Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire medication-like (...) effects. We found a total of 22studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Importantly, provided that nondisclosure is pre-authorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated. (shrink)
“The Ethics of Infection Challenges in Primates,” by Anne Barnhill, Steven Joffe, and Franklin Miller, is an exceptionally timely contribution to the literature on animal research ethics. Animal research has long been both a source of high hopes and a cause for moral concern. When it comes to infection challenge studies with nonhuman primates, neither the hope—to save thousands of human lives from such diseases as Ebola and Marburg—nor the concern—the conviction that primates deserve especially strong protections—could be much higher. (...) Coming just a few years after the National Institutes of Health adopted the Institute of Medicine's recommendations regarding chimpanzees, Barnhill and colleagues attempt to nudge the clarification and specification—one might say the evolution—of NHP research ethics and regulation. They assert that NHP challenge studies “are not justified by marginal gains in human safety or by efficacy gains that are unlikely to translate directly into saving human lives or preventing morbidity.” How, in turn, is their standard—which, although stringent, does permit causing NHPs to suffer and die for human benefit—to be justified? (shrink)
This paper defends a qualified version of moral vegetarianism. It defends a weak thesis and, more tentatively, a strong thesis, both from a very broad basis that assumes neither that animals have rights nor that they are entitled to equal consideration. The essay's only assumption about moral status, an assumption defended in the analysis of the wrongness of cruelty to animals, is that sentient animals have at least some moral status. One need not be a strong champion of animal protection, (...) then, to embrace moral vegetarianism. One need only assume some reasonable view of animals' moral status. (shrink)
Animal research has long been a source of biomedical aspirations and moral concern. Examples of both hope and concern are abundant today. In recent months, as is common practice, monkeys have served as test subjects in promising preclinical trials for an Ebola vaccine or treatment 1 , 2 , 3 and in controversial maternal deprivation studies. 4 The unresolved tension between the noble aspirations of animal research and the ethical controversies it often generates motivates the present issue of the Cambridge (...) Quarterly of Healthcare Ethics. As editors of this special section, we hope that these original and timely articles will push the professional discussion of animal research ethics in a positive direction that will benefi t research scientists and others interested in moral problems in animal research. We also look forward to a day when animal research will genuinely meet both appropriate scientifi c and appropriate ethical criteria—criteria that themselves can be improved by critical scrutiny. Animal research—that is, the use of live animals as experimental subjects in biomedical and behavioral fi elds of learning—has been deeply entrenched for well over half a century. One signal development was the enactment in the late 1930s of federal product safety legislation in the United States and other nations that required animal testing of food, drugs, and medical devices prior to use by human subjects or consumers. 5 Another development was the publication of codes of research ethics that called for animal research prior to human research. The Nuremberg Code, published by an American military tribunal in 1947–48 after scrutiny of Nazi medical atrocities, stated that experiments involving the use of human subjects should be " based on the results of animal experimentation. " 6 The Declaration of Helsinki, fi rst published in 1964, reaffi rmed this assumption and added, rather imprecisely, that " the welfare of animals used for research must be respected. " 7 Against the background of such statements, the institutionalization and widespread acceptance of animal research in the twentieth century rested on two basic assumptions, one factual and one moral. The factual assumption was that animal research is suffi ciently reliable as a basis for predicting the effects of drugs, products, and other materials on human beings that animal trials can be expected to yield signifi cant scientifi c conclusions and medical benefi ts to humanity. (shrink)
Creation Ethics illuminates an array of issues in "reprogenetics" through the lens of moral philosophy. With novel frameworks for understanding prenatal moral status and human identity, David DeGrazia tackles the ethics of abortion and embryo research, genetic enhancement and prenatal genetic interventions, procreation and parenting, and obligations to future generations.
As the President's Council on Bioethics emphasized in a recent report, rapid growth of biotechnologies creates increasingly many possibilities for enhancing human traits. This article addresses the claim that enhancement via biotechnology is inherently problematic for reasons pertaining to our identity. After clarifying the concept of enhancement, and providing a framework for understanding human identity, I examine the relationship between enhancement and identity. Then I investigate two identity-related challenges to biotechnological enhancements: (1) the charge of inauthenticity and (2) the charge (...) of violating inviolable core characteristics. My thesis is that a lucid, plausible understanding of human identity largely neutralizes these charges, liberating our thinking from some seductive yet unsound objections to enhancement via biotechnology. (shrink)
This volume provides a general overview of the basic ethical and philosophical issues of animal rights. It asks questions such as: Do animals have moral rights? If so, what does this mean? What sorts of mental lives do animals have, and how should we understand welfare? By presenting models for understanding animals' moral status and rights, and examining their mental lives and welfare, David DeGrazia explores the implications for how we should treat animals in connection with our diet, zoos, and (...) research. Animal Rights distinguishes itself by combining intellectual rigor with accessibility, offering a distinct moral voice with a non-polemical tone. (shrink)
Some people contend that fetuses have moral status but less than that of paradigm persons. Many people hold views implying that sentient animals have moral status but less than that of persons. These positions suggest that moral status admits of degrees. Does it? To address this question, we must first clarify what it means to speak of degrees of moral status. The paper begins by clarifying the more basic concept of moral status and presenting two models of degrees ofmoral status. (...) It then sketches several significant considerations in favor of, and several against, the assertion of degrees of moral status. The paper concludes by drawing lessons from the discussion. (shrink)
Might it be morally wrong to procreate? David Benatar answers affirmatively in Better Never to Have Been , arguing that coming into existence is always a great harm. I counter this view in several ways. First, I argue against Benatar’s asserted asymmetry between harm and benefit—which would support the claim that any amount of harm in a human life would make it not worth starting—while questioning the significance of his distinction between a life worth starting and one worth continuing. I (...) further contend that his understanding of hedonism and desire-fulfillment theories distorts their implications for the quality of human life; as for objective-list theories, I rebut his critique of their human-centered basis of evaluation. Notwithstanding this multi-tiered challenge to Benatar’s reasoning, I conclude with praise for his work and the intellectual virtues it embodies. (shrink)
The field of bioethics has deployed different models of justification for particular moral judgments. The best known models are those of deductivism, casuistry, and principlism (under one, rather limited interpretation). Each of these models, however, has significant difficulties that are explored in this essay. An alternative model, suggested by the work of Henry Richardson, is presented. It is argued that specified principlism is the most promising model of justification in bioethics. Keywords: casuistry, deductivism, ethical theories, intuition principlism, specified principlism, specification (...) CiteULike Connotea Del.icio.us What's this? (shrink)
In addressing the shape of appropriate gun policy, this essay assumes for the sake of discussion that there is a legal and moral right to private gun ownership. My thesis is that, against the background of this right, the most defensible policy approach in the United States would feature moderate gun control. The first section summarizes the American gun control status quo and characterizes what I call “moderate gun control.” The next section states and rebuts six leading arguments against this (...) general approach to gun policy. The section that follows presents a positive case for moderate gun control that emphasizes safety in the home and society as well as rights whose enforcement entails some limits or qualifications on the right to bear arms. A final section shows how the recommended gun regulations address legitimate purposes, rather than imposing arbitrary restrictions on gun rights, and offers concluding reflections. (shrink)
When it comes to caring about and helping those in need, our imaginations tend to be weak and our motivation tends to be parochial. This is a major moral problem in view of how much unmet need there is in the world and how much material capacity there is to address that need. With this problem in mind, the present paper will focus on genetic means to the enhancement of a moral capacity—a disposition to altruism—and of a cognitive capacity that (...) facilitates use of the moral capacity: the ability to grasp vividly the needs of individuals who are unknown and not present. I will address two questions, with more extensive attention to the first question. First, assuming we had excellent reason to believe that the enhancements were safe, effective, and available to all who desired them, would seeking these enhancements be inherently morally acceptable—that is, free of inherent wrongness? Second, would it be wise for a society to pursue these enhancements? I will defend an affirmative answer to the first question while leaving the second question open. (shrink)
In this paper, we present three necessary conditions for morally responsible animal research that we believe people on both sides of this debate can accept. Specifically, we argue that, even if human beings have higher moral status than nonhuman animals, animal research is morally permissible only if it satisfies (a) an expectation of sufficient net benefit, (b) a worthwhile-life condition, and (c) a no unnecessary-harm/qualified-basic-needs condition. We then claim that, whether or not these necessary conditions are jointly sufficient conditions of (...) justified animal research, they are relatively demanding with the consequence that many animal experiments may fail to satisfy them. (shrink)
Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In light of persisting reasonable disagreement (...) about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence. (shrink)
Few human uses of nonhuman animals have incited as much controversy as the use of animals in biomedical research. The political exchanges over this issue tend to produce much more heat than light, as representatives of both biomedicine and the animal protection community accuse opponents of being and the like. However, a healthy number of individuals within these two communities offer the possibility of a more illuminating discussion of the ethics of animal research.
Implicit in our everyday attitudes and practices is the assumption that death ordinarily harms a person who dies. A far more contested matter is whether death harms sentient individuals who are not persons, a category that includes many animals and some human beings. On the basis of the deprivation account of the harm of death, I argue that death harms sentient nonpersons. I next consider possible bases for the commonsense judgment that death ordinarily harms persons more than it harms sentient (...) nonpersons. Contrary to what some philosophers believe, it is doubtful that the familiar resources of prudential value theory can vindicate this judgment. I show that the approach that at first glance seems most promising for supporting this judgment – namely, invoking an objective account of well-being – faces substantial challenges, before arguing that McMahan's time-relative interest account supplies the needed theoretical basis. I then go on to extract a significant practical implication of the first thesis, that death ordinarily harms sentient nonpersons: We should find a way to discontinue the routine killing of animal subjects following their use in experiments. (shrink)
Agnieszka Jaworska and Julie Tannenbaum address a central problem confronting efforts to understand moral status: the Problem of Nonparadigm Humans. The authors contend that human infants and cognitively disabled human beings whose capacities are comparable to those of dogs nevertheless have higher moral status. In this discussion, I will first reconstruct the authors’ assumptions and argumentative goals. In the article’s two major sections, I will examine the authors’ reasoning in pursuit of those goals and contend that the chain of argumentation (...) contains several weak links. The discussion will close with brief reflections on how the problem might be addressed. (shrink)
Underlying President Bush's view regarding stemcell research and cloning are two assumptions: we originate at conception, and we have full moral status as soon as we originate. I will challenge both assumptions, argue that at least the second is mistaken, and conclude that the President's approach is unsustainable.
The idea of a patient's best interests raises issues in prudential value theory–the study of what makes up an individual's ultimate good or well‐being. While this connection may strike a philosopher as obvious, the literature on the best interests standard reveals almost no engagement of recent work in value theory. There seems to be a growing sentiment among bioethicists that their work is independent of philosophical theorizing. Is this sentiment wrong in the present case? Does value theory make a significant (...) difference in interpreting best interests? In pursuing this question, I begin with a quick sketch of broad kinds of value theories, identifying representatives that are plausible enough to count as contenders. I then explore what each account suggests in neonatal treatment decisions, and decisions for patients in persistent vegetative states. I conclude that while these accounts converge somewhat in their interpretations of best interests, they also have importantly different implications. (shrink)
Many critics of American gun culture and policy argue that the public health benefits of stricter regulations compensate for the associated loss of freedom: a bit less freedom is an acceptable cost for the expected gains in public safety. By contrast, gun advocates sometimes claim that freedom to own guns underlies all other important freedoms and therefore deserves priority over considerations of public health. In this volume, philosopher Firmin DeBrabander takes a distinct critical approach, denying any significant loss of freedom (...) associated with gun control. Widespread gun ownership in the context of lax regulation makes Americans—and anyone else similarly situated—less free. In developing his... (shrink)
Regarding the sinking lifeboat scenario involving several human beings and a dog, nearly everyone agrees that it is right to sacrifice the dog. I suggest that the best explanation for this considered judgment, an explanation that appears to time-relative interests, contains a key insight about prudential value. This insight, I argue, also provides perhaps the most promising reply to the future-like-ours argument, which is widely regarded as the strongest moral argument against abortion. Providing a solution to a longstanding puzzle in (...) value theory across species while illuminating the morality of abortion, the time-relative interest account proves worthy of sustained theoretical attention. (shrink)
As one of the most important ethicists to emerge since the Second World War, Alan Gewirth continues to influence philosophical debates concerning morality. In this ground-breaking book, Gewirth's neo-Kantianism, and the communitarian problems discussed, form a dialogue on the foundation of moral theory. Themes of agent-centered constraints, the formal structure of theories, and the relationship between freedom and duty are examined along with such new perspectives as feminism, the Stoics, and Sartre. Gewirth offers a picture of the philosopher's theory and (...) its applications, providing a richer, more complete critical assessement than any which has occurred to date. (shrink)
Responding to several leading ideas from a paper by Allen Buchanan, the present essay explores the implications of genetic enhancement for moral status. Contrary to doubts expressed by Buchanan, I argue that genetic enhancement could lead to the existence of beings so superior to contemporary human beings that we might aptly describe them as post-persons. If such post-persons emerged, how should we understand their moral status in relation to ours? The answer depends in part on which of two general models (...) of moral status—one based on respect and one based on interests—is more adequate. Buchanan tentatively argues that a respect-based model is preferable. I challenge Buchanan's view, along these lines: If we embrace a respect-based model of moral status featuring a threshold that divides persons, who are thought to have full and equal moral status, from sentient nonpersons, thought to have less moral status, then we should acknowledge a second threshold and a level of moral status higher than ours. A better option, I tentatively suggest, is to drop the idea of levels of moral status, accept that all sentient beings have moral status, and allow that some differences in interests and capacities justify some significant differences in how we should treat beings of different kinds. (shrink)
: Those who are morally opposed to abortion generally make several pivotal assumptions. This paper focuses on the assumption that we have full moral status throughout our existence. Coupled with the assumption that we come into existence at conception, the assumption about moral status entails that all human fetuses have full moral status, including a right to life. Is the assumption about moral status correct? In addressing this question, I respond to several arguments advanced, in this journal and other venues, (...) by Alfonso Gómez-Lobo. Gómez-Lobo's reasoning resolves into two basic arguments: (1) an appeal to the practical necessity of early moral protection and (2) an appeal to our kind membership and potentiality. I respond to these in turn before offering further reflections. (shrink)
We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result — or perhaps take the form — of a variety of states including pain, anxiety, fear, and boredom. Third, (...) pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states. (shrink)
Kagan argues that human beings who are neither persons nor even potential persons — if their impairment is independent of genetic constitution — are modal persons: individuals who might have been persons. Moreover, he proposes a view according to which both personhood and modal personhood are sufficient for counting more, morally, than nonhuman animals. In response to this proposal, I raise one relatively minor concern about Kagan's reasoning — that he judges too quickly that insentient beings can have interests — (...) before engaging the appeal to modal personhood. I challenge the thesis that modal personhood is relevant to one's moral status, first, by way of analogy to a kicker who misses a field goal though he might have made it; second, by casting doubt on implications for two impaired infants ; and, finally, by examining implications for dogs who would count as modal persons when genetic enhancements are capable of transforming them into persons. (shrink)
Earthcare: Readings and Cases in Environmental Ethics presents a diverse collection of writings from a variety of authors on environmental ethics, environmental science, and the environmental movement overall. Exploring a broad range of world views, religions and philosophies, David W. Clowney and Patricia Mosto bring together insightful thoughts on the ethical issues arising in various areas of environmental concern.
We argue that the current ethical and regulatory framework for permissible risk levels in pediatric research can be helpfully understood in terms of children’s moral right to adequate protection from harm. Our analysis provides a rationale for what we propose as the highest level of permissible risk in pediatric research without the prospect of direct benefit: what we call “relatively minor” risk. We clarify the justification behind the usual standards of “minimal risk” and “a minor increase over minimal risk” and (...) explain why it is permissible to impose any risks at all on child participants who do not stand to benefit directly from enrollment in research. Finally, we illuminate some aspects of the concept of “best interests.”. (shrink)