This paper suggests that public health, due to its community orientation, may be ignoring certain ethical principles--namely the rights of individuals and communities to self-determination. The expectation of individual rights as a member of a community is reviewed and the additional right of a community for self-determination is proposed. The influences on ethical evaluations by the legal and economic environments are suggested, using US examples. The conclusion argues that as the focus of health-care delivery changes, it will become more important (...) to consider these questions of group ethics. (shrink)

An increase in autonomy and freedom is often considered one ofthe main arguments in favour of a broad use of genetic testing.Starting from Gerald Dworkin's reflections on autonomy and choicethis article examines some of the implications which accompanythe increase in choices offered by prenatal genetic diagnosis.Although personal autonomy and individual choice are importantaspects in the legitimation of prenatal genetic diagnosis, itseems clear that an increase in choice offered by prenatalgenetic diagnosis also leads to various implications that maynegatively influence the freedom (...) of the persons involved. (shrink)

"Petty corruption and honesty in all health care systems" is the original title of one of the bioethics networks within the world-wide study projects of the International Association of Bioethics. As the co-ordinator of this network, it still puzzles me why the word "petty" is in the title when in the past few years - through interviews and questionnaires involving 18 countries - it has become evident to me that not only trivial but important, significant corruption exists in many health (...) care systems. (shrink)

There are several strategies for exposing the defects of established moral discourse, one of which is critical argumentation. However, under certain specific historical circumstances, the apparent self-evidence of established moral discourse has gained such dominance, such a capacity of resistance or incorporation, such an ability to conceal its basic vulnerability that its validity simply seems beyond contestation. Notwithstanding the moral subject’s basic discontent, he or she remains unable to challenge the dominant discourse effectively by means of critical argument. Or, to (...) borrow a phrase from Michel Foucault, individuals find themselves faced with a certain rationality, a moral regime that dominates moral discourse to such an extent that they cannot offer any resistance without raising the suspicion of being unreasonable. They (that is, we) find ourselves confronted with a discourse quite unable to recognize its own deficiencies. Although we are forced to accept its basic claims, our chronic discontent nevertheless persists. That is, although we are forced to participate in this discourse, we remain basically ambivalent, and our attitude towards established morality contains both a Yes and a No. Then, all of a sudden, the basic vulnerability of the dominant regime dawns on us or is revealed to us – and this is the experience of laughter. (shrink)

Since the 1980’s, surrogacy has become a popular reproductive alternative for individuals experiencing infertility. The ethical and legal analyses of surrogacy have been rich and varied. Some bioethicists have charged the commercial surrogacy industry with the exploitation of global southern women or with the impermissible commodification of children and women’s reproductive capacities. Others have praised the potential for economic empowerment and bodily autonomy that surrogacy may accord to women. However, throughout these explorations of the ethics of surrogacy, comparatively little attention (...) has been paid to the moral status of a crucial actor: the fertility doctor. Without doctors willing to provide prenatal and postnatal care to surrogates and make use of assisted reproductive technologies (ARTs), commercial surrogacy would not take place. Yet, doctors’ involvement in surrogacy is far from morally neutral. In my thesis, I aim to explore what duties doctors have in the context of commercial surrogacy. To do so, I take up the framework of fiduciary obligation. I argue that doctors have fiduciary obligations to surrogates, and that these obligations shape if and when doctors can ethically facilitate surrogacy. My thesis is divided into four chapters. The first defends the view that the doctor-patient relationship is fiduciary in nature. The second chapter extends this view to the realm of commercial surrogacy, arguing that doctors also owe the surrogates they treat fiduciary obligations. The third chapter addresses a challenge posed by my view, namely that surrogacy seems to place doctors in positions where they constantly face conflicts of interest, and are therefore unable to uphold their fiduciary duty of loyalty to surrogates. I address this concern by arguing that conflicts of interest are not inherent in surrogacy, but that surrogacy arrangements must be substantially rethought in order to safeguard the doctor-surrogate fiduciary relationship. The final chapter considers the obligations doctors have to the children they help create through surrogacy and through assisted reproduction more generally. (shrink)