Recent decades have seen the emergence of two new fields of inquiry into ethical issues in medicine. These are the fields of bioethics and of health and human rights. In this critical review of these fields, the author argues that bioethics, partly because it has been construed so broadly, suffers from quality control problems. The author also argues that the field of health and human rights is superfluous because it does nothing that cannot be done by either bioethics of the (...) law. (shrink)

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.

In his review of my book, Better never to have been, Len Doyal suggests, contrary to my view, that rational beings in the original position might prefer coming into existence to the alternative of never existing, if their lives were to include enough good and not too much bad. I argue, in response, that Professor Doyal fails to make his case.

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.

Seth Baum suggests that my claim that it is better never to come into existence “can readily be rejected not just out of reflexive distaste for the claim but also out of sound ethical reasoning”. In my reply, I argue that Mr Baum fails to state accurately what my arguments are, and then attempts to refute them by association with other views that he dismisses perfunctorily. Where he does actually engage in my views, his response is effectively merely to assert (...) the opposite. (shrink)

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.

Introduction -- Part I: The meaning of life -- Richard Taylor, The meaning of life -- Thomas Nagel, The absurd -- Richard Hare, Nothing matters -- W.D. Joske, Philosophy and the meaning of life -- Robert Nozick, Philosophy and the meaning of life -- David Schmidtz, The meanings of life -- Part II: Creating people -- Derek Parfit, Whether causing someone to exist can benefit this person -- John Leslie, Why not let life ecome extinct? -- James Lenman, On becoming (...) extinct -- David Benatar, Why it is better never to come into existence -- Part III: Death -- Stephen E. Rosenbaum, How to be dead and not care : a defense of epicurus -- GeorgePpitcher, The misfortunes of the dead -- Steven Luper, Annihilation -- Fred Fldman, Some puzzles about the evil of death -- Frederick Kaufman, Pre-vital and post-mortem non-existence -- David B. Suits, Why death is not bad for the one who died -- Part IV: Suicide -- David Hume, Of suicide -- Immanuel Kant, Suicide and duty -- David Benatar, Suicide : a qualified defence -- Part V: Immortality -- James Lenman, Immortality : a letter -- Bernard Williams, The Makropulos case : reflections on the tedium of immortality -- John Martin Fischer, Why immortality is not so bad -- Christine Overall, from here to eternity : is it good to live forever? -- Part VI: Optimism and pessimism -- Margaret A. Boden, Optimism -- Michaelis Michael and Peter Caldwell, The consolations of optimism -- Bruce N. Waller, The sad truth : optimism, pessimism, and pragmatism -- Arthur Schopenhauer, On the suffering of the world. (shrink)

Benatar argues that the absence of cosmic meaning is part of the reason why our lives are so bad that we had better not procreate. The goal of this paper is to argue against this claim from a Kantian point of view. For this goal, I argue first that the fact that human life is a product of blind evolution is not a reason for justifying that our lives are overall bad, mainly on the grounds that the concepts of good (...) and bad make sense only within the logical space of reasons. I also argue that the fact that we can hardly make a significant difference to the universe is not a reason for justifying that our lives are overall bad, either, mainly on the grounds that whether one's life is good or bad can be evaluated primarily in terms of whether one's permissible ends are achieved to a satisfactory extent, and so one's good life does not depend on making a significant difference to the universe. (shrink)

A recent exchange on Benatar’s book Better never to have been between Doyal and Benatar discusses Benatar’s bold claim that people should not be brought into existence. Here, I expand the discussion of original position that the exchange focused on. I also discuss the asymmetries, between benefit and harm and between existence and non-existence, upon which Benatar’s bold claim rests. In both discussions, I show how Benatar’s bold claim can be rejected.

Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of observational studies.3 Circumcised men in the South African trial were 60% (...) less likely to acquire HIV than their uncircumcised counterparts. A mathematical modelling study, based on the South African trial, estimates that the practice of male circumcision could avert two million new HIV infections and 300 000 HIV-related deaths over the next 10 years in sub-Saharan Africa.4 More recently, two randomised controlled trials in Kisumu, Kenya and Rakai, Uganda showed, respectively, 53% and 48% reductions in HIV acquisition among circumcised men than uncircumcised men in the trial.5 These results strongly suggest that male circumcision could play an important role in the struggle against the continued rise in new HIV infections. However, as observers noted at the 2006 XVI International AIDS Conference in Toronto, Canada, excitement about the potential epidemiological impact has overshadowed the debate over the difficult translation of research on male circumcision, into policy and practice.6 Similar calls for caution have been raised before and elsewhere.7,8The topic of male circumcision carries an enormous amount of ethical baggage. Male infants, worldwide, are circumcised for various medical, social and/or religious reasons. Circumcision is a cultural act and a surgical procedure; medical reasons are not the only reasons to circumcise that people have found and continue to find as compelling. Benatar and Benatar9 have argued that—when …. (shrink)

D Benatar argues that in the author’s recent article Moral theories in teaching applied ethics, the author overlooked important roles that could be played by moral theories in such teaching. In this reply, the cases that Benatar suggests are considered and for each an alternative approach is suggested that will avoid the costs discussed in the original paper and will also be a more effective response to that particular issue.

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)

Interviews with David Benatar and Thaddeus Metz about some core aspects of their views about meaning in life, including debate between them. Accessible to a generally educated audience. Edited by Mark Oppenheimer and Jason Werbeloff.

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)

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)

Procreation and Parenthood offers new and original essays by leading philosophers on some of the main ethical issues raised by these activities.

Better Never to Have Been argues for a number of related, highly provocative, views: (1) Coming into existence is always a serious harm. (2) It is always wrong to have children. (3) It is wrong not to abort fetuses at the earlier stages of gestation. (4) It would be better if, as a result of there being no new people, humanity became extinct. These views may sound unbelievable--but anyone who reads Benatar will be obliged to take them seriously.

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)

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)

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.

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

In Better Never to Have Been: The Harm of Coming into Existence, I argued that coming into existence is always a harm and that procreation is wrong. In this paper, I respond to those of my critics to whom I have not previously responded. More specifically, I engage the objections of Tim Bayne, Ben Bradley, Campbell Brown, David DeGrazia, Elizabeth Harman, Chris Kaposy, Joseph Packer and Saul Smilansky.

Sara Kolmes has argued that the human ‘handlers’ of emotional support animals should have the sorts of body-like rights to those animals that people with prosthetics have to their prosthetics. In support of this conclusion, she argues that ESAs both function and feel like prosthetics, and that the disanalogies between ESAs and prosthetics are irrelevant to whether humans can have body-like rights to their ESAs. In response, we argue that Ms Kolmes has failed to show that ESAs are body-like in (...) the ways that paradigmatic prostheses are and that, even if they were, these similarities would be outweighed by a crucial dissimilarity that she underestimates. (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)

While procreation is ubiquitous, attention to the ethical issues involved in creating children is relatively rare. In Debating Procreation, David Benatar and David Wasserman take opposing views on this important question. David Benatar argues for the anti-natalist view that it is always wrong to bring new people into existence. He argues that coming into existence is always a serious harm and that even if it were not always so, the risk of serious harm is sufficiently great to make procreation wrong. (...) In addition to these "philanthropic" arguments, he advances the "misanthropic" one that because humans are so defective and cause vast amounts of harm, it is wrong to create more of them.David Wasserman defends procreation against the anti-natalist challenge. He outlines a variety of moderate pro-natalist positions, which all see procreation as often permissible but never required. After criticizing the main anti-natalist arguments, he reviews those pronatalist positions. He argues that constraints on procreation are best understood in terms of the role morality of prospective parents, considers different views of that role morality, and argues for one that imposes only limited constraints based on the well-being of the future child. He then argues that the expected good of a future child and of the parent-child relationship can provide a strong justification for procreation in the face of expected adversities without giving individuals any moral reason to procreate. (shrink)

Machine generated contents note: Preface; Introduction; Part I. Global Health, Definitions and Descriptions: 1. What is global health? Solly Benatar and Ross Upshur; 2. The state of global health in a radically unequal world: patterns and prospects Ron Labonte and Ted Schrecker; 3. Addressing the societal determinants of health: the key global health ethics imperative of our times Anne-Emmanuelle Birn; 4. Gender and global health: inequality and differences Lesley Doyal and Sarah Payne; 5. Heath systems and health Martin McKee; Part (...) II. Global Health Ethics, Responsibilities and Justice: Some Central Issues: 6. Is there a need for global health ethics? For and against David Hunter and Angus Dawson; 7. Justice, infectious disease and globalisation Michael Selgelid; 8. International health inequalities and global justice: toward a middle ground Norman Daniels; 9. The human right to health Jonathan Wolff; 10. Responsibility for global health? Allen Buchanan and Matt DeCamp; 11. Global health ethics: the rationale for mutual caring Solly Benatar, Abdallah Daar and Peter Singer; Part III. Analyzing Some Reasons for Poor Health: 12. Trade and health: the ethics of global rights, regulation and redistribution Meri Koivusalo; 13. Debt, structural adjustment and health Jeff Rudin and David Sanders; 14. The international arms trade and global health Salahaddin Mahmudi-Azer; 15. Allocating resources in humanitarian medicine Samia Hurst, Nathalie Mezger and Alex Mauron; 16. International aid and global health Anthony Zwi; 17. Climate change and health: risks and inequities Sharon Friel, Colin Butler and Anthony McMichael; 18. Animals, the environment and global health David Benatar; 19. The global crisis and global health Stephen Gill and Isabella Bakker; Part IV. Shaping the Future: 20. Health impact fund: how to make new medicines accessible to all Thomas Pogge; 21. Biotechnology and global health Hassan Masun, Justin Chakma and Abdallah Daar; 22. Food security and global health Lynn McIntyre and Krista Rondeau; 23. International taxation Gillian Brock; 24. Global health research: changing the agenda Tikki Pang; 25. Justice and research in developing countries Alex John London; 26. Values in global health governance Kearsley Stewart, Gerald T. Keusch and Arthur Kleinman; 27. Poverty, distance and two dimensions of ethics Jonathan Glover; 28. Teaching global health ethics James Dwyer; 29. Towards a new common sense: the need for new paradigms of global health Isabella Bakker and Stephen Gill; Index. (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)

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)

_Does sexism against men exist? What it looks like and why we need to take it seriously_ This book draws attention to the "second sexism," where it exists, how it works and what it looks like, and responds to those who would deny that it exists. Challenging conventional ways of thinking, it examines controversial issues such as sex-based affirmative action, gender roles, and charges of anti-feminism. The book offers an academically rigorous argument in an accessible style, including the careful use (...) of empirical data, and includes examples and engages in a discussion of how sex discrimination against men and boys also undermines the cause for female equality. (shrink)

Many people are resistant to the conclusions for which I argued in Better Never to Have Been . I have previously responded to most of the published criticisms of my arguments. Here I respond to a new batch of critics (and to some fellow anti-natalists) who gathered for a conference at the University of Johannesburg and whose papers are published in this special issue of the South African Journal of Philosophy . I am also taking the opportunity to respond to (...) two other critics whose articles have previously been published in South African philosophy journals. Clearly I cannot respond to all the arguments in each of these papers and thus I shall focus on what I take to be some of the central issues in each. None of the arguments to which I shall respond have caused me to revise my views. However, I am pleased to have the opportunity to show why this is the case. (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)