This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

According to the Intergovernmental Panel on Climate Change, human population growth is one of the two primary causes of increased greenhouse gas emissions and accelerating global climate change. Slowing or ending population growth could be a cost effective, environmentally advantageous means to mitigate climate change, providing important benefits to both human and natural communities. Yet population policy has attracted relatively little attention from ethicists, policy analysts, or policy makers dealing with this issue. In part, (...) this is because addressing population matters means wading into a host of contentious ethical issues, including family planning, abortion, and immigration. This article reviews the scientific literature regarding voluntary population control's potential contribution to climate change mitigation. It considers possible reasons for the failure of climate ethicists, analysts, and policy makers to adequately assess that contribution or implement policies that take advantage of it, with particular reference to the resistance to accepting limits to growth. It explores some of the ethical issues at stake, considering arguments for and against noncoercive population control and asking whether coercive population policies are ever morally justified. It also argues that three consensus positions in the climate ethics literature regarding acceptable levels of risk, unacceptable harms, and a putative right to economic development, necessarily imply support for voluntary population control. (shrink)

This is a review of contemporary philosophical discussions of population policies. The focus is on normative justification, and the main question is whether population policies can be ethically justified. Although few analytical philosophers have directly addressed this question – it has been discussed more in other academic fields – many arguments and considerations can be placed in the analytical philosophical discourse. This article offers a comprehensive review and analysis of ethically relevant aspects of population policies evaluated on (...) the basis of the main ethical theories. This analysis is preceded by a brief historical contextualisation of when and how population policies became ethically contentious and how this relates to philosophical debates in environmental ethics, population ethics and political philosophy. The article also includes a conceptual analysis of population policies in which the empirical intricacies around individual fertility decisions are sorted out and the different ways in which they can be affected are categorised in a taxonomy which highlight the most relevant ethical aspects of population policies. The ethical analysis shows that while population policies can be justified on the basis of most ethical theories, it all depends on what prior assumptions are made about what is at stake. (shrink)

I shall briefly evaluate the common claim that ethically acceptable population policies must let individuals to decide freely on the number of their children. I shall ask, first, what exactly is the relation between population policies that we find intuitively appealing, on the one hand, and population policies that maximize procreative freedom, on the other, and second, what is the relation between population policies that we tend to reject on moral grounds, on the one hand, and (...) population policies that use coercive methods such as laws or economic incentives and deterrents, on the other. I shall argue that when changing a population policy, it may be morally desirable to affect people's procreative decisions more rather than less, and that sometimes it may be morally desirable to prefer a population policy that does not maximize procreative freedom to a population policy that does maximize it. I shall also point out that indirect population policies that use incentives and deterrents are not necessarily incompatible with liberal principles. Finally, I try to show what is assumed by those who defend the view that coercive population policies are morally wrong in all circumstances. (shrink)

Population policy has taken two divergent trajectories. In the developing part of the world, controlling population growth has been a major tune of the debate more than a half-century ago. In the more developed part of the world, an inverse pattern results in the discussion over the facilitation of population growth. The ethical debates on population policy have primarily focused on the former and ignored the latter. This paper proposes a more comprehensive account that (...) justifies states’ population policy interventions. We first consider the reasons that support pro-natalist policies to enhance fertility rates and argue that these policies are ethically problematic. We then establish an ethics of population policy grounded on account of self-sustaining the body politic, which consists of four criteria: survival, replacement, accountability, and solidarity. We discuss the implications of this account regarding birth-control and pro-natalist policies, as well as non-procreative policies such as immigration, adoption, and unintended baby-saving strategies. (shrink)

Ovaj rad opisuje promene naucne paradigme u demografiji do kojih je doslo u kontekstu drustveno-politickih procesa tokom zadnje dve decenije dvadesetog veka. Promena se posmatra u domenu analize reproduktivnog ponasanja gde je, kako tvrdi autorka, teorija demografske tranzicije ostala dominantan okvir analize ali je prednost dobila njena modifikovana verzija koja primat daje idejnim u odnosu na struktrualne varijable u objasnjavanju reproduktivnog ponasanja; i u domenu socijalne politike, gde je, po recima autorke, napusten koncept planiranja porodice a na njegovo mesto stupio (...) koncept populacione politike. Autorka, medjutim, tvrdi da alarmirajuca upozorenja i ostra retorika o populacionim problemima nisu doveli do formulisanja specificnih mera populacione politike te da su demografski diskursi koji su u to vreme prepravili javni prostor bili mnogo znacajniji za politiku identiteta - nacionalnog i rodnog - nego za socijalnu politiku. (shrink)

This paper addresses whether universal, general education programs are enough to satisfy basic criteria of human rights, or whether comprehensive family planning programs, in conjunction with universal education programs, might also be morally required. Even before the Reagan administration instituted the ‘global gag rule’ at the 1984 conference in Mexico City, prohibiting funding to nongovernmental organizations that included providing information about abortion as a possible method of family planning, the moral acceptability of family planning programs has been called into question. (...) This paper makes a moral argument for family planning by appealing to both data and to theory: data about the efficacy of universal and comprehensive family planning education programs at reducing fertility and infant mortality, and theory about what is required for the establishment of autonomy. It reasons that universal educational programs are insufficient for the promotion of autonomy, and therefore argues on substantive autonomy grounds for comprehensive family planning programs in addition to universal education programs. (shrink)

A survey of women in two highly developed rural counties of China, Sichuan and Jiangsu Provinces, was carried out in late 1991, to gain information about demographic and economic change between 1980 and 1990. Three separate surveys were conducted: the first a questionnaire administered to married women aged 30–39, eliciting information about childbearing and contraception, as well as the social and economic background of the respondents; the second, focus group interviews emphasizing the motivation for childbearing. Official information about the selected (...) villages, townships and counties was also collected. (shrink)

This article addresses India's contemporary population control policies and practices as a form of gender violence perpetrated by the state and transnational actors against poor, Adivasi and Dalit women. It argues that rather than meeting the needs and demands of these women for access to safe contraception that they can control, the Indian state has targeted them for coercive mass sterilisations and unsafe injectable contraceptives. This is made possible by the long-term construction of particular women's lives as devalued and (...) disposable, and of their bodies as excessively fertile and therefore inimical to development and progress. It further considers how population policy is currently embedded in the neoliberal framework of development being pursued by the Indian state. In particular, it argues that the violence of population policies is being deepened as a result of three central and interrelated aspects of this framework: corporate dispossession and displacement, the intensification and extension of women's labour for global capital, and the discourses and embodied practices of far-right Hindu supremacism. At the same time, India's population policies cannot be understood in isolation from the global population control establishment, which is increasingly corporate-led, and from broader structures of racialised global capital accumulation. The violence of India's contemporary population policies and the practices they produce operate at several different scales, all of which involve the construction of certain bodies as unfit to reproduce and requiring intervention and control. (shrink)

This article examines recent ageing policies and the way they are framed. Here it identifies underlying but sometimes contradictory narratives of growth and decline. It concludes that the overall aim of such policies is to reconstitute elderly subjectivities, conduct and everyday experience in light of neoliberal ambitions for sustained economic growth and geopolitical anxieties about regional decline nurtured by an unprecedented demographic process of population ageing. As a consequence, the language of inclusion is judged to be of ambiguous value (...) for elderly people. Although the article is critical of the ways older people are perceived as a problem and of the solutions – such as pension reform, biopolitical-cum-economic behaviour modification and pronatalism – that are being pursued, in response it also finds some potential in current thinking for a more radical reappraisal of the elderly lifestyle and of the life cycle as a whole in relation to work regimes. It speculates that the generation of post-war baby boomers now approaching retirement just might rediscover resources in its counter-cultural memory to imagine a more emancipatory elder life congruent with a more sustainable environment. (shrink)

This article considers how the metaphor of Mother Earth, for women, concerns a dual stance of both belonging and distance. The link between women, nature and Mother Earth is problematised by considering the possible, or contested, link between population growth and climate change, and the South African population policy specifically is considered as an example. Ecofeminism’s challenge to the perceived connection between women, motherhood and Earth, that is the ‘distance’ stance, is considered and a response to that (...) is offered by reflecting on Mercy Oduyoye’s notion of mothering, which represents the ‘belonging’ stance. In this regard, an intercultural approach to the definition of motherhood is implied. It is ultimately indicated that for women to reclaim their own agency regarding a perceived responsibility towards nature, it is necessary to deconstruct and reconstruct ‘motherhood’ to free themselves from being stuck between Mother Earth and a mother’s womb.Contribution: This article makes a contribution to feminist studies at the intersection of gender roles and the climate crisis, as it relates to population growth and an intercultural definition of motherhood. It contributes to UN’s sustainable development agenda as it relates to both SDG 5 (gender equality) and SDG 13 (climate action). (shrink)

What are the prospects for using population policy as tool to reduce carbon emissions? In this paper, we review evidence from population science, in order to inform debates in population ethics that, so far, have largely taken place within the academic philosophy literature. In particular, we ask whether fertility policy is likely to have a large effect on carbon emissions, and therefore on temperature change. Our answer is no. Prospects for a policy of fertility-reduction-as-climate-mitigation (...) are limited by population momentum, a demographic factor that limits possible variation in the size of the population, even if fertility rates change very quickly. In particular, a hypothetical policy that instantaneously changed fertility and mortality rates to replacement levels would nevertheless result in a population of over 9 billion people in 2060. We use a leading climate-economy model to project the consequence of such a hypothetical policy for climate change. As a standalone mitigation policy, such a hypothetical change in the size of the future population-much too large to be implementable by any foreseeable government programme-would reduce peak temperature change only to 6.4°C, relative to 7.1°C under the most likely population path. Therefore, fertility reduction is unlikely to be an adequate core approach to climate mitigation. (shrink)

This is the first of a series of reports on the research groups of the institute: Death and Dying, Behavior Control, Genetic Engineering/Genetic Counseling, the Teaching of Medical Ethics, and the subject of this report, Population Control.

Nearly all large policy decisions influence not only the quality of life for existing individuals but also the number-and even identities-of yet-to-exist individuals. Accounting for these effects in a policy evaluation framework requires taking difficult stances on concepts such as the value of existence. These issues are at the heart of a literature that sits between welfare economics and philosophical population ethics. Despite the inherent challenges of these questions, this literature has produced theoretical insights and subsequent progress (...) on variable-population welfare criteria. A surprisingly bounded set of coherent alternatives exists for practitioners once a set of uncontroversial axioms is adopted from the better-studied welfare criteria for cases where populations are assumed to be fixed. Although consensus has not yet been reached among these remaining alternatives, their recommendations often agree. The space has been sufficiently restricted and well explored that applications of the theoretical insights are possible and underway in earnest. (shrink)

Book reviewed in this article: Basic Rights: Subsistence, Affluence, and U.S. Foreign Policy. By Henry Shue Morality and Population Policy. By Michael D. Bayles.

Future population growth is uncertain and matters for climate policy: higher growth entails more emissions and means more people will be vulnerable to climate-related impacts. We show that how future population is valued importantly determines mitigation decisions. Using the Dynamic Integrated Climate-Economy model, we explore two approaches to valuing population: a discounted version of total utilitarianism (TU), which considers total wellbeing and is standard in social cost of carbon dioxide (SCC) models, and of average utilitarianism (AU), (...) which ignores population size and sums only each time period’s discounted average wellbeing. Under both approaches, as population increases the SCC increases, but optimal peak temperature decreases. The effect is larger under TU, because it responds to the fact that a larger population means climate change hurts more people: for example, in 2025, assuming the United Nations (UN)-high rather than UN-low population scenario entails an increase in the SCC of 85% under TU vs. 5% under AU. The difference in the SCC between the two population scenarios under TU is comparable to commonly debated decisions regarding time discounting. Additionally, we estimate the avoided mitigation costs implied by plausible reductions in population growth, finding that large near-term savings ($billions annually) occur under TU; savings under AU emerge in the more distant future. These savings are larger than spending shortfalls for human development policies that may lower fertility. Finally, we show that whether lowering population growth entails overall improvements in wellbeing—rather than merely cost savings—again depends on the ethical approach to valuing population. (shrink)

Changes in the scope of health policy in the United States are creating opportunities and obligations for lawmakers and the lawyers who advise them. These changes are the result of a new politics of policy for the health of populations. The new politics is connecting areas of policy that, because they have had separate histories, are governed by distinct, usually uncoordinated laws and regulations.The subject of the new politics of health policy is what the Iowa Senate (...) President, speaking in a plenary at the 2003 conference on Public Health Law in the 21st Century, called the “quality of life, what the people think is important.” An increasing number of leaders in general govemment–people who run for office and their staff–have practical reasons to make policy that acknowledges the expanding scope of what their constituents define as health policy. (shrink)

This study examines the educational policy related to the inclusion of ethnic minority population in the contemporary China. It has undergone three stages of the educational policy transformation, including the beginning, development and perfection stages. It is characterized by the steadiness, caution, rapidity, quality improvement, standardization and quality. Through implementing the educational policy of the inclusion of ethnic minority population, it has made retrogress and achievements, which has played a positive role in national integration, maintaining (...) national unity and regional stability, improving the academic level and cross-cultural ability of minority students, and sharing educational resources. However, in current China’s education context, the implementation of education policy is faced with some prominent problems, such as the marginalized educational identity, non-communicative education, relative separation of systems and serious cultural barriers, relative emphasis on explicit education. Therefore, it suggested to construct a new integrative and open ethnic education system, strengthen the consciousness of the united integrated education, and enhancing the bi-directionality of ethnic integration. (shrink)

During 1980–90, Japan's annual real GDP growth rate was 4.6%, but which declined to 1.2% in the 1990s. While the drop in itself is a problem, at the same time it exacerbated many other problems, namely inequality, budget deficits, and the increasing burden of an aging society.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.4 (2004) 411-425 [Access article in PDF] Vulnerability, Vulnerable Populations, and Policy Mary C. Ruof "Special justification is required for inviting vulnerable individuals to serve as research subjects and, if they are selected, the means of protecting their rights and welfare must be strictly applied."Guideline 13: Research Involving Vulnerable Persons International Ethical Guidelines for Biomedical Research Involving Human Subjects Council for International Organizations (...) of Medical Sciences (CIOMS) and World Health Organization (WHO) Geneva, Switzerland, 2002 Within medical research and healthcare certain groups are afforded special protections and services because of their designation as vulnerable. The vulnerable require special justification to participate in human subject research in order to eliminate potential human rights abuses. The Nuremberg Code of 1947 was written in response to the extreme human subject abuses that occurred under the Nazi regime, and, although the intent of the 1947 Code was to protect human rights, rigid voluntary consent requirements deprived some individuals of the right to participate in clinical trials. Recent human research guidelines, such as the CIOMS/WHO guidelines referenced above and the guidelines referenced in Section V of this Scope Note, attempt to balance both protection from abuse in research and access to new, experimental treatments for the vulnerable.Although various protective guidelines stipulate special protections for vulnerable populations, the concept of vulnerability and consequently the criteria designating vulnerable populations remain vague. Precisely who are the vulnerable? The word "vulnerability" stems from the Latin vulnerare, "to wound." (Oxford Encyclopedic English Dictionary 1995). In clinical research, the term [End Page 411] vulnerable generally is applied to individuals who are unable to give informed consent or who are susceptible to coercion. The Common Rule (45 CFR 46, Subpart A) includes as vulnerable research subjects: children, prisoners, pregnant women, and persons who are handicapped, mentally disabled, economically disadvantaged, or educationally disadvantaged. Although the Common Rule specifies certain vulnerable categories, the guidelines were not intended to be exclusive, leaving open the interpretation of vulnerability.In medical research and health policy, vulnerability is an abstract concept that has concrete effects both for those labeled vulnerable and for those not. Clinical researchers, healthcare workers, ethical reviewers, and policymakers must be able to identify vulnerable subjects to establish how healthcare resources will be allocated and who will qualify for special protections and socialized benefits. Attempts to quantify vulnerability in clear, measurable ways have met little if any consensus. As Alexander Morawa (II, 2003, p. 150) states, "There is no single approach to definition of vulnerability. In fact, there is no purposeful categorisation at all."Difficulties in defining vulnerability have prompted discourse surrounding its utility as a qualifying factor in the allocation of health resources and its appropriateness as a guiding principle in bioethics. Some of the authors cited in this Scope Note argue against the labeling and categorization of vulnerable individuals and populations. "Labeling individuals as 'vulnerable' risks viewing vulnerable individuals as 'others' worthy of pity, a view rarely appreciated" (III, Danis and Patrick 2002, p. 320). The categories of vulnerable groups listed under the Common Rule have been the source of controversy, "for example, many find the suggestion that pregnant women are vulnerable to be quite sexist" (IV, DeBruin 2001, p. 7). Instead of creating categories of vulnerable populations, would it not be better to derive an account of just treatment from a just social policy at large that encompasses human vulnerabilities (II, Brock 2002, p. 283).For some of the authors listed here, the concept of vulnerability is essential to bioethics. Robert Goodin (I, 1985, p. 107) writes that the vulnerability of other human beings is the source of our special responsibilities to them. In contrast to the four American principles of biomedical ethics—autonomy, nonmaleficence, beneficence, and justice—the four principles of European bioethics and biolaw include vulnerability along with autonomy, dignity, and integrity. According to, Jacob Dahl Rendtorff and Peter Kemp (I, 2000, p. 274) "the principle of vulnerability is ontologically prior to the other [European] principles, it expresses better than all of the other ethical principles... the finitude of the human condition."Some of the... (shrink)

A common tale of moral cacophony and euphemism on the city streets:Each day, an owner of a small business decides, “once and for all,” how to respond to the “homeless person” panhandling for “spare change” as she makes her way to work in the morning. Today, she looks the other way and holds more tightly to her purse. Nearby, a building contractor waits impatiently for the traffic light to change as his van is approached by a small and shabby band (...) of “street people” demanding to clean his windshield. He turns his wipers on to signal them away. Sometimes this works. At the next light, a woman carrying an infant swaddled to her torso offers a tube of three roses for a dollar. The driver smiles pleasantly, but does not stop. The businesswoman, now close to work, buys two tubes of roses and does not wait for the change from the five-dollar bill she earnestly presses into the mother's hand. (shrink)

Population ageing is one of the key processes affecting the development of European Union countries. The aim of this paper is an indication of the possibility of collective action against this challenge at the regional level. Article describe assumptions and recommendations for strategic management which taking into account the cooperation of entities from public sector (local governments), market sector (business) and social sector (NGOs). Closer analyses will be conducted on two examples of initiatives from European Union: the Regions for (...) All Ages programme and network organization SEN@ER - Silver Economy Network of European Regions. The summary will indicate possible directions of further research. -/- . (shrink)

This brief commentary reappraises the issue of emigration of physicians from developing countries to developed countries. A methodological framework is developed for assessing the impact of physician emigration on population health outcomes. The evidence from macro and micro studies suggest that developing countries especially in sub-Saharan Africa would benefit from regulating physician emigration because the loss of physicians can lower quality of healthcare services and lead to worse health outcomes. Further discussion is contained in an e-letter: http://jme.bmj.com/content/early/2013/05/30/medethics-2013-101409/reply.

We analyze the role of ethical values in the determination of the social cost of carbon, arguing that the familiar debate about discounting is too narrow. Other ethical issues are equally important to computing the social cost of carbon, and we highlight inequality, risk, and population ethics. Although the usual approach, in the economics of cost-benefit analysis for climate policy, is confined to a utilitarian axiology, the methodology of the social cost of carbon is rather flexible and can (...) be expanded to a broader set of social-welfare approaches. [Open access]. (shrink)

Population axiology concerns how to evaluate populations in terms of their moral goodness, that is, how to order populations by the relations “is better than” and “is as good as”. The task has been to find an adequate theory about the moral value of states of affairs where the number of people, the quality of their lives, and their identities may vary. So far, this field has largely ignored issues about uncertainty and the conditions that have been discussed mostly (...) pertain to the ranking of risk-free outcomes. Most public policy choices, however, are decisions under uncertainty, including policy choices that affect the size of a population. Here, we shall address the question of how to rank population prospects—that is, alternatives that contain uncertainty as to which population they will bring about—by the relations “is better than” and “is as good as”. We start by illustrating how well-known population axiologies can be extended to population prospect axiologies. And we show that new problems arise when extending population axiologies to prospects. In particular, traditional population axiologies lead to prospect-versions of the problems that they praised for avoiding in the risk-free settings. Finally, we identify an intuitive adequacy condition that, we contend, should be satisfied by any population prospect axiology, and show how given this condition, the impossibility theorems in population axiology can be extended to (non-trivial) impossibility theorems for population prospect axiology. (shrink)

The objective of this article is to explore people’s attitudes toward responsibility in the allocation of public health care resources. Special attention is paid to conceptualizations of responsibility involving blame and sanctions. A representative sample of the Norwegian population was asked about various responsibility mechanisms that have been proposed in the theoretical literature on health care and personal responsibility, from denial of treatment to a tax on unhealthy consumer goods. Survey experiments were employed to study treatment effects, such as (...) whether fairness considerations affect attitudes about responsibility. We find that, overall, a substantial minority of the respondents find it fair to let the health care system sanction people—in one way or another—for voluntary behaviors that increase the risk of becoming ill. Quite surprisingly, we find that people are more prone to report that they should themselves be held responsible for unhealthy lifestyles than others. (shrink)