Scientists engaged in global health research are increasingly faced with barriers to access and use of human tissues from the developing world communities where much of their research is targeted. In part, the problem can be traced to distrust of researchers from affluent countries, given the history of 'scientific-imperialism' and 'biocolonialism' reflected in past well publicized cases of exploitation of research participants from low to middle income countries. To a considerable extent, the failure to adequately engage host communities, the opacity (...) of informed consent, and the lack of fair benefit-sharing have played a significant role in eroding trust. These ethical considerations are central to biomedical research in low to middle income countries and failure to attend to them can inadvertently contribute to exploitation and erode trust. A 'tissue trust' may be a plausible means for enabling access to human tissues for research in a manner that is responsive to the ethical challenges considered. Preventing exploitation and restoring trust while simultaneously promoting global health research calls for innovative approaches to human tissues research. A tissue trust can reduce the risk of exploitation and promote host capacity as a key benefit. (shrink)

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.

Medicine and health care generate many bioethical problems and dilemmas that are of great academic, professional and public interest. This comprehensive resource is designed as a succinct yet authoritative text and reference for clinicians, bioethicists, and advanced students seeking a better understanding of ethics problems in the clinical setting. Each chapter illustrates an ethical problem that might be encountered in everyday practice; defines the concepts at issue; examines their implications from the perspectives of ethics, law and policy; and then provides (...) a practical resolution. There are 10 key sections presenting the most vital topics and clinically relevant areas of modern bioethics. International, interdisciplinary authorship and cross-cultural orientation ensure suitability for a worldwide audience. This book will assist all clinicians in making well-reasoned and defensible decisions by developing their awareness of ethical considerations and teaching the analytical skills to deal with them effectively. (shrink)

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...) Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

The international context of the last fifty years of modern bioethics have been significant in establishing health-care ethics or bioethics as a common parlance - an ideology of our times, achieving near universal acceptance, with little dissent. Most international health organizations have developed important declarations that have become the credo of their daily practice and long-term commitments. However, in the last decade in particular, bioethicists and other health-care practitioners and scholars have worried about the persistence of health-care inequities and the (...) inadequate realization of bioethics, particularly in low-to-middle income countries. Global bioethics, now well into the new millennium, has entered a regulatory crisis: it needs to confront not just global bioethical commitments around major scientific revolutions such as genomics, but further, a regulatory crisis about the persisting national public law silences and health inequities, especially in low-to-middle income countries. (shrink)

The international context of the last fifty years of modern bioethics have been significant in establishing health-care ethics or bioethics as a common parlance - an ideology of our times, achieving near universal acceptance, with little dissent. Most international health organizations have developed important declarations that have become the credo of their daily practice and long-term commitments. However, in the last decade in particular, bioethicists and other health-care practitioners and scholars have worried about the persistence of health-care inequities and the (...) inadequate realization of bioethics, particularly in low-to-middle income countries. Global bioethics, now well into the new millennium, has entered a regulatory crisis: it needs to confront not just global bioethical commitments around major scientific revolutions such as genomics, but further, a regulatory crisis about the persisting national public law silences and health inequities, especially in low-to-middle income countries. (shrink)

Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in (...) the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements. (shrink)

Human reproductive cloning has become the most palpable example of the globalization of science. Throughout the world, events and conjectures in the media, such as the birth and death in the United Kingdom of the cloned sheep Dolly and projects to clone human beings by Korean scientists, by members of the Canadian-based Raelian cult, and by the Italian physician Antinori in an undisclosed country, have galvanized the political will of individual countries to ban human reproductive cloning.Yet, international attempts to harmonize (...) policies in the area of biomedical ethics and human research, such as the 1997 Council of Europe’s Convention on Human Rights and Biomedicine, and most recently, the United Nations’ efforts to adopt an international convention against human reproductive cloning, have been insufficient to trigger a substantial global policy design process on issues relating to these new technologies. (shrink)

As I write this, in November 1971, people are dying in East Bengal from lack of food, shelter, and medical caxc. The suffering and death that are occurring there now axe not inevitable, 1101; unavoidable in any fatalistic sense of the term. Constant poverty, a cyclone, and a civil war have turned at least nine million people into destitute refugees; nevertheless, it is not beyond Lhe capacity of the richer nations to give enough assistance to reduce any further suffering to (...) very small proportions. The decisions arid actions of human beings can prevent this kind of suffering. Unfortunately, human beings have not made the necessary decisions. At the individual level, people have, with very few exceptions, not responded to the situation in any signihczmt way. Generally speaking, people have not given large sums to relief funds; they have not written t0 their parliamentaxy representatives demanding increased government assistance; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward providing thc refugees with the means to satisfy their essential needs. At thc government level, no govcrmmcnt has given the sort of massive aid that would enable the refugees to survive fm: more than a few days. Britain, for instance, has given rather more than most countries. It has, to date, given £14,750,000. For comparative purposes, B1~itain’s share of thc nonreccverabla development costs of the Anglo-French Concorde project is already in excess of £275,000,000, and on present estimates will reach £440,000,¤00. The implication is that the British government values a supersonic transport more than thirty times as.. (shrink)

The Institute of Medicine's report, the American Medical Association's project, the Open Society Institute's and the initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives. Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences (...) could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form. (shrink)

Since its original publication in 1975, this groundbreaking work has awakened millions of people to the existence of "speciesism"—our systematic disregard of nonhuman animals—inspiring a worldwide movement to transform our attitudes to animals and eliminate the cruelty we inflict on them. In Animal Liberation, author Peter Singer exposes the chilling realities of today’s "factory farms" and product-testing procedures—destroying the spurious justifications behind them, and offering alternatives to what has become a profound environmental and social as well as moral (...) issue. An important and persuasive appeal to conscience, fairness, decency, and justice, it is essential reading for the supporter and the skeptic alike. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

It may seem that there is no need to review such a well-known book. This is the second edition of Peter Singer's text, Practical Ethics. The first edition has been widely used and influential; indeed for many it defines the field of applied ethics. The field is lucky; rarely is such popular work so carefully argued, so factually well informed and so well written. In addition, it is unusual for the author of a basic text to be so (...) daring. Peter Singer deserves credit for placing the interests of animals and famine victims on the agenda of applied ethics, and for making that agenda so prominent in public fora. But it behooves us to scrutinize carefully the power of definitive works as well. What sets the agenda is, for that very reason, more difficult to assess critically. (shrink)

What is ethics? Where do moral standards come from? Are they based on emotions, reason, or some innate sense of right and wrong? For many scientists, the key lies entirely in biology---especially in Darwinian theories of evolution and self-preservation. But if evolution is a struggle for survival, why are we still capable of altruism? In his classic study The Expanding Circle, Peter Singer argues that altruism began as a genetically based drive to protect one's kin and community members (...) but has developed into a consciously chosen ethic with an expanding circle of moral concern. Drawing on philosophy and evolutionary psychology, he demonstrates that human ethics cannot be explained by biology alone. Rather, it is our capacity for reasoning that makes moral progress possible. In a new afterword, Singer takes stock of his argument in light or recent research on the evolution of morality.--Publisher's description. (shrink)

Few subjects have generated so many newspaper headlines and such heated controversy as the treatment, or non-treatment, of handicapped newborns. In 1982, the case of Baby Doe, a child born with Down's syndrome, stirred up a national debate in the United States, while in Britain a year earlier, Dr. Leonard Arthur stood trial for his decision to allow a baby with Down's syndrome to die. Government intervention and these recent legal battles accentuate the need for a reassessment of the complex (...) issues involved. This volume--by two authorities on medical ethics--presents a philosophical analysis of the subject based on particular case studies. Addressing the doctrine of the absolute sanctity of life, Singer and Kuhse examine some actual cases where decisions have been reached; consider the criteria for making these decisions; investigate the differences between killing and letting die; compare Western attitudes and practices with those of other cultures; and conclude by proposing a decision-making framework that offers a rational alternative to the polemics and confusion generated by this highly controversial topic. (shrink)

This eye-opening read spans the foundations of ethics and key Buddhist concepts. Professor Peter Singer is a world-renowned moral philosopher and preeminent voice in bioethics whose writings have helped shape the animal rights and effective altruism movements. Venerable Shih Chao-Hwei of Taiwan is a Buddhist monastic and social activist who's been a key figure in the Buddhist gender equality movement. This unlikely duo came together in conversation at a meditation retreat center in 2016 and continued discussions in writing. (...) They shed light on the intersection of philosophy, religion, and day-to-day life. (shrink)

Provocative essays on real-world ethical questions from the world's most influential philosopher Peter Singer is often described as the world's most influential philosopher. He is also one of its most controversial. The author of important books such as Animal Liberation, Practical Ethics, Rethinking Life and Death, and The Life You Can Save, he helped launch the animal rights and effective altruism movements and contributed to the development of bioethics. Now, in Ethics in the Real World, Singer shows (...) that he is also a master at dissecting important current events in a few hundred words. In this book of brief essays, he applies his controversial ways of thinking to issues like climate change, extreme poverty, animals, abortion, euthanasia, human genetic selection, sports doping, the sale of kidneys, the ethics of high-priced art, and ways of increasing happiness. Singer asks whether chimpanzees are people, smoking should be outlawed, or consensual sex between adult siblings should be decriminalized, and he reiterates his case against the idea that all human life is sacred, applying his arguments to some recent cases in the news. In addition, he explores, in an easily accessible form, some of the deepest philosophical questions, such as whether anything really matters and what is the value of the pale blue dot that is our planet. The collection also includes some more personal reflections, like Singer’s thoughts on one of his favorite activities, surfing, and an unusual suggestion for starting a family conversation over a holiday feast. Provocative and original, these essays will challenge—and possibly change—your beliefs about a wide range of real-world ethical questions. (shrink)

Singer returns to the major arguments and examples of his seminal 1975 work and brings us to the current moment. This edition, revised from top to bottom, covers important reforms in the European Union, and now in various U.S. states. On the flip side, Singer shows the impact of the expansion of factory farming due to demand for animal products in China. Singer describes how meat consumption is taking a toll on the environment, and factory farms pose (...) a profound risk for spreading new viruses even worse than COVID-19. Animal Liberation Now includes alternatives to what has become a profound environmental and social as well as moral issue. Framed as an appeal to conscience, fairness, decency, and justice, it is intended for the supporter and the skeptic alike. -- Provided by publisher. (shrink)

This response to the articles in this issue of ‘Analyse & Kritik’ begins with some general remarks on the ‘Singer-Affair’ in which I suggest that while the rational discussion of the ethical issue of euthanasia poses no threat of a return to Nazism, there is a real danger in the creation of a climate in which people are ready to use force to suppress ideas with which they disagree. I then state and criticise two popular theses about t he (...) wrongness of killing: that there is a crucial moral distinction between an act and an omission, and that all human beings possess an intrinsic right to life that no nonhuman beings have. This serves as a background to the section that follows, in which I take up the detailed criticisms of my views made by Professors Lenzen, Birnbacher, J.C. Wolf and Hoerster. (shrink)

The second edition sold a total of 19k copies since release in 2006, with strong sales (at least 1300 ) every year since release. The third edition has sold 6k copies since coming to market in December 2015. Solid 5-star reviews on Amazon, and #1 result when searching for 'Bioethics'. Will includes several new additions, including important historical readings and new contemporary material published since release of last edition in 2015.

The Covid-19 pandemic of 2020/21 has posed old ethical questions in a new and sharper form, as well as given rise to some new ethical issues. In this lecture, I look at the lessons we can learn from five of these issues: the allocation of scarce medical resources; experimenting on humans; setting priorities for vaccination; when lockdowns are justified; and preventing more pandemics.

This chapter contains sections titled: Notes.

The following response to the essays by Dietrich, Kesselring and Schefczyk discusses impartiality and foundations of special duties; utilitarianism, foreign aid, NGOs and human rights; and ethical aspects of free trade and the World Trade Organization.

We examine the view that all human life is of equal worth or sanctity. We find that this view is a legacy of the Judeo- Christian tradition, and cannot be justified in non - religious terms. We therefore argue that it should be rejected, and that we should openly acknowledge that some Jives are of less worth than others. We then consider a common objection: that this will lead us down a slippery slope to Nazi- style atrocities. We give our (...) reasons for finding this objection unpersuasive. We explain why no-one has any grounds for feeling threatened by our proposal. Finally we discuss who should make the decision involved in selecting whether a person should come into existence, and how that decision should be carried out. (shrink)

ABSTRACT In Germany, applied ethics is under attack from a diverse coalition of left‐wing organisations, disability groups, and some conservative defenders of a strict doctrine of the sanctity of human life. The attack has been pressed to the point of forcing the cancellation of conferences and disrupting lectures or classes so that they cannot take place. This essay describes the extent and nature of the attack, and makes a preliminary assessment of its significance.

This collection of articles pays homage to the creativity and scientific rigor Jerome Singer has brought to the study of consciousness and play. It will interest personality, social, clinical and developmental psychologists alike.

For thirty years, Peter Singer's Practical Ethics has been the classic introduction to applied ethics. For this third edition, the author has revised and updated all the chapters and added a new chapter addressing climate change, one of the most important ethical challenges of our generation. Some of the questions discussed in this book concern our daily lives. Is it ethical to buy luxuries when others do not have enough to eat? Should we buy meat from intensively reared (...) animals? Am I doing something wrong if my carbon footprint is above the global average? Other questions confront us as concerned citizens: equality and discrimination on the grounds of race or sex; abortion, the use of embryos for research and euthanasia; political violence and terrorism; and the preservation of our planet's environment. This book's lucid style and provocative arguments make it an ideal text for university courses and for anyone willing to think about how she or he ought to live. (shrink)

Since its original publication in 1975, this groundbreaking work has awakened millions of concerned men and women to the shocking abuse of animals everywhere--inspiring a worldwide movement to eliminate much of the cruel and unnecessary laboratory animal experimentation of years past. In this newly revised and expanded edition, author Peter Singer exposes the chilling realities of today's "factory farms" and product-testing procedures--offering sound, humane solutions to what has become a profound environmental and social as well as moral issue. (...) An important and persuasive appeal to conscience, fairness, decency and justice, Animal Liberation is essential reading for the supporter and the skeptic alike.--From publisher description. (shrink)

In 1972, the young philosopher Peter Singer published "Famine, Affluence and Morality," which rapidly became one of the most widely discussed essays in applied ethics. Through this article, Singer presents his view that we have the same moral obligations to those far away as we do to those close to us. He argued that choosing not to send life-saving money to starving people on the other side of the earth is the moral equivalent of neglecting to save (...) drowning children because we prefer not to muddy our shoes. If we can help, we must--and any excuse is hypocrisy. Singer's extreme stand on our moral obligations to others became a powerful call to arms and continues to challenge people's attitudes towards extreme poverty. Today, it remains a central touchstone for those who argue we should all help others more than we do. As Bill and Melinda Gates observe in their foreword, in the age of today's global philanthropy, Singer's essay is as relevant now as it ever was. This attractively packaged, concise edition collects the original article, two of Singer's more recent popular writings on our obligations to others around the world, and a new introduction by Singer that discusses his current thinking. (shrink)

In a new preface, Peter Singer discusses the prospects for the ethical approach he advocates."--BOOK JACKET.

For millennia, philosophers have speculated about the origins of ethics. Recent research in evolutionary psychology and the neurosciences has shed light on that question. But this research also has normative significance. A standard way of arguing against a normative ethical theory is to show that in some circumstances the theory leads to judgments that are contrary to our common moral intuitions. If, however, these moral intuitions are the biological residue of our evolutionary history, it is not clear why we should (...) regard them as having any normative force. Research in the neurosciences should therefore lead us to reconsider the role of intuitions in normative ethics. (shrink)

From the ethicist the_ New Yorker_ calls “the most influential living philosopher,” a new way of thinking about living ethically.

In recent years a number of oppressed groups have campaigned vigorously for equality. The classic instance is the Black Liberation movement, which demands an end to the prejudice and discrimination that has made blacks second-class citizens. The immediate appeal of the black liberation movement and its initial, if limited, success made it a model for other oppressed groups to follow. We became familiar with liberation movements for Spanish-Americans, gay people, and a variety of other minorities. When a majority group—women—began their (...) campaign, some thought we had come to the end of the road. Discrimination on the basis of sex, it has been said, is the last universally accepted form of discrimination, practiced without secrecy or pretense even in those liberal circles that have long prided themselves on their freedom from prejudice against racial minorities. (shrink)

Impartialism in ethics has been said to be the common ground shared by both Kantian and utilitarian approaches to ethics. Lawrence Blum describes this common ground as follows: Both views identify morality with a perspective of impartiality, impersonality, objectivity and universality. Both views imply the ‘ubiquity of impartiality” – that our commitments and projects derive their legitimacy only by reference to this impartial perspective.

In German-speaking countries, there have been concerted and successful attempts to prevent any discussion of euthanasia from taking place. Both the present writers have been invited to give lectures on this topic, and had these lectures cancelled at short notice because of this opposition. Against that background, we welcome Pauer-Studer’s airing of these issues, and her clear statement that attempts to prevent advocates of euthanasia from speaking are “definitely unacceptable.” Nevertheless, we find much that Pauer-Studer says to be in error.