The transplant community has quietly initiated efforts to expand the current pool of cadaver organ donors to include those who are dead by cardiac criteria but cannot be pronounced dead using brain-based criteria. There are many reasons for concern about "policy creep" regarding who is defined as a potential organ donor. These reasons include loss of trust in the transplant community because of confusion over the protocols to be used, blurring the line between life and death, stress on family members, (...) and burdens imposed on health care providers when a long-standing policy regarding who can serve as a cadaver organ donor is unilaterally changed. While these concerns are not sufficient reason for abandoning efforts to broaden existing eligibility standards for cadaver donation, they are sufficient reasons for the transplant community to desist in changing existing standards without widespread professional and public discussion. (shrink)

Minnesota's recently enacted HealthRight legislation places the state at the forefront of American health reform. How did the state manage to overcome the policy gridlock in evidence in other states and at the national level? And how well does the legislation fare under close ethical scrutiny? Among the most important factors that permitted Minnesota to enact reforms were the explicit linkage in the legislative debate of the goal of cost containment to the desire to expand access, the public perception that (...) HealthRight is incremental and consistent with earlier reform efforts in Minnesota, and the lengthy public debate that preceded the enactment of HealthRight. Although it endeavors to create a fair and efficient health care system, it is not at all certain that HealthRight, in its present form, will achieve these normative goals. (shrink)

Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates (...) against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective. (shrink)

: Pluripotent human stem cell research may offer new treatments for hundreds of diseases, but opponents of this research argue that such therapy comes attached to a Faustian bargain: cures at the cost of the destruction of many frozen embryos. The National Bioethics Advisory Commission (NBAC), government officials, and many scholars of bioethics, including, in these pages, John Robertson, have not offered an adequate response to ethical objections to stem cell research. Instead of examining the ethical issues involved in sacrificing (...) human embryos for the goal of curing fatal and disabling diseases, they seek to either dismiss the moral concerns of those with objections or to find an "accommodation" with those opposed to stem cell research. An ethical argument can be made that it is justifiable to modify or destroy certain human embryos in the pursuit of cures for dread and lethal diseases. Until this argument is made, the case for stem cell research will rest on political foundations rather than on the ethical foundations that the funding of stem cell research requires. (shrink)

Mechanisms in a theory are defined here as bits of theory about entities at a different level (e.g., individuals) than the main entities being theorized about (e.g., groups), which serve to make the higher-level theory more supple, more accurate, or more general. The criterion for whether it is worthwhile to theorize at lower levels is whether it makes the theory at the higher levels better, not whether lower-level theorizing is philosophically necessary. The higher-level theory can be made better by mechanisms (...) known to be inadequate in the discipline dealing with the lower level. Conditions for the usefulness of lower-level theorizing are proposed, with many examples from various social and physical sciences. (shrink)

There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with (...) prevailing norms governing human subjects research. Some maintain that only randomized controlled trials with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs. (shrink)

Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

Experts discuss the economic, legal, and social issues surrounding the use of genetic testing in determining eligibility for life insurance. Insurance companies routinely use an individual's medical history and family medical history in determining eligibility for life insurance; this is part of the process of medical underwriting. Insurers have also long used genetic information, often derived from family history, in underwriting. But rapid advances in gene identification and genetic testing are changing the way we look at genetic information. Should the (...) results of genetic testing (which might identify a predisposition toward disease not related to medical history) be available to life insurance medical underwriters? Few if any life insurers currently require genetic testing, but there are no laws or regulations prohibiting its use. Genetics and Life Insurance examines the complex economic, legal, and social issues surrounding the use of genetic information in life insurance underwriting. The contributors are legal scholars, representatives of the life insurance industry (including an actuary and an insurance physician), a geneticist, a genetic counselor, a philosopher, and a consumer advocate. They explore all aspects of an issue that has only recently drawn the attention of policymakers and the public. The book opens with a report on the results of a public opinion poll on genetics and life insurance. Succeeding chapters present the insurer perspective, a discussion of the economics of risk selection in life insurance, background information on the process of underwriting, a scientific analysis of genetic risks and mortality rates, a philosophical discussion of fairness and genetic underwriting, the viewpoints of consumers and genetics counselors, a comparison of different international policy approaches to the issue, and a legal analysis of antitrust implications when insurers collaborate in setting standards for medical underwriting. In the final chapter the editor addresses various policy options, examining the pros and cons of each one and assessing their political feasibility. (shrink)

Biomedical science suffered a loss of trust during the Covid‐19 pandemic. Why? One reason is a crisis fueled by confusion over the epistemology of science. Attacks on biomedical expertise rest on a mistaken view of what the justification is for crediting scientific information. The ideas that science is characterized by universal agreement and that any evolution or change of beliefs about facts and theories undermines trustworthiness in science are simply false. Biomedical science is trustworthy precisely because it is fallible, admits (...) error, adjusts to new information, and, most importantly, is practical. Successful diagnosis and cure demarcate the boundaries of warranted knowledge. The other reason is sociological. As the pandemic made all too clear, the loss of faith in scientific experts was due to the failure of most of them to engage in regular public dialogue, reflecting a failure to recognize the obligation that science has to bolster trust in its work and findings by concerted public engagement. (shrink)

If scientists can successfully clone sheep, will humans be next? Today's headlines read like a science fiction novel! Due Consideration takes a poignant look at the rapidly changing field of biomedicine and the consequences it will have on our lives. Arthur Caplan, one of this nation's leading bioethicists, explores these issues and analyzes moral questions including: * Will we retain our essential humanity if we modify our biological blueprint? * Would it be irresponsible to procreate without a thorough genetic (...) examination? * Who will decide if physical traits like short stature and baldness are considered diseases? * Can biomedicine make our lives better? You'll also learn about the most current and controversial topics such as: * Cloning, abortion and assisted suicide. * Genetically engineering a human to be immune from infectious diseases. * The ability to "design" our children from head to toe. * Diagnosing and treating illnesses during fetal development. * Programs to prevent the transmission of HIV. No other book on the market today combines this analytic clarity with the latest from medical journals and media headlines. Now, you can decide for yourself what the future ought to hold in store. (shrink)

The field of medical rehabilitation is relatively new.... Until recently, the ethical problems of this new field were neglected. There seemed to be more pressing concerns as rehabilitation medicine struggled to establish itself, sometimes in the face of considerable skepticism or hostility. There also seemed no pressing moral questions of the kind and intensity to be encountered, say, in high-technology acute care medicine or genetic engineering.... Those in biomedical ethics could and did easily overlook the quiet, less obtrusive issues of (...) rehabilitation.... The Hastings Center set out in 1985 to rectify that situation.... To explore the issues, the Center assembled a group of practitioners in the field, Hastings Center staff members, and individuals experienced in other areas of medical ethics.... The report that follows was written by Arthur Caplan and Daniel Callahan, assisted by Dr. Janet Haas of the Moss Rehabilitation Hospital in Philadelphia... (shrink)

A former Prime Minister of Israel is alleged to have said that her country would never ascend to the status of authentic statehood until it possessed certain well-known social attributes — organized crime, prostitution, and corruption. These features, while obviously undesirable, were she felt, reliable indices of societal maturation. This anecdote is suggestive in understanding current events pertaining to the field of applied ethics.Philosophers have produced a massive body of opinion and argument on a diverse range of subjects under the (...) rubric of applied ethics. Moreover, they have assumed positions on various panels, commissions, governmental bodies and committees in the hope of making an informed contribution to the formulation of institutional and public policy. These accomplishments have begun to elicit the kinds of attributes commonly associated with philosophical maturation — exposées, debunkings, refutations, and ideologically informed critiques. (shrink)

With increasing awareness of environmental issues, there has been rising demand for environmental-friendly business practices. Prior research has shown that the implementation of environmental management practices is influenced by existing and potential stakeholder groups in the form of external pressures from legislators, environmental groups, financial institutions and suppliers, as well as internally by employees and owner/manager attitudes and knowledge. However, it has been reported that despite business owner/managers having strong “green” attitudes, the level of implementation of environmental-friendly practices is low. (...) In order to explore the connection between pressures for improved practices and the management actions taken, this article examines how influence from various stakeholders is related to awareness of environmental issues, and how this awareness relates to actions taken within the businesses to reduce the environmental impact of their operations. The results indicate that legislation does result in general environmental awareness, and that organizations are then willing to␣change their business processes and environmental strategies. However, despite their actions they have little awareness of the benefits that might arise from cost reductions from their environmental-friendly practices. Those influenced by their suppliers act to reduce waste, but do not put into place formal environmental management systems, or use environmental messages to market their goods or services. Nevertheless, it can be argued that they have a real commitment to environmental issues, as evidenced by a willingness to voluntarily contribute to environmental organizations. (shrink)

Doctoral students in clinical, counseling, and school psychology programs often collaborate with faculty on research projects in their training as scientist-practitioners. Yet, the determination of publications' credit and order of authorship on resulting manuscripts continues to be a major concern and challenging process for professional psychologists and student collaborators. This article describes the use of case-based learning and semi-structured interview approaches to instruct first-year clinical psychology doctoral students in publication ethics during a research seminar. The instructor models ethical decision-making with (...) 1) a discussion of four cases from his own professional experiences and 2) a description of the Authorship Eligibility Assessment form, which he developed for use with junior researchers. The authors advocate for more educational strategies to supplement the APA standards in teaching the ethics of the publication process. Implications in terms of graduate student development and research collaborations in the field of professional psychology were discussed. (shrink)

For decades The People’s Republic of China has been expanding its capacity to perform organ transplants, primarily kidneys and livers but also hearts, lungs and multiorgan transplants. The annual number of organ transplants performed is estimated to be over 30 000. The number is expected to grow with a projected market for immunosuppressants expected to be over ¥30 billion/$4.3 billion by 2024.1 China is second only to the USA and is expected to become the country with the largest number of (...) organ transplants by 2021 or 2022. Many transplants are performed on Chinese citizens but an active market in transplants for ‘tourists’ is ongoing.2 The source of the supply of organs to fuel this rapid growth has long been suspect.3 China had no system for obtaining organs for many years from cadaver sources making it impossible to credit claims that gifts from the newly dead were the sole or even majority source of transplantable organs. Critics, including myself, have long alleged that the only possible source of organs for both Chinese citizens and transplant tourists are executed prisoners. Many accounts, commissions and investigations have confirmed an immoral reliance on this vulnerable …. (shrink)

A former Prime Minister of Israel is alleged to have said that her country would never ascend to the status of authentic statehood until it possessed certain well-known social attributes — organized crime, prostitution, and corruption. These features, while obviously undesirable, were she felt, reliable indices of societal maturation. This anecdote is suggestive in understanding current events pertaining to the field of applied ethics.Philosophers have produced a massive body of opinion and argument on a diverse range of subjects under the (...) rubric of applied ethics. Moreover, they have assumed positions on various panels, commissions, governmental bodies and committees in the hope of making an informed contribution to the formulation of institutional and public policy. These accomplishments have begun to elicit the kinds of attributes commonly associated with philosophical maturation — exposées, debunkings, refutations, and ideologically informed critiques. (shrink)

The essays in this collection, on stratification, organization and the discipline of sociology, all bear upon a general theoretical question: what models of rationality are necessary or suitable to explain individual and collective action in institutional contexts? Professor Stinchcombe was one of the first sociologists to write on this question; and this collection includes a new essay which takes account of recent work done in the tradition Stinchcombe did much to institute. The first group of essays - on class, stratification (...) and mobility - addresses core problems of the discipline and offers imaginative conceptualizations with interesting empirical consequences. The second section - essays on the sociology of organizations - displays, like the first, Stinchcombe's wide knowledge of sociological traditions from structuralism to Marxism. The final section, 'comments on the discipline', deepens the readers understanding of sociological theorizing by presenting different modes of analysis of universities and research institutions and providing challenging, and often funny, insights into the subject. (shrink)

In modern work on the Parmenides it is commonly supposed that in the First Part of the dialogue Plato's main concern is criticism of his own doctrine of Forms, or of some formulations of that doctrine, and that the criticisms have some sort of validity and are in some degree ‘damaging’ to the doctrine. It is thus often assumed that Plato's purpose is to make the reader ask himself, ‘Where is Plato wrong? Where is his doctrine of Forms, or his (...) statement of it, inadequate?’ This is no doubt due partly to the fact that no reply is offered to the criticisms, and partly to the fact that they are put into the mouth of Parmenides, for whom Plato had a very great respect. Nevertheless, Plato can hardly have had a greater respect for Parmenides than he had for Socrates; and therefore on general grounds it is at least as likely that he intends us to ask ourselves the question, ‘Where is Parmenides wrong, or inadequate?’ It is, of course, obvious that Socrates is represented as a young man, who, in his enthusiasm for a new doctrine which he has invented himself, has not thought out all the difficulties involved in it or prepared replies to all the possible criticisms. Yet again, on general principles it is not likely that Plato would have written a dialogue primarily to represent Parmenides' position as substantially more satisfactory than that of Socrates. It is therefore of the first importance not merely to have clearly in our minds the nature and purpose of the doctrine of Forms, but also to examine carefully the basis of the criticisms which Parmenides is made to bring against Socrates, and the methods by which Parmenides conducts his arguments. (shrink)

hope of obtaining a comprehensive and coherent understand ing of the human condition, we must somehow weave together the biological, sociological, and psychological components of human nature and experience. And this cannot be done indeed, it is difficult to even make sense of an attempt to do it-without first settling our accounts with Darwin, Marx, and Freud. The legacy of these three thinkers continues to haunt us in other ways as well. Whatever their substantive philosophical differences in other respects, Darwin, (...) Marx, and Freud shared a common, overriding intellectual orientation: they taught us to see human things in historical, developmental terms. Phil osophically, questions of being were displaced in their works by questions of becoming. Methodologically, genesis replaced teleological and essentialist considerations in the explanatory logic of their theories. Darwin, Marx, and Freud were, above all, theorists of conflict, dynamism, and change. They em phasized the fragility of order, and their abiding concern was always to discover and to explicate the myriad ways in which order grows out of disorder. For these reasons their theories constantly confront and challenge the cardinal tenet of our modern secular faith: the notion of progress. To be sure, their emphasis on conflict and the flux of change within the flow of time was not unprecedented; its origins in Western thought can be traced back at least as far as Heraclitus. (shrink)

There is widespread agreement among large segments of western society that we are living in a period of hard times. At first glance such a belief might seem exceedingly odd. After all, persons in western society find themselves living in a time of unprecedented material abundance. Hunger and disease, evils all too familiar to the members of earlier generations, although far from eradicated from modern life, are plainly on the wane. Persons alive today can look forward to healthier, longer, and (...) more comfortable lives than those of their grand parents. Nevertheless, the feeling that life today is especially difficult is rampant in government, in the media, in popular books, and in academic circles. Western society is perceived in many quarters as wracked by crises of all sorts-of faith, of power, of authority, of social turmoil, of declining quality in workmanship and products, and of a general intellectual malaise afflicting both those on the Left and the Right. A tone of crisis permeates the language of public life. Editorials in major newspapers are full of dire warnings about the dangers of unbridled egoism, avarice and greed, and the risks and horrors of pollution, overpopulation, the arms race, crime, and indulgent lifestyles. (shrink)

Sports are more than just "games". They can unite countries, start wars, and revolutionize views on race, class, and gender. Through works from philosophy, sociology, medicine, and law, this collection explores intersections of sports and ethics, and identifies the immense role of sports in shaping and reflecting social values.