Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

"A very good book indeed: there is scarcely an issue anyone has thought to raise about the topic which Childress fails to treat with sensitivity and good judgement....Future discussions of paternalism in health care will have to come to terms with the contentions of this book, which must be reckoned the best existing treatment of its subject."--Ethics. "A clear, scholarly and balanced analysis....This is a book I can recommend to physicians, ethicists, students of both fields, and to those most (...) affected--the patients themselves."--Edmund D. Pellegrino, John Carroll Professor of Medicine and Medical Humanities, Georgetown University Medical Center. (shrink)

This book explores, in rich and rigorous ways, the possibilities and limitations of “thick” autonomy in light of contemporary debates in philosophy, ethics, and bioethics. Many standard ethical theories and practices, particularly in domains such as biomedical ethics, incorporate minimal, formal, procedural concepts of personal autonomy and autonomous decisions and actions. Over the last three decades, concerns about the problems and limitations of these “thin” concepts have led to the formulation of “thick” concepts that highlight the mental, corporeal, biographical and (...) social conditions of what it means to be a human person and that enrich concepts of autonomy, with direct implications for the ethical requirement to respect autonomy. The chapters in this book offer a wide range of perspectives on both the elements of and the relations between “thin” and “thick” concepts of autonomy as well as their relative roles and importance in ethics and bioethics. This book offers valuable and illuminating examinations of autonomy and respect for autonomy, relevant for audiences in philosophy, ethics, and bioethics. (shrink)

"Public Bioethics collects the most influential essays and articles of James F. Childress, a leading figure in the field of contemporary bioethics. These essays, including new, previously unpublished material, cohere around the idea of "public bioethics," which involves analyzing and assessing public policies in biomedicine, health care, and public health, often through public deliberative bodies. The volume is divided into four sections. The first concentrates on the principle of respect for autonomy and paternalistic policies and practices. The second (...) explores the tension among bioethics, public policy, and religious convictions. It pays particular attention to the role of religious convictions in the formation of public policies and to the basis and limits of exemptions of health care providers who conscientiously oppose providing certain legal and patient-sought services. The third section looks at practices and policies related to organ transplantation. Childress focuses particularly on determining death, obtaining first-person consent for deceased organ donation, and allocating donated organs effectively and fairly. The book's fourth and final section maps the broad terrain of public health ethics, proposes a triage framework for the use of resources in public health crises, addresses public health interventions that potentially infringe civil liberties, and sheds light on John Stuart Mill's misunderstood legacy for public health ethics."--Provided by publisher. (shrink)

Journal of Religious Ethics, Volume 50, Issue 1, Page 7-19, March 2022.

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and (...) prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems. (shrink)

Organ allocation policy involves a mixture of ethical, scientific, medical, legal, and political factors, among others. It is thus hard, and perhaps even impossible, to identify and fully separate ethical considerations from all these other factors. Yet I will focus primarily on the ethical considerations embedded in the current debate in the United States about organ allocation policy. I will argue that it is important to putpatientsfirstbut even then significant ethical questions will remain about exactly how to put patients first.

This essay explores some of the conceptual and moral issues raised by illegal actions in health care. The author first identifies several types of illegal action, concentrating on civil disobedience, conscientious objection or refusal, and evasive noncompliance. Then he sketches a framework for the moral justification of these types of illegal action. Finally, he applies the conceptual and normative frameworks to several major cases of illegal action in health care, such as "mercy killing" and some decisions not to treat incompetent (...) patients. Keywords: illegal actions, mercy killing, non-treatment of incompetent patients, civil disobedience, conscientious objection, evasive non-compliance, moral justification and disobedience, dissent in health care CiteULike Connotea Del.icio.us What's this? (shrink)

Focusing mainly on respect for autonomy, particularly autonomous choices and actions in bioethical decisions, I examine several complexities of enacting this respect through the case of a fourteen-year-old boy who died after being allowed to refuse a necessary blood transfusion on religious grounds. I argue that thicker concepts of autonomy, closely connected with relational autonomy, direct our attention to aspects of respect for autonomy that are often neglected or underappreciated in much bioethical theory and practice. In particular, they illuminate the (...) interpretive complexity of respecting autonomous choices by focusing attention on the relational context of individuals’ decisions, on respect for individuals’ social-cultural beliefs and values, and on the temporality of selves, as expressed in their past consent or future consent as well as in—and sometimes in contradiction to—their present consent or dissent. However, it is important not to convert the illuminating and valuable insights from theories of relational autonomy into necessary conditions of autonomous choices and actions and hence of respect for autonomy. (shrink)

This study examines some of the moral and theological convictions that created tensions for early Christians who affirmed that the government's sword is ordained by God for a fallen world but also that Christians should not exercise it at least in warfare. Three important moral pressures toward Christian participation in war were the recognition of prevention or removal of harm as a requirement of neighbor-love, the related sense of responsibility, fault, and guilt for omissions, and the generalization test proposed by (...) Celsus, who asked Christians to consider what would happen if everyone did what they were doing, i.e., refrained from military service. Along with many other factors, these ideas contributed to the legitimation of Christian participation in war. But this legitimation itself created additional tensions, particularly because of the requirements to "turn the other cheek," to "go the second mile," etc. In order to lessen these tensions, the Church and its theologians developed several interrelated distinctions that could reduce the scope or strength of the radical demands: higher/lower; for oneself/ for others; inner/outer; and private/public. (shrink)

Case studies raise questions about patients' rights, advanced lifeprolonging measures, human subjects in medical research, and the allocation of health care resources.

The Westminster Dictionary of Christian Ethics is an invaluable reference work. Included are articles on basic ethical concepts; biblical and theological ethics; philosophical traditions; major non-Christian religious traditions; psychological, sociological, political, and other concepts important to Christian ethics; and, finally, substantial problems, such as war, usually including both information and options. With 620 entries cover a spectrum of topics that concern thinking people everywhere, providing clear, concise and accurate information about ethical concerns.

Tom Beauchamp and I were asked by the editors of The Journal of Medicine and Philosophy to prepare “intellectual autobiographies,” with particular attention to sources and influences on our work, including but not limited to Principles of Biomedical Ethics. Of course, it is artificial and even impossible to try fully to separate the “intellectual” from other aspects of our lives. So, while emphasizing the “intellectual” aspects of my autobiography, I have attended to other aspects, too. The huge debts of gratitude (...) I owe also mix the “intellectual” and other aspects of life. (shrink)

Do pacifists and proponents of justified violence share a starting point? Whether or not just war theory contains an embedded presumption against violence is an important and disputed question. Substantively it is important not only because it has implications for the possibility of dialogue among Christians of different persuasions but also because the belief that the tradition advances no moral reservations about the use of force may have the effect of lowering the moral barriers against the resort to war. Conceptually (...) it is important because it reflects a fundamental methodological disagreement concerning the meaning and resolution of conflicts among moral duties. (shrink)

This paper analyzes nonviolent resistance and direct action, as seen by its practitioners and theoreticians, from the standpoint of trust and risk-taking. After an examination of the nature of trust, the author indicates how it can illuminate what selected figures such as Gandhi and King have claimed about nonviolence. He offers this analysis not as a defense but as a way of understanding nonviolence that can serve as a starting point for further discussion.

This paper analyzes some issues that emerge in attempts to distinguish and relate "moral" and "nonmora1' action-guides. It examines one material criterion (otherregardingness) and three formal criteria (universalizability, prescriptivity, and overridingness) and considers whether they constitute necessary and/or sufficient conditions of "morality." It treats these criteria in relation to ideals and prudential, political, and religious considerations. Furthermore, it contends that the classification of action-guides as moral or nonmoral should not prejudge their respective weights or replace substantive moral debate. The formal (...) and material criteria may determine what counts as morality, not how much morality counts. (shrink)

: Moral frameworks for evaluating non-donation strategies to increase the supply of cadaveric human organs for transplantation and ways to overcome barriers to organ donation are explored. Organ transplantation is a very complex area, because the human body evokes various beliefs, symbols, sentiments, and emotions as well as various rituals and social practices. From a rationalistic standpoint, some policies to increase the supply of transplantable organs may appear to be quite defensible but then turn out to be ineffective and perhaps (...) even counterproductive because of inadequate attention to these rich and complex features of human body parts. Excessively rationalistic policies neglect deep beliefs, symbols, sentiments, and emotions and the like, and that deficiency marks many actual and proposed policies. In addition, policies are often too individualistic and too legalistic. (shrink)

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement (...) with our commentators and respond to their critical evaluations. (shrink)

This essay appreciatively and critically engages the late Robert Veatch’s extensive and important contributions to transplantation ethics, in the context of his overall ethical theory and his methods for resolving conflicts among ethical principles. It focuses mainly on ways to obtain and allocate organs from deceased persons, with particular attention to express donation, mandated choice, and presumed consent/routine salvaging in organ procurement and to conflicts between medical utility and egalitarian justice in organ allocation. It concludes by examining the unclear relations (...) between Veatch’s ideal moral theory and his nonideal moral theory, especially in organ allocation. (shrink)

: Managed care organizations can produce conflicts of obligation and conflicts of interest that may lead to problems of conscience for health care professionals. This paper provides a basis for understanding the notions of conscience and conscientious objection and offers a framework for clinicians to stake out positions grounded in personal conscience as a way for them to respond to unacceptable pressures from managers to limit services.

This article responds to the four pieces in this special symposium of the Journal of Law, Medicine & Ethics on uncontrolled organ donation following circulatory death . The response will focus on lessons and debates about the kinds of consent necessary and sufficient for temporary organ preservation in the context of DCD and for organ donation itself; on conflicts of obligation, loyalty, and interest in DCD and ways to address those conflicts; and on benefit, cost, risk assessments of uDCD programs, (...) including measures to achieve a more favorable balance of benefits, costs, and risks. (shrink)

The several articles in this special issue on organ donation after circulatory determination of death or, as it is often put, donation after cardiac death, draw lessons from different kinds of experience in order to guide efforts in the U.S. to develop or refine policies for DCD. One lesson comes from a major and, by many measures, successful experimental DCD program in Washington, D.C. in the 1990s. Another lesson comes from European countries that have adopted presumed-consent legislation, a form of (...) “opt out” that facilitates DCD as well as donation after neurological determination of death. Another lesson, from the perspective of critical care medicine in Canada, attends to the implications of viewing a dying patient, undergoing resuscitative procedures, as a potential organ donor. A final lesson sketches implications of legislation and court cases in the U.S., often involving DND, for initiating temporary organ preservation in DCD programs before consent has been obtained for organ donation. Some of these lessons are optimistic about the prospects for DCD, especially if certain steps are taken, while others are more cautious, particularly because of the costs and risks involved in DCD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics and the Allocation of Organs for TransplantationJames F. Childress (bio)A quarter of a century ago, in my second year of teaching at the University of Virginia, I began to explore the emerging field of biomedical ethics through a seminar on “Artificial and Transplanted Organs,” which included both faculty and students from law, medicine, and the humanities. My paper for the seminar was entitled “Who Shall Live When (...) Not All Can Live?” This experience drew me into biomedical ethics, because of the complex mix of ethical, legal, and medical issues and the fruitfulness of interdisciplinary and interprofessional dialogue.Several of the major problems confronting that seminar have persisted, often in altered form. In the area of organ transplantation, two significant issues continue to require society’s attention: (1) how can the organ supply be increased, and (2) how should the available organs be allocated? I want to make a few points about ethical criteria in the allocation of donated organs, as a way to indicate some directions for organ allocation policies in the twenty-first century. I will focus on the second question because I believe that a tremendous and ever-widening gap will persist between the need for transplantable organs and the supply of human cadaveric organs.Community Ownership of Donated Organs and Public ParticipationSince the mid-1980s, the operative conception of the ownership of donated organs has shifted, with major implications for the procedures used to formulate policies for organ allocation. As vice-chair of the federal Task Force on Organ Transplantation in the mid-1980s, I did not immediately realize that debates about allocation policies often reflected different conceptions of the ownership of donated organs. More specifically, organ allocation policies largely presupposed that donated organs belonged to, or were under the dispositional authority of, transplant surgeons, with only limited public accountability. However, the Task Force (1986) held that donated organs belong to the community, and that transplant professionals are only trustees and stewards of those organs for the [End Page 397] community’s welfare. This conception of ownership implies that the public should participate in setting the criteria for organ allocation.According to Jeffrey Prottas (1994), another member of the Task Force, these shifts represent the “socialization” of organ transplantation. Although professional dominance, through knowledge and power, continues in the United Network for Organ Sharing (UNOS)—the national organ procurement and transplantation network that was established in the late 1980s—that dominance is now more circumscribed and accountable, particularly because UNOS, in developing any allocation policy, has to respond “to public criticisms with public answers.” Not only is organ allocation policy now in the public domain—and thus a matter of public ethics rather than medical ethics—the terms of the debate have changed, as Prottas further notes, so that equity must be considered along with efficiency.Balancing Several Ethical Principles or ValuesThe main ethical criteria for organ allocation express principles that are prominent in the major competing theories of justice, particularly libertarian, egalitarian, utilitarian, and communitarian theories. The principles of liberty, equality, utility, and community all play important roles, and organ allocation policies often seek to balance these competing principles, which frequently are specified or circumscribed—for instance, utility is specified as medical utility. Just or equitable policies are found in the process of balancing.UNOS (1994) attempts to develop an equitable organ allocation system in light of a “set of basic principles” and “specific measurable objectives” that have been derived from these principles. It uses the metaphor of “balance” for its efforts to relate these different principles and objectives. For instance, it holds that balancing requires that “equal consideration” be given to both medical utility and to justice, so that neither can be ranked a priori over the other. However, it may not be possible to “give equal weight to [both] medical utility and justice” (UNOS 1994, p. 123) because trade-offs appear to be unavoidable in many policies and are consistent with the metaphor of balancing.Medical Utility and EqualityMedical utility—maximizing the welfare of patients suffering from end-stage organ failure—includes, at a minimum, attention to the factors that influence both graft and patient survival, as well... (shrink)

In response to theJournal of Religious Ethics(JRE) editors' request for reflections on “how religious ethicists have interacted with, and ought to interact with, public policy decision makers,” this essay focuses on doing religious ethics in the context of doing public bioethics, especially through participating in public bioethics bodies (PBBs) established to provide advice to public policymakers in what might be called “mediated advocacy.” Drawing heavily on the author's experience as a member of and a consultant to several PBBs, it features (...) case studies of PBBs deliberating about and recommending public policies to address the scarcity of postmortem organs for transplantation, the equitable allocation of COVID‐19 vaccine, cloning humans, and human embryonic stem cell research. (shrink)