Human enhancement has emerged in recent years as a blossoming topic in applied ethics. With continuing advances in science and technology, people are beginning to realize that some of the basic parameters of the human condition might be changed in the future. One important way in which the human condition could be changed is through the enhancement of basic human capacities. If this becomes feasible within the lifespan of many people alive today, then it is important now to consider the (...) normative questions raised by such prospects. The answers to these questions might not only help us be better prepared when technology catches up with imagination, but they may be relevant to many decisions we make today, such as decisions about how much funding to give to various kinds of research. Enhancement is typically contraposed to therapy. In broad terms, therapy aims to fix something that has gone wrong, by curing specific diseases or injuries, while enhancement interventions aim to improve the state of an organism beyond its normal healthy state. However, the distinction between therapy and enhancement is problematic, for several reasons. First, we may note that the therapy-enhancement dichotomy does not map onto any corresponding dichotomy between standard-contemporary-medicine and medicineas-it-could-be-practised-in-the-future. Standard contemporary medicine includes many practices that do not aim to cure diseases or injuries. It includes, for example, preventive medicine, palliative care, obstetrics, sports medicine, plastic surgery, contraceptive devices, fertility treatments, cosmetic dental procedures, and much else. At the same time, many enhancement interventions occur outside of the medical framework. Office workers enhance their performance by drinking coffee. Make-up and grooming are used to enhance appearance. Exercise, meditation, fish oil, and St John’s Wort are used to enhance mood. Second, it is unclear how to classify interventions that reduce the probability of disease and death.. (shrink)

Several feminist philosophers of science have argued that social and political values are compatible with, and may even enhance, scientific objectivity. A variety of normative recommendations have emerged regarding how to identify, manage, and critically evaluate social values in science. In particular, several feminist theorists have argued that scientific communities ought to: 1) include researchers with diverse experiences, interests, and values, with equal opportunity and authority to scrutinize research; 2) investigate or “study up” scientific phenomena from the perspectives, interests, and (...) conditions of marginalized stakeholders potentially affected by the research; and 3) make gender, ethnicity, class, and geographical location “visible,” or use them as categories of analysis when appropriate. Yet, more work is needed to determine what exactly these recommendations would require, and the benefits they would yield, in specific research contexts.Using the recent development of the human papillomavirus (HPV) vaccines, we examine how these three feminist recommendations would have applied. We argue that these principles would have yielded several epistemic and social benefits in the HPV case, as well as in biomedical research more generally. That is, biomedical research guided by these principles would not only be epistemically superior, but also more socially responsible. (shrink)

Representations of breast cancer are examined in three popular women's periodicals targeting African American readers: Ebony, Essence, and Black Elegance. The researcher focuses specifically on representations that reflect certain ideas/ideals about the sharing and creating of information about the disease and related issues, such as health care and body image. Magazine selections are analyzed and critiqued according to the epistemological principles outlined by Patricia Hill Collins in Black Feminist Thought. The author calls for further research into how and why particular (...) social and cultural groups consume information about health and illness in particular ways. (shrink)

In research ethics there is a canon regarding what ethical rules ought to be followed by investigators vis-à-vis their treatment of subjects and a canon regarding what fundamental ethical principles apply to the endeavor. What I aim to demonstrate here is that several of the rules find no support in the principles. This leaves anyone who would insist that we not abandon those rules in the difficult position of needing to establish that we are nevertheless justified in believing in the (...) validity of the rules. I conclude by arguing that this is not likely to be accomplished.The rules I call into question are the rules requiring:– that studies be designed in a scientifically valid way– that risks to subjects be minimized– that subjects be afforded post-trial access to experimental interventions– that inducements paid to subjects not be counted as a benefit to them– that inducements paid to subjects not be ‘undue’– that subjects must remain free to withdraw from the study at any time for any reason without penaltyBoth canons, the canon on principles and the canon on rules, are found in the overlap among ethical pronouncements that are themselves canonical: the Nuremberg Code, the Declaration of Helsinki, the Belmont Report, CIOMS's International Ethical Guidelines for Biomedical Research Involving Human Subjects, and NBAC's 2001 report, Ethical Issues in International Research: Clinical Trials in Developing Countries. (shrink)

Cognitive enhancement may be defined as the amplification or extension of core capacities of the mind through improvement or augmentation of internal or external information processing systems. Cognition refers to the processes an organism uses to organize information. These include acquiring information (perception), selecting (attention), representing (understanding) and retaining (memory) information, and using it to guide behavior (reasoning and coordination of motor outputs). Interventions to improve cognitive function may be directed at any of these core faculties.

Abstract: This article begins by showing how recent controversies over the widespread promotion of artificially gene-altered foods are rooted in opposing ethical and ideological worldviews. It then explains how these contrasting worldviews have led to a practical, ethical, and ideological standoff and, finally, suggests the combined use of casuistry and virtue ethics as a way for both sides to move ahead on this pressing issue.

Recent advancements in stem-cell research have given scientists hope that new technologies will soon enable them to grow a variety of organs for transplantation into humans. Though such developments are still in their early stages, romantic prognosticators are hopeful that scientists will be capable of growing fully functioning and complex organs, such as hearts, kidneys, muscles, and livers. This raises the question of whether such profound medical developments might have other potentially fruitful applications. In the spirit of innovation, this paper (...) examines the ethical ramifications of a spin-off technology that has just begun being considered by scientists and enthusiastic entrepreneurs: animal organs grown, independently of their host animals, for food. -/- Most importantly, this paper presents the homegrown organs market as a philosopher's Gedankenexperiment come true. By comparing three of the primary arguments against the use of animals for meat production -- Peter Singer's Utilitarianism, Tom Regan's Kantianism, and Cora Diamond's non-cognitivism -- this paper proposes that the case of organs grown in a laboratory for food further accentuates the point that the critical moral difference between an animal and a slab of meat lies in the way in which the animal interacts with us, not in specific attributes or values intrinsic to that animal. It suggests that our main impetus for not eating, and even for protecting, animals ought to be grounded in our sense of who we are, in our own practical identity as ethical agents, which develops over a long course of interactive interrelations with human and non-human others. (shrink)

Topic Read 01. Jan 09 Introduction/Pretest/Critical Thinking 02. Jan 11 Ethical Theory Homepage 03. Jan 16 More about Ethical Theory 04. Jan 18 Euthanasia CC-2 05. Jan 23 More about Euthanasia CC-4 06. Jan 25 Birth Defects CC-9 07. Jan 30 Euthanasia/Birth Defects Symposium 08. Feb 01 Animals as Research Subjects CC-10 09. Feb 06 More about Animals as Research Subjects 10. Feb 08 Humans as Research Subjects CC-11 11. Feb 13 Organ/Tissue Donation & Xenografts CC-13/14 12. Feb 15 Research (...) Symposium 13. Feb 20 MID-TERM EXAM 14. Feb 22 Sexual Orientation/Discrimination 15. Feb 27 Human Sexuality/Sexual Ethics Homepage 16. Mar 01 Human Sexuality Symposium 17. Mar 06 Pharmaceuticals & Empiricism 18. Mar 08 Recreational Drugs 19. Mar 20 HIV/AIDS CC-17 20. Mar 22 Contraception 21. Mar 27 Drugs/AIDS Symposium 22. Mar 29 Abortion CC-5 23. Apr 03 More about Abortion 24. Apr 05 Abortion Symposium 25. Apr 10 Assisted Reproduction CC-6 26. Apr 12 Cloning and Stem Cell Research CC-7/8 27. Apr 17 Cloning and Stem Cell Research Symposium 28. Apr 19 LATE-TERM EXAM 29. Apr 24 Medicare/HMO CC-18 30. Apr 26 Medicare/HMO Symposium.. (shrink)

A number of controversial topics related to bioethics and biotechnology 17 papers that deal with various aspects of release and development of genetically modified organisms (GMOs), stem cells and cloning, privacy and bio-banking.

The procurement of fetal tissue for transplantation may promise great benefit to those suffering from various pathologies, e.g., neural disorders, diabetes, renal problems, and radiation sickness. However, debates about the use of fetal tissue have proceeded without much attention to ethical theory and application. Two broad moral questions are addressed here, the first formal, the second substantive: Is there a framework from other moral paradigms to assist in ethical debates about the transplantation of fetal tissue? Does the use of fetal (...) tissue entail cooperation in abortion? To answer these questions I develop a theoretical framework by combining the paradigm of just-war reasoning with canons governing the use of cadaverous tissue. The kinds of safeguards provided by this paradigm allow fetal tissue to be procured without the taint of association with abortion. Central to solving the problem of cooperation is the distinction between intending and foreseeing a moral misdeed. Fetal researchers may foresee fetal death in elective abortions without intending such deaths to occur. Thus, even those who object unequivocally to elective abortion may condone the procurement of fetal tissue, if sufficient reason exists. Keywords: fetal tissue, casuistry, prima facie duties, just-war tenets, complicity CiteULike Connotea Del.icio.us What's this? (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

Though the vegetarian movement sparked by Peter Singer’s book Animal Liberation has achieved some success, there is more animal suffering caused today due to factory farming than there was when the book was originally written. In this paper, I argue that there may be a technological solution to the problem of animal suffering in intensive factory farming operations. In particular, I suggest that recent research indicates that we may be very close to, if not already at, the point where we (...) can genetically engineer factory-farmed livestock with a reduced or completely eliminated capacity to suffer. In as much as animal suffering is the principal concern that motivates the animal welfare movement, this development should be of central interest to its adherents. Moreover, I will argue that all people concerned with animal welfare should agree that we ought to replace the animals currently used in factory farming with animals whose ability to suffer is diminished if we are able to do so. (shrink)

Until now, philosophical debate about human embryonic stem cell (hESC) research has largely been limited to its ethical dimensions and implications. Although the importance and urgency of these ethical debates should not be underestimated, the almost undivided attention that mainstream and feminist philosophers have paid to the ethical dimensions of hESC research suggests that the only philosophically interesting questions and concerns about it are by and large ethical in nature. My argument goes some distance to challenge the assumption that ethical (...) considerations alone must be foregrounded in philosophical discussions about hESC research by introducing a critical stance on the epistemological and ontological assumptions that underlie and condition it. A central aim of the paper is to show how Foucault's insights into knowledge-power, taken in combination with Hacking's claims about styles of reasoning, can make these assumptions evident, as well as cast light on their potentially deleterious implications for disabled people. Arguing in this way also enables me to draw out constitutive effects of research on stem cells, that is, to indicate how the discursive practices surrounding research on stem cells, as well as the technology itself, contribute to the constitution of impairment. (shrink)

Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is (...) meant by becoming another person from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of individual identity which centers on the idea of core attitudes . Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a foundational-function model highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal. (shrink)

The time is near where ‘therapeutic’ bodily assistive devices, developed to mimic species-typical body structures in order to enable normative body functioning, will allow the wearer to outperform the species-typical body in various functions. Although such devices are developed for people that are seen to exhibit sub species-typical abilities, many ‘therapeutic enhancements’ might also be desired and used by people that exhibit species-typical body abilities. This paper presents the views of members of the World Federation of the Deaf on potential (...) beyond species-typical abilities enabling therapeutic assistive devices (i.e. related to hearing). Survey respondents showed support for the development and uptake of beyond normal hearing enabling devices. The views of survey respondents as clients affect hearing-enabling professions (such as audiologist and speech pathologists). The paper analyzes what guidance code of ethics of hearing enabling professions give in regards to beyond normal hearing enabling devices. This paper suggests that people labeled impaired and the professions that serve them should more involved in the enhancement discourse. (shrink)

Human beings are a marvel of evolved complexity. Such systems can be difficult to enhance. When we manipulate complex evolved systems which are poorly understood, our interventions often fail or backfire. It can appear as if there is a “wisdom of nature” which we ignore at our peril. Sometimes the belief in nature’s wisdom – and corresponding doubts about the prudence of tampering with nature, especially human nature – manifest as diffusely moral objections against enhancement. Such objections may be expressed (...) as intuitions about the superiority of the natural or the troublesomeness of hubris, or as an evaluative bias in favor of the status quo. This paper explores the extent to which such prudence‐derived anti‐enhancement sentiments are justified. We develop a heuristic, inspired by the field of evolutionary medicine, for identifying promising human enhancement interventions. The heuristic incorporates the grains of truth contained in “nature knows best” attitudes while providing criteria for the special cases where we have reason to believe that it is feasible for us to improve on nature. (shrink)

Immortality has long preoccupied everyone from alchemists to science fiction writers. In this intriguing investigation, Stephen Clark contends that the genre of science fiction writing enables the investigation of philosophical questions about immortality without the constraints of academic philosophy. He shows how fantasy accounts of phenomena such as resurrection, outer body experience, reincarnation or life extending medicines can be related to philosophy in interesting ways. Reading Western myths such as that of vampire, he examines the ways fear and hopes of (...) immortality are an intrinsic part of Western culture and philosophy. As one of the first works to suggest the use of science fiction in the study of philosophy, Clark creates a ground for intellectual, philosophical and experimental inquiry. (shrink)

Opponents of biomedical enhancement often claim that, even if such enhancement would benefit the enhanced, it would harm others. But this objection looks unpersuasive when the enhancement in question is a moral enhancement — an enhancement that will expectably leave the enhanced person with morally better motives than she had previously. In this article I (1) describe one type of psychological alteration that would plausibly qualify as a moral enhancement, (2) argue that we will, in the medium-term future, probably be (...) able to induce such alterations via biomedical intervention, and (3) defend future engagement in such moral enhancements against possible objections. My aim is to present this kind of moral enhancement as a counter-example to the view that biomedical enhancement is always morally impermissible. (shrink)

Several authors have suggested that we cannot fully grapple with the ethics of human enhancement unless we address neglected questions about our place in the world, questions that verge on theology but can be pursued independently of religion. A prominent example is Michael Sandel, who argues that the deepest objection to enhancement is that it expresses a Promethean drive to mastery which deprives us of openness to the unbidden and leaves us with nothing to affirm outside our own wills. Sandel's (...) argument against enhancement has been criticized, but his claims about mastery and the unbidden, and their relation to religion, have not yet received sufficient attention. I argue that Sandel misunderstands the notions of mastery and the unbidden and their significance. Once these notions are properly understood, they have surprising implications. It turns out that the value of openness to the unbidden is not just independent of theism, as Sandel claims, but is in fact not even fully compatible with it. But in any case that value cannot support Sandel's objection to enhancement. This is because it is not enhancement but certain forms of opposition to enhancement that are most likely to express a pernicious drive to mastery. (shrink)

The conviction that high self-esteem is beneficial both to the individual and to society in general has been pervasive both in academia and in popular culture. If it is indeed beneficial, it is a prime candidate for pharmacological enhancement. There is evidence to suggest, however, that the benefits of high self-esteem to the individual have been exaggerated; and that there are few - if any - social benefits. With this evidence in mind, I consider in what ways high self-esteem is (...) valuable, and suggest how enhancement could play a role in maximising its valuable aspects. (shrink)

Though the vegetarian movement sparked by Peter Singer’s book Animal Liberation has achieved some success, there is more animal suffering caused today due to factory farming than there was when the book was originally written. In this paper, I argue that there may be a technological solution to the problem of animal suffering in intensive factory farming operations. In particular, I suggest that recent research indicates that we may be very close to, if not already at, the point where we (...) can genetically engineer factory-farmed livestock with a reduced or completely eliminated capacity to suffer. In as much as animal suffering is the principal concern that motivates the animal welfare movement, this development should be of central interest to its adherents. Moreover, I will argue that all people concerned with animal welfare should agree that we ought to replace the animals currently used in factory farming with animals whose ability to suffer is diminished if we are able to do so. (shrink)

American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.

The use of antibiotics by one person can profoundly affect the welfare of other people. I will argue that efforts to combat antimicrobial resistance generate a global collective action problem that only a well-designed international treaty can overcome. I begin by describing the problem of resistance and outlining some market-friendly policy tools that participants in a global treaty could use to control the problem. I then defend the claim that these policies can achieve their aim while protecting individual liberty and (...) state autonomy. Finally, I offer some suggestions for a treaty, drawing lessons from the failure of the Kyoto Protocol on climate change and the success of the Montreal Protocol on ozone depletion. (shrink)

In the long history of moral theory, non-human animals—hereafter, just animals—have often been neglected entirely or have been relegated to some secondary status. Since its emergence in the early 19th century, utilitarianism has made a difference in that respect by focusing upon happiness or well-being (and their contraries) rather than upon the beings who suffer or enjoy. Inevitably, that has meant that human relations to and use of other animals have appeared in a different light. Some cases have seemed easy: (...) once admit that the interests of animals matter and there can be little hesitation in condemning their cruel treatment. Among the more difficult cases has been the bearing of utilitarianism upon the use of animals in various kinds of research where, though the animals might suffer, there were believed to be prospects of great human benefit and where no cruel or malicious motives need be involved. What I shall provide in the current paper is an extended discussion of the bearing of utilitarianism upon practices of animal research. Since such practices have attracted both utilitarian criticism and defense, this will require the examination of arguments on both sides, including consideration of the human benefits, the animal costs, and the ways in which the one can be weighed against the other. (shrink)

The concept of human dignity is increasingly invoked in bioethical debate and, indeed, in international instruments concerned with biotechnology and biomedicine. While some commentators consider appeals to human dignity to be little more than rhetoric and not worthy of serious consideration, the authors of this groundbreaking new study give such appeals distinct and defensible meaning through an application of the moral theory of Alan Gewirth.

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for (...) the utilization of each principle. (shrink)

In this paper, I critically summarize John Cartwrtight’s Evolution and Human Behavior and evaluate what he says about certain moral implications of Darwinian views of human behavior. He takes a Darwinism-doesn’t-rock-the-boat approach and argues that Darwinism, even if it is allied with evolutionary psychology, does not give us reason to be worried about the alterability of our behavior, nor does it give us reason to think that we may have to change our ordinary practices and views concerning free-will and moral (...) responsibility. In response, I contend that Darwinism, when it is allied with evolutionary psychology, makes for a more potent cocktail than Cartwright suspects. (shrink)

General Practice and Ethics explores the ethical issues faced by general physicans in their everyday practice, addressing two central themes: the uncertainty of outcomes and effectiveness in general practice and the changing pattern of general practitioners' responsibilities.

"Carl Elliott always writes intriguing essays at the intersection between ethics, medicine, and general philosophy, so it is a real pleasure to have a new ...

This book is a survey of practical moral issues applying the Middle Way (as developed in 'A Theory of Moral Objectivity') as the basis of 'Buddhist' Ethics. No appeal is made to Buddhist traditions or scriptures, but instead the Middle Way is applied consistently as a universal philosophical and practical principle to suggest the direction of resolutions to moral debates. Practical ethics topics covered include sexual ethics, medical ethics, environmental ethics, animals, violence, the arts, scientific issues and political ethics.

The intriguing issue of pain and suffering in patients with disorders of consciousness (DOCs), particularly in Unresponsive Wakefulness Syndrome/Vegetative State (UWS/VS) and Minimally Conscious State (MCS), is assessed from a theoretical point of view, through an overview of recent neuroscientific literature, in order to sketch an ethical analysis. In conclusion, from a legal and ethical point of view, formal guidelines and a situationist ethics are proposed in order to best manage the critical scientific uncertainty about pain and suffering in DOCs (...) and ensure the best possible care for the patient. (shrink)

This paper critically examines the predominant arguments that have been proposed either in favour or against non-benefit medical research with human subjects incapable of informed consent. It is argued that none of the arguments succeeds, while acknowledging that such research is necessary.

This volume illustrates the central importance of diversity of human values throughout healthcare.

What role should religion play in a religiously pluralistic liberal society? Public bioethics unavoidably raises this question in a particularly insistent fashion. As the 20 papers in this collection demonstrate, the issues are complex and multifaceted. The authors address specific and highly contested issues as assisted suicide, stem cell research, cloning, reproductive health, and alternative medicine as well as more general questions such as who legitimately speaks for religion in public bioethics, what religion can add to our understanding of justice, (...) and the value of faith-based contributions to healthcare. Christian (Catholic and Protestant), Jewish, Islamic, and Buddhist viewpoints are represented. The first book to focus on the interface of religion and bioethics, this collection fills a significant void in the literature. (shrink)

Topic Read 01. Jan 09 Introduction/Pretest/Critical Thinking 02. Jan 11 Ethical Theory Homepage 03. Jan 16 More about Ethical Theory 04. Jan 18 Euthanasia CC-2 05. Jan 23 More about Euthanasia CC-4 06. Jan 25 Birth Defects CC-9 07. Jan 30 Euthanasia/Birth Defects Symposium 08. Feb 01 Animals as Research Subjects CC-10 09. Feb 06 More about Animals as Research Subjects 10. Feb 08 Humans as Research Subjects CC-11 11. Feb 13 Organ/Tissue Donation & Xenografts CC-13/14 12. Feb 15 Research (...) Symposium 13. Feb 20 MID-TERM EXAM 14. Feb 22 Sexual Orientation/Discrimination 15. Feb 27 Human Sexuality/Sexual Ethics Homepage 16. Mar 01 Human Sexuality Symposium 17. Mar 06 Pharmaceuticals & Empiricism 18. Mar 08 Recreational Drugs 19. Mar 20 HIV/AIDS CC-17 20. Mar 22 Contraception 21. Mar 27 Drugs/AIDS Symposium 22. Mar 29 Abortion CC-5 23. Apr 03 More about Abortion 24. Apr 05 Abortion Symposium 25. Apr 10 Assisted Reproduction CC-6 26. Apr 12 Cloning and Stem Cell Research CC-7/8 27. Apr 17 Cloning and Stem Cell Research Symposium 28. Apr 19 LATE-TERM EXAM 29. Apr 24 Medicare/HMO CC-18 30. Apr 26 Medicare/HMO Symposium.. (shrink)

This book is for those interested in an extensive review of the field of bioethics. It is for philosophers who wish to understand the core conceptual issues in health care ethics, and for bioethicists who wish to better understand classical problems in philosophy that have a bearing on health care ethics. The Handbook of Bioethics: Taking Stock of the Field from a Philosophical Perspective: -presents a comprehensive survey of bioethics in one volume; -has 27 of the most prominent scholars in (...) the field take stock of the issues they helped define; -contains essays that outline areas where future research is needed; -identifies potential areas for fruitful collaboration between traditional philosophers and bioethicists; -is an ideal text for graduate or upper level undergraduate courses. (shrink)

A growing number of medical professionals claim a right of conscience, a right to refuse to perform any professional duty they deem immoral—and to do so with impunity. We argue that professionals do not have the unqualified right of conscience. At most they have a highly qualified right. We focus on the claims of pharmacists, since they are the professionals most commonly claiming this right.

A compilation of 16 papers selected from two UNESCO Bangkok Bioethics Roundtables, with research and policy dialogues from different countries in the region. It includes papers on informed consent, ethics committees, communication, organ transplants, traditional medicines and sex selection.

We are unlikely to stop seeking pleasure, as this would prejudice our health and well-being. Yet many psychoactive substances providing pleasure are outlawed as illicit recreational drugs, despite the fact that only some of them are addictive to some people. Efforts to redress their prohibition, or to reform legislation so that penalties are proportionate to harm have largely failed. Yet, if choices over seeking pleasure are ethical insofar as they avoid harm to oneself or others, public health strategies should foster (...) ethical choice by moving beyond current risk management practices embodied in the harm reduction movement. The neuroscience of pleasure has much to offer neuroethics and public health strategies. Distinguishing between ‘wanting’ and ‘liking’ fosters new understandings of addiction. These hold promise for directing the search for pharmacotherapies which prevent addiction and relapse or disrupt associated neuromechanisms. They could inform new research into creating lawful psychoactive substances which give us pleasure without provoking addiction. As the health and well being of human and other animals rests upon the experience of pleasure, this would be an ethical objective within public health strategy. Were ethical and neurobiological obstacles to ending addiction to be overcome, problems associated with excessive consumption, the lure of unlawful psychoactive substances and the paucity of lawful means to achieve pleasurable altered states would remain. Non-addictive designer drugs, which reliably provided lawful access to pleasures and altered states, would ameliorate these public health concerns insofar as they fostered citizens’ informed, ethical choices according to a neurobiological taxonomy of pleasures. (shrink)

" This book has been carefully crafted in that spirit.

All persons, while different from one another, have the same value: this is the author's relatively uncontroversial starting point. Her end point is not uncontroversial: an ideal of justice as human flourishing, based on each person's unique set of capabilities. Because the book's focus is women's health care, gender justice, a necessary component of justice, is central to examination of the issues. Classical pragmatists and feminist standpoint theorists are enlisted in support of a strategy by which gender justice is promoted. (...) Two features of the book are unique: (1) the topics presented cover the entire life span of women, not just those related to reproduction; (2) a range views about moral status are applied not only to fetuses but also to individuals already born. Attention to these features is intended to facilitate ethical consistency or moral integrity and respect for those who hold different moral views. While delineating and defending the book's perspective, the first section provides an overview of bioethics, critiques prevalent approaches to bioethics and models of the physician-patient relationship, and sketches distinguishing aspects of women's health care that are prevalently neglected. Positions about moral status are also presented. The second section identifies topics that are indirectly as well as directly related to women's health, such as domestic violence and caregiving. Brief cases illustrate variables relevant to each topic. Empirical and theoretical considerations follow each set of cases; these are intended to precipitate more expansive and critical examination of the issues raised. The last section is devoted to an egalitarian ideal that may be pursued through an ethic of virtue or supererogation rather than obligation. By embracing this ideal, according to the author, moral agents support a more demanding level of morality than guidelines or laws require. (shrink)

In apparent conflict with the popular conception of veterinarians as animals' best friends, the Veterinarian's Oath, as well as its clarifying Principles of Animal Welfare, imply that animal welfare is entirely derivative from human welfare. This article calls for an explicit alignment of the Oath and Principles with the priority of nonhuman animals.

Various commentaries on the use of animals in biomedical research and related.

Timely and provocative essays on bioethical questions brought to the forefront by the bioterrorist threat.

This book offers a thorough reflection on the relationship between autonomy and paternalism, and argues that, from both theoretical and practical angles, the ...

This volume explores the focus of interest in community and the emerging theoretical opposition between communitarianism and liberalism, including the practical, theoretical and ethical issues that relate to community in the healthcare professions.

This book shows how environmental decline relates to human health and to health care practices in the U.S. and other industrialized countries. It outlines the environmental trends that will strongly affect health, and challenges us to see the connections between ways of practicing medicine and the very environmental problems that damage ecosystems and make people sick. In addition to philosophical analysis of the converging values of bioethics and envrionmental ethics, the book offers case studies as well as a number of (...) practical suggestions for moving health care toward sustainability. (shrink)

This new series of books brings thoughtful, biblically informed perspectives to contemporary issues in bioethics.

The conviction that high self-esteem is beneficial both to the individual and to society in general has been pervasive both in academia and in popular culture. If it is indeed beneficial, it is a prime candidate for pharmacological enhancement. There is evidence to suggest, however, that the benefits of high self-esteem to the individual have been exaggerated; and that there are few - if any - social benefits. With this evidence in mind, I consider in what ways high self-esteem is (...) valuable, and suggest how enhancement could play a role in maximising its valuable aspects. (shrink)

This paper examines the morality of kidney markets through the lens of choice, inequality, and weak agency looking at the case for limiting such markets under both non-ideal and ideal circumstances. Regulating markets can go some way to addressing the problems of inequality and weak agency. The choice issue is different and this paper shows that the choice for some to sell their kidneys can have external effects on those who do not want to do so, constraining the options that (...) are now open to them. I believe that this is the strongest argument against such markets. (shrink)

Critical review of Glenn McGee, ed., Pragmatic Bioethics.

Along the way, she calls upon us to recognize the mysteries that lie at the heart of our lives and the metaphysical reality that gives meaning to life.The ...

This collection of papers explores one of the central debates in the field of bioethics in the new century. It evaluates the controversy between the claim that there is a common morality accepted by all and the opposing view that there are different moral visions and moral rationalities, within which complex bioethical issues demand a solution. Contributions within this volume offer different approaches and perspectives on the pursuit of global ethics in the new century. They are organized under five major (...) themes. The first theme explores the different plausible understandings of the foundations of bioethics and contemporary reflections on the nature and role of moral theory. The second theme analyses the impact of moral loss and moral diversity on the character of bioethics and the search for alternative perspectives in post-traditional and post-modern societies. The third theme examines a number of theoretical issues raised by concrete examples of bioethnological applications, which bear importantly on contemporary debates between the possibility and impossibility of global bioethics. The fourth theme discusses examples of moral conflicts and dilemmas in everyday health care practice regarding the permissible treatment of humans by humans under different ethical perspectives and cultural traditions. The fifth theme explores alternative suggestions for opening up new modes of self-understanding and new strategies for bioethical exploration in the new century. The volume is an important work of reference for philosophers, moral theologians, ethicists, counsellors, doctors, nurses, sociologists, journalists, health care professionals, public policy makers and everyone who is interested in the profound ethical issues arising from modern technological advancements which are not only transforming our lives but are also demanding urgent ethical decision-making and `pragmatic' solutions from a cross-cultural perspective. (shrink)

The topic of professionalism has dominated the content of major academic medicine publications (e.g. Journal of the American Medical Association, New England Journal of Medicine, Academic Medicine, Annals of Internal Medicine, The Lancet) during the past decade and continues to do so. The message of this current wave of professionalism is that medical educators need to be more attentive to the moral sensibilities of trainees, to their interpersonal and affective dimensions, and to their social conscience, all to the end of (...) skilled, humanistic physicians. Urgent calls to address professionalism from such groups as the Association of American Medical Colleges (representing the nation's 126 accredited medical schools and nearly 400 major teaching hospitals), the American Board of Internal Medicine, and the Accreditation Council for Graduate Medical Education, among others. In fact, at the 2004 annual meeting of the AAMC six separate presentations addressed professionalism with such titles as "Evaluating Humanism and Professionalism," Professionalism: Expectation, Education, Evaluation," or "Toward Assessing Professional Behaviors of Medical Students through Peer Observations" (note the preoccupation with assessment). Professionalism, then, has become part of the current academic medicine parlance, used by administrators, clinical faculty, residency programs, and professional organizations with an expectation of shared meanings and goals. All of these stakeholders focus on what has become a consistent list of attributes deemed to be the essence of professionalism, which usually include variations on altruism, duty, excellence, honor and integrity, accountability, and respect. In fact, most of the scholarly work to date has been listing (attributes of professionalism), describing (activities that may foster it), decrying (the environment that works against it), and measuring/evaluating it. In this collection of essays, we don’t argue with these attributes. Instead, we ask questions of the discourse from which they arise, how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label "professional" or "professionalism." This collection aims to be a critical text, one that questions the profession’s beliefs about the nature of its work and how such beliefs are enacted (or not) in medical education, particularly as they fuel the professionalism discourse. In addition, we will scrutinize how the discourse is enacted in both the formal and hidden curriculum, and in the larger medical environment. (shrink)

The author raises the ethical problem of the widespread use of drugs such as Prozac, among individuals with normal mental disorders, such as nostalgia or discomfort. Referring to the work of practitioner P. Kramer, the author shows that Prozac is a psychiatric tool allowing individuals to better integrate into a society increasingly medicalized.

Three main claims are made in this paper. First, it is argued that Onora O’Neill has uncovered a serious problem in the way medical ethicists have thought about both respect for autonomy and informed consent. Medical ethicists have tended to think that autonomous choices are intrinsically worthy of respect, and that informed consent procedures are the best way to respect the autonomous choices of individuals. However, O’Neill convincingly argues that we should abandon both these thoughts. Second, it is argued that (...) O’Neill’s proposed solution to this problem is inadequate. O’Neill’s approach requires that a more modest view of the purpose of informed consent procedures be adopted. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. It is argued that contrary to what O’Neill claims, the wrongness of coercion cannot be derived from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Third, it is argued that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. -/- Respect for autonomy is in trouble. In recent work in this journal1 and elsewhere,2 O’Neill has forcefully argued that respect for autonomy, as it has come to be used in medical ethics, is philosophically indefensible. If her arguments are sound, then, contrary to the standard view, respect for autonomy cannot be the source of the ethical requirement to seek informed consent before treating a patient or enrolling a participant in a trial. So her critique goes to the heart of contemporary medical ethics: if O’Neill is right, medical ethicists have systematically misunderstood two of the most fundamental concepts they deal with—respect for autonomy and informed consent. -/- This paper has four sections. Section 1 distinguishes between three different ways of talking about respect for autonomy, and looks in more detail at the one that has come to be central to bioethical writing on informed consent—namely, the idea that we should respect autonomous choices. Section 2 argues, following O’Neill, that it is implausible to think that the purpose of informed consent requirements is to respect autonomous choices. Section 3 argues that O’Neill’s proposed reworking of autonomy and informed consent is inadequate. O’Neill’s approach requires us to adopt a more modest view of the purpose of informed consent procedures. In her view, the purpose of informed consent procedures is simply to avoid deception and coercion, and the ethical justification for informed consent derives from a different ethical principle, which she calls principled autonomy. I argue that contrary to what O’Neill claims, we cannot derive the wrongness of coercion from principled autonomy, and so its credentials as a justification for informed consent procedures is weak. Section 4 argues that we do better to rethink autonomy and informed consent in terms of respecting persons as ends in themselves, and a characteristically liberal commitment to allowing individuals to make certain categories of decisions for themselves. (shrink)