BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were exposed (...) to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Background As a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many (...) were exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk. Discussion In the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics. Summary An honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Recent developments in the field of neurosurgery, specifically those dealing with the modification of mood and affect as part of psychiatric disease, have led some researchers to discuss the ethical implications of surgery to alter personality and personal identity. As knowledge and technology advance, discussions of surgery to alter undesirable traits, or possibly the enhancement of normal traits, will play an increasingly larger role in the ethical literature. So far, identity and enhancement have yet to be explored in a neurosurgical (...) context, despite the fact that 1) neurological disease and treatment both potentially alter identity, and 2) that neurosurgeons will likely be the purveyors of future enhancement implantable technology. Here, we use interviews with neurosurgical patients to shed light on the ethical issues and challenges that surround identity and enhancement in neurosurgery. The results provide insight into how patients approach their identity prior to potentially identity-altering procedures and what future ethical challenges lay ahead for clinicians and researchers in the field of neurotherapeutics. (shrink)

Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional (...) therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatric context, with its use currently limited to clinical trials and investigative studies. The combination of a patient population at the limits of conventional therapy and a novel technology in a new indication poses interesting challenges to the informed consent process as it relates to clinical trial enrollment. These challenges can be divided into those that relate to the patient, their disease and the technology, with each illustrating how traditional conceptualisations of research consent may be inadequate in the surgical psychiatry context. With specific reference to risk analysis, patient autonomy, voluntariness and the duty of the clinician-researcher, this paper will discuss the unique challenges that clinical trials of surgery for refractory psychiatric disease present to the consent process. Recommendations are also made for an ethical approach to clinical trial consent acquisition in this unique patient population. (shrink)

The principle of gratuitous suffering -- The value of humans and the value of animals -- The holocaust of factory farming -- Hunting -- Animal experimentation -- The law and animals -- Women and animals.

It has become virtually a matter of dogma—among both philosophers and laypersons—that human lives are more valuable than animal lives. One argument for this claim dominates the philosophical literature and, despite its employment by a host of philosophers, should be found wanting. I try to show that this line of reasoning, as well as one that is less popular but still with significant appeal, are faulty. The errors in each argument seem fatal: the pervasive argument begs the question, and the (...) more selective is, at bottom, unintelligible. We should judge that the lives of humans and animals are equally valuable, an assessment that should be accompanied by major changes in some of our fundamental practices. (shrink)

In the past few years, the focus of arguments against theism has shifted. Where previously the existence of evil has been thought by many demonstrative of the impossibility of God's existence, now it is frequently purveyed as merely evidence against the existence of a Supreme Being. Even this more modest claim has been forcefully denied by William Alston and Peter van Inwagen. I argue that their arguments are not persuasive. Not only do they suffer logical flaws but, if accepted, actually (...) have pernicious effects on the values of reasoning and religious practice. (shrink)

The decision to initiate invasive, first-in-human trials involving Parkinson’s disease presents a vexing ethical challenge. Such studies present significant surgical risks, and high degrees of uncertainty about intervention risks and biological effects. We argue that maintaining a favorable riskbenefit balance in such circumstances requires a higher than usual degree of confidence that protocols will lead to significant direct and/or social benefits. One critical way of promoting such confidence is through the application of stringent evidentiary standards for preclinical studies. We close (...) with a series of recommendations for strengthening the internal and external validity of preclinical studies, reducing their tendency toward optimism and publication biases, and improving the knowledge base used to design and evaluate preclinical studies. (shrink)

Virtually all persons—philosophers and laypersons alike—agree that, special circumstances aside, killing humans is more morally objectionable than killing animals. I argue for a radical inversion of this dogma: all else being equal, killing nonhuman animals is more morally objectionable than killing humans. We will discover that the dominant reason for the pervasive belief that killing humans is worse than killing animals—that the human kind of animal uniquely has the capacities for self-consciousness and self-reflection—can be implemented to demonstrate the very opposite (...) conclusion. (shrink)

One tolerably clear statement of Determinism has it that all events are caused. Expanded upon, this thesis has been taken as the claim that the existence of any event E1, has a set of events, E2 … En which antedate E1, and which are causally sufficient for the occurrence of E1. That is, given the occurrence of E2 … En, E1 is causally necessary. I would hardly wish to claim that this is the only plausible statement of the doctrine of (...) Determinism; nonetheless it is a common one, and the one that I’ll use as definitive. Some have believed both that this premise is true and that it inevitably leads to a denial of free actions. While remaining neutral as to the merits of the Hard Determinist position, what I wish to show is that the consequences of the argumentation that has led them to such a position have been neither fully nor adequately understood. (shrink)

In this Introduction, I have two goals. First, I try to contextualize the reasons most people believe both that, all else being equal, killing animals is wrong, and that some justification is needed, at least implicitly, to perform these killings. In the course of this discussion, I briefly discuss the comparative badness of killing human and nonhuman animals. Second, I provide short summaries of all of the papers in this section of the Handbook.

A problem closely related to the perennial free will question is whether autonomy of persons can be reconciled with socialization. If this latter compatibilism can be established, It would have great bearing on the more general issue of freedom being reconcilable with determinism. In several recent articles robert young has tried to demonstrate the consistency of autonomy with socialization, But the author argues that he has failed to notice the depth and global nature of the socialization critic's position, And as (...) such fails in his attempt. As a result, There are no beneficial consequences reaped for the free will problem. (shrink)

It is undeniable that many human practices are detrimental to the well-being of non-human animals. Among other things, we trap and hunt them, experiment upon them, and kill them to use their flesh for food. We cause pain and suffering, and so a moral justification for these activities is required. Traditionally such a justification has taken the form of claiming that humans have some property–intelligence, ability to morally deliberate, etc.–which is both morally significant and missing in non-humans. However, once we (...) recall the existence of marginal or deficient humans, those who suffer from senility, retardation, Alzheimer disease, etc., this appeal loses much of its force. I investigate whether loyalty appeals can be used to support our treatment of non-humans as resources. That is, can we legitimately appeal to the fact that an individual is a fellow human to ground inferior moral behaviors toward non-human animals. I conclude that, concerning any of the major uses of animals, including the experimenting upon them in the hopes of finding cures and treatments of human diseases, loyalty appeals have no efficacy. (shrink)