The dominant language of politics in the United States has been political individualism, with minimal restrictions on property and personal, voluntary conduct. But there are second languages of community that stress cooperation and group action. These second languages include the constitutional tradition for public health. Public health offers a community justification for paternalistic measures that, for example, discourage smoking or require seatbelts.

With increasing momentum for health care reform, attention is shifting to finance reform that will provide for direct methods for controlling health care spending. This article outlines the two principal paths to direct cost control and outlines a national plan that retains our multiple sources of payment, yet also contains a powerful direct cost control technique: a single fund to finance all health care.

Book reviewed in this article: Seeking Fair Treatment: From the AIDS Epidemic to National Health Care Reform. By Norman Daniels.

La Commission de l’éthique de la science et de la technologie peut-elle s’inscrire dans une perspective préventive? C’est pour partie une question piège, pour partie une question fascinante à laquelle il vaut la peine de s’attarder. Prima facie, la création d’une commission d’éthique a forcément une fonction prospective et préventive. Mais cette fonction peut être illusoire pour diverses raisons. Je propose dans ce qui suit une réflexion en trois points : les caractéristiques de la CEST, les attentes de l’État en (...) matière d’éthique, la prévention éthique. (shrink)

L'actuel débat sur l'« égalité face aux soins » et le « droit aux soins » est la conséquence directe des progrès techniques réalisés dans le domaine de la santé, mais il reste encore à fonder rationnellement les politiques suivies en la matière et à formuler une théorie adéquate de la justice distributive. Le présent article analyse le rôle et le statut du droit aux soins, ainsi que les considérations tenant à la justice qui vont à rencontre de la rentabilité (...) et de l'utilité sociales. Les choix de répartition budgétaire sont décisifs pour la formulation de revendications au nom de l'existence d'un droit positif aux soins, et il convient de se demander si un tel droit existe et quelles en sont les limites. Discussions today of « equal access » and « the right to health care » are the direct descendants of advances in the technology of health care, and we are still in search of a rationale for our policies and a theory of distributive justice adequate to the task. The role and status of rights to health care, together with considerations of justice in conflict with social efficiency and utility are discussed in this paper. It is argued that allocation decisions are central to claims on behalf of a positive right to health care, which forces questions both of whether there is such a right and of the limits to the right. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

This accessible overview of classical and modern moral theory with short readings provides comprehensive coverage of ethics and unique coverage of rights, justice, liberty and law. Real-life cases introduce each chapter. While the book's content is theoretical rather than applied ethics, Beauchamp consistently applies the theories to practical moral problems. Aristotle, Hume, Kant, and Mill are at the book;s core and they are placed in the context of moral philosophical controversies of the last 30 years. In this edition one-third (...) of the reading selections are new and all the selections in chapter 8 on rights are new. Chapter 7 on Hume has been heavily reshaped. Chapter 1 has been reduced to get students past introductory material and into the philosophers. (shrink)

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the “standard” Jehovah’s (...) Witness case that having autonomously chosen the authority of his religious institution, a Jehovah’s Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author’s view of the child of a Jehovah’s Witness scenario is that it is morally required—not merely permitted—to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. (shrink)

This volume will collect Tom Beauchamp's 15 most important published articles in bioethics, most of which were published over the last 25 years, and most of ...

Volume 19, Issue 11, November 2019, Page 9-12.

... Let me start my investigation by taking a brief look at the way in which self-awareness is expressed linguistically, as in the sentences "I am tired" or ...

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

Humans encounter and use animals in a stunning number of ways. The nature of these animals and the justifiability or unjustifiabilitly of human uses of them are the subject matter of this volume.

Written by epidemiologists, ethicists and legal scholars, this book provides an in-depth account of the moral problems that often confront epidemiologists, including both theoretical and practical issues. The first edition has sold almost three thousand copies since it was published in 1996. This edition is fully revised and includes three new chapters:Ethical Issues in Public Health Practice, Ethical Issues in Genetic Epidemiology, and Ethical Issues in International Health Research and Epidemiology. These chapters collectively address important developments of the past decade. (...) Three chapters from the first edition have also been reorganized: Ethicall Optimized Study Deisgns in Epidemiology, Ethical Issues in Epidemiologic Research with Children, and The Ethics of Epidemiologic Research with Older Populations. Instead of standing alone, these chapters have been integrated into chapters on informed consent, confidentiality and privacy protection, and community-based intervention studies. (shrink)

For forty years, successive editions of Ethical Theory and Business have helped to define the field of business ethics. The 10th edition reflects the current, multidisciplinary nature of the field by explicitly embracing a variety of perspectives on business ethics, including philosophy, management, and legal studies. Chapters integrate theoretical readings, case studies, and summaries of key legal cases to guide students to a rich understanding of business ethics, corporate responsibility, and sustainability. The 10th edition has been entirely updated, ensuring that (...) students are exposed to key ethical questions in the current business environment. New chapters cover the ethics of IT, ethical markets, and ethical management and leadership. Coverage includes climate change, sustainability, international business ethics, sexual harassment, diversity, and LGBTQ discrimination. New case studies draw students directly into recent business ethics controversies, such as sexual harassment at Fox News, consumer fraud at Wells Fargo, and business practices at Uber. (shrink)

The practice of obtaining informed consent has its history in, and gains its meaning from, medicine and biomedical research. Discussions of disclosure and justified nondisclosure have played a significant role throughout the history of medical ethics, but the term “informed consent” emerged only in the 1950s. Serious discussion of the meaning and ethics of informed consent began in medicine, research, law, and philosophy only around 1972.

: Phenomena of moral conflict and disagreement have led writers in ethics to two antithetical conclusions: Either valid moral distinctions hold universally or they hold relative to a particular and contingent moral framework, and so cannot be applied with universal validly. Responding to three articles in this issue of the Journal that criticize his previously published views on the common morality, the author maintains that one can consistently deny universality to some justified moral norms and claim universality for others. Universality (...) is located in the common morality and nonuniversality in other parts of the moral life, called "particular moralities." The existence of universal moral standards is defended in terms of: (1) a theory of the objectives of morality, (2) an account of the norms that achieve those objectives, and (3) an account of normative justification (both pragmatic and coherentist). (shrink)

Principles that provide general normative frameworks in bioethics have been criticized since the late 1980s, when several different methods and types of moral philosophy began to be proposed as alternatives or substitutes. Several accounts have emerged in recent years, including: (1) Impartial Rule Theory (supported in this issue by K. Danner Clouser), (2) Casuistry (supported in this issue by Albert Jonsen), and (3) Virtue Ethics (supported in this issue by Edmund D. Pellegrino). Although often presented as rival methods or theories, (...) these approaches are consistent with and should not be considered adversaries of a principle-based account. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

The distinction between clinical research and clinical practice directs how we partition medicine and biomedical science. Reasons for a sharp distinction date historically to the work of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, especially to its analysis of the “boundaries” between research and practice in the Belmont Report (1978). Belmont presents a segregation model of the research-practice distinction, according to which research and practice form conceptually exclusive sets of activities and interventions. This (...) model is still the standard in federal regulations today. However, the Commission’s deliberations and conclusions about the boundaries are more complicated, nuanced, and instructive than has generally been appreciated. The National Commission did not conclude that practice needs no oversight comparable to the regulation of research. It debated the matter and inclined to the view that the oversight of practice needed to be upgraded, though the Commission stopped short of proposing new regulations for its oversight, largely for prudential political reasons. (shrink)

About HumeDavid Hume is one of the greatest of philosophers. Today he probably ranks highest of all British philosophers in terms of influence and philosophical standing. His philosophical work ranges across morals, the mind, metaphysics, epistemology, and aesthetics; he had broad interests not only in philosophy as it is now conceived but in history, politics, economics, religion, and the arts. He was a master of English prose. The Clarendon Hume Edition General Editors: Professor T. L. Beauchamp, Georgetown University, USA, (...) Professor D. F. Norton, McGill University, Canada, and Professor M. A. Stewart, University of Lancaster, EnglandThe Clarendon Hume will include all of his works except his History of England and minor historical writings; it will be the only thorough critical edition, and will provide a far more extensive scholarly treatment than any previous editions. This edition offers authoritative annotation, bibliographical information, and indexes, and draws upon the major advances in textual scholarship that have been made since the publication of earlier editions--advances both in the understanding of editorial principle and practice and in knowledge of the history of Hume's own texts. The Edition will comprise: Volumes 1 and 2: A Treatise of Human Nature, edited by D. F. Norton Volume 3: An Enquiry concerning Human Understanding, edited by T. L. Beauchamp Volume 4: An Enquiry concerning the Principles of Morals, edited by T. L. Beauchamp Volume 5: The Natural History of Religion and the Dissertation on the PassionsVolumes 6 and 7: EssaysVolume 8: Dialogues concerning Natural Religion and other posthumous publications, edited by M. A. Stewart About this workAn Enquiry concerning the Principles of Morals was Hume's third great philosophical work, first published in 1751. Hume's aim in this elegant and lucid work was to present in an accessible way his theory of the foundation of morality in human nature, which had developed significantly since he first addressed the subject in the Treatise of Human Nature. He discusses moral psychology; freedom, necessity, and causation; practical reasoning; justice; virtues and other moral qualities. He considered this Enquiry to be 'of all my writings, historical, philosophical, or literary, incomparably the best'. About this volumeThe authoritative version of the text, based upon the 1772 edition that was seen through the press by Hume himself, is presented here accurately and clearly. The editor's introduction sets the work in its historical context; the annotation and glossary provide information about Hume's sources, allusions, citations, and meanings, to help readers towards a full understanding of the text. A biographical appendix identifies the many people mentioned by Hume in the Enquiry. Bibliographies list the works cited by Hume and a selection of the secondary literature. Hume's original index is reproduced, together with a new general index by the editor. (shrink)

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.I make no presumption that bioethics is integrally linked to (...) philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms. (shrink)

Literature on the mental capacities and cognitive mechanisms of the great apes has been silent about whether they can act autonomously. This paper provides a philosophical theory of autonomy supported by psychological studies of the cognitive mechanisms that underlie chimpanzee behavior to argue that chimpanzees can act autonomously even though their psychological mechanisms differ from those of humans. Chimpanzees satisfy the two basic conditions of autonomy: (1) liberty (the absence of controlling influences) and (2) agency (self-initiated intentional action), each of (...) which is specified here in terms of conditions of understanding, intention, and self-control. In this account, chimpanzees make knowledge-based choices reflecting a richly information-based and socially sophisticated understanding of the world. Finally, two major theories of autonomy (Kantian theory and two-level theory) are rejected as too narrow to adequately address these issues, necessitating the modifications made in the present approach. (shrink)

It is commonly believed that Edmund Husserl (1859-1938), well known as the founder of phenomenology and as the teacher of Heidegger, was unable to free himself from the framework of a classical metaphysics of subjectivity. Supposedly, he never abandoned the view that the world and the Other are constituted by a pure transcendental subject, and his thinking in consequence remains Cartesian, idealistic, and solipsistic. The continuing publication of Husserl’s manuscripts has made it necessary to revise such an interpretation. Drawing upon (...) both Husserl’s published works and posthumous material, Husserl’s Phenomenology incorporates the results of the most recent Husserl research. It is divided into three parts, roughly following the chronological development of Husserl’s thought, from his early analyses of logic and intentionality, through his mature transcendental-philosophical analyses of reduction and constitution, to his late analyses of intersubjectivity and lifeworld. It can consequently serve as a concise and updated introduction to his thinking. (shrink)

“Applied ethics” has been the major growth area in North American philosophy in the last decade, yet a robust confidence and enthusiasm over its promise is far from universal in academic philosophy. It is considered nonphilosophical in West Germany, and has largely failed to penetrate British departments of philosophy. Whether it has any intellectually or pedagogically redeeming value is still widely debated in North America, where many who have tried to teach some area of applied ethics for the first time (...) have seen their courses grind to a halt in unresolvable quandaries, practical exigencies, or unavailable technical information. Consequently, some departments are at war over whether to hire or confer tenure on those who teach these subjects. Many also remain unconvinced that philosophical generalizations or theories can play any significant role in applied contexts. They may even doubt both that applied ethics is really ethics and that philosophy should accomodate this creature in its curriculum. (shrink)

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement (...) with our commentators and respond to their critical evaluations. (shrink)

Tom Beauchamp presents a new edition, designed especially for the student reader, of An Enquiry concerning Human Understanding, the classic work in which David Hume gave a general exposition of his philosophy to a broad educated readership. An authoritative new version of the text is preceded by a substantial introduction explaining the historical and intellectual background to the work and surveying its main themes. The volume also includes detailed explanatory notes on the text, a glossary of terms, and a (...) section of supplementary readings. (shrink)

Research suggests that Canadian police officers are exposed to trauma at a greater frequency than the general population. This, combined with other operational stressors, such as risk of physical injury, high consequence of error, and strained resources, can leave officers less resilient to organizational stressors. In my experience, a significant and impactful organizational stressor is ineffective leadership, which include leaders who are non-supportive, inconsistent, egocentric, and morally ambiguous. Ineffective leadership in the context of paramilitary police culture has been recognized as (...) psychologically distressing. Further, moral injury may result when leadership fails to meet officers’ needs, expectations, and values. Ineffective leadership and resulting moral injuries are an understudied area in the literature. This review will help provide a comprehensive context of policing and the impact of ineffective leadership on police mental health. (shrink)

What grounds and justifies conclusions in medical ethics? Is the source external or internal to medicine? Thee influential types of answer have appeared in recent literature: an internal account, an external account, and a mixed internal / external account. The first defends an ethic derived from either the ends of medicine or professional practice standards. The second maintains that precepts in medical ethics rely upon and require justification by external standards such as those of public opinion, law, religious ethics, or (...) philosophical ethics. The third claims that distinct medical ethics have emerged from distinct cultural frameworks, each with norms that govern physicians. There is merit in each perspective, but each overreaches its supporting arguments and fails to appreciate what is legitimate in the theses of its competitors. I propose a fourth account that offers a way to escape limitations of the other three, while retaining their most attractive features. (shrink)

: The belief persists in philosophy, religion, science, and popular culture that some special cognitive property of persons like self-consciousness confers a unique moral standing. However, no set of cognitive properties confers moral standing, and metaphysical personhood is not sufficient for either moral personhood or moral standing. Cognitive theories all fail to capture the depth of commitments embedded in using the language of "person." It is more assumed than demonstrated in these theories that nonhuman animals lack a relevant form of (...) self-consciousness or its functional equivalent. Although nonhuman animals are not plausible candidates for moral personhood, humans too fail to qualify as moral persons if they lack one or more of the conditions of moral personhood. If moral personhood were the sole basis of moral rights, then these humans would lack rights--and precisely for the reasons that nonhuman animals would. (shrink)

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and (...) prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems. (shrink)