Despite tendencies to compete for a prime place in moral theory, neither virtue ethics nor the four principles approach should claim to be superior to, or logically prior to, the other. Together they provide a more adequate account of the moral life than either can offer on its own. The virtues of principlism are clarity, simplicity and (to some extent) universality. These are well illustrated by Ranaan Gillon’s masterly analysis of the cases he has provided. But the vices of this (...) approach are the converse of its virtues: neglect of emotional and personal factors, oversimplification of the issues, and excessive claims to universality. Virtue ethics offers a complementary approach, providing insights into moral character, offering a blend of reason and emotion, and paying attention to the context of decisions. The cases provided can be more adequately understood if we combine the approaches. Both should foster the virtues of humility and magnanimity. (shrink)

The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional practice (...) of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families. (shrink)

In the United Kingdom there have been few committees or commissions dealing specifically with biomedical ethics, and where such bodie.

Political argument and institutions in the UnitedKingdom have frequently been represented as the products of ablend of nationalistic conservatism, liberal individualism andsocialism, in which consensus has been prized over ideology. This situation changed, as the standard story has it, with therise of Thatcherism in the late 1970s, and again with the arrivalof Tony Blair's ``New Labour'' pragmatism in the late 1990s. Solidarity as an element of political discourse makes itsappearance in the UK late in the day. It has been most (...) stronglylinked to the Third Way debate, as framed most influentially inthe work of Prof. Anthony Giddens.In this paper we review the history and pre-history of the debateon solidarity in the UK, focussing mostly on its implications forwelfare state reform. In particular we discuss the proposals forthe long-term care of the Elderly issued by the Royal Commissionon long-term care in 1999. In this context we critically examinethe idea that solidarity is a new concept in British politicalculture, and that it is a concept which has real political ``bite''in the project of welfare reform. We examine this through aconsideration of Giddens's attempted synthesis of politicalargument and social theory. (shrink)

During a pandemic, where there is widespread human infection, various and varying measures are taken that are targeted at public health objectives. During the early stages of a pandemic, these objectives may focus on containing the disease and minimizing its spread, but they may switch to mitigation as the emergent infectious disease takes hold in a population. There has been considerable debate and elucidation of the ethical principles and framework for the various responses including the need to fast track research (...) and vaccine development. However, the measures imposed during a pandemic would have unintended and untoward effect on ongoing clinical research. For example, precautionary measures, such as social distancing, may hamper ongoing clinical research, because recruitment and participation of patients and healthy volunteers is a potential source of virus spread. In this paper, we argue that a framework is needed to ensure the continuity of such research. Such a framework that considers the pertinent issues would need the ‘buy in’ of the key stakeholders (policy makers, funding agencies, institutional authorities, researchers and subjects) to ensure that the issues that are ethically relevant to pandemic planning would not be neglected or overlooked. (shrink)

A large number of definitions of the concept “model” have been given by various authors in recent years. Thirty-seven definitions are listed by A. I. Uyemov in a recent monograph. This list is somewhat one-sided since it contains a disproportionate number of references to the work of Soviet authors. However, most of the important definitions given by Western writers are included. I shall give three definitions, all of great generality, so that various types of models, replicas, maps, theories and, most (...) importantly, cybernetic models, are included. The advantage of this high degree of generality, or all-inclusiveness, is that the task of the investigator of uses of models in science, is reduced to classifying the various types of models, their construction, function, and structure, thus avoiding indecisive arguments such as the Duhem–Campbell controversy, so perceptively discussed by Mary Hesse. (shrink)

The concept of free will is fraught with controversy, as readers of this volume likely know. Philosophers disagree about what free will is, whether we have it, what mitigates or destroys it, and what it's good for. Indeed, philosophers even disagree about how to fix the referent of the term 'free will' for purposes of describing and exploring these disagreements. What one person considers a reasonably neutral working definition of 'free will' is often considered question-begging or otherwise misguided by another. (...) Such disputes make it difficult to summarize the problem of free will, roughly the debate over the nature and existence of free will, in a clear and uncontentious way. In generic terms, however, the two basic solutions to the problem of free will are free-willism, the view that we have free will, and free-will denialism, i.e. the view that we do not have free will. As stated here, neither denialism nor free-willism constitutes a complete solution to the problem of free will; to be complete, a proposed solution must also tell us a convincing story about what free will is and that, as it turns out, is a very difficult task indeed. One historically popular way of approaching the problem of free will is to ask about the relationship between free will and determinism: "Does free will stand in relation R to determinism: yes or no?" This is just a template for a question, of course. To transform this template-question into a substantive question with a clear meaning, we need to flesh out the template's free-will relatum, its determinism relatum, and give a precise value to relation R. There is, however, no uncontroversial way to do this. In addition to the standard difficulties raised by fixing the referent of 'free will', philosophers hold radically different views about what is-or should be-meant by 'determinism', Shabo ), and they identify relations which are as substantively different as correlation and causation when characterizing relation R. In practical terms, then, it may be best to think of the problem of determinism as a loose collection of disagreements about how to best spell out and answer the template-question, and how asking and answering such questions would help us to solve the problem of free will. (shrink)

"We wish this volume to be a sure companion to the study of free will, broadly construed to include action theory, moral and legal responsibility, and cohort studies feathering off into adjacent fields in the liberal arts and sciences. In addition to general coverage of the discipline, this volume attempts a more challenging and complementary accompaniment to many familiar narratives about free will. In order to map out some directions such accompaniment will take, in this introduction we anchor the thirty (...) contributions to this volume in some common history from which they arise, and attempt to indicate where future work in free will and moral responsibility will–and has already begun to–depart from that history." -Excerpt from Introduction. ... ... To read full introduction, (1) download attached file or (2) follow wiley_dot_com link below, click "Read An Excerpt", then click :Excerpt 3:(pdf)". (shrink)

In this chapter, I shall give an account of the emergence of bioethics as a field of study and then describe its common features in an international context. In the final section I shall suggest how some concept of public reason might be used to meet the challenges thrown up by the contentious nature of the field.

Fortunately, to be a commentator on a lecture does not entail that one disagrees with it! I heartily endorse a great deal of what Jonathan has argued for in this lecture; and I cannot think of a more timely moment to speak up for respect for human dignity in an absolute opposition to humiliation, when In the USA and in the UK political leaders have used public humiliation of minority groups as a way of gaining power, and such denial of (...) basic human rights has seemingly become acceptable to large section of the population. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

The author explores different views of the significance of the human body and contrasts those which regard it as a commodity or personal possession with those which stress its moral value as integral to the personal identity of individuals. This study provides background to many of the controversies in medical ethics.

This book is intended as a practical introduction to the ethical problems which doctors and other health professionals can expect to encounter in their practice. It is divided into three parts: ethical foundations, clinical ethics, and medicine and society. The authors incorporate new chapters on topics such as theories of medical ethics, cultural aspects of medicine, genetic dilemmas, aging, dementia and mortality, research ethics, justice and health care (including an examination of resource allocation), and medicine, ethics and medical law. Medical (...) Ethics also covers issues having to do with the beginning and end of life, as well as ethical questions surrounding the human body and the use of human tissue, confidentiality and AIDS, care of the mentally ill, and the implications of genetic technology. Each chapter presents a range of ethical views, drawing both from traditional philosophy and the most recent contemporary trends. The theoretical discussion is extended and illustrated by case studies and examples. This book is a non-technical guide to ethics written with the needs of medical students and medical practitioners in mind. It will also appeal to students and practitioners of allied health professions, and for all users of health care services. (shrink)

Deftly quilting themes of Latin American and feminist liberation theologies with those of philosophers such as Immanuel Kant and John Rawls, Alastair V. Campbell displays our rich interconnectedness and our moral responsibilities to one another. Suggesting that many American citizens are oppressed by our current health-care system, he contends that prior to questions of health-care allocation are questions of what we mean as a society by the term health--and how that term is inextricably linked to personal and social freedom (...) and liberation. In the forceful final chapter of the book, Campbell articulates ethical standards for just health-care delivery in the United States--standards that, above all, take account of deep religious faith and concern for one's neighbor. Health as Liberation is a critical analysis of justice and modern health care, and of a society's moral obligations to its citizens. (shrink)

In this paper I shall be arguing against the claim made by Erin and Harris and others, that creating a “regulated market” in organs for transplantation taken from living vendors is both viable practically and a moral imperative. No-one can doubt that there is currently a crisis in the provision of organs for transplantation, with a massive gap between supply and demand. There are a number of reasons for this crisis. Since its development as a life-saving measure in the second (...) half of the last century, organ transplantation has expanded exponentially, both in terms of survival rates, the number of people on the waiting list for the procedure, and the range of transplantable organs. Advances in immuno-suppression and in prevention of infection have led to improvement in both the survival of the recipients and of the transplanted organs. At the same time, there has been an increase in repeat transplantations and in multiple organ transplants. The range of conditions for which transplantation is offered has widened, and transplantable organs now include: kidney, liver, pancreas, heart and lung. Brain-dead donors can provide all of these organs, while the kidney and sections of the liver and pancreas can also be obtained from living donors. Survival outcomes are better from living donors than from cadaveric donors, and, in the case of kidney failure, better from transplantation than from dialysis. [End Page 164] The relevant question, however, is whether permitting a market in human organs is morally justifiable, and, even if it were, whether it would provide a solution to the current crisis. I argue in this paper that organ trading is wrong in principle, since it commodifies the human body and inevitably exploits the poor and the socially vulnerable, and that, far from alleviating the crisis, it is likely to make it worse. First we should note that there is an uncompromising opposition to all forms of organ trading from two major international healthcare organisations. (shrink)

This highly speculative paper seeks to discern where the discipline of Bioethics may be heading in the next decade or two. It is clear that the rapid pace of scientific discovery and technological innovation will not slacken, and, as a result, fresh moral issues, for which there are no precedents in currently accepted moral wisdom, will rapidly emerge. This mushrooming of ethical problems will be taking place at a time of increasing moral pluralism, when common moral values become harder to (...) establish, and powerful subgroups embrace moral dogmatism, whether religious or secular in character.Faced with such complexity and confusion, governments and industrial groups will increasingly seek guidance from bioethics "experts", through paid consultancies, advisory panels and commissioned reports on specific topics. But Bioethics itself is currently in a stage of flux: 1. Certain research areas in Bioethics have 'bolted' (in the horticultural sense), because of a rich injection of funds - notably genetics and stem cell research - while other areas are relatively under-researched. 2. Inter-disciplinarity has become de rigueur, largely under funder pressure, and, allied to this, an insistence on empirical work has created conceptual confusions. 3. There is a continuing ferment in bioethical theory, with little sign of productive co-operation between rival camps. Indeed theoretical enrichment seems to lag far behind the constant demand for relevance and 'applied ethics'.So what of the future? I detect certain trends, some to be deplored and discouraged, others to be applauded and nurtured. On my 'black list' are: the commercialisation of Bioethics; and the dumbing down of several critical disciplines in the name of relevance. On my 'white list' are: further adventures in theory; inter-disciplinarity come of age; and the future envisioned in today's young minds. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren (...) Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

Over the last decade, stem cell research has generated an enormous amount of public, political and bioethical debate. These debates have overwhelmingly tended to focus on two moral issues: the moral status of human embryos and the duty to care for the sick and vulnerable. This preoccupation, especially on the question of moral status, has not only dichotomized the debate around two fundamentally incommensurable positions, it has come at the cost of other important issues largely being ignored. In highlighting some (...) of the bioethical and regulatory deficiencies of this fixation, we draw on recent developments in the experimental use of autologous adult stem cells to argue for a more inclusive approach to the ethical issues surrounding stem cell research. (shrink)

In responce to criticisms of proposed regulation of surrogacy, it isargued that surrogate mothers and providers of fertility serviceshave duties which make the selling of claims to parenthood unethicaland which justify regulation of surrogacy arrangements.

The distinctiveness of Bioethics in New Zealand stems in part from a renewal of emphasis on Maori rights, based on the Treaty of Waitangi, the foundation document of the New Zealand state. Increasingly, committees dealing with health research ethics and with the ethics of assisted reproductive technology have to incorporate Maori values and perspectives.

The distinctiveness of Bioethics in New Zealand stems in part from a renewal of emphasis on Maori rights, based on the Treaty of Waitangi, the foundation document of the New Zealand state. Increasingly, committees dealing with health research ethics and with the ethics of assisted reproductive technology have to incorporate Maori values and perspectives.

This is a practical introduction to the range of ethical questions which doctors and other health-care professionals may be expected to encounter in practice. The books covers both the traditional "end of life" issues and also deals with medical research and consent issues, confidentiality and AIDS, resource allocation, care of the mentally ill, and the doctor/patient relationship. Each chapter canvasses a range of ethical views, drawing both from traditional philosophical responses and the most recent contemporary responses. Theoretical discussion is extended (...) and enlivened by the use of hypothetical and actual examples, suitable both for private study or group discussion. While the needs of medical students for a non-technical guide to ethics have been kept firmly in mind, the clarity of writing and avoidance of specialist medical and philosophical terminology ensure that it will be of value to students of nursing and related disciplines, and accessible to the lay reader. (shrink)

The New Zealand health service has been extensively changed over the past four years, with the introduction of Jour new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a “core” and no list, either positive or negative has been defined. Instead (...) general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scare resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need. (shrink)

The New Zealand health service has been extensively changed over the past four years, with the introduction of Jour new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a “core” and no list, either positive (inclusions) or negative (exclusions) has been (...) defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scare resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need. (shrink)

The Medical Faculty of the University of Otago, New Zealand is experimenting with a new approach to the teaching of medical ethics, making it an integral part of several courses in all years of the medical curriculum. During the author's twelve-month period as a visiting professor in the faculty, trial runs in ethics have been introduced in the preclinical sciences, in behavioural science and medical-decision analysis and in every clinical attachment. Proposals for permanent course requirements will be considered by the (...) faculty after a full evaluation of these experiments by both students and teaching staff. If such courses are to be implemented and maintained, medical facilities will need to appoint specialists in ethics, at least on a part-time basis. (shrink)

Background Several jurisdictions, including Singapore, Australia, New Zealand and most recently Ireland, have a public interest or public good criterion for granting waivers of consent in biomedical research using secondary health data or tissue. However, the concept of the public interest is not well defined in this context, which creates difficulties for institutions, institutional review boards and regulators trying to implement the criterion. Main text This paper clarifies how the public interest criterion can be defensibly deployed. We first explain the (...) ethical basis for requiring waivers to only be granted to studies meeting the public interest criterion, then explore how further criteria may be set to determine the extent to which a given study can legitimately claim to be in the public interest. We propose an approach that does not attempt to measure magnitude of benefit directly, but rather takes into account metrics that are more straightforward to apply. To ensure consistent and justifiable interpretation, research institutions and IRBs should also incorporate procedural features such as transparency and public engagement in determining which studies satisfy the public interest requirement. Conclusion The requirement of public interest for consent waivers in secondary biomedical research should be guided by well-defined criteria for systematic evaluation. Such a criteria and its application need to be periodically subject to intra-committee and intra-institution review, reflection, deliberation and amendment. (shrink)

This article discusses the establishment of a governance framework for biomedical research in Singapore. It focuses on the work of the Bioethics Advisory Committee , which has been instrumental in institutionalizing a governance framework, through the provision of recommendations to the government, and through the coordination of efforts among government agencies. However, developing capabilities in biomedical sciences presents challenges that are qualitatively different from those of past technologies. The state has a greater role to play in balancing conflicting and potentially (...) irreconcilable economic, social, and political goals. This article analyzes the various ways by which the BAC has facilitated this. (shrink)