This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. (shrink)

This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. (shrink)

"Be All You Can Be," the Army recruiting poster urges young men and women. Many parents share the sentiment. They want their children to be the best they can be. For many parents, their most important project in life is to pursue that goal, and they make sacrifices to see it happen. And why shouldn't parents aim to make their offspring the best they can be?

In the months preceding the writing of this review, bioethics has been in the news a great deal. In congressional and public policy debates surrounding stem cell research, human cloning, and the Human Genome Project, bioethics and bioethicists have gained national attention and been subject to public scrutiny. Commentators have asked who these self-appointed moral experts are to tell us what is right and wrong.

Which inequalities in longevity and health among individuals, groups, and nations are unfair? And what priority should health policy attach to narrowing them? These essays by philosophers, economists, epidemiologists, and physicians attempt to determine how health inequalities should be conceptualized, measured, ranked, and evaluated.

Scientific knowledge of how genes work is giving human beings unprecedented power to shape future human lives, for better or for worse. People involved in government, business and science are facing new questions related to the application of genetic technologies to human beings. Our technical knowledge is growing fast, but does our moral wisdom grow at the same rate?

Everyone wants to be healthy, but many of us decline to act in healthy ways. Should these choices have any bearing on the ethics of clinical practice and health policy? How may personal responsibility for health be manipulated in health policy debates.

Humans massively depend on communication with others, but this leaves them open to the risk of being accidentally or intentionally misinformed. To ensure that, despite this risk, communication remains advantageous, humans have, we claim, a suite of cognitive mechanisms for epistemic vigilance. Here we outline this claim and consider some of the ways in which epistemic vigilance works in mental and social life by surveying issues, research and theories in different domains of philosophy, linguistics, cognitive psychology and the social sciences.

Eugenics casts a long shadow over contemporary genetics. Any measure, whether in clinical genetics or biotechnology, which is suspected of eugenic intent is likely to be opposed on that ground. Yet there is little consensus on what this word signifies, and often only a remote connection to the very complex set of social movements which took that name. After a brief historical summary of eugenics, this essay attempts to locate any wrongs inherent in eugenic doctrines. Four candidates are examined and (...) rejected. The moral challenge posed by eugenics for genetics in our own time, I argue, is to achieve social justice. (shrink)

In this paper we examine some issues of distributive justice in relation to the distribution of health in a population. Our focus is on socioeconomic inequalities in health within a society. Research suggests that socioeconomic status and level of education are strongly correlated with level of health such that those with lower status in a society are relatively sicker than their counterparts who have higher status. Importantly, the correlation we are concerned with is not the obvious correlation between poor health (...) and absolute material deprivation, or poor health and bad health habits. In nearly all countries, those at the bottom of the socioeconomic scale suffer anywhere from 2–4 times the mortality and morbidity rates of those at the top. This startling statistic apparently holds true regardless of differences in the material position of the worst-off. Moreover, even in the wealthiest countries the groups who have the highest status enjoy better health and longer life than those who have the next-highest status, and so on down the socioeconomic scale. Our question is whether these social inequalities in health are unjust in and of themselves. -/- . (shrink)

Dan Zahavi engages with classical phenomenology, philosophy of mind, and a range of empirical disciplines to explore the nature of selfhood. He argues that the most fundamental level of selfhood is not socially constructed or dependent upon others, but accepts that certain dimensions of the self and types of self-experience are other-mediated.

In his recent book ‘Kant and the Mind’ Andrew Brook makes a distinction between two types of selfawareness. The first type, which he calls empirical self-awareness, is an awareness of particular psychological states such as perceptions, memories, desires, bodily sensations etc. One attains this type of self-awareness simply by having particular experiences and being aware of them. To be in possession of empirical self-awareness is, in short, simply to be conscious of one’s occurrent experience. The second type of self-awareness he (...) calls apperceptive self-awareness. This type of self-awareness entails an awareness of oneself as the subject of experience. For this type of self-awareness to obtain, it would not be enough merely to be conscious of, say, an occurrent perception of a chair, one would also have to be aware that it was oneself who was perceiving the chair. And as Brook adds, when I am self-aware in this way, I am not only aware of being the subject of a single experience, but also aware of myself as the common subject of other psychological states (Brook, 1994: 55-57). I find Brook’s distinction illuminating, but it raises a question which I would like to pursue in this paper. When we speak of self-awareness, do we then necessarily also speak of a self, is there so to speak always a self involved in self-awareness, or is it rather the case, as Brook’s notion of empirical selfawareness might suggest, that there are types of self-awareness which are ‘selfless’, or to use two other related terms ‘subjectless’ or ‘non-egological’? Is self-awareness always to be understood as an awareness of a self, or can it be understood simply as the awareness which a specific experience has of itself? Ultimately, I believe an answer to these questions are important, both when it comes to an understanding of what exactly self-awareness amounts to, and also when it comes to a proper understanding of what a self is.. (shrink)

Michael Bloomberg's three terms in New York City's mayoral office are coming to a close. His model of governance for public health influenced cities and governments around the world. What should we make of that model? This essay introduces a symposium in which ethicists Sarah Conly, Roger Brownsword and Alex Rajczi discuss that legacy.

The aim of this volume is to discuss recent research into self-experience and its disorders, and to contribute to a better integration of the different ...

The alleged for-me-ness or mineness of conscious experience has been the topic of considerable debate in recent phenomenology and philosophy of mind. By considering a series of objections to the notion of for-me-ness, or to a properly robust construal of it, this paper attempts to clarify to what the notion is committed and to what it is not committed. This exercise results in the emergence of a relatively determinate and textured portrayal of for-me-ness as the authors conceive of it.

Only recently have historians explored in depth the role of the medical profession in Nazi Germany. Several recent works reveal that physicians joined the Nazi party in disproportionate numbers and lent both their efforts and their authority to Nazi eugenic and racist programs. While the crimes of the physician Mengele and a few others are well known, recent research points to a much broader involvement by the profession, even in its everyday clinical work. Analogous activities existed in the German legal (...) and industrial communities; disruption of the medical ethic thus sprang from the broader social contexts of Nazi Germany. The new United States Holocaust Memorial Museum, now opening on the Mall in Washington, D.C, will have an opportunity to educate the public about both the great crimes at Auschwitz and other camps, and the gradual but thorough degradation of ethics in the German medical profession. From this presentation, contemporary bioethics can ponder the proper use of the Nazi analogy in bioethical debate. (shrink)

Scientists seeking to conduct research with human subjects must first submit their proposals to research ethics committees (Institutional Review Boards [IRBs], in the United States). Some of these studies pose risks to “bystanders,” i.e., people who may be affected by the research but who are not enrolled as study subjects. Should IRBs expand their scope to include oversight over possible harms to bystanders as well as research subjects? This paper presents arguments against this step. Prior review of research with human (...) subjects, despite its evident burden on the research enterprise, is a necessary caution, because the tension between the objectives of humane treatment of research subjects and sound scientific design and procedure has in the past led to serious abuses. This rationale is inapplicable in the case of bystanders. Moreover, in view of the many and varied effects of both research practices and scientific advances on the broader public over time, those who may be considered to be “bystanders” may potentially expand without limit; requiring IRBs to anticipate these distant and long‐term effects as part of prior ethical review could greatly increase its burden and its deterrent effect on research. While conducting research without concern for serious potential harm to bystanders may be irresponsible and unethical, expanding the scope of prior review by IRBs to include risks to bystanders is not required by the principles governing human subjects research, and the costs and burdens of this expansion may outweigh any expected gains. (shrink)

This chapter contains sections titled: The Case for Restricting the Civil Liberties of the Cognitively Disabled Two Conceptions of Competence Further Topics Editor's Note.

Current medical and legal literature generally favors a definition of death based on total cessation of brain functioning. It does not, however, supply the reasoning for this recommendation. None of the arguments for whole-brain death is convincing; there exists, however, a satisfactory rationale for identifying death with cortical death. Policymakers should refrain from endorsing any of these arguments, focussing instead on the pragmatic tasks involved in guiding medical care at the end of life.