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)

Prevailing ethical thinking about informed consent to clinical research is characterized by theoretical confidence and practical disquiet. On the one hand, bioethicists are confident that informed consent is a fundamental norm. And, for the most part, they are confident that what makes consent to research valid is that it constitutes an autonomous authorization by the research participant. On the other hand, bioethicists are uneasy about the quality of consent in practice. One major source of this disquiet is substantial evidence of (...) the “therapeutic misconception”—the tendency of patient-subjects in clinical trials to confuse participating in research with receiving personalized medical care. This .. (shrink)

According to the standard view of informed consent, a prospective subject's consent to participate in a research study is invalid if the individual fails to comprehend the information about the study standardly disclosed to him. I argue that this involves three mistakes. First, the standard view confuses an ethical aspiration with a minimum ethical standard. Second, it assigns the entire responsibility for producing comprehension in study participants to the investigators. Most importantly, the standard view requires the termination of many otherwise (...) perfectly ethical research studies. This last conclusion follows from appreciating a pervasive phenomenon that is known as the "therapeutic misconception." I argue that a prospective subject's consent to participate in research can be perfectly valid even if he or she does not comprehend the information that investigators are required to disclose. Furthermore, I explain that this alternative view does not in the least compromise the vital goal of ensuring the protection of subjects in research. (shrink)

In recent years, ‘nudge’ theory has gained increasing attention for the design of population-wide health interventions. The concept of nudge puts a label on efficacious influences that preserve freedom of choice without engaging the influencees’ deliberative capacities. Given disagreements over what it takes genuinely to preserve freedom of choice, the question is whether health influences relying on automatic cognitive processes may preserve freedom of choice in a sufficiently robust sense to be serviceable for the moral evaluation of actions and policies. (...) In this article, I offer an argument to this effect, explicating preservation of freedom of choice in terms of choice-set preservation and noncontrol. I also briefly explore the healthcare contexts in which nudges may have priority over more controlling influences. (shrink)

Late 2009, the Microsoft Corporation terminated its sales, distribution and upgrading of Microsoft Office Accounting. This article presents an ethical analysis of the way in which Microsoft Corporation effected its decision to withdraw the product with special emphasis on how consumer expectations were formed, maintained and handled throughout the lifecycle of the accounting software in question. The analysis proceeds from initial reflections on and arguments for the ethical significance of consumer expectations – an area which has until recently only received (...) little attention in moral analysis. (shrink)

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

In both theoretical and applied contexts the concept of autonomy has assumed increasing importance in recent normative philosophical discussion. Given various problems to be clarified or resolved the author characterizes the concept by first setting out conditions of adequacy. The author then links the notion of autonomy to the identification and critical reflection of an agent upon his first-order motivations. It is only when a person identifies with the influences that motivate him, assimilates them to himself, that he is autonomous. (...) In addition this process of identification must itself meet certain procedural constraints. (shrink)

In both theoretical and applied contexts the concept of autonomy has assumed increasing importance in recent normative philosophical discussion. Given various problems to be clarified or resolved the author characterizes the concept by first setting out conditions of adequacy. The author then links the notion of autonomy to the identification and critical reflection of an agent upon his first-order motivations. It is only when a person identifies with the influences that motivate him, assimilates them to himself, that he is autonomous. (...) In addition this process of identification must itself meet certain procedural constraints. (shrink)

Libertarian paternalism's notion of “nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence, which at times favors paternalistic influence. A growing body of literature attempts to assess the merits of nudging in health care. However, this literature deals almost exclusively with health policy, while the question of the potential benefit of nudging (...) for the practice of informed consent has escaped systematic analysis. This article focuses on this question. While it concedes that nudging could amount to improper exploitation of cognitive weaknesses, it defends the practice of nudging in a wide range of other conditions. The conclusion is that, when ethically legitimate, nudging offers an important new paradigm for informed consent, with a special potential to overcome the classical dilemma between paternalistic beneficence and respect for autonomy. (shrink)

The concept of individual autonomy is one of the most frequently utilized--and perhaps least understood--terms of current moral, political, and legal debate. The first anthology devoted entirely to this philosophical concept, The Inner Citadel includes both extensive discussions of autonomy itself and theoretical applications of autonomy to various areas of philosophical inquiry. John Christman has assembled essays, many appearing in print for the first time, by such eminent philosophers as Gerald Dworkin, Joel Feinberg, Harry Frankfurt, and David A. J. Richards. (...) Together, these essays provide the necessary foundation for the myriad debates and controversies in areas such as bioethics, feminism, and paternalism whose resolution turns on the nature and value of individual autonomy. As the idea of autonomy is central to such a wide range of philosophical issues and impinges on other disciplines as well, The Inner Citadel will be essential for courses in moral, political, social, and legal philosophy, as well as a valuable resource for students of law, political science, and psychology. (shrink)

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for (...) the utilization of each principle. (shrink)

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This is a detailed, sophisticated and comprehensive treatment of autonomy. Moreover it argues for a quite different conception of autonomy from that found in the philosophical literature. Professor Berofsky claims that the idea of autonomy originating in the self is a seductive but ultimately illusory one. The only serious way of approaching the subject is to pay due attention to psychology, and to view autonomy as the liberation from the disabling effects of physiological and psychological afflictions. A sustained critique of (...) concepts such as moral autonomy, self-realisation, ideal autonomy, and identification is offered. The author replaces these with an alternative model that reveals how spontaneity, vitality and competence enable human beings to act in the real world. (shrink)