In her thorough and thoughtful contribution to the Cambridge Quarterly of Healthcare Ethics titled “Medical Ethics: Common or Uncommon Morality” Rosamond Rhodes argues that contrary to American mainstream bioethics, medical ethics is not, and should not be, based on common morality, but rather, that the medical profession requires its own distinctive morality.1 She goes on to list sixteen duties that, according to her, form the core of medical ethics proper.

Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention and return-to-work. However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional (...) contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility, social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences. (shrink)

Abstract:This article looks at what anarchism has to offer in debates concerning health and healthcare. I present the case that anarchism’s interest in supporting the poor, sick, and marginalized, and rejection of state and corporate power, places it in a good position to offer creative ways to address health problems. I maintain that anarchistic values of autonomy, responsibility, solidarity, and community are central to this endeavor. Rather than presenting a case that follows one particular anarchist theory, my main goal is (...) to raise issues and initiate debate in this underresearched field in mainstream bioethics. (shrink)

The idea of using biomedical means to make people more likely to behave morally may have a certain appeal. However, it is very hard to find two persons – let alone two moral philosophers – who agree on what it means to be moral or to act morally. After discussing some of the proposals for moral enhancements that all ethicists could agree on, I engage more closely with the recent idea of “procedural moral enhancement” that aims at improving deliberative processes (...) instead of particular moral views, motivations, or dispositions. I argue that it is better understood as a contribution to moral epistemology and should thus be labeled “moral-epistemic enhancement”. I then defend perspective-taking as a moral epistemic capacity which can be enhanced by both traditional and non-traditional biomedical means; a capacity which almost always contributes to the epistemic value of moral decision-making. Perspective-taking seems to be an uncontroversial non-trivial capacity for moral decision-making reasonably widely shared by proponents of ethical beliefs within the academic community. The enhancement of this capacity is thus a good candidate for an uncontroversial non-trivial moral enhancement. (shrink)

Background: The pharmaceutical industry has been responsible for major medical advances, but the industry has also been heavily criticized. Such criticisms, and associated regulatory responses, are no doubt often warranted, but do not provide a framework for those who wish to reason systematically about the moral dimensions of drug development. We set out to develop such a framework using Beauchamp and Childress's “four principles” as organizing categories. Methods: We conducted a qualitative interview study of people working in the “medical affairs” (...) departments of pharmaceutical companies to determine: (1) whether our data could meaningfully be organized under the headings of “autonomy,” “beneficence,” “nonmaleficence,” and “justice”; (2) how principles might be expressed in this particular commercial setting; and (3) if these principles are expressed, whether and how competing principles are balanced. We then critiqued these findings using existing normative theory. Results: Our interviews demonstrated that three of Beauchamp and Childress's four principles were salient to our participants: beneficence, nonmaleficence, and justice. Within each of these principles, participants had two broad ethical orientations: an altruistic public focus (“other-ness”) and a commitment to their companies (“firm-ness”). Our participants also demonstrated efforts to balance these principles and highlighted the importance of phronesis (or practical wisdom) in balancing and enacting principles. Notably, however, our participants did not spontaneously emphasize the importance of autonomy. Conclusions: It is possible to use qualitative empirical research, together with normative analysis, to derive a framework for pharmaceutical ethics. We suggest that our framework would be useful for those who wish to reason ethically within, or in collaboration with, the pharmaceutical industry. (shrink)