Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different (...) approaches lead to different conclusions and there is no consensus about which ones are correct, and they are too abstract to be directly used in actual decision making. Empirical approaches are necessary because they help to identify what is being done and what can be done, but are insufficient because they cannot identify what should be done. Moreover, to be really helpful, an improvement strategy must utilize rigorous research methods that are able to analyze and capture experience so that past problems are corrected and lessons can be shared with others. Therefore, a constructive, practical and accessible improvement strategy must be research-based and combine both normative and empirical methods. In this paper we propose a research-based improvement strategy that involves combining three linked methods: case study research to describe priority setting; interdisciplinary research to evaluate the description using an ethical framework; and action research to improve priority setting. This describe-evaluate-improve strategy is a generalizable method that can be used in different health care institutions to improve priority setting in that context. (shrink)

Since its original publication in 1975, this groundbreaking work has awakened millions of people to the existence of "speciesism"—our systematic disregard of nonhuman animals—inspiring a worldwide movement to transform our attitudes to animals and eliminate the cruelty we inflict on them. In Animal Liberation, author Peter Singer exposes the chilling realities of today’s "factory farms" and product-testing procedures—destroying the spurious justifications behind them, and offering alternatives to what has become a profound environmental and social as well as moral (...) issue. An important and persuasive appeal to conscience, fairness, decency, and justice, it is essential reading for the supporter and the skeptic alike. (shrink)

This volume collects a wealth of articles covering a range of topics of practical concern in the field of ethics, including active and passive euthanasia, abortion, organ transplants, capital punishment, the consequences of human actions, slavery, overpopulation, the separate spheres of men and women, animal rights, and game theory and the nuclear arms race. The contributors are Thomas Nagel, David Hume, James Rachels, Judith Jarvis Thomson, Michael Tooley, John Harris, John Stuart Mill, Louis Pascal, Jonathan Glover, Derek Parfit, R.M. Hare, (...) Janet Radcliffe Richards, Peter Singer, and Nicholas Measor. (shrink)

Scientists engaged in global health research are increasingly faced with barriers to access and use of human tissues from the developing world communities where much of their research is targeted. In part, the problem can be traced to distrust of researchers from affluent countries, given the history of 'scientific-imperialism' and 'biocolonialism' reflected in past well publicized cases of exploitation of research participants from low to middle income countries. To a considerable extent, the failure to adequately engage host communities, the opacity (...) of informed consent, and the lack of fair benefit-sharing have played a significant role in eroding trust. These ethical considerations are central to biomedical research in low to middle income countries and failure to attend to them can inadvertently contribute to exploitation and erode trust. A 'tissue trust' may be a plausible means for enabling access to human tissues for research in a manner that is responsive to the ethical challenges considered. Preventing exploitation and restoring trust while simultaneously promoting global health research calls for innovative approaches to human tissues research. A tissue trust can reduce the risk of exploitation and promote host capacity as a key benefit. (shrink)

ABSTRACT In Germany, applied ethics is under attack from a diverse coalition of left‐wing organisations, disability groups, and some conservative defenders of a strict doctrine of the sanctity of human life. The attack has been pressed to the point of forcing the cancellation of conferences and disrupting lectures or classes so that they cannot take place. This essay describes the extent and nature of the attack, and makes a preliminary assessment of its significance.

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.

Medicine and health care generate many bioethical problems and dilemmas that are of great academic, professional and public interest. This comprehensive resource is designed as a succinct yet authoritative text and reference for clinicians, bioethicists, and advanced students seeking a better understanding of ethics problems in the clinical setting. Each chapter illustrates an ethical problem that might be encountered in everyday practice; defines the concepts at issue; examines their implications from the perspectives of ethics, law and policy; and then provides (...) a practical resolution. There are 10 key sections presenting the most vital topics and clinically relevant areas of modern bioethics. International, interdisciplinary authorship and cross-cultural orientation ensure suitability for a worldwide audience. This book will assist all clinicians in making well-reasoned and defensible decisions by developing their awareness of ethical considerations and teaching the analytical skills to deal with them effectively. (shrink)

While moral perfectionists rank conscious beings according to their cognitive abilities, Paola Cavalieri launches a more inclusive defense of all forms of subjectivity. In concert with Peter Singer, J. M. Coetzee, Harlan B. Miller, and other leading animal studies scholars, she expands our understanding of the nonhuman in such a way that the derogatory category of "the animal" becomes meaningless. In so doing, she presents a nonhierachical approach to ethics that better respects the value of the conscious self. (...) Cavalieri opens with a dialogue between two imagined philosophers, laying out her challenge to moral perfectionism and tracing its influence on our attitudes toward the "unworthy." She then follows with a roundtable "multilogue" which takes on the role of reason in ethics and the boundaries of moral status. Coetzee, Nobel Prize winner for Literature and author of _The Lives of Animals_, emphasizes the animality of human beings; Miller, a prominent analytic philosopher at Virginia Polytechnic Institute, dismantles the rationalizations of human bias; Cary Wolfe, professor of English at Rice University, advocates an active exposure to other worlds and beings; and Matthew Calarco, author of _Zoographies: The Question of the Animal from Heidegger to Derrida_, extends ethical consideration to entities that traditionally have little or no moral status, such as plants and ecosystems. As Peter Singer writes in his foreword, the implications of this conversation extend far beyond the issue of the moral status of animals. They "get to the heart of some important differences about how we should do philosophy, and how philosophy can relate to our everyday life." From the divergences between analytical and continental approaches to the relevance of posthumanist thinking in contemporary ethics, the psychology of speciesism, and the practical consequences of an antiperfectionist stance, _The Death of the Animal_ confronts issues that will concern anyone interested in a serious study of morality. (shrink)

For thirty years, Peter Singer's Practical Ethics has been the classic introduction to applied ethics. For this third edition, the author has revised and updated all the chapters and added a new chapter addressing climate change, one of the most important ethical challenges of our generation. Some of the questions discussed in this book concern our daily lives. Is it ethical to buy luxuries when others do not have enough to eat? Should we buy meat from intensively reared (...) animals? Am I doing something wrong if my carbon footprint is above the global average? Other questions confront us as concerned citizens: equality and discrimination on the grounds of race or sex; abortion, the use of embryos for research and euthanasia; political violence and terrorism; and the preservation of our planet's environment. This book's lucid style and provocative arguments make it an ideal text for university courses and for anyone willing to think about how she or he ought to live. (shrink)

Since its original publication in 1975, this groundbreaking work has awakened millions of concerned men and women to the shocking abuse of animals everywhere--inspiring a worldwide movement to eliminate much of the cruel and unnecessary laboratory animal experimentation of years past. In this newly revised and expanded edition, author Peter Singer exposes the chilling realities of today's "factory farms" and product-testing procedures--offering sound, humane solutions to what has become a profound environmental and social as well as moral issue. (...) An important and persuasive appeal to conscience, fairness, decency and justice, Animal Liberation is essential reading for the supporter and the skeptic alike.--From publisher description. (shrink)

In 1972, the young philosopher Peter Singer published "Famine, Affluence and Morality," which rapidly became one of the most widely discussed essays in applied ethics. Through this article, Singer presents his view that we have the same moral obligations to those far away as we do to those close to us. He argued that choosing not to send life-saving money to starving people on the other side of the earth is the moral equivalent of neglecting to save (...) drowning children because we prefer not to muddy our shoes. If we can help, we must--and any excuse is hypocrisy. Singer's extreme stand on our moral obligations to others became a powerful call to arms and continues to challenge people's attitudes towards extreme poverty. Today, it remains a central touchstone for those who argue we should all help others more than we do. As Bill and Melinda Gates observe in their foreword, in the age of today's global philanthropy, Singer's essay is as relevant now as it ever was. This attractively packaged, concise edition collects the original article, two of Singer's more recent popular writings on our obligations to others around the world, and a new introduction by Singer that discusses his current thinking. (shrink)

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...) Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

The international context of the last fifty years of modern bioethics have been significant in establishing health-care ethics or bioethics as a common parlance - an ideology of our times, achieving near universal acceptance, with little dissent. Most international health organizations have developed important declarations that have become the credo of their daily practice and long-term commitments. However, in the last decade in particular, bioethicists and other health-care practitioners and scholars have worried about the persistence of health-care inequities and the (...) inadequate realization of bioethics, particularly in low-to-middle income countries. Global bioethics, now well into the new millennium, has entered a regulatory crisis: it needs to confront not just global bioethical commitments around major scientific revolutions such as genomics, but further, a regulatory crisis about the persisting national public law silences and health inequities, especially in low-to-middle income countries. (shrink)

The international context of the last fifty years of modern bioethics have been significant in establishing health-care ethics or bioethics as a common parlance - an ideology of our times, achieving near universal acceptance, with little dissent. Most international health organizations have developed important declarations that have become the credo of their daily practice and long-term commitments. However, in the last decade in particular, bioethicists and other health-care practitioners and scholars have worried about the persistence of health-care inequities and the (...) inadequate realization of bioethics, particularly in low-to-middle income countries. Global bioethics, now well into the new millennium, has entered a regulatory crisis: it needs to confront not just global bioethical commitments around major scientific revolutions such as genomics, but further, a regulatory crisis about the persisting national public law silences and health inequities, especially in low-to-middle income countries. (shrink)

Liver transplantation is the treatment of choice for many forms of liver disease. Unfortunately, the scarcity of cadaveric donor livers limits the availability of this technique. To improve the availability of liver transplantation, surgeons have developed the capability of removing a portion of liver from a live donor and transplanting it into a recipient. A few liver transplants using living donors have been performed worldwide.Our purpose was to analyze the ethics of liver transplants using living donors and to propose guidelines (...) for the procedure before it was introduced in the United States. We used a process of research ethics consultation that involves a collaboration between clinical investigators and clinical ethicists. We concluded that it was ethically appropriate to perform liver transplantation using living donors in a small series of patients on a trial basis, and we published our ethical guidelines in a medical journal before the procedure was introduced. We recommend this prospective, public approach for the introduction of other innovative therapies in medicine and surgery. (shrink)

What is ethics? Where do moral standards come from? Are they based on emotions, reason, or some innate sense of right and wrong? For many scientists, the key lies entirely in biology---especially in Darwinian theories of evolution and self-preservation. But if evolution is a struggle for survival, why are we still capable of altruism? In his classic study The Expanding Circle, Peter Singer argues that altruism began as a genetically based drive to protect one's kin and community members (...) but has developed into a consciously chosen ethic with an expanding circle of moral concern. Drawing on philosophy and evolutionary psychology, he demonstrates that human ethics cannot be explained by biology alone. Rather, it is our capacity for reasoning that makes moral progress possible. In a new afterword, Singer takes stock of his argument in light or recent research on the evolution of morality.--Publisher's description. (shrink)

As I write this, in November 1971, people are dying in East Bengal from lack of food, shelter, and medical caxc. The suffering and death that are occurring there now axe not inevitable, 1101; unavoidable in any fatalistic sense of the term. Constant poverty, a cyclone, and a civil war have turned at least nine million people into destitute refugees; nevertheless, it is not beyond Lhe capacity of the richer nations to give enough assistance to reduce any further suffering to (...) very small proportions. The decisions arid actions of human beings can prevent this kind of suffering. Unfortunately, human beings have not made the necessary decisions. At the individual level, people have, with very few exceptions, not responded to the situation in any signihczmt way. Generally speaking, people have not given large sums to relief funds; they have not written t0 their parliamentaxy representatives demanding increased government assistance; they have not demonstrated in the streets, held symbolic fasts, or done anything else directed toward providing thc refugees with the means to satisfy their essential needs. At thc government level, no govcrmmcnt has given the sort of massive aid that would enable the refugees to survive fm: more than a few days. Britain, for instance, has given rather more than most countries. It has, to date, given £14,750,000. For comparative purposes, B1~itain’s share of thc nonreccverabla development costs of the Anglo-French Concorde project is already in excess of £275,000,000, and on present estimates will reach £440,000,¤00. The implication is that the British government values a supersonic transport more than thirty times as.. (shrink)

For millennia, philosophers have speculated about the origins of ethics. Recent research in evolutionary psychology and the neurosciences has shed light on that question. But this research also has normative significance. A standard way of arguing against a normative ethical theory is to show that in some circumstances the theory leads to judgments that are contrary to our common moral intuitions. If, however, these moral intuitions are the biological residue of our evolutionary history, it is not clear why we should (...) regard them as having any normative force. Research in the neurosciences should therefore lead us to reconsider the role of intuitions in normative ethics. (shrink)

Do animals other than humans feel pain? How do we know? Well, how do we know if anyone, human or nonhuman, feels pain? We know that we ourselves can feel pain. We know this from the direct experience of pain that we have when, for instance, somebody presses a lighted cigarette against the back of our hand. But how do we know that anyone else feels pain? We cannot directly experience anyone else's pain, whether that "anyone" is our best friend (...) or a stray dog. Pain is a state of consciousness, a "mental event", and as such it can never be observed. Behavior like writhing, screaming, or drawing one's hand away from the lighted cigarette is not pain itself; nor are the recordings a neurologist might make of activity within the brain observations of pain itself. Pain is something that we feel, and we can only infer that others are feeling it from various external indications. (shrink)

From the ethicist the_ New Yorker_ calls “the most influential living philosopher,” a new way of thinking about living ethically.

In a new preface, Peter Singer discusses the prospects for the ethical approach he advocates."--BOOK JACKET.

Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in (...) the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements. (shrink)

This second edition of _A Companion to Bioethics,_ fully revised and updated to reflect the current issues and developments in the field, covers all the material that the reader needs to thoroughly grasp the ideas and debates involved in bioethics. Thematically organized around an unparalleled range of issues, including discussion of the moral status of embryos and fetuses, new genetics, life and death, resource allocation, organ donations, AIDS, human and animal experimentation, health care, and teaching Now includes new essays on (...) currently controversial topics such as cloning and genetic enhancement Topics are clearly and compellingly presented by internationally renowned bioethicists A detailed index allows the reader to find terms and topics not listed in the titles of the essays themselves. (shrink)

Utilitarianism may well be the most influential secular ethical theory in the world today. It is also one of the most controversial. It clashes, or is widely thought to clash, with many conventional moral views, and with human rights when they are seen as inviolable. Would it, for example, be right to torture a suspected terrorist in order to prevent an attack that could kill and injure a large number of innocent people? In this Very Short Introduction Peter (...) class='Hi'>Singer and Katarzyna de Lazari-Radek provide an authoritative account of the nature of utilitarianism, from its nineteenth-century origins, to its justification and its varieties. Considering how utilitarians can respond to objections that are often regarded as devastating, they explore the utilitarian answer to the question of whether torture can ever be justified. They also discuss what it is that utilitarians should seek to maximize, paying special attention to the classical utilitarian view that only pleasure or happiness is of intrinsic value. Singer and de Lazari-Radek conclude by analysing the continuing importance of utilitarianism in the world, indicating how it is a force for new thinking on contemporary moral challenges like global poverty, the treatment of animals, climate change, reducing the risk of human extinction, end-of-life decisions for terminally-ill patients, and the shift towards assessing the success of government policies in terms of their impact on happiness. ABOUT THE SERIES: The Very Short Introductions series from Oxford University Press contains hundreds of titles in almost every subject area. These pocket-sized books are the perfect way to get ahead in a new subject quickly. Our expert authors combine facts, analysis, perspective, new ideas, and enthusiasm to make interesting and challenging topics highly readable. (shrink)

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, (...) but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient? (shrink)

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, (...) but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient? (shrink)

B'Imagine that you could choose a book that everyone in the world would read. My choice would be this book.' Roger Crisp, Ethics -/- Many people have an uneasy feeling that they may be missing out on something basic that would give their lives a significance it currently lacks. But how should we live? What is there to stop us behaving selfishly? In a highly readable account which makes reference to a wide variety of sources and everyday issues, Peter (...) Singer suggests that the conventional pursuit of self- interest is individually and collectively self-defeating. Taking into consideration the beliefs of Jesus, Kant, Rousseau, and Adam Smith amongst others, he looks at a number of different cultures, including America, Japan, and the Aborigines to assess whether or not selfishness is in our genes and how we may find greater satisfaction in an ethical lifestyle. (shrink)

In his book A Theory of Justice, John Rawls introduces and employs the concept of “reflective equilibrium” as a method of testing which of rival moral theories is to be preferred. The introduction of this concept is plainly a significant event for moral philosophy. The criterion by which we decide to reject, say, utilitarianism in favour of a contractual theory of justice is, if anything, even more fundamental than the choice of theory itself, since our choice of moral theory may (...) well be determined by the criterion we use. (shrink)

Sidgwick's defence of esoteric morality has been heavily criticized, for example in Bernard Williams's condemnation of it as 'Government House utilitarianism.' It is also at odds with the idea of morality defended by Kant, Rawls, Bernard Gert, Brad Hooker, and T.M. Scanlon. Yet it does seem to be an implication of consequentialism that it is sometimes right to do in secret what it would not be right to do openly, or to advocate publicly. We defend Sidgwick on this issue, and (...) show that accepting the possibility of esoteric morality makes it possible to explain why we should accept consequentialism, even while we may feel disapproval towards some of its implications. (shrink)

There is too much that we do not know about COVID-19. The longer we take to find it out, the more lives will be lost. In this paper, we will defend a principle of risk parity: if it is permissible to expose some members of society (e.g. health workers or the economically vulnerable) to a certain level of ex ante risk in order to minimize overall harm from the virus, then it is permissible to expose fully informed volunteers to a (...) comparable level of risk in the context of promising research into the virus. We apply this principle to three examples of risky research: skipping animal trials for promising treatments, human challenge trials to speed up vaccine development, and low-dose controlled infection or “variolation.” We conclude that if volunteers, fully informed about the risks, are willing to help fight the pandemic by aiding promising research, there are strong moral reasons to gratefully accept their help. To refuse it would implicitly subject others to still graver risks. (shrink)

Many people believe that all human life is of equal value. Most of them also believe that all human beings have a moral status superior to that of nonhuman animals. But how are these beliefs to be defended? The mere difference of species cannot in itself determine moral status. The most obvious candidate for regarding human beings as having a higher moral status than animals is the superior cognitive capacity of humans. People with profound mental retardation pose a problem for (...) this set of beliefs, because their cognitive capacities are not superior to those of many animals. I argue that we should drop the belief in the equal value of human life, replacing it with a graduated view that applies to animals as well as to humans. (shrink)

In this ground-breaking book, a renowned bioethicist argues that the political left must radically revise its outdated view of human nature. He shows how the insights of modern evolutionary theory, particularly on the evolution of cooperation, can help the left attain its social and political goals. Singer explains why the left originally rejected Darwinian thought and why these reasons are no longer viable. He discusses how twentieth-century thinking has transformed our understanding of Darwinian evolution, showing that it is compatible (...) with cooperation as well as competition, and that the left can draw on this modern understanding to foster cooperation for socially desirable ends. A Darwinian left, says Singer, would still be on the side of the weak, poor, and oppressed, but it would have a better understanding of what social and economic changes would really work to benefit them. It would also work toward a higher moral status for nonhuman animals and a less anthropocentric view of our dominance over nature. (shrink)

Impartialism in ethics has been said to be the common ground shared by both Kantian and utilitarian approaches to ethics. Lawrence Blum describes this common ground as follows: Both views identify morality with a perspective of impartiality, impersonality, objectivity and universality. Both views imply the ‘ubiquity of impartiality” – that our commitments and projects derive their legitimacy only by reference to this impartial perspective.

In this volume, some of today's most distinguished philosophers survey the whole field of ethics, from its origins, through the great ethical traditions, to theories of how we ought to live, arguments about specific ethical issues, and the nature of ethics itself. The book can be read straight through from beginning to end; yet the inclusion of a multi-layered index, coupled with a descriptive outline of contents and bibliographies of relevant literature, means that the volume also serves as a work (...) of reference, both for those coming afresh to the study of ethics and for readers already familiar with the subject. (shrink)

In recent years a number of oppressed groups have campaigned vigorously for equality. The classic instance is the Black Liberation movement, which demands an end to the prejudice and discrimination that has made blacks second-class citizens. The immediate appeal of the black liberation movement and its initial, if limited, success made it a model for other oppressed groups to follow. We became familiar with liberation movements for Spanish-Americans, gay people, and a variety of other minorities. When a majority group—women—began their (...) campaign, some thought we had come to the end of the road. Discrimination on the basis of sex, it has been said, is the last universally accepted form of discrimination, practiced without secrecy or pretense even in those liberal circles that have long prided themselves on their freedom from prejudice against racial minorities. (shrink)

In the Brazilian film "Central Station," Dora is a retired schoolteacher who makes ends meet by sitting at the station writing letters for illiterate people. Suddenly she has an opportunity to pocket $1,000. All she has to do is persuade a homeless 9-year-old boy to follow her to an address she has been given. (She is told he will be adopted by wealthy foreigners.) She delivers the boy, gets the money, spends some of it on a television set and settles (...) down to enjoy her new acquisition. Her neighbor spoils the fun, however, by telling her that the boy was too old to be adopted —he will be killed and his organs sold for transplantation. Perhaps Dora knew this all along, but after her neighbor's plain speaking, she spends a troubled night. In the morning Dora resolves to take the boy back. (shrink)