory must be taught, but rather that there is more to be said for it than Dr Lawlor’s arguments reveal.

Since the early 20th century, bioethics in South Africa has moved through several stages, responding to the same forces and developments as elsewhere, for example in the United Kingdom and United States. In addition, some unique developments in South Africa, for example the death of Steve Biko, the HIV/AIDS pandemic, and a peaceful transition to democracy with increased focus on human rights have given bioethics in South Africa its own dimension. Bioethics in South Africa reflects the general concerns of the (...) field elsewhere, but it also stands at the intersection of the concerns of both developed and developing worlds. Thus, issues such as resource allocation, HIV/AIDS, and medical research take on an urgency and character that reflect South Africa's particular historical, geographical, and social conditions. (shrink)

Many people think that promiscuity is morally acceptable, but rape and pedophilia are heinous. I argue, however, that the view of sexual ethics that underlies an acceptance of promiscuity is inconsistent with regarding (1) rape as worse than other forms of coercion or assault, or (2) (many) sex acts with willing children as wrong at all. And the view of sexual ethics that would fully explain the wrong of rape and pedophilia would also rule out promiscuity. I intend this argument (...) neither as a case against promiscuity nor as either a mitigation of rape or a partial defense of pedophilia. My purpose is to highlight an inconsistency in many people's judgements. Whether one avoids the inconsistency by extending or limiting the range of practices one condemns, will depend on which underlying view of the ethics of sex one accepts. (shrink)

Opinion about neonatal male circumcision is deeply divided. Some take it to be a prophylactic measure with unequivocal and significant health benefits, while others consider it a form of child abuse. We argue against both these polar views. In doing so, we discuss whether circumcision constitutes bodily mutilation, whether the absence of the child's informed consent makes it wrong, the nature and strength of the evidence regarding medical harms and benefits, and what moral weight cultural considerations have. We conclude that (...) nontherapeutic circumcision of infant boys is a suitable matter for parental discretion. (shrink)

Peter Singer has argued that the affluent have very extensive duties to the world’s poor. His argument has some important implications for procreation, most of which have not yet been acknowledged. These implications are explicated in this paper. First, the rich should desist from procreation and instead divert to the poor those resources that would have been used to rear the children that would otherwise have been produced. Second, the poor should desist from procreation because doing so can prevent the (...) very bad things that would otherwise have befallen the children they would have brought into existence. Third, the rich sometimes have a duty to prevent the poor from procreating. Fourth, the rich sometimes have a right to prevent the poor from reproducing. Although these implications may not amount to a categorical prohibition on all procreation, they do significantly restrict the permissibility of procreation. They are, in that sense, anti-natalist. (shrink)

ABSTRACTA number of problems plague universal declarations. To the extent that those drafting and adopting the declaration represent a range of different views, consensus can only be obtained if the declaration makes minimalist claims that all can support, or makes claims that are vague enough that they can be interpreted to everybody's satisfaction. To the extent that a universal declaration avoids these problems, and takes an unequivocal and controversial stand, it does so by privileging the view that is hegemonic . (...) After discussing these problems I ask whether such declarations could nonetheless do any good. (shrink)

Opinion about neonatal male circumcision is deeply divided. Some take it to be a prophylactic measure with unequivocal and significant health benefits, while others consider it a form of child abuse. We argue against both these polar views. In doing so, we discuss whether circumcision constitutes bodily mutilation, whether the absence of the child's informed consent makes it wrong, the nature and strength of the evidence regarding medical harms and benefits, and what moral weight cultural considerations have. We conclude that (...) nontherapeutic circumcision of infant boys is a suitable matter for parental discretion. (shrink)

Opinion about neonatal male circumcision is deeply divided. Some take it to be a prophylactic measure with unequivocal and significant health benefits, while others consider it a form of child abuse. We argue against both these polar views. In doing so, we discuss whether circumcision constitutes bodily mutilation, whether the absence of the child's informed consent makes it wrong, the nature and strength of the evidence regarding medical harms and benefits, and what moral weight cultural considerations have. We conclude that (...) nontherapeutic circumcision of infant boys is a suitable matter for parental discretion. (shrink)

The progress of history rests on the battle for supremacy of competing ideas.... The power and wealth of western countries give them a dominant role in shaping the international public discourse. This is a privileged position... [an] imbalance of voice in the international discourse [that] has built up a dangerous sense of resentment by the silent majority of the world’s people. The dominant bioethical paradigm that provides the context for research ethics discourse has evolved within western philosophy’s powerful normative framework (...) and is built on a relationship model that explains and underpins the obligations doctors have to their patients. In this one-to-one relationship, the doctor is... (shrink)

ABSTRACT A number of problems plague universal declarations. To the extent that those drafting and adopting the declaration represent a range of different views, consensus can only be obtained if the declaration makes minimalist claims that all can support, or makes claims that are vague enough that they can be interpreted to everybody's satisfaction. To the extent that a universal declaration avoids these problems, and takes an unequivocal and controversial stand, it does so by privileging the view that is hegemonic (...) (at least among those responsible for the declaration). After discussing these problems I ask whether such declarations could nonetheless do any good. (shrink)

It is commonly thought that theism entails full religious observance and that atheism entails either the abandonment of religious practice or, at least, its reform. Focusing on Judaism, I argue against both of these entailment claims. Both theistic departure from religious observance and atheistic adherence to religious practice are coherent. I outline the features of those religions that make them more conducive to atheistic observance. Finally, I consider various objections to full observance by atheists.

In his response to my earlier criticism, Rob Lawlor argues that the benefits I suggest can be derived from teaching moral theories in applied ethics courses can be obtained in other ways. In my reply, I note that because I never claimed the benefits could be obtained only from teaching moral theories, Dr Lawlor’s response fails to refute my earlier argument that some attention to moral theories is an option in applied ethics courses.

Do our lives have meaning? Should we create more people? Is death bad? Should we commit suicide? Would it be better to be immortal? Should we be optimistic or pessimistic? Since Life, Death, and Meaning: Key Philosophical Readings on the Big Questions first appeared, David Benatar’s distinctive anthology designed to introduce students to the key existential questions of philosophy has won a devoted following among users in a variety of upper-level and even introductory courses.

Do our lives have meaning? Should we create more people? Is death bad? Should we commit suicide? Would it be better to be immortal? Should we be optimistic or pessimistic? Since Life, Death, and Meaning: Key Philosophical Readings on the Big Questions first appeared, David Benatar's distinctive anthology designed to introduce students to the key existential questions of philosophy has won a devoted following among users in a variety of upper-level and even introductory courses.

One common mistake in discussions about the ethics of infant male circumcisioni is to attempt to answer the question of the practice's permissibility by appealing to general principles and bypassing the empirical evidence about purported benefits and harms of the practice.Joseph Mazor1 avoids the mistake of appealing only to general principles. He correctly argues that it is not sufficient to invoke a child's right to bodily integrity or to self-determinationii. Moreover, he does not appeal to parents’ rights to religious or (...) cultural freedom in order to make his case for the permissibility of parents having their sons circumcised for religious or cultural reasons.However, in invoking empirical considerations, he is insufficiently careful. For example, he includes, on the negative side of the circumcision ledger, a reduction in sexual pleasure, yet it is not clear that even his own reasoning warrants this. The problem is that he seems to want both, to acknowledge the absence of clear evidence for this claim, and to accept it as one of the costs of circumcision.He says that Michael Benatar and I2 ‘carefully reviewed the medical evidence’1 about circumcision. In the paper that he cites, we noted that competing claims were made about the effect of circumcision on sexual pleasureiii and we established that no conclusion could be drawn from the limited and conflicting evidence available on this question. Dr Mazor notes that critics could point to those studies that lend support to the conclusion that circumcision reduces sexual pleasure, but he concedes that this would be controversial,1 …. (shrink)

This book's thirty essays explore philosophically the nature and morality of sexual perversion, cybersex, masturbation, homosexuality, contraception, same-sex marriage, promiscuity, pedophilia, date rape, sexual objectification, teacher-student relationships, pornography, and prostitution. Authors include Martha Nussbaum, Thomas Nagel, Alan Goldman, John Finnis, Sallie Tisdale, Robin West, Alan Wertheimer, John Corvino, Cheshire Calhoun, Jerome Neu, and Alan Soble, among others. A valuable resource for sex researchers as well as undergraduate courses in the philosophy of sex.

Why it is better never to come into existence Not coming into existence would be good, since existence has no net advantage over non-existence. Indeed, the presence of pain is bad, and the presence of pleasure is good for every existent. However, an equivalent symmetrical consideration does not apply to the absence of pain and pleasure. Indeed, the absence of pain is good even if there is no one to experience that absence, while the absence of pleasure is not bad (...) if there is nobody to be deprived of that pleasure. The argument just presented forms the core of the article, along with other considerations about the preferability of not bringing children into the world, the quality of human life, the unreliability of subjective judgments about one's existential condition, the preferability to phase human extinction. (shrink)