"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?
Is it ethical for medical science to do more than treat illness--to actually make us "better than human"? Currently the U.S. military is searching for a drug that will allow soldiers to stop sleeping, completely--and tests have already been conducted on promising candidates. In fact, scientists are presently investigating many ways to alter our DNA and give us abilities that we currently lack--much as we produce genetically modified fish and crops. Where do we draw the line, between using medical science (...) to improve our lives, and providing an unfair advantage enjoyed only by those who afford it? In Better than Human, noted bioethicist Allen Buchanan grapples with the ethical dilemmas of the medical revolution now upon us. Biomedical enhancements, he writes, can make us smarter, have better memories, be stronger, quicker, have more stamina, live much longer, be more resistant to disease and to the frailties of aging, and enjoy richer emotional lives. They can even improve our character, or at least strengthen our powers of self-control. One problem, he argues, is that the debate over these enhancements has divided into polar extremes--into denunciations of meddling in the natural (or divine) order, or else a heady optimism that we can cure all that ails humanity. In fact, Buchanan notes, the human genome has always been unstable, and intervention is no offense against nature. But we must be aware of the danger of unintended consequences of these enhancements, and avoid the risk that only the wealthy will enjoy enhancements, exacerbating social inequalities. "Allen Buchanan has, throughout his career, shown an almost uncanny ability to see the issues on the horizon of professional ethics," writes leading bio-ethicist Tom Beauchamp. In Better than Human, Buchanan takes readers on a fascinating tour of that horizon, laying out a reasoned, practical path to reach it safely. (shrink)
Many philosophers invoke the "wisdom of nature" in arguing for varying degrees of caution in the development and use of genetic enhancement technologies. Because they view natural selection as akin to a master engineer that creates functionally and morally optimal design, these authors tend to regard genetic intervention with suspicion. In Part II, we examine and ultimately reject the evolutionary assumptions that underlie the master engineer analogy (MEA). By highlighting the constraints on ordinary unassisted evolution, we show how intentional genetic (...) modification can overcome many of the natural impediments to the human good. Our contention is that genetic engineering offers a solution that is more eff icient, reliable, versatile, and morally palatable than the lumbering juggernaut of Darwinian evolution. In Part III, we evaluate a recent attempt to ground precautionary enhancement heuristics in adaptive etiology. Our problem with this approach is two-fold: first, it is based on the same "strong adaptationist" interpretation of evolution that motivates the flawed MEA, and second, the etiological concept of function on which it relies provides indirect and potentially misleading information about the likely consequences of genetic intervention. We offer instead enhancement criteria based on causal relationships in ontogeny. We conclude that rather than grounding a presumption against deliberate genetic modification, the causal structure of the living world gives us good moral reason to pursue it. (shrink)
The thirteen essays by Allen Buchanan collected here are arranged in such a way as to make evident their thematic interconnections: the important and hitherto unappreciated relationships among the nature and grounding of human rights, the legitimacy of international institutions, and the justification for using military force across borders. Each of these three topics has spawned a significant literature, but unfortunately has been treated in isolation. In this volume Buchanan makes the case for a holistic, systematic approach, and in so (...) doing constitutes a major contribution at the intersection of International Political Philosophy and International Legal Theory. -/- A major theme of Buchanan's book is the need to combine the philosopher's normative analysis with the political scientist's focus on institutions. Instead of thinking first about norms and then about institutions, if at all, only as mechanisms for implementing norms, it is necessary to consider alternative "packages" consisting of norms and institutions. Whether a particular norm is acceptable can depend upon the institutional context in which it is supposed to be instantiated, and whether a particular institutional arrangement is acceptable can depend on whether it realizes norms of legitimacy or of justice, or at least has a tendency to foster the conditions under which such norms can be realized. In order to evaluate institutions it is necessary not only to consider how well they implement norms that are now considered valid but also their capacity for fostering the epistemic conditions under which norms can be contested, revised, and improved. (shrink)
Appeals to the idea of human nature are frequent in the voluminous literature on the ethics of enhancing human beings through biotechnology. Two chief concerns about the impact of enhancements on human nature have been voiced. The first is that enhancement may alter or destroy human nature. The second is that if enhancement alters or destroys human nature, this will undercut our ability to ascertain the good because, for us, the good is determined by our nature. The first concern assumes (...) that altering or destroying human nature is in itself a bad thing. The second concern assumes that human nature provides a standard without which we cannot make coherent, defensible judgments about what is good. I will argue (1) that there is nothing wrong, per se, with altering or destroying human nature, because, on a plausible understanding of what human nature is, it contains bad as well as good characteristics and there is no reason to believe that eliminating some of the bad would so imperil the good as to make the elimination of the bad impermissible, and (2) that altering or destroying human nature need not result in the loss of our ability to make judgments about the good, because we possess a conception of the good by which we can and do evaluate human nature. I will argue that appeals to human nature tend to obscure rather than illuminate the debate over the ethics of enhancement and can be eliminated in favor of more cogent considerations. (shrink)
In this volume Allen Buchanan collects ten of his most influential essays on justice and healthcare and connects the concerns of bioethicists with those of political philosophers, focusing not just on the question of which principles of justice in healthcare ought to be implemented, but also on the question of the legitimacy of institutions through which they are implemented. With an emphasis on the institutional implementation of justice in healthcare, Buchanan pays special attention to the relationship between moral commitments and (...) incentives. The volume begins with an exploration of the difficulties of specifying the content of the right to healthcare and of identifying those agents and institutions that are obligated to help ensure that the right thus specified is realized, and then progresses to an examination of the problems that arise in attempts to implement the right through appropriate institutions. In the last two essays Buchanan pursues the central issues of justice in healthcare at the global level, exploring the idea of healthcare as a human right and the problem of assigning responsibilities for ameliorating global health disparities. Taken together, the essays provide a unique and consistent position on a wide range of issues, including conflicts of interest in clinical practice and the claims of medical professionalism, the nature and justification for the right to health care, the relationship between responsibility for healthcare and the nature of the healthcare system, and the problem of global health disparities. The result is an approach to justice in healthcare that will facilitate more productive interaction between the normative analysis of philosophers and the policy work of economists, lawyers, and political scientists. (shrink)
abstract Part 1 of this essay argues that one of the most important contributions of philosophers to sound public policy may be to combat the influence of bad Philosophy (which includes, but is not limited to, bad Philosophy produced by accredited academic philosophers). Part 2 argues that the conventional conception of Practical Ethics (CPE) that philosophers bring to issues of public policy is defective because it fails to take seriously the phenomenon of the subversion of morality, the role of false (...) factual beliefs in this subversion, and the vulnerability to the exploitation of our moral powers that our social-epistemic dependency entails. Given the serious risks of the subversion of morality through the propagation of false factual beliefs, CPE's near exclusive emphasis on identifying sound moral principles greatly constrains its potential contribution to the Negative Task of Practical Ethics, the endeavour to reduce the incidence of the most grievously wrong behaviour. Practical ethicists should focus more on the ethics of believing, and develop a more sophisticated conception of the moral and epistemic virtues of individuals and of institutions, one that includes protective meta-virtues, whose function it is to guard us against the more frequent and predictable subversions of morality, including those subversions that are facilitated by the processes of belief-formation that our social institutions and practices foster. (shrink)
Much of the debate about the ethics of enhancement has proceeded according to two framing assumptions. The first is that although enhancement carries large social risks, the chief benefits of enhancement are to those who are enhanced (or their parents, in the case of enhancing the traits of children). The second is that, because we now understand the wrongs of state-driven eugenics, enhancements, at least in liberal societies, will be personal goods, chosen or not chosen in a market for enhancement (...) services. This article argues that both framing assumptions must be rejected, once it is understood that some enhancements— especially those that are most likely to garner resources and become widespread— will increase human productivity. Once one appreciates the productivity-increasing potential of enhancements, one can begin to see that enhancement need not be primarily a zero sum affair, that the social costs of forgoing enhancements may be great, and that the state may well take an interest in facilitating biomedical enhancements, just as it does in facilitating education and other productivity-increasing traditional enhancements. Appreciating the productivity-increasing potential of enhancements also makes it possible to view the enhancement debate in a new light, through the lens of the ethics of development. (shrink)
There are several reasons for the current prominence of global health issues. Among the most important is the growing awareness that some risks to health are global in scope and can only be countered by global cooperation. In addition, human rights discourse and, more generally, the articulation of a coherent cosmopolitan ethical perspective that acknowledges the importance of all persons, regardless of where they live, provide a normative basis for taking global health seriously as a moral issue. In this paper (...) we begin the task of translating the vague commitment to doing something to improve global health into a coherent set of more determinate obligations. One chief conclusion of our inquiry is that the responsibilities of states regarding global health are both more determinate and more extensive than is usually assumed. We also argue, however, that institutional innovation will be needed to achieve a more comprehensive, fair distribution of concrete responsibilities regarding global health and to provide effective mechanisms for holding various state and nonstate actors accountable for fulfilling them. (shrink)
There is a puzzling disconnect between recent philosophical literature on equality and the modern theory and practice of human rights. This disconnect is puzzling because the modern human rights movement is arguably the most salient and powerful manifestation of the commitment to equality in our time. One likely source of this disconnect is the tendency of contributors to the philosophical literature on equality to focus on justice within the state, considered in isolation. This article begins the task of connection. Section (...) II outlines a philosophical conception of human rights, the Modest Objectivist View, according to which the list of human rights is grounded in descriptive and normative egalitarian assumptions about what is required to help ensure that every individual has the opportunity for a minimally good or decent human life. Next, I explore the resources of the Modest Objectivist View for rationally reconstructing the conventional conception of human rights. Section III examines challenges to the Modest Objectivist View’s egalitarian assumptions. Section IV explores the question of whether the minimal egalitarianism of the Modest Objectivist View is compatible with the more robust egalitarianisms advanced in recent philosophical literature. I conclude that the minimalist egalitarianism of human rights is compatible with more robust egalitarian principles, once we understand the distinctive function of human rights as standards of transnational justice. Key Words: basic interests • decent human life • egalitarianism • equality • minimally good life • Modest Objectivist View • minimalism • opportunity for a decent life • transnational justice. (shrink)
This book articulates a systematic vision of an international legal system grounded in the commitment to justice for all persons. It provides a probing exploration of the moral issues involved in disputes about secession, ethno-national conflict, "the right of self-determination of peoples," human rights, and the legitimacy of the international legal system itself. Buchanan advances vigorous criticisms of the central dogmas of international relations and international law, arguing that the international legal system should make justice, not simply peace among states, (...) a primary goal, and rejecting the view that it is permissible for a state to conduct its foreign policies exclusively according to what is in the "national interest." He also shows that the only alternatives are not rigid adherence to existing international law or lawless chaos in which the world's one superpower pursues its own interests without constraints. This book not only criticizes the existing international legal order, but also offers morally defensible and practicable principles for reforming it. Justice, Legitimacy, and Self-Determination will find a broad readership in political science, international law, and political philosophy. (shrink)
: Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: (1) regulatory oversight, (2) confidentiality and privacy, (3) informed consent, (4) availability of drugs, (5) access, and (6) clinicians' changing responsibilities in (...) the era of pharmacogenetic medicine. We analyze each of these categories of ethical issues and provide policy approaches for addressing them. (shrink)
: Two basic criticisms of managed care are that it erodes patient trust in physicians and subjects physicians to incentives and pressures that compromise the physician's fiduciary obligation to the patient. In this article, I first distinguish between status trust and merit trust, and then argue (1) that the value of status trust in physicians is probably over-rated and certainly underdocumented; (2) that erosion of status trust may not be detrimental if accompanied by an increase in well-founded merit trust; and (...) (3) that under conditions of managed care the physician's commitment to traditional medical ethics cannot serve as an adequate basis for merit trust. Next, drawing on an analogy between managed care organizations and polities, I argue that (4) the most appropriate basis for merit trust in managed care is a conception of organizational legitimacy that includes procedural justice, empowerment of constructive criticism within the organization, and organizational accommodation of the noninstrumental commitment to patient well-being that is distinctive of medical professionalism. I then explore the conditions necessary for robust competition for merit trust among managed care organizations and indicate the kinds of public policies needed to facilitate such competition. Finally, I show how the account of organization-based merit trust can accommodate the special fiduciary obligation of medical professionals, without indulging in the delusion that it is the physician's fiduciary obligation always to provide all care that is expected to be of any net benefit to the patient. (shrink)
All theories of the right to secede either understand the right as a remedial right only or also recognize a primary right to secede. By a right in this context is meant a general, not a special, right (one generated through promising, contract, or some special relationship). Remedial Right Only Theories assert that a group has a general right to secede if and only if it has suffered certain injustices, for which secession is the appropriate remedy of last resort.1 Different (...) Remedial Right Only Theories identify different injustices as warranting the remedy of secession. (shrink)
Ethical problems in business include not only genuine moral dilemmas and compliance problems but also problems arising from the distinctive characteristics of imperfect duties. Collective action by business to perfect imperfect duties can yield significant benefits. Sucharrrangements can (1) reduce temptations to moral laxity, (2) achieve greater efficiency by eliminating redundancies and gaps that plague uncoordinated individual efforts, (3) reap economies of scale and achieve success where benefits can be provided only if a certain threshold of resources can be brought (...) to bear on a social problem; (4) solve assurance problems where voluntary compliance by some parties depends upon their perception that competitors are doing their fair share, and (5) produce higher levels of contribution than would occur through independent action in response to imperfect duties, stimulated by the perception that there is a fair distribution of burdens of contribution among all parties involved. (shrink)
This essay articulates a crucial and neglected element of a general theory of the ethics of bureaucratic organizations, both private andpublic. The key to the approach developed here is the thesis that the distinctive ethical principles applicable to bureaucratic organizations are responses to the distinctive agency-risks that arise from the nature of bureaucratic organizations as complex webs of principal/agent relationships. It is argued that the most important and distinctive ethical principles for bureaucratic organizations express commitments on the part of bureaucrats (...) that function to reduce the agency risks that are inherent in such organizations. This approach to the ethics of bureaucratic organizations is shown to be more illuminating than those that concentrate exclusively or primarily on determining the conditions for corporate responsibility or on the idea that the ethical obligations distinctive of bureaucracies are role-derived. (shrink)
: The mandate of the U.S. Advisory Committee on Human Radiation Experiments required that the Committee take a position on the validity of retrospective moral judgments. However, throughout its period of operation, the Committee remained divided on the question of whether sound judgments of individual culpability and wrongdoing should be included in its Final Report. This essay examines the arguments that various committee members marshalled to support their opposing views on retrospective moral judgment and explains the significance of the controversy.
Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and to professional organizations. (...) The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies. (shrink)
For several decades the work of Joel Feinberg has been the most influential in legal, political, and social philosophy in the English-speaking world. This volume honours that body of work by presenting fifteen original essays, many of them by leading legal and political philosophers, that explore the problems that have engaged Feinberg over the years. Amongst the topics covered are issues of autonomy, responsibility, and liability. It will be a collection of interest to anyone working in moral, legal, or political (...) philosophy. (shrink)
This book is the most comprehensive treatment available of one of the most urgent--and yet in some respects most neglected--problems in bioethics: decisionmaking for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance directives, and investigates the (...) role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly, and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)
The ethical implications of the growth of for-profit health care institutions are complex. Two major moral criticisms of for-profit medicine are analyzed. The first claim is that for-profit health care institutions fail to fulfill their obligations to do their fair share in providing health care to the poor and so exacerbate the problem of access to health care. The second claim is that profit seeking in medicine will damage the physician-patient relationship, creating conflicts of interest that will diminish the quality (...) of care and erode patients' trust in their physicians and the public's trust in the medical profession. The authors conclude that while the continued expansion of for-profit health care may exacerbate in some respects problems of access, trust and conflicts of interest, it is a mistake to consider these problems as unique to for-profit health care; they are problems for not for-profit health care as well. Though these issues justify continuing moral concern, they do not at this time provide decisive grounds for substantially curbing or eliminating for-profit enterprise in health care. Keywords: for-profit medicine, competetion, access to health care, justice, patient-physician relationship CiteULike Connotea Del.icio.us What's this? (shrink)
This is a systematic evaluation of the main arguments for and against the market as an instrument of social organization, balancing efficiency and justice .
