Online research in philosophy

Can torture be morally justified? I shall criticise arguments that have been adduced against torture and demonstrate that torture can be justified more easily than most philosophers dealing with the question are prepared to admit. It can be justified not only in ticking nuclear bomb cases but also in less spectacular ticking bomb cases and even in the socalled Dirty Harry cases. There is no morally relevant difference between self-defensive killing. of a culpable aggressor and torturing someone (...) who is culpable of a deadly threat that can be averted only by torturing him. Nevertheless, I shall argue that torture should not be institutionalised, for example by torture warrants. (shrink)

In this article I try to elucidate the concept of human dignity by taking a closer look at the features of a paradigmatic torture situation. After identifying the salient aspects of torture, I discuss various accounts for the moral wrongness of such acts and argue that what makes torture a violation of human dignity is the perverted moral relationship between torturer and victim. This idea is subsequently being substantiated and defended against important objections. In the final part (...) of the chapter I give a (qualified) defense of the methodology employed in the previous sections. (shrink)

Does A cause B simply if A prevents what would have prevented B? Such a case is known as double prevention: where we have the prevention of a prevention. One theory of causation is that A causes B when B counterfactually depends on A and, as there is such a dependence, proponents of the view must rule that double prevention is causation.<br><br>However, if double prevention is causation, it means that causation can be an extrinsic matter, (...) that the cause and effect need not be connected by a continuous chain of events, that there can be causation by absence, and that there can be causation at a distance. All of these implications jar with strong intuitions we have about the nature of causation. There is, on the other hand, a theory of causation based on an ontology of real dispositions, where causation involves the passing around of powers. This theory in contrast entails that double prevention is not causation and, on this issue, it can claim a victory over the counterfactual dependence account. (shrink)

The military claims to be an honourable profession, yet military torture is widespread. Why is the military violating its own values? Jessica Wolfendale argues that the prevalence of military torture is linked to military training methods that cultivate the psychological dispositions connected to crimes of obedience. While these methods are used, the military has no credible claim to professional status. Combating torture requires that we radically rethink the nature of the military profession and military training.

Machine generated contents note: Part I. The Concept of Evil: 1. Inexcusable wrongs; 2. Between good and evil; 3. Complicity in structural evils; 4. To whom (or to what?) can evils be done?; Part II. Terrorism, Torture, Genocide: 5. Counterterrorism; 6. Low-profile terrorism; 7. Conscientious torture?; 8. Ordinary torture; 9. Genocide is social death; 10. Genocide by forced impregnation; Bibliography; Filmography; Websites; Index.

The problem of “dirty hands” has become an important term, indeed one of the most important terms of reference, in contemporary academic scholarship on the issue of torture. The aim of this essay is to offer a better understanding of this problem. Firstly, it is argued that the problem of “dirty hands” can play neither within rule-utilitarianism nor within absolutism. Still, however, the problem of “dirty hands” represents an acute, seemingly irresolvable, conflict within morality, with the moral agent understood, (...) following Nagel, as necessarily holding mixed, absolutist-consequentialist moral intuitions, pulling in opposite directions. Secondly, a distinction is drawn between real situations of “dirty hands,” and other conflictual scenarios, which are commonly, but unjustifiably placed under the metaphorical title of “dirty hands.” Finally, it is suggested - utilizing Nagel’s own ideas, as developed in his later work, and Sen’s notion of evaluator relativity—that the moral “blind alley” manifested in the problem of “dirty hands” may not be totally blind after all, at least from the situated agent’s own internal point of view (as opposed to that of an external observer trying to put herself in the agent’s position by way of moral simulation). Thus, contrary to Walzer’s approach, it is possible for a person (politician) acting in a situation of “dirty hands,” not to believe herself to be guilty, but still be a moral person. (shrink)

The effectiveness of antiretroviral regimes (ARVs) to reduce risk of HIV transmission from mother to child and as post-exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs can also reduce the risk of HIV transmission via sexual intercourse in two other ways. With pre-exposure prophylaxis (PrEP), ARVs are used to reduce risk of HIV acquisition among persons who are HIV negative and significantly exposed to the virus. With treatment as prevention (TasP), ARVs are used to (...) reduce risk of HIV transmission from persons who are already HIV positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs for HIV-infected persons in need of treatment, is it ethically justified to allocate ARVs for PrEP and/or TasP? This article examines the intuitively appealing view that allocation of ARVs for treatment should be the highest priority, the use of ARVs for TasP should be a secondary priority, and that utilizing ARVs for PrEP would be unethical. I will argue that selective, evidence-based allocation of ARVs for prevention in certain cases could be ethically justified even when there is insufficient anti-retroviral access for all those needing it for treatment. (shrink)

Understanding Torture surveys the massive literature surrounding torture, arguing that, once properly understood, there can be no defence of torture in any circumstances.

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether (...) moral claims justify the provision of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

Ethics for Enemies comprises three original philosophical essays on torture, terrorism, and war. F. M. Kamm deploys ethical theory in her challenging new treatments of these most controversial practical issues. First she considers the nature of torture and the various occasions on which it could occur, in order to determine why it might be wrong to torture a wrongdoer held captive, even if this were necessary to save his victims. In the second essay she considers what makes (...) terrorism wrong--whether it is the intention to harm civilians, rather than harm to them being 'collateral damage,' or something else--and whether terrorism is always wrong. The third essay discusses whether having a right reason, in the sense of a right intention, is necessary in order for a war to be just. Kamm then examines ways in which the harms of war can be proportional to the achievement of the just cause and other goods that war can bring about, so as to make the declaration of war permissible. (shrink)

This collection by leading scholars represents state of the art writings on the ethics of war. Many of the most important and contested controversies in modern war receive comprehensive discussion: the practice of torture, terrorism, assassination and targeted killing, the bombing of civilians in war, humanitarian intervention, and the invasion of Iraq Analytical introduction provides a guide to recent developments in the ethics of war An excellent overview for general readers interested in the current debate and controversies over the (...) ethics of war. (shrink)

I argue that it is possible to prevent (and to be praiseworthy for preventing) an unwelcome outcome that had no chance of occurring. I motivate this position by constructing examples in which it makes sense to explain the non-occurrence of a certain outcome by referring to a particular agent's intentional and willing behavior, and yet the non-occurrence of the outcome in question was ensured by factors external to the agent. I conclude that even if the non-occurrence of an unwelcome outcome (...) is ensured, the agent whose action explains this non-occurrence is praiseworthy for preventing the outcome. My examples are similar in important respects to Frankfurt-type cases. In the second half of the paper, I discuss the relationship between my examples and Frankfurt-type cases involving both actions and omissions. I conclude that while I may be responsible for the consequences of an action even if those consequences are unavoidable, this is not necessarily so for the consequences of omissions. (shrink)

In the aftermath of September 11, 2001, policy makers and others have debated the question of whether or not the United States should torture in an effort to prevent terrorist attacks. In a series of controversial essays, the legal theorist Alan Dershowitz argues that, if a democratic society is going to torture, it should at least be done under the cover of law. To that end, he recommends establishing a legal mechanism by which a judge could issue (...) class='Hi'>torture warrants—much as they do now for search warrants. In this essay, I examine Dershowitz's proposal in light of Michael Walzer's classic essay on dirty hands. Just as Walzer uses political theater as a lens for viewing the issue of political assassination, I similarly draw upon a dramatic response to Dershowitz's proposal to think through the issue of torture warrants. (shrink)

Despite the fact that torture of prisoners has been condemned by every major document in international law, it has seemed to some, especially those in the Bush Administration, that terrorism creates a special case for how prisoners are to be treated. The prisoner may belong to a “cell” of those who have committed themselves to the use of tactics that risk horrible consequences for many innocent people. The prisoner may have information about future attacks on civilian populations that could, (...) if learned, be instrumental in the prevention of these attacks. Nonetheless, I will argue that normally even suspected international terrorists should be treated humanely in that they are not subject to torture when captured and imprisoned. Our humanity demands as much.I will ask what it is about humanity that might restrict or prohibit the use of torture and other forms of physical coercion in the treatment of prisoners. I will attempt to explain why torture has been so roundly condemned and yet why torture, especially in ticking time-bomb cases, has been seen as justifiable. In section 1, I argue that humane treatment should be seen as the centerpiece of international humanitarian law. In section 2, I discuss a 1999 case from Israel concerning soldiers who committed torture to obtain information from suspected terrorists in the Occupied Territories. In section 3, I discuss how the principle of proportionality complicates the picture, and end with some conclusions about what restrictions should be recognized in times of war, concerning what are sometimes called “the laws of humanity.”. (shrink)

Genomic and neuro-scientific research into the causes and course of antisocial behaviour triggers bioethical debate. Often, these new developments are met with reservation, and possible drawbacks and negative side-effects are pointed out. This article reflects on these scientific developments and the bioethical debate by means of an exploration of the perspectives of one important stakeholder group: juveniles convicted of a serious crime who stay in a juvenile justice institution. The views of juveniles are particularly interesting, as possible applications of current (...) and future scientific findings are considered to be most effective if applied early in life. Based on their statements we come to the following provisional conclusions. Concerns about labelling and stigmatization are recognized and widely shared. Possible effects on one's identity are acknowledged too. Yet, a possible biological underpinning of one's antisocial behaviour is not considered to result in the development of a criminal identity. Nonetheless, psychopharmacological interventions are experienced as endangering one's current self. Concerns regarding the refusal of responsibility and the blaming of one's genes or brain can be put into perspective. Instead, participants emphasize the motive of own choice as underlying their criminal behaviour. Moreover, bioethical debate should pay attention to the role of parents of children at risk and the parent-child relationship in families at-risk. We argue that the short-term and long-term interests of children at risk, as well as their interests and those of society at large, may conflict. In order to deal appropriately with newly arising dilemmas, a normative framework needs to be developed. (shrink)

Following the September 2001 terrorist attacks on the United States, much support for torture interrogation of terrorists has emerged in the public forum, largely based on the “ticking bomb” scenario. Although deontological and virtue ethics provide incisive arguments against torture, they do not speak directly to scientists and government officials responsible for national security in a utilitarian framework. Drawing from criminology, organizational theory, social psychology, the historical record, and my interviews with military professionals, I assess the potential of (...) an official U.S. program of torture interrogation from a practical perspective. The central element of program design is a sound causal model relating input to output. I explore three principal models of how torture interrogation leads to truth: the animal instinct model, the cognitive failure model, and the data processing model. These models show why torture interrogation fails overall as a counterterrorist tactic. They also expose the processes that lead from a precision torture interrogation program to breakdowns in key institutions—health care, biomedical research, police, judiciary, and military. The breakdowns evolve from institutional dynamics that are independent of the original moral rationale. The counterargument, of course, is that in a society destroyed by terrorism there will be nothing to repair. That is why the actual causal mechanism of torture interrogation in curtailing terrorism must be elucidated by utilitarians rather than presumed. (shrink)

"Does torture work?" is a factual rather than ethical or legal question. But legal and ethical discussions of torture should be informed by knowledge of the answer to the factual question of the reliability of torture as an interrogation technique. The question as to whether torture works should be asked before that of its legal admissibility—if it is not useful to interrogators, there is no point considering its legality in court.

After the events of 9/11, the concept of torture has emerged as one that is both pertinent and provoking. National polls have shown that some Americans support torture in some situations, though the majority still stand opposed. Torture has not received a tremendous amount of discussion in the philosophical literature, though I suspect that the leftward slant of academia would, for the most part, ensure limited support for torture. In this paper, I would like to first (...) discuss why torture is an important issue and then advance an argument that supports torture in limited cases. (shrink)

In all likelihood, the Bush Administration’s aim is to continue abusive interrogation methods that on any reasonable definition amount to torture (methods such as waterboarding,” for example, in which a detainee is laid on his back and choked with water until he believes he is drowning). This new law, however, is both foolish and immoral: foolish, because torture won’t make Americans safer; and immoral, because torture is the grossest of affronts to human dignity.

In this paper, I argue for the permissibility of torture in idealized cases by application of separation of cases: if torture is permissible given any of the dominant moral theories (and if one of those is correct), then torture is permissible simpliciter and I can discharge the tricky business of trying to adjudicate among conflicting moral views. To be sure, torture is not permissible on all the dominant moral theories as at least Kantianism will prove especially (...) recalcitrant to granting moral license of torture, even in idealized cases. Rather than let the Kantian derail my central argument, I directly argue against Kantianism (and other views with similar commitments) on the grounds that, if they cannot accommodate the intuitions in ticking time-bomb cases, they simply cannot be plausible moral views—these arguments come in both foundationalist and coherentist strains. Finally, I postulate that, even if this paper has dealt with idealized cases, it paves the way for the justification of torture in the real world by removing some candidate theories (e.g., Kantianism) and allowing others that both could and are likely to justify real-world torture. (shrink)

Abstract. To understand the problem of torture in a democratic society, we have to take up a political-theological perspective. We must ask how violence creates political meaning. Torture is no more destructive and no more illiberal than other forms of political violence. The turn away from torture was not a turn away from violence, but a change in the locus of sacrifice: from scaffold to battlefield. Torture had been a ritual of mediation between sovereign and subject. (...) Once sovereignty is located in the people, it no longer makes sense to speak of being sacrificed for the sovereign. Instead, sovereign presence is now realized in an act of self-sacrifice. The wars of modern nation-states have been acts of reciprocal self-sacrifice. Terror invokes torture in response because both speak a primitive language of political sacrifice, denying the enemy the privilege of self-sacrifice. (shrink)

Since Henry Shue’s classic 1978 paper on torture, the “ticking-bomb case” has seemed to demonstrate that torture is morally justified in some moral emergencies (even if not as an institution). After presenting an analysis of torture as such and an explanation of why it, and anything much like it, is morally wrong, I argue that the ticking-bomb case demonstrates nothing at all—for at least three reasons. First, it is an appeal to intuition. The intuition is not as (...) widely shared as necessary to constitute the required demonstration. Second, the intuition is not as reliable as necessary for such a demonstration. We lack the experience that would vouch for it. And, third, Shue’s own discussion suggests that what we are intuiting (if we share Shue’s intuition) is an excuse rather than a justification. (shrink)

Cruelty is the deliberate infliction of physical or psychological pain on other living creatures, sometimes indifferently, but often with delight. Though cruelty is an overwhelming presence in the world, there is no neurobiological or psychological explanation for its ubiquity and reward value. This target article attempts to provide such explanations by describing three stages in the development of cruelty. Stage 1 is the development of the predatory adaptation from the Palaeozoic to the ethology of predation in canids, felids, and primates. (...) Stage 2, through palaeontological and anthropological evidence, traces the emergence of the hunting adaptation in the Pliocene, its development in early hominids, and its emotional loading in surviving forager societies. This adaptation provides an explanation for the powerful emotions – high arousal and strong affect – evoked by the pain-blood-death complex. Stage 3 is the emergence of cruelty about 1.5 million years ago as a hominid behavioural repertoire that promoted fitness through the maintenance of personal and social power. The resulting cultural elaborations of cruelty in war, in sacrificial rites, and as entertainment are examined to show the historical and cross-cultural stability of the uses of cruelty for punishment, amusement, and social control. Effective violence prevention must begin with perpetrators, not victims. If the upstream approaches to violence prevention advocated by the public-health model are to be effective, psychologists must be able to provide violence prevention workers with a fine-grained understanding of perpetrator gratifications. This is a distasteful task that will compel researchers to interact with torturers and abusers, and to acknowledge that their gratifications are rooted in a common human past. It is nonetheless an essential step in developing effective strategies for the primary prevention of violence. Key Words: compassion; cruelty; entertainment industry; evolutionary psychology; intraspecific killing; pain; predation; punishment; torture; violence prevention. Correspondence:c1 Correspondence to: West Hill House, 6 Swains Lane, Highgate, London N6 6QS, United Kingdom. (shrink)

In this paper I argue that torture is morally justified in some extreme emergencies. However, I also argue that notwithstanding the moral permissibility of torture in some extreme emergencies, torture ought not to be legalised or otherwise institutionalised.

The so-called ticking bomb is invoked by philosophers and lawyers trying to justify, on behalf of their political masters, the use of torture in extremis. I show that the scenario is spurious; and that the likely consequences of the use of interrogational torture in such cases are disastrous. Finally, I test the argument against a real case.

I make two arguments in this paper. First, I argue briefly that the ticking time bomb case is unrealistic and as such is liable to mislead us badly on the ground. Second, after conceding that the conditions of the ticking time bomb case might someday be realized, I argue that it may in fact be morally permissible to torture a terrorist in this case on the grounds of self-defense. My reason for making this argument is that rejecting torture (...) in even the ticking time bomb case risks discrediting objections to torture in other, more realistic cases. Yet the principle established by the ticking time bomb case is of extremely limited application. Given the extreme improbability that the conditions of this case could ever be realized, public authorities who sanction torturing someone should have to bear a heavy burden of proof that this decision was justified on the grounds of self-defense. (shrink)

Even people who think torture is justified in certain circumstances regard it - to say the least - as undesirable, however necessary they think it is. So I approach the issue by analysing the extreme case where people such as Dershowitz, Posner and Walzer think torture is justified, the so-called ticking bomb scenario. And since the justification offered is always consequentialist - no one thinks that torture is in any way “good in itself” – I confine myself (...) to consequentialist arguments. That is to say, I take the argument on its own terms, since any non-consequentialist objection to torture merely invites the response, ‘So much the worse for non-consequentialism’: if a moral theory insists that torture is wrong even if it would save thousands of lives that just shows how wrong the theory is . I focus only on the question of the moral justifiability of torture in the ‘ticking bomb’ case, and do not not ask whether, even if admittedly immoral, it should nonetheless be legalised (see Brecher, Torture and the Ticking Bomb, Wiley-Blackwell 2007)). My main argument is in two parts: (1) the “ticking bomb” scenario falls apart when analysed; and (2), even if it did not, the likely consequences of permitting torture would be worse than the bomb’s going off. Finally I briefly consider a genuine case. Further questions and readings are appended. (shrink)

: This essay provides a critical analysis of rape prevention since the 1980s. I argue that we must challenge rape prevention's habitual reinforcement of the notion that fear is a woman's best line of defense. I suggest changes that must be made in the anti-rape movement if we are to move past fear. Ultimately, I raise the question of what, if not vague threats and scare tactics, constitutes prevention.

I offer an argument for why torture, as an act of state-sponsored force to gain information crucial to the well-being of the common good, should be considered as a tactic of war, and therefore scrutinized in terms of just war theory. I argue that, for those committed to the justifiability of the use of force, most of the popular arguments against all acts of torture are unpersuasive because the logic behind them would forbid equally any act of mutilating (...) or killing in battle. I will also argue that looking at torture through the perspective of the just war tradition forces us to place strictures on the practice that make it hard to justify, helps us to see why torture should never be legalized, helps us to clarify when circumstances might justify torture, and suggests what sort of character is required to recognize when those circumstances have occurred. (shrink)

Those of us who oppose torture, and who are acutely conscious of the grave wrongs being committed in our name by our present government, had better be clear and convincing about the basis of our opposition. While I admire the spirit of Ben Juratowitch’s essay, I cannot accept its arguments.i I believe that the case against torture cannot plausibly take an absolutist form and that effective opposition to torture is illserved by appeals to unexplicated and ultimately unserviceable (...) notions such as that torture violates the victim’s human dignity and undermines the perpetrator’s humanity. We fail to take the problem of torture sufficiently seriously if we treat it as a simple matter of civilization versus barbarism, or a choice between respect for human dignity and a collapse into moral degradation and defilement. (shrink)

In this paper, I argue for the permissibility of torture in idealized cases by application of separation of cases: if torture is permissible given any of the dominant moral theories (and if one of those is correct), then torture is permissible simpliciter and I can discharge the tricky business of trying to adjudicate among conflicting moral views. To be sure, torture is not permissible on all the dominant moral theories as at least Kantianism will prove especially (...) recalcitrant to granting moral license of torture, even in idealized cases. Rather than let the Kantian derail my central argument, I directly argue against Kantianism (and other views with similar commitments) on the grounds that, if they cannot accommodate the intuitions in ticking time-bomb cases, they simply cannot be plausible moral views—these arguments come in both foundationalist and coherentist strains. Finally, I postulate that, even if this paper has dealt with idealized cases, it paves the way for the justification of torture in the real world by removing some candidate theories (e.g., Kantianism) and allowing others that both could and are likely to justify real-world torture. (shrink)

This paper investigates the moral permissibility of torture. After briefly considering some empirical evidence, it discusses the conflict between deontological and consequentialist approaches to torture. It is argued that, even if we are to take rights seriously, torture should at least be allowed if some conditions are satisfied. Finally, the paper discusses what those conditions should be and what sorts of torture are morally permissible.

Although torture can establish guilt through confession, how are judgments of guilt made when tortured suspects do not confess? We suggest that perceived guilt is based inappropriately upon how much pain suspects appear to suffer during torture. Two psychological theories provide competing predictions about the link between pain and perceived blame: cognitive dissonance, which links pain to blame, and moral typecasting, which links pain to innocence. We hypothesized that dissonance might characterize the relationship between torture and blame (...) for those close to the torture, while moral typecasting might characterize this relationship for those more distant from it. Accordingly, this experiment placed participants into one of two different roles in which people may be exposed to torture. Participants in the proximal role of prison staffer saw suffering torture victims as relatively more guilty, while participants in the relatively distant role of a radio listener saw suffering victims as more innocent. (shrink)

This chapter considers the wider significance of torture, addressing the manner in which it represents a touchstone for any universalistic morality, and arguing that it offers a means of refuting any moral relativism, something that ties in closely with my long-term theoretical work in metaethics (eg Getting What You Want? A Critique of Liberal Morality (Routledge: London and New York, 1998; and ongoing work around the ultimate justification of morality). Since torture consists in the erasure of a person (...) on the basis of their being an embodied rational agent, that is to say, of their being a person, it requires that the torturer at once recognise and negate the personhood of the person being tortured. The contradiction involved is immediate and integral: torture, one might say, is practical self-contradiction par excellence. For it is embodied rational agents who constitute the subject of any form, and thus of any theory, of morality -- and thus of global social and thus to torture a person is to both accept and deny our identity as embodied rational agents. This work also led to the opportunity for further collaboration with one of the editors, Heather Widdows, this time as part of a larger project on which I have been working for some time – both academically and as an activist -- namely to rescue work from the 1970s and 1980s for the Left. I have so far made two academic contributions: Andrea Dworkin’s Pornography: Men Possessing Women – a Reassessment’, in eds H Marway and H Widdows, Women and Violence: the Agency of Victims and Perpetrators. Palgrave Macmillan: London, forthcoming 2013 and ‘The family and neo-liberalism: time to revive a critique’, Ethics and Social Welfare, forthcoming 2012. (shrink)

Many of us want to say that there is an absolute—or at least a virtually absolute—prohibition on torturing people. But we live in a world in which firm moral restraints of all sorts are hard to defend. Neither contemporary conventional morality, nor any of the available moral theories, provides adequate support for the deliverances of the “wisdom of repugnance” in this area. Nor do they support casuistry capable of distinguishing torture from (sometimes legitimate) forms of rough treatment. I here (...) make some suggestions concerningthe improvement of this situation. (shrink)

Torture is unethical and usually counterproductive. It is prohibited by international and national laws. Yet it persists: according to Amnesty International, torture is widespread in more than a third of countries. Physicians and other medical professionals are frequently asked to assist with torture. -/- Medical complicity in torture, like other forms of involvement, is prohibited both by international law and by codes of professional ethics. However, when the victims of torture are also patients in need (...) of treatment, doctors can find themselves torn. To accede to the requests of the torturers may entail assisting or condoning terrible acts. But to refuse care to someone in medical need may seem like abandoning a patient and thereby fail to exhibit the beneficence expected of physicians. -/- In this paper, we argue that this dilemma is real and that sometimes the right thing for a doctor to do, overall, is to be complicit in torture. Though complicity in a wrongful act is itself prima facie wrongful, this judgment may be outweighed by other factors. We propose three criteria for analyzing how those factors apply to particular cases of medical complicity in torture. (shrink)

A perceived national emergency creates the temptation to abandon principled constraints to official action in order to pursue whatever is thought necessary to confront the crisis. Principled constraints are thought good precisely when they are least needed - during normal times - and thought obstructionist when they are most needed to guide and constrain official action - during times of perceived exceptional circumstances. We are accustomed to thinking of constitutional rights not as absolutes, but as subject to balancing against compelling (...) governmental need. When compelling government interest is expressed in terms of necessity, otherwise prohibited actions, such as torture, may be justified in specific circumstances. In this Article, I argue that we should reject the temptation to rely on necessity to justify extralegal responses to emergencies. Moreover, we should also reject the claim that the Constitution contains a core principle of necessity that frees executive officials to act unfettered by other constitutional constraints under some circumstances. One problem with necessity is that it displaces constitutional commitments to constrained action because necessity, not constitutional principle, becomes the ultimate authority for official action. A second problem with necessity is that when it is used to justify the practice of torture, it undermines the liberal conception of the person that grounds the political legitimacy of the State. Finally, when we prioritize necessity, we change how we look at the world in ways that have pervasive legal and cultural consequences for how we employ other constitutional rights. When we rely on necessity to override principled commitments, such as the prohibition against torture, we change our practices and principles, creating the conditions for changing fundamental aspects of our constitutional culture. I argue that although it is always subject to change, our constitutional culture does not support a worldview that legitimates treating persons as objects of torture, and that arguments to change our culture in light of the needs of necessity are insufficient. (shrink)

PPACA epitomizes comprehensive health care reform legislation. Public health, disease prevention, and wellness were integral considerations in its development. This article reveals the author's personal experiences while working on the framework for health care reform in the United States Senate and reviews activity in the United States House of Representatives. This insider's perspective delineates PPACA's positive effect on public health by examining the infrastructure Congress designed to focus on prevention, wellness, and public health, with a particular focus on (...) the National Prevention, Health Promotion and Public Health Council; the National Prevention, Health Promotion, Public Health, and Integrative Health Care Strategy; and the Prevention and Public Health Fund. The Council, strategy, and fund are especially important because they reflect compliance with some of the Institute of Medicine's recommendations to improve public health in the United States, as well as international health and human rights norms that protect the right to health. (shrink)

HIV/AIDS prevention campaigns have been overshadowed by conflicting, competing, and contradictory views between those who support condom use as a last resort and those who are against it for fear of promoting sexual immorality. We argue that abstinence and faithfulness to one partner are the best available moral solutions to the HIV/AIDS pandemic. Of course, deontologists may argue that condom use might appear useful and effective in controlling HIV/AIDS; however, not everything that is useful is always good. In principle, (...) all schools of thought and faith seem to agree on the question of faithfulness for married couples and abstinence for those who are not married. But they differ on condom use. On the ground, the situation is far more complex. We simply lack a single, entirely reliable way to resolve all disagreements regarding HIV/AIDS prevention strategies. (shrink)

Heart disease is a complex condition that is a leading cause of death worldwide. It is often seen as a disease of affluence, yet is strongly associated with a gradient in socio-economic status. Its highly complex causality means that many different facets of social and economic life are implicated in its aetiology, including factors such as workplace hierarchy and agricultural policy, together with other well-known factors such as what passes for individual 'lifestyle'. The very untangling of causes for heart disease (...) thus inevitably raises social, moral and political issues. These include the proper role of the individual and of larger social forces in its aetiology, prevention and treatment. The construction of risk factors for heart disease likewise is enmeshed with questions of distributive justice in the responsible targeting of those at risk for heart disease, a debate which has received much overt attention in the medical literature, but less attention within the ethical literature. Strategies for addressing a condition of such complex causality can be highly diverse, from pharmaceutical to social interventions, and value issues attach to the choice and presentation of such strategies. For example, prevention strategies may raise complex issues of responsibility and of judgements of what it is to 'live well'. Further ethical debate on this highly political disease would be welcome. (shrink)

(earlier version published on Tom Dispatch, May 21, 2009) The torture memos released by the White House elicited shock, indignation, and surprise. The shock and indignation are understandable -- particularly the testimony in the Senate Armed Services Committee report on Cheney-Rumsfeld desperation to find links between Iraq and al-Qaeda, links that were later concocted as justification for the invasion, facts irrelevant. Former Army psychiatrist Maj. Charles Burney testified that "a large part of the time we were focused on trying (...) to establish a link between Al Qaeda and Iraq. The more frustrated people got in not being able to establish this link ... there was more and more pressure to resort to measures that might produce more immediate results"; that is, torture. The McClatchy press reported that a former senior intelligence official familiar with the interrogation issue added that "The Bush administration applied relentless pressure on interrogators to use harsh methods on detainees in part to find evidence of cooperation between al Qaida and the late Iraqi dictator Saddam Hussein's regime ... [Cheney and Rumsfeld] demanded that the interrogators find evidence of al Qaida-Iraq collaboration. ... 'There was constant pressure on the intelligence agencies and the interrogators to do whatever it took to get that information out of the detainees, especially the few high-value ones we had, and when people kept coming up empty, they were told by Cheney's and Rumsfeld's people to push harder'.". (shrink)

Torture continues to be a pressing political issue in North America, yet religious scholarly reflection on the ethics of torture remains all but sidelined in public discourse for a variety of complex reasons. These reasons are explored—and critiqued—in this collection of reflections by Christian, Jewish, Muslim, and feminist religious ethicists. These scholars find that historical amnesia, forced if not twisted readings of classical texts and contemporary human rights instruments, and sociological factors are but a few of the factors (...) challenging contemporary religious ethical discourse on torture. (shrink)

In this essay, I critically evaluate the new South African state's approach to crime prevention in light of the Kantian principle of respect of persons. I show that the five most common explanations of why the state must fight crime are unconvincing; provide a novel, respect-based account of why justice requires the state to prevent crime; and specify which crime fighting techniques the state must adopt in order to meet this requirement. Reviewing the South African state's criminal justice policies (...) and practices since 1994, I also argue that it has failed to fulfill its obligation to fight crime, which failure is neither excused nor justified. -/- . (shrink)

Many preventive intervention studies with adolescents address high-risk behaviors such as drug and alcohol use, and unprotected sex. Randomized controlled trials (RCT) are the gold standard methodology used to test the effectiveness of these behavioral interventions. Interventions outside the rigidly described protocol are prohibited. However, there are ethical challenges to implementing inflexible intervention protocols, especially when the target population is young, experiences many stressful events, and lives in a resource-poor environment. Teens who are at high risk for substance use or (...) sexual risk behaviors tend to be at risk for other problems such as exposure to violence, sexual and physical abuse, depression, and homelessness. How should investigators deal with the psychological and social needs of teenagers in prevention programs in an ethically appropriate way and at the same time preserve the validity of RCT results? We have identified program characteristics, participant characteristics, interaction with parents, and problems with adolescents not in the study as sources of ethical dilemmas in RCT with at-risk adolescents. As a result of our experience, we recommend that every behavioral intervention study develop an ethics protocol, which should include rules for providing help to participants, has contact information for experts to provide guidance, and an emergency procedure for dealing with life threatening situations. In addition, studies should have a resource manual, train research staff in these ethical issues, and work with a data safety and monitoring board or ethics committee. (shrink)

The conventional dictionary definition of a term is important to the citizen and soldier obeying laws and judging actions that might fall under the term. The “Convention Against Torture” is both binding U.S. law and gives a clear, conventional definition of torture. But the Bush Administration’s standards for interrogating foreign detainees, originating from the Attorney General’s office, failed to respect the prohibitions of torture in the Convention and two other important international human rights documents. I criticize these (...) standards on seven grounds. The directives from President Bush and his Administration thus ordered or allowed most of the terrible recent tortures of Afghanis and Iraqis at Bagram Air Force Base, Guantanamo Bay and Abu Ghraib prisons. (shrink)

Using material taken from contemporary feminist theory and also from work on human rights, it is argued that rape is a form of torture, and that it operates on powerful levels, both literally and metaphorically. Part of the argument is that rape has achieved the status it has as political force for exploitation because of strong beliefs about cultural reproduction and about the roles that women play in cultural reproduction.

Feminists look critically at any infliction of pain on others, usually requiring that it be consensual, and often both consensual and for the benefit of the person afflicted. Most torture of women is not recognized under official definitions of torture because it is not performed by or with the consent of (government) officials. Women are, however, also victims of torture under official definitions as military or civilian prisoners or as members of defeated populations in war, and are (...) more often subjected to sexual torture, which until recently has not been understood either as torture or even a war crime. Rape, especially serial gang rape, it is argued, should be understood as torture, as the essence of torture is the use of severe pain to obscure or obliterate the victim's sense of agency. (shrink)

Interrogational torture is torture that is done in order to gain information. It is wrong if it either wrongs the person being interrogated or is a free-floating wrong. In the relevant cases, interrogational torture need not wrong the person being interrogated. This is because in many cases it doesn’t, and is known not to, infringe on the tortured person’s moral rights. It is not clear whether interrogational torture is a free-floating wrong since we lack confidence in (...) judging whether it violates a consequentialist duty. Even if interrogational torture is morally permissible, it doesn’t follow that it is the best policy for a country to adopt. (shrink)

This paper examines deviant managerial behavior, and compares such behavior to the clinical psychological sociopathic model. The scope of a multinational corporate operation can enhance or degrade the quality of life for individuals with more impact than at any previous time in history. Social costs are compared to the results of sociopathic behavior and examined as the result of amoral or immoral behavior. The idea of the sociopathic manager is discussed, and theoretical causes of sociopathic development are examined with bases (...) in behavioral, economic and criminological literature. Future research and recommendations for prevention of sociopathic behavior are advanced. (shrink)

With the growing focus on prevention in medicine, studies of how to describe risk have become increasing important. Recently, some researchers have argued against giving patients “comparative risk information,” such as data about whether their baseline risk of developing a particular disease is above or below average. The concern is that giving patients this information will interfere with their consideration of more relevant data, such as the specific chance of getting the disease (the “personal risk”), the risk reduction the (...) treatment provides, and any possible side effects. I explore this view and the theories of rationality that ground it, and I argue instead that comparative risk information can play a positive role in decision-making. The criticism of disclosing this sort of information to patients, I conclude, rests on a mistakenly narrow account of the goals of prevention and the nature of rational choice in medicine. (shrink)

In response to a series of allegations of scientific misconduct in the 1980’s, a number of scientific societies, national agencies, and academic institutions, including Harvard Medical School, devised guidelines to increase awareness of optimal scientific practices and to attempt to prevent as many episodes of misconduct as possible. The chief argument for adopting guidelines is to promote good science. There is no evidence that well-crafted guidelines have had any detrimental effect on creativity since they focus on design of research studies, (...) documentation of research findings, assignment of credit through authorship, data management and supervision of trainees, not on the origin and evolution of ideas. This paper addresses a spectrum of causes of scientific misconduct or unacceptable scientific behavior and couples these with estimates of the potential for prevention if guidelines for scientific investigation are adopted. The conclusion is that clear and understandable guidelines should help to reduce the chance that flawed research will escape from our institutions. However, they cannot be relied upon alone to prevent all instances of scientific misconduct and should be regarded rather as one means of bolstering the integrity of the entire scientific enterprise. (shrink)

European animal disease policy seems to find its justification in a “harm to other” principle. Limiting the freedom of animal keepers—e.g., by culling their animals—is justified by the aim to prevent harm, i.e., the spreading of the disease. The picture, however, is more complicated. Both during the control of outbreaks and in the prevention of notifiable, animal diseases the government is confronted with conflicting claims of stakeholders who anticipate running a risk to be harmed by each other, and who (...) ask for government intervention. In this paper, we first argue that in a policy that aims to prevent animal diseases, the focus shifts from limiting “harm” to weighing conflicting claims with respect to “risks of harm.” Therefore, we claim that the harm principle is no longer a sufficient justification for governmental intervention in animal disease prevention. A policy that has to deal with and distribute conflicting risks of harm needs additional value assumptions that guide this process of assessment and distribution. We show that currently, policies are based on assumptions that are mainly economic considerations. In order to show the limitations of these considerations, we use the interests and position of keepers of backyard animals as an example. Based on the problems they faced during and after the recent outbreaks, we defend the thesis that in order to develop a sustainable animal disease policy other than economic assumptions need to be taken into account. (shrink)

Fly strike is a painful conditioncaused by live maggots eating at the flesh of sheep.Remedies for this disorder are traumatic, with sheepundergoing painful mulesing and tail dockingoperations to protect against flystrike. In an attemptto find control solutions and to understand thedisorder, Australasian researchers increase sheepsuffering by conducting experiments that artificiallyinduce fly strike. Some of these experiments have noapplication in prevention and control of fly strike.Many others could be modified or replaced with lesspainful techniques.Anecdotal evidence through communication withorganic farmers suggests (...) that fly strike is largelypreventable if farmers keep sheep healthy and inspectthem regularly. Some organic farmers have largelyeliminated fly strike from their farm. Investigationson fly strike control using non-intrusive techniquesare also progressing in Australasia and the UnitedKingdom. (shrink)

Abstract This paper explores brutality and torture in the history of British counter-insurgency campaigns. Taking as a pretext the British government's announcement in January 2012 to scrap a judicial review into the rendition and torture of UK citizens at Guantanamo Bay by American intelligence operatives with the complicity of British intelligence agencies, the paper posits that the actions this review was supposed to evaluate are not restricted to counter-terrorism. By examining the historical usage of interrogation methods by the (...) British in counter-insurgency campaigns against suspected IRA members in the first decade of the ?Troubles? in Northern Ireland, this article builds a wider frame of reference for the recent controversies surrounding the treatment of detainees during the British occupation of southern Iraq. Although the detention and interrogation of suspects in counter-insurgency campaigns is a necessary security measure, the oft-heralded British adherence to ?minimum force? is heavily mythologised given the prevalence of the brutal treatment of detainees. Considering the detrimental impact (in an ethical, legal and security context) that the existence of torture during detention and interrogation had in these cases, the article upholds an absolutist position on the prohibition of torture. (shrink)

There are approximately one million cases oftype 1 diabetes in the US, and the incidenceis increasing worldwide. Given that two-thirdsof cases present in childhood, it is criticalthat prediction and prevention research involvechildren. In this article, I examine whethercurrent research methodologies conform to theethical guidelines enumerated by the NationalCommission for the Protection of Human Subjectsof Biomedical and Behavioral Research, andadopted into the federal regulations thatprotect research subjects. I then offer twopolicy recommendations to help researchersdesign studies that conform to these ethicalrequirements.

The role of ethics in organizational crisis management has received limited but growing attention. However, the majority of research has focused on applications of ethical theories to managing crisis events after they have occurred, as opposed to the implications of ethical theories for the primary prevention of these situations. The relationship between concepts derived from a contemporary ethic of care (resistance, voice, silence, connection) (Gilligan, C.: 1988, ‘Exit–voice Dilemmas in Adolescent Development’, in C. Gilligan, J. V. Ward and (...) J. M. Taylor (eds.) (Harvard University Press, Cambridge, MA), pp. 141–158, Gilligan, C.: 1990, ‘Preface’, in C. Gilligan, N. P. Lyons and T. J. Hanmer (eds.) (Harvard University Press, Cambridge, MA), pp. 6–29, Gilligan, C.: 1991, ‘Women’s Psychological Development: Implications for Psychotherapy’, in C. Gilligan, A. G. Rogers and D. L. Tolman (eds.) (Harrington Park Press, New York), pp. 5–32), and, concepts derived from a classic theory of organizational decline and recovery (exit, voice, loyalty) (Hirschman, A. O.: 1970, Exit, Voice, and Loyalty: Responses to Decline in Firms,Organizations, and States (Harvard University Press, Cambridge, MA)) is described. The relevance of these notions for signal detection and uptake in organizational crisis prevention is discussed. Implications for prevention are highlighted through consideration of a case involving organizational crisis, the explosion of the space shuttle Challenger. Directions for both business practice and future research are identified. (shrink)

Jeremy Waldron has been a challenging and influential voice in the moral, political and legal debates surrounding the response to terrorism since 9/11. His contributions have spanned the major controversies of the War on Terror - including the morality and legality of torture, whether security can be 'balanced' with liberty, and the relationship between public safety and individual rights. He has also tackled underlying questions essential to understanding the practical debates - including what terrorism is, and what a right (...) to security would entail. -/- This volume collects all Waldron's work on these issues, including six published essays and two previously unpublished essays. It also includes a new introduction in which Waldron presents an overview of his contribution, and looks at the problems currently facing the Obama administration and the UK Government in dealing with the legacy of the Bush White House. -/- The volume will be essential reading for all those engaged with contemporary politics, security law, and the continuing struggle for an ethical response to terrorism. (shrink)

With the great increase in litigation, insurance costs, and consumer prices, both managers and businesses should take a proactive position in avoiding liability. Legal liability may attach when a duty has been breached; many actions falling into this category are also considered unethical. Since much of business liability is caused by a breach of a duty by a business to either an individual, another business, or to society, this article asserts that the practice of liability prevention is a practical (...) business application of ethics. In today's highly litigious environment, it is appropriate for the concept of general liability prevention to be included in corporate codes of ethics. (shrink)

Edward Peters, Torture Oxford: Basil Blackwell, 1985, viii + 202 pp.

Research and intervention involving primary prevention have grown dramatically in the past 10 years. However, little attention has been paid to ethical issues in primary prevention. This article proposes a framework for increasing awareness of such issues. The framework centers on explicating the contexts where prevention activities occur and the roles adopted by interventionists engaging in these activities. Several assumptions underlying primary prevention are stated, and ways of clarifying ethical issues are proposed.

Medieval Muslim scholars unequivocally prohibited the torture of prisoners of war out of a concern for maintaining theoretical constructs about the boundaries of the Muslim and non-Muslim communities. Muslim scholars worried that the torturing prisoners of war would compromise values and ideals predicated on such constructs, and that the demands of citizenship trumped any benefit to the Muslim community that might accrue from torture.

Abstract The purpose of this paper is to develop and analyse a possible theory of ?just torture?, by reference to the framework of just war theory, which proposes moral criticism of war, in order that we can critically consider the morality or otherwise of torture, including that undertaken for interrogation purposes. Initially, we will explore the legal definitions and regulations of torture. Secondly, we will investigate several ethical aspects of torture. Thirdly, in order to apply the (...) principles of just war theory to the issue of torture, we examine how these principles work. Finally, in order to construct this ?just torture? theory and consider whether torture, if any, can be considered to be morally permissible under certain exceptional circumstances, we will propose a tentative framework for just torture, and investigate the set of principles behind the framework. (shrink)

Some participants will get HIV-infected in HIV prevention trials, despite risk reduction measures. The subsequent treatment responsibilities of sponsor-investigators have been widely debated, especially where access to antiretroviral therapy (ART) is not available. In this paper, we explore two accounts of beneficence to establish whether they can shed light on sponsor-investigator responsibilities. We find the notion of general beneficence helpful insofar as it clarifies that some beneficent actions will be obligatory where they can be dispensed without scuppering the trial. (...) We find the notion of specific beneficence helpful insofar as it directs investigators to attend to the needs of trial participants; however the range of interventions that could be provided remains unhelpfully broad. We then examine accounts of the investigator-participant relationship to narrow the range of interventions that investigators should provide, concluding that health-care, and HIV infection, are appropriate foci. We conclude that when investigators are able to meet the ART needs of their participants (e.g. referral, assisted referral or direct provision) without sacrificing trial quality, they must do so. However, there is little of this explicit direction to be found in the account of specific beneficence itself, but rather it is found in accounts of the relationship that are compatible with beneficence. (shrink)

HIV infection and AIDS create many dilemmas in Chinese AIDS/HIV prevention policy. A strategy of clinical tolerance is proposed to address these dilemmas. The immediate purpose of the strategy of clinical tolerance is to win the cooperation of members of stigmatized groups at high risk for contracting HIV infection and AIDS, which occurs as a result of acts done in private and thus beyond the reach of regulation. The strategy of clinical tolerance differs from both tolerance as liberal tolerance (...) and tolerance as a moral ideal of tolerance. A strategy of clinical tolerance does not ask the government, health worker, health official or the public to change either laws or the disapproval of prostitution, homosexuality and drug use. A strategy of clinical tolerance asks, instead, that we weigh what we may regard as the wrong involved in prostitution, homosexuality, and drug use against the greater evil of an HIV/AIDS epidemic. A strategy of clinical tolerance offers the most effective and practical way to confront a growing and significant public health problem in China. (shrink)

A particular amount of punishment is justified if and only if that amount of punishment is deserved and the desert claim is not overridden. In the case of some multiple murderers or people who perform serious violent acts in addition to murder, the deserved punishment must involve torture. I argue that this legitimate desert claim is not overridden by objections based on notions of brutality and inhumanity, the Kantian concern that persons be treated as ends, the intuitive distaste that (...) many persons have for torture, the negative consequences of institutionalized torture, the concern for bias in the imposition of punishment, and the need for accuracy in measuring harms. (shrink)

On the 3rd of March 380, Theodosius, moved by the qualitas (pro reverentia religionis) of the pre-paschal period, a special time of preparation for Easter,mandates the suspension during Christian Lent of all penal trials which normally resulted in torture (Cod. Theod. 9,35,4 = Cod. Iust. 3,12,5). Lent is a specifically Christian time which developed to a large degree in the course of the fourth century, but which varied in duration and organization in the various churches. The law adapts the (...) judicial calendar for the administration of justice to the rhythms of Christian liturgy. Theodosius in 389 (Cod. Theod. 9,35,5; 9,35,7) decrees that during Lent supplicia corporis could not take place, due to the sacredness of those days intended as a salutary penance which culminates in Easter reconciliation. Since the duration of Lent varied within the various churches, civil authorities of the provinces were to be informed by local Christians of the beginning and end of Lent. (shrink)

The U.S. turn toward torture tested the moral resources of all faiths, but perhaps especially of Christianity, which has the greatest number of adherents in the United States. This moral crucible revealed that American Christian scholars and leaders were generally blind to the resources available in relation to the resources available to address torture in a study of scripture, early Christian experience under empire, Christian abuses of suspected heretics, and the just war theory, all of which are considered (...) here. Uses of just war theory have revealed a fracture in that theory between deontological/virtue orientations and consequentialist reasoning, the latter proving susceptible to exploitation in defense of torture. Just war theory also revealed a lacuna of explicit reasoning about torture through the centuries, in a world where torture has so often been an instrument of state power. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about (...) the ethics and the feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against (...) placebo. But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)

Many older people in western countries express a desire to live independently and stay in control of their lives for as long as possible in spite of the afflictions that may accompany old age. Consequently, older people require care at home and additional support. In some care situations, tension and ambiguity may arise between professionals and clients whose views on risk prevention or health promotion may differ. Following Antonovsky’s salutogenic framework, different perspectives between professionals and clients on the pathways (...) that lead to health promotion might lead to mechanisms that explain the origin of these tensions and how they may ultimately lead to reduced responsiveness of older clients to engage in care. This is illustrated with a case study of an older woman living in the community, Mrs Jansen, and her health and social care professionals. The study shows that despite good intentions, engagement, clear division of tasks and tailored care, the responsiveness to receive care can indeed not always be taken for granted. We conclude that to harmonize differences in perspectives between professionals and older people, attention should be given to the way older people endow meaning to the demanding circumstances they encounter (comprehensibility), their perceived feelings of control (manageability), as well as their motivation to comprehend and manage events (meaningfulness). Therefore, it is important that both clients and professionals have an open mind and attempt to understand each others’ perspective, and have a dialogue with each other, taking the life narrative of clients into account. (shrink)

Shortly before his death in 2004, Jacques Derrida provocatively suggested that the greatest problem confronting contemporary democracy is that ‘the alternative to democracy can always be represented as a democratic alternative ’. This article analyses the manner in which certain manifestly anti-democratic practices, like terror and torture, come to be taken up in defense of democracies as a result of what Derrida calls democracy’s ‘autoimmune’ tendencies.

"Active intervention" with suicidal callers to telephone crisis lines involves breaking confidentiality by dispatching emergency services, typically the police, to a suicidal person without that person's consent and sometimes without his or her knowledge.1 Those who oppose active intervention often refer to it as "nonvoluntary intervention." Active intervention is rapidly becoming the standard of practice for crisis centers and is required for certification by the American Association of Suicidology (AAS), the primary organization that certifies telephone crisis centers. A policy of (...) active intervention is also required for any crisis center affiliated with the Hope Line and the National Suicide Prevention Lifeline .. (shrink)

Must treatment be provided to subjects who acquire HIV during the course of a prevention study? An analysis of ethical foundation, regulation, and recent argumentation provides no basis for the obligation. We outline an alternative approach to the problem based on moral negotiation.

Access to treatment, in HIV vaccine trials (HVTs), remains ethically controversial. In most prevention trials, including in South Africa, participants who seroconvert are referred to publicly funded programmes for treatment. This strategy is problematic when there is inadequate and uneven access to public sector antiretroviral therapy (ART) and support resources. The responsibilities, if any, of researchers, sponsors and public health authorities involved in HVTs has been hotly debated among academics, scholars, representatives of international organizations and sponsors. However, there is (...) little published on community perceptions. Recent guidance asserts that communities should make inputs into treatment and care decisions. This qualitative study explored a South African community's perceptions of who should provide what to HVT participants as well as how and why this should be done. Twenty-nine adults working at or attending five primary health care clinics in two rural areas in KwaZulu-Natal participated in in-depth interviews. Respondents expressed that researchers should ‘help participants to access’ treatment and care ‘because they are in a position to do so’ and ‘are in a relationship with’ trial participants. Respondents suggested that researchers could help by ‘facilitating referral’ until such time that participants can access care and treatment on their own. We highlight a series of implications for researchers in HVTs, including their need to be aware of prospective participants' considerable trust in and respect for researchers, the responsibility that this places on them, and the need for clear communication with communities so as not to erode community trust. (shrink)

A surprising lack of consensus exists among contemporary Jewish scholars about Judaism's position vis-à-vis torture. Some claim that Judaism condones torture while others insist that Judaism condemns it. These diverging opinions on such a troubling practice suggest an ambivalence deep within the Judaic textual tradition about torturing bodies. This brief essay critiques both perspectives for twisting the textual tradition and offers some preliminary suggestions for a more robust Judaic approach to torture.

"Torture and Photography: Abu Ghraib" attempts to think the mutual relationships between torture and photography, addressingissues of objectivity, publicity, and distance. In a world where bodies have been divested of human rights, the objectification of the camera seems the perfect complement. Exploring the "prophylactic" character of film, the author proposes human "touch" as always in excess of this objectified state of affairs. Along with memoranda from the Bush administration on the issues of detainee rights and the role of (...) torture in interrogation, the essay engages with the theoretical work of Susan Sontag, Elaine Scarry, Michel Foucault, Georges Bataille, Erwin Straus, and Giorgio Agamben in staking out the intersection of torture and photography. (shrink)

Ethical issues flow from and are embedded in contexts of practice. Contexts of practice refer to the diverse social settings where interventions occur. Primary prevention activities require new professional roles in these diverse social settings. These new roles engage the professional in new activities, which in mm allow new ethical issues to arise. This article takes an ecological perspective on ethical issues arising from the enactment of new preventive roles intended to affect groups or communities. Within this perspective, (...) the concepts of context and culture take on special conceptual significance. Four ecological assumptions about preventive interventions intended to affect groups or communities are offered as a means of framing ethical issues in such interventions. Finally, several approaches to developing ecological knowledge about the contexts of practice are presented as ways of furthering our ability to conceptualize and cope with ethical issues in preventive interventions intended to affect groups or communities. (shrink)

Background: In 2006, the Centers for Disease Control and Prevention (CDC) recommended three changes to HIV testing methods in US healthcare settings: (1) an opt-out approach, (2) removal of separate signed consent, and (3) optional HIV prevention counseling. These recommendations led to a public debate about their moral acceptability. Methods: We interviewed 25 members from the fields of US HIV advocacy, care, policy, and research about the ethical merits and demerits of the three changes to HIV testing methods. (...) We performed a qualitative analysis of the participant responses in the interviews and summarized the major themes. Results: In general, arguments in favor of the methods were based upon their ultimate contribution to increasing HIV testing and permitting the consequent benefits of identifying those who are HIV infected and linking them to further care. Conclusions: The prevailing theme of ethical concern focused on suspicions that the methods might not be properly implemented, and that further safeguards might be needed. (shrink)

Issues: We present key aspects of our paper, commissioned by UNAIDS in 2005, entitled, “Revisiting the ethics of HIV prevention research in developing countries.” In 2004 and 2005 we witnessed the closure or suspension of three international clinical trials testing tenofovir in the prevention of HIV infection in high risk groups due to the failure to provide free treatment to those who seroconvert during the conduct of the study. We examine critically moral claims for the provision of treatment (...) to those who seroconvert in HIV prevention trials and ask whether it is a matter of moral obligation or moral negotiation?Description: Using the tools of philosophical and regulatory analysis we examine the moral foundations of research ethics, international regulation, and the contemporary literature in search of valid arguments in support of a moral obligation to treat. Arguments supporting the obligation to provide such treatment are found in a wide variety of documents. These claims are variously rooted in the demand to compensate for research-related injury, maximization of research benefit, justice as reciprocity, and justice as equality.Lessons learned: Our analysis reveals that there is as of yet no robust moral argument supporting a moral obligation to provide treatment to participants in HIV prevention trials who seroconvert. We argue that moral negotiation offers distinct advantages over moral obligation. Moral negotiation finds support in the principle of respect for communities that holds researchers responsible to respect communal values, protect and empower social institutions and abide by the decisions of accepted communal authorities.Recommendations: Moral negotiation, rather than moral obligation, reduces the chance of polarization of positions by inviting trial participants, sponsors, researchers and all other involved parties to the table for discussion. Moral negotiation favors middle ground solutions that fit the specific health needs and priorities of the community in question. (shrink)

This book addresses a dilemma at the heart of counter-terrorist policy: is it ever justifiable to torture terrorists in order to save the lives of others, the so-called 'ticking bomb' scenario? -/- The book opens with an analysis of the pure moral argument from the standpoint of the individual as torturer. It then looks at the issues that arise once a state has decided to sanction torture in certain situations: how to establish factually that the situation is urgent, (...) deciding who to torture, training people to carry out torture, and the efficacy of torture as a means of gathering information. The final part examines attempts to operate legal systems which tolerate torture; how they relate to the criminal law notion of necessity and to international human rights norms. -/- After examining the utilitarian arguments for torture, and the impact on a society of permitting torture, the author presents a powerful argument for maintaining the absolute legal prohibition. (shrink)

Torture, assassination, and blackmail in modern, asymmetric conflict -- Friends, foes or brothers in arms : the puzzle of combatant equality -- Dilemmas and paradoxes of combatancy -- Shooting to kill : the paradox of prohibited weapons -- Shooting to stun : the paradox of nonlethal warfare -- Murder, self-defense or execution : the dilemma of assassination -- Human dignity or human life : the dilemmas of torture -- Dilemmas and paradoxes of noncombatancy -- Blackmailing the innocent : (...) the dilemma of noncombatant immunity -- Killing the innocent : the dilemma of terror -- Risking our lives to save others : the paradox (and dilemma) of humanitarian intervention -- Torture, assassination, and blackmail : new norms for asymmetric conflict. (shrink)

This paper offers a phenomenological description of torture that delves beneath its mere physical effect on the human body, in order to demonstrate that bodily pain is only one dimension of the experiential structure of torture. In fact, this paper’s central claim is that torture is better understood as a radical ontological violation of a lived world through the body. This claim is supported through Merleau-Ponty’s theory of the embodied subject. The main purpose of this paper is (...) to show that no matter how physically “unscarred” a survivor of torture may be, their lived world remains irretrievably damaged. (shrink)

The number of women living with HIV/AIDS is increasing worldwide, and there is an urgent public health need to develop new user-initiated HIV prevention methods, including microbicides. Although funding for microbicide development has increased since 2000, financial support is provided predominantly by governmental agencies and private foundations. Many donors, including the US Agency for International Development (USAID) and the US National Institutes of Health (NIH), have policies that restrict how research funds may be used. Among these are the now-rescinded (...) Mexico City Policy, elements of the US Foreign Assistance Act, and restrictions on non-study-related care. The effect of these restrictions on the design and conduct of clinical research is poorly understood. As part of a recent mapping exercise conducted by the Global Campaign for Microbicides, we reviewed the impact of donor restrictions on seven HIV prevention trials. We found considerable confusion within the HIV prevention field as to whether and how Mexico City and other policies affect the use of research funds. We also found that these donor-imposed policies limited the level of care provided to trial participants and the types of capacity building projects undertaken. (shrink)

Public health is an important and fast-developing area of ethical discussion. In this volume a range of issues in public health ethics are explored using the resources of moral theory, political philosophy, philosophy of science, applied ethics, law, and economics. The twelve original papers presented consider numerous ethical issues arise within public health ethics. To what extent can the public good or the public interest justify state interventions that impose limits upon the freedom of individuals? What role should the law (...) play in regulating risks? Should governments actively aim to change our preferences about such things as food, smoking or physical exercise? What are public goods, and what role (if any) do they play in public health? To what extent do individuals have moral obligations to contribute to protecting the community or the public good? Where is it appropriate to concentrate upon prevention rather than cure? Given the fact that we cannot be protected from all harm, what sorts of harm provide a justification for public health action? What limits do we wish to place upon public health activities? How do we ensure that the interests of individuals are not set aside or forgotten in the pursuit of population benefits? -/- An excellent line-up of authors from North America, Europe, and the UK tackle these questions. (shrink)

Ford, Norman There has been some confusion in the media over what Pope Benedict XVI meant by his comments on the use of condoms. He was discussing acts of sexual intercourse performed by male prostitutes in relation to HIV (human immune deficiency virus) infection in reply to a question put to him during an interview with Peter Seewald. The Vatican spokesman Fr Lombardi SJ said the Pope 'had confirmed to him that the example was valid in the case of all (...) prostitutes. The point of the example, he said, "was not the sex of the prostitute but the process of growing awareness of the risk [to] the life of the other person".' He was not referring to married couples nor contraception but the prevention of HIV infection from acts of prostitution. (shrink)

Of the many ideological blind spots that have afflicted US and, to a lesser extent, European, perceptions and analysis of the economic, political and social milieu, none have been more debilitating than the equation of democracy with political liberalism. Thus those who attempt to derive propaganda value from such an equation are vulnerable, as the US government has found, to the rhetorical counter attack that in opposing democratically elected governments, such as that of Hamas or Hugo Chavez, they are not (...) merely being anti-democratic, but are in illiberally opposition to human rights and civil liberties also; an argument quiteindependent of the same charges, emanating more legitimately, from their support of, for example, the Masharraf regime and the Saud dictatorship.Furthermore no less an august body than the Council of Europe has drawn attention to the US government’s inhumane, humiliating, degrading and cruel treatment, including torture, of prisoners, at Guantanamo, and, seemingly even more extreme treatment of prisoners in the supposedly secret or “black” prisons operated both by the CIA, and other countries, where the torture of prisoners, often illegally or extra judicially rendered to them, has been outsourced. In light of this the paper takes up a discussion of the nature of the relationship between Liberalism, Democracy and Torture as it is germane to the current legitimation crisisfacing liberal democracies. (shrink)

Civil society organizations (CSOs) have significantly impacted on the politics of health research and the field of bioethics. In the global HIV epidemic, CSOs have served a pivotal stakeholder role. The dire need for development of new prevention technologies has raised critical challenges for the ethical engagement of community stakeholders in HIV research. This study explored the perspectives of CSO representatives involved in HIV prevention trials (HPTs) on the impact of premature trial closures on stakeholder engagement. Fourteen respondents (...) from South African and international CSOs representing activist and advocacy groups, community mobilisation initiatives, and human and legal rights groups were purposively sampled based on involvement in HPTs. Interviews were conducted from February-May 2010. Descriptive analysis was undertaken across interviews and key themes were developed inductively. CSO representatives largely described positive outcomes of recent microbicide and HIV vaccine trial terminations, particularly in South Africa, which they attributed to improvements in stakeholder engagement. Ongoing challenges to community engagement included the need for principled justifications for selective stakeholder engagement at strategic time-points, as well as the need for legitimate alternatives to CABs as mechanisms for engagement. Key issues for CSOs in relation to research were also raised. (shrink)

Given current constraints on universal treatment campaigns, recent advances in public health prevention initiatives have revitalized efforts to stem the tide of HIV transmission. Yet, despite a growing imperative for prevention—supported by the promise of behavioral, structural and biomedical approaches to lower the incidence of HIV—human rights frameworks remain limited in addressing collective prevention policy through global health governance. Assessing the evolution of rights-based approaches to global HIV/AIDS policy, this review finds that human rights have shifted from (...) collective public health to individual treatment access. While the advent of the HIV/AIDS pandemic gave meaning to rights in framing global health policy, the application of rights in treatment access litigation came at the expense of public health prevention efforts. Where the human rights framework remains limited to individual rights enforced against a state duty bearer, such rights have faced constrained application in framing population-level policy to realize the public good of HIV prevention. Concluding that human rights frameworks must be developed to reflect the complementarity of individual treatment and collective prevention, this article conceptualizes collective rights to public health, structuring collective combination prevention to alleviate limitations on individual rights frameworks and frame rights-based global HIV/AIDS policy to assure research expansion, prevention access and health system integration. (shrink)

In order to cope with the changing health needs in the community, an holistic approach on AIDS prevention and control with particular reference to essential quality was introduced at an educational seminar at Hebei Medical University in China, 1996. We have identified three major points in the present study through learning and research process: 1. The importance of ‘cultural norm’ for the unification of science and technology is identified for the community approach; 2. ‘community care’ emphasising human quality provides (...) unity in diversity for educational program; and 3. ‘community control’ emphasising quality assurance demonstrates the effectiveness for program analysis from the viewpoint of human centred systems. (shrink)

Most of the attention regarding the balance between autonomy and paternalism has been focused on the therapeutic relation. Much less attention has been devoted to the problem of autonomy in the application of medical knowledge for preventive purposes. Here, because the good to be achieved is social as well as individual, an unavoidable dilemma ensues. Effective preventive measures of benefit to all must necessarily limit autonomy and involve some coercion. I argue that there are principles which can be established to (...) guide society in a moral use of coercion. The question of employing medical knowledge is not, as it is in therapeutic medicine, to preserve or enhance autonomy. Rather its aim is to enhance voluntary co-operation. Principles for moral use of coercion must thereby be derived from health as a moral value. (shrink)

Moral puzzles about actions which bring about very small or what are said to be imperceptible harms or benefits for each of a large number of people are well known. Less well known is an argument by Warren Quinn that standard theories of rationality can lead an agent to end up torturing himself or herself in a completely foreseeable way, and that this shows that standard theories of rationality need to be revised. We show where Quinn's argument goes wrong, and (...) apply this to the moral puzzles. (shrink)

As the ball flew towards us I leapt to my left to catch it. But it was you, reacting more rapidly than I, who caught the ball just in front of the point at which my hand was poised. Fortunate for us that you took the catch. The ball was headed on a course which, unimpeded, would have taken it through the glass window of a nearby building. Your catch prevented the window from being broken.

In a recent article published in this journal, Andrew Chignell proposes some candidates for greater or ‘balancing out’ goods that could explain why God allows some infants to be tortured to death. I argue that each of Chignell's proposals is either incoherent, metaphysically dubious, and/or morally objectionable. Thus, his proposals do not explain what might justify God in allowing infants to be tortured, and the existence of infant suffering remains a serious problem for traditional theism.

In 1992, The Danish Medical Research Council established a national committee on scientific dishonesty with the twofold task of handling cases of scientific misconduct and taking preventive initiatives. Scientific dishonesty was proven in only five cases, but in another nine cases lesser degrees of deviations from good scientific practice were found. The experiences from a total of 24 treated cases indicated that three key areas were at the basis of most of the accusations and the deviations from good practice: uncertainty (...) about 1) authorship, about 2) rights and duties to use scientific data and about 3) agreements at the initiation of joint studies. As a consequence guidelines on good practice have been issued on these key subjects. (shrink)

Lawrence Weschler, A Miracle, A Universe: Settling Accounts with Torturers New York: Pantheon, 1990, ix + 293 pp.

The analysis of different theoretical approaches to the structure of the notion "viability" is presented in the article. Basing on the analysis the author attempted to reveal the interrelation of viability and hardiness, adaption, social competence and coping strategies. It is shown that viability is an integrated property system including the abovementioned personality resources. It is concluded that viability is a model of the adaptive personality behavior. Viability forms the basis for coping the dependent personality behavior and obtains the status (...) of the basic category of preventive pedagogic. (shrink)