A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and (...) differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues. (shrink)

Dr de Zulueta articulates some important and commonly held concerns about the anonymised screening programme for HIV in pregnant women, which is one of a number of such programmes that are current. However, in my view, many of these concerns reflect a failure to understand two key distinctions.In both these regards, there is a danger of putting up a “straw man” for challenge. In this commentary, I wish to pick up some of these issues to help to resolve the apparent (...) ethical tensions that Dr de Zulueta has set out.Firstly, the unlinked seroprevalence surveillance programmes, including that on pregnant women, comprise research studies that are designed to inform policy and practice, as well as individual decision making. They are not screening for the purpose of clinical care. The anonymisation is a procedural research tool, which enables the studies to be done in a way that does not undermine consent or individual autonomy. The ethical standards and duties expected of professionals are thus, in this specific regard, those that relate to the conduct of clinical research. That research is evidently designed to improve the quality of clinical care as a result of the information and insight gained. The duty of care is to apply the results of properly conducted and valid research in order to improve clinical practice on behalf of the individuals receiving care, in this case the mother and unborn child. The research conducted, in this case by a particular form of screening procedure, is not the same as a screening procedure done for clinical purposes to identify individuals who could benefit from an intervention. The ethical debate must therefore focus on the purpose in applying the procedure, not on the procedure itself, regardless of intent.Secondly, it is vital to distinguish, in debating such …. (shrink)

Guest Editors' introductionFor this special issue of the Journal of Medical Ethics we have assembled articles that reflect some of the newer issues or fresh perspectives. There is a mix of approaches including forward looks, present dilemmas and reflections on the past, now that sufficient time has elapsed to allow a considered view. We are most grateful to our wide range of contributors for their thoughtful analyses of several key areas of contemporary debate. Our own contributions include the following editorials (...) in which each of us has considered, from his own perspective, the impact of AIDS on medical ethics, a case study and a lexicon that allows brief probing of some topics.The impact of aids on medical ethics -1ANTHONY J PINCHINGMedical ethics has been matured through being tested and refined through the multifaceted challenge of AIDS. As with the society and social values from which its moral framework is derived, so medical ethics has been subjected to intense scrutiny by the emergence of this new disease. Few areas of ethical discourse have been untouched. This infection is so intensely private in its transmission, the disease so isolating and so personally devastating in its impact, it readily distinguishes the reality of what people are and do, from the rhetoric of what others may feel they should be and do. AIDS has forced us to recognise that respecting individual rights is a critical safeguard for the health of the community, as well as for the person. These issues are well illustrated by the interweaving issues of patient empowerment, respect for confidentiality, and patient advocacy and activism.EMPOWERMENTPhysicians in this field have been struck by the way in which people affected have wanted to be involved in decision making. While this has often been ascribed to their social groups, it probably was more a reflection of their younger age and a generation change …. (shrink)

This thoughtful reflection on a valuable questionnaire survey of patients' attitudes regarding being told that their dentist had been infected with hepatitis B is of very direct relevance to HIV, as the authors show.1 The measured tone and analytical approach are a welcome change from the stridency that has characterised some of the debate elsewhere. I am very conscious that more time and effort has gone into drafting and redrafting, amending, revising and refining policy in this area than in any (...) other area of HIV control, with the probable exception of blood transfusion. Yet this is the setting that has the lowest risk among all established routes. Why has it been so hard to establish a satisfactory policy and practice to deal with this situation?Many factors, of course, apply. However, much seems to stem from a prevailing view, fostered by recent political administrations, that health care can be delivered in a risk-free way. This has also been linked with a “blame culture”, where adverse outcomes are seen as someone's fault, and where the professions are regarded with distrust. It has been fuelled by levels of concern about risk for HIV that have stemmed more from media “stories” about risk than careful risk assessment.Hence Blatchford et al comment that public anxiety about HIV relative to hepatitis B was a factor in assessing how the incident was handled, implying that HIV was of greater concern - even though the risk of transmission is some two orders of magnitude less. Interestingly, they also comment that, because the risk of death with HIV is higher than for hepatitis B, this balances the overall risk. I am not sure of the validity of this argument, …. (shrink)

Ethical dilemmas abound in the neonatal intensive care unit as hour-to-hour life and death decisions are made for premature or compromised newborns. This book is a rich tapestry of parental perceptions woven from the many stories parents tell about their experiences with a baby in the unit, as well as major events after discharge related to the ethical decision making.

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the (...) reasoning of four women. The implications for ethical decision-making and future research are discussed. (shrink)

A project featuring scholars in nursing ethics was planned in 2005. The goal was to document the contributions of some 24 selected American nurse ethicists to bioethics, and to discuss and explore the future trajectory of that work through a two-day working seminar. This article outlines the beginnings of bioethics in the USA and the specific contribution of nurse scholars to the debate, the preparation for the seminar, the results of the project, and the possible application of such a model (...) for teaching and archiving in the future. Documentation of the work carried out at the seminar resulted in the publication of a book. Short biographies of the participants at the seminar are included in Appendix 1. (shrink)

If I have any objection to this book, it is to the title, in that it might narrow the audience that would benefit from it. Although the title is formally quite accurate in describing the contents, it underplays the relevance of the arguments set out herein to a very broad range of clinical arenas, for which HIV/AIDS can be a notable example. This fascinating series of essays covering the topics in the subtitle and much more, shows how valuable AIDS has (...) been as a worked example of a series of interdigitating core issues in medical ethics, as it has been in so many areas of clinical medicine, public health and public policy. Although the authors and editors underplay this wider relevance, I found myself, despite my own substantial involvement in HIV and AIDS over the past …. (shrink)

Passmore is one of the most outstanding historians of the contemporary philosophical scene. He seems to have read everything, digested it, and has an uncanny ability to empathize with diverse philosophical viewpoints and elucidate them in a clear, witty, cogent style. Although the first three quarters of this revised edition is basically the same as earlier editions, we now have additions to his account of Ayer, Popper, Wittgenstein and Sartre; enlarged sections on Austin, Jaspers and Heidegger; a new section on (...) Merleau-Ponty and a chapter bringing us right up to the present discussions of the mind-body problem in Anglo-Saxon philosophy. With this revised edition, one feels more acutely the pinch of the limitations that Passmore initially set for himself, viz., to treat the ideas of those writers that entered into the public domain of philosophical discussion in England during the past hundred years. Consequently his treatment of continental thinkers is not nearly as complete or perceptive as his treatment of British philosophers, or his chapters on "classical" American thinkers which are among the best written by anybody.—R. J. B. (shrink)

We inhabit a world in which the market is a dominant institutional form of social organization. This influence is not without its critics, and there is considerable debate amongst political philosophers and policy-makers about whether the range of the market should expand or contract and, further, about the extent to which the market should be subject to constraints and government regulation. The expansion of the market into realms hitherto unknown is the theme of a number of recent books, including Michael (...) Sandel's What Money Can't Buy and Debra Satz's Why Some Things Should Not Be for Sale, which build on earlier work by, amongst others, Elizabeth Anderson, Margaret Jane Radin, and Michael Walzer. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:610 Feminist Studies 43, no. 3. © 2017 by Raina J. León Pandora’s Box Opens and Terence Crutcher Dies Raina J. León Fresh from the bath, my husband comes nude, beard trimmed, still glistening and pinked. He shares the fullness of his skin, freckles and moles in their constellations. What little fat on his lank jiggles, begs for pinch as he turns to the closet to dig. I am (...) encapsulated by covers. No sleep for hours since I woke to watch the video I couldn’t with him awake. How I watched it, over and over, and knew this might be how I die: a broken-down car, my hands up, helicopters above with a man saying, a real bad dude, must be, and then shot, because Terence is me, like Sandy and Aisha... because just that day, earlier, I was transformed into child, questioned on the body of my work, made invisible and hypervisible, bleeding shadow for another’s feet. One leads to another in a mass of entangled links. Now, he moves. He does not feel the cold I dread out there where reality gnashes. Raina J. León 611 Inside the cocoon, the smell of last night’s tremble sweat, I can imagine entrance into another dreaming, breathe in and out our twining. He slips on boxers, then soft cotton shirt, then jeans. All black, his style. In my mourning, I call him close, and he comes to bed. With his body, he creates another womb as suddenly the weeping starts, says, when you are ready, tell me, because he doesn’t know how the world turns, yet in that moment, there is a hope.... (shrink)

A number of recent papers have described the successful derivation of egg and sperm precursor cells from mouse embryonic stem cells—so-called “artificial” gametes. Although many scientific questions remain, this research suggests numerous new possibilities for stem cell research and assisted reproductive technology, if a similar breakthrough is achieved with human embryonic stem cells. The novel opportunities raised by artificial gametes also prompt new ethical questions, such as whether same-sex couples should be able to access this technology to have children who (...) are genetically related to them both.THE CREATION OF “ARTIFICIAL” GAMETESOver the past two years, a number of papers have been published detailing the first successful attempts at differentiating mouse embryonic stem cells into egg1 and sperm2 precursor cells. Previously, researchers had used embryonic stem cells to generate tissues such as brain, liver, and pancreatic cells, but not germ cells of any kind. Production of gamete precursor cells was achieved initially through allowing stem cell lines to differentiate more or less randomly, but recent research has focused on identifying the precise ways in which differentiation into gametes can be precipitated and controlled. These breakthroughs make it seem likely that ongoing research on human stem cells will yield similar possibilities,3 raising questions over the practicalities of what might be achieved with such “artificial” gametes. In turn, the novel opportunities presented by artificial gametes raise a number of ethical concerns.The initial breakthrough, namely the obtaining of egg cells from mouse stem cells, was achieved by means of relatively simple science. Rather than coaxing stem cells to develop into eggs using complicated cocktails of growth factors, researchers adopted standard cell culture conditions, but grew the cells at higher density than usual.3–6 Growing the cells in this way led to the formation of ovary-like cell aggregates, which (when separated and stimulated with …. (shrink)

Spinoza’s Ethics must contain some of philosophy’s most baffling statements. All things are animate; the order and connection of ideas is the same as the order and connection of things: what would I be committed to in agreeing with these doctrines? His austere mode of exposition, sparing of illustrations and discursive explanations, ensures that any answer must be highly speculative.His weakness for dark sayings seems to have communicated itself to some of his best-known commentators. Of course where a philosopher’s thought (...) is itself opaque one would be unreasonable to expect lucidity in a commentator’s exposition of it. However he has been described as holding puzzling, to my mind unintelligible opinions on subjects concerning which, as far as I can see, his own statements more naturally suggest a much clearer and more comprehensible interpretation. There are problems enough in understanding his thought without adding needlessly to the list. I think there has been such an addition in discussion of his doctrines about the causal relationship between God and finite creatures, and this paper is devoted to suggesting another account of his thought on that topic which combines, I think, the advantages of being more intelligible and a more natural construction to place on his own statements, than the set of opinions generally laid at his door. (shrink)

C. A. J. Littlewood approaches Seneca's tragedies as Neronian literature rather than as reworkings of Attic drama, and emphasizes their place in the Roman world and in the Latin literary corpus. The Greek tragic myths are for Seneca mediated by non-dramatic Augustan literature. In literary terms Phaedra's desire, Hippolytus' innocence, and Hercules' ambivalent heroism look back through allusion to Roman elegy, pastoral, and epic respectively. Ethically, the artificiality of Senecan tragedy, the consciousness that its own dramatic worlds, events, and people (...) are literary constructs, responds to the contemporary Stoical dismissal of the public world as mere theatre. (shrink)

Albert O. Hirschman was a development economist and political theorist whose work is essential reading for anyone interested in understanding how economic life figures in the political worlds we inhabit and the ways in which we give meaning to our lives in market-based societies. Perhaps best known for the distinction between 'exit' and 'voice', Hirschman was a prolific theorist who wrote about the role individual moral virtue and individual self-interest should play in economic activity, how economic growth in the developing (...) world might best be achieved, and the reactionary rhetoric of neo-conservative politicians in the late 1980s, to list but some of the areas he covered. Hirschman's writing was elegant; further, he understood the importance of the well-chosen word. He was, as this new biography by Jeremy Adelman shows, an economist for whom the essays of Montaigne were as important as the writings of Ricardo and Smith. (shrink)

Jason Stanley argues in his new book that propaganda is more prevalent within liberal democracies - and is of far greater concern - than is typically assumed. Indeed, Stanley suggests that the very idea that propaganda only proliferates within authoritarian regimes, which have ministries set aside for its production, is a central tenet of the propaganda of the West. Stanley's aim in this book is to outline the distinctive features of propaganda within a liberal democracy. On his account, the 'flawed (...) ideology' of vested and powerful interest groups undermines the genuinely valuable ideals at the heart of the democratic project; this is what he refers to as 'demagogic propaganda'. Although I am highly sceptical of the argumentative strategies Stanley employs, the book raises significant issues about the extent to which public debates in countries like the United States and Australia involve distorted conceptions of what democratic principles properly entail. Criticisms of the undemocratic and illiberal nature of political processes within liberal democracies are of course common on the left. Two key features set Stanley's work apart from much of that literature. First, he regards democratic principles as genuinely valuable and does not dismiss them as 'mere reactionary claptrap', as many in the New Left did forty years ago. Second, and more significantly, his intellectual background is highly unusual. Stanley is an analytic philosopher whose training was primarily in epistemology and formal semantics rather than in social theory or political philosophy. This is uncommon, since most analytic philosophers who are focused on epistemology and similar issues avoid political questions, a reticence of which Stanley does not approve. Indeed, the book is driven, as he says, by a profound sense of regret that analytic philosophy has surrendered many of its central questions to sociology and social theory. (shrink)

Over the past 50 years, we have witnessed a revolution in the organisation and social understanding of elite sport. Elite sport has been commercialised. Top-level athletes have become professionals who often receive remarkable levels of income and sporting events, such as the World Cup, are multi-billion dollar exercises that attract enormous levels of sponsorship. Many sports, such as cricket, have been substantially revamped in order to make them more appealing to mass audiences and, accordingly, more beneficial to sponsors and many (...) clubs, such as Manchester United, have become corporations in their own right. (shrink)

Invisible Hand accounts of the operations of the competitive market are often thought to have two implications for morality as it confronts economic life. First, explanations of agents economic activities eschew constitutive appeal to moral notions; and second, such moralism is pernicious insofar as it tends to undermine the operations of a socially valuable social process. This is the Mandevillean Conceit. The Conceit rests on an avarice-only reading of the profit-motive that is mistaken. The avarice-only reading is not the only (...) way of characterising the profit-motive, and there are some positive grounds for thinking the benefits of profit pursuit are better attributed to the "lucrephile", and not the avarice-only "lucrepath". (shrink)

This is a surprisingly good book. Published by Longmans in Great Britain as part of a series on "Education Today," it provides a very lucid and cogent first glimpse at the discipline of the philosophy of religion. The author's perspective is derivative of the analytic school, but what makes the book so valuable is that Goodall relates linguistic distinctions to Biblical categories. The author makes it obvious that he is a believer and authenticates the conviction that one can be a (...) believer and still sound like Flew or Ryle. The influence of Ian T. Ramsey comes through loud and clear. Goodall presents his proofs for the validity of religious statements with clarity and vigor. Worth the price of the book alone is Goodall's discussion of Lear's "The pobble who had no toes."--W. A. J. (shrink)

Consider the following dilemma. If it is possible to identify the cause of a person's action and beliefs - causes that are outside the agent's own conscious reasoning - in what sense can we say that the person chooses what she does or she thinks? If the person did not consciously choose, then it is reasonable to ask whether she should be held morally responsible for any of the subsequent consequences of her actions. This is the general territory of the (...) puzzle that Neil Levy's thoughtful and elegantly written new book addresses. He explores what scientific advances in the study of consciousness might tell us about our capacity for choice and, hence, our responsibility for those choices. (shrink)