This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. (shrink)

In Beyond Humanity a leading philosopher offers a powerful and controversial exploration of urgent ethical issues concerning human enhancement.

This book articulates a systematic vision of an international legal system grounded in the commitment to justice for all persons. It provides a probing exploration of the moral issues involved in disputes about secession, ethno-national conflict, "the right of self-determination of peoples," human rights, and the legitimacy of the international legal system itself. Buchanan advances vigorous criticisms of the central dogmas of international relations and international law, arguing that the international legal system should make justice, not simply peace among states, (...) a primary goal, and rejecting the view that it is permissible for a state to conduct its foreign policies exclusively according to what is in the "national interest." He also shows that the only alternatives are not rigid adherence to existing international law or lawless chaos in which the world's one superpower pursues its own interests without constraints. This book not only criticizes the existing international legal order, but also offers morally defensible and practicable principles for reforming it. Justice, Legitimacy, and Self-Determination will find a broad readership in political science, international law, and political philosophy. (shrink)

This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The (...) book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science. (shrink)

Steven Pinker has said that one of the most important questions humans can ask of themselves is whether moral progress has occurred or is likely to occur. Buchanan and Powell here address that question, in order to provide the first naturalistic, empirically-informed and analytically sophisticated theory of moral progress--explaining the capacities in the human brain that allow for it, the role of the environment, and how contingent and fragile moral progress can be.

This book is the first in-depth attempt to provide a moral assessment of the heart of the modern human rights enterprise: the system of international legal human rights.

The authors articulate a global public standard for the normative legitimacy of global governance institutions. This standard can provide the basis for principled criticism of global governance institutions and guide reform efforts in circumstances in which people disagree deeply about the demands of global justice and the role that global governance institutions should play in meeting them.

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

In Better than Human, noted bioethicist Allen Buchanan grapples with the ethical dilemmas of the medical revolution and biomedical enhancements. One problem, he argues, is that the debate over these enhancements has divided into polar extremes--into denunciations of meddling in the natural order, or else a heady optimism that we can cure all that ails humanity. In fact, Buchanan notes, the human genome has always been unstable, and intervention is no offense against nature.

Appeals to the idea of human nature are frequent in the voluminous literature on the ethics of enhancing human beings through biotechnology. Two chief concerns about the impact of enhancements on human nature have been voiced. The first is that enhancement may alter or destroy human nature. The second is that if enhancement alters or destroys human nature, this will undercut our ability to ascertain the good because, for us, the good is determined by our nature. The first concern assumes (...) that altering or destroying human nature is in itself a bad thing. The second concern assumes that human nature provides a standard without which we cannot make coherent, defensible judgments about what is good. I will argue (1) that there is nothing wrong, per se, with altering or destroying human nature, because, on a plausible understanding of what human nature is, it contains bad as well as good characteristics and there is no reason to believe that eliminating some of the bad would so imperil the good as to make the elimination of the bad impermissible, and (2) that altering or destroying human nature need not result in the loss of our ability to make judgments about the good, because we possess a conception of the good by which we can and do evaluate human nature. I will argue that appeals to human nature tend to obscure rather than illuminate the debate over the ethics of enhancement and can be eliminated in favor of more cogent considerations. (shrink)

Preventive use of force may be defined as the initiation of military action in anticipation of harmful actions that are neither presently occurring nor imminent. This essay explores the permissibility of preventive war from a cosmopolitan normative perspective, one that recognizes the basic human rights of all persons, not just citizens of a particular country or countries. It argues that preventive war can only be justified if it is undertaken within an appropriate rule-governed, institutional framework that is designed to help (...) protect vulnerable countries against unjustified interventions while also avoiding unacceptable risks of the costs of inaction. The key to ensuring the fairness of rules governing the preventive use of force is accountability.This essay proposes a scheme that would make those promoting and those rejecting the preventive use of force more accountable. The proposal contains the following crucial features:States proposing preventive war are required to enter into a contract with a diverse body of states as a condition for authorization of their actions;Prior to taking preventive action, states must make an evidence-based case to the UN Security Council, and agree in advance to submit themselves to an evaluation by an impartial body after the preventive action occurred;Both proponents of action and those opposing it will be held accountable ex post for the accuracy of their prior statements and the proportionality of their actions;Sanctions will be imposed against intervening states or states that opposed preventive action, respectively, depending on the findings of the ex post evaluation.If preventive action were blocked in the Security Council, states seeking to engage in preventive action could then present their case in a different body–a coalition of democratic states–with its own ex post and ex ante accountability procedures. (shrink)

All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...) instance, companies should not be obligated to provide host countries with additional booster shots at the expense of fulfilling bilateral contracts with countries in which there are surges. Finally, any satisfactory approach should include mechanisms for assurance that all parties are honouring their obligations. This assurance enables countries, pharmaceutical companies, global organisations, and others to verify compliance with the chosen approach and protect ethically compliant stakeholders from being unfairly exploited by unethical behaviour of others. (shrink)

All theories of the right to secede either understand the right as a remedial right only or also recognize a primary right to secede. By a right in this context is meant a general, not a special, right (one generated through promising, contract, or some special relationship). Remedial Right Only Theories assert that a group has a general right to secede if and only if it has suffered certain injustices, for which secession is the appropriate remedy of last resort.1 Different (...) Remedial Right Only Theories identify different injustices as warranting the remedy of secession. (shrink)

Traditional conservative arguments against the possibility of moral progress relied on underevidenced assumptions about the limitations of human nature. Contemporary thinkers have attempted to fill this empirical gap in the conservative argument by appealing to evolutionary science. Such “evoconservative” arguments fail because they overstate the explanatory reach of evolutionary theory. We maintain that no adequate evolutionary explanation has been given for important features of human morality, namely cosmopolitan and other “inclusivist” moral commitments. We attribute these evolutionarily anomalous features to a (...) capacity for open-ended normativity, which presents a serious obstacle to theorists who wish to draw substantive moral and political lessons from human evolutionary history. (shrink)

This is a systematic evaluation of the main arguments for and against the market as an instrument of social organization, balancing efficiency and justice. It links the distinctive approaches of philosophy and economics to this evaluation.

Much of the debate about the ethics of enhancement has proceeded according to two framing assumptions. The first is that although enhancement carries large social risks, the chief benefits of enhancement are to those who are enhanced (or their parents, in the case of enhancing the traits of children). The second is that, because we now understand the wrongs of state-driven eugenics, enhancements, at least in liberal societies, will be personal goods, chosen or not chosen in a market for enhancement (...) services. This article argues that both framing assumptions must be rejected, once it is understood that some enhancements— especially those that are most likely to garner resources and become widespread— will increase human productivity. Once one appreciates the productivity-increasing potential of enhancements, one can begin to see that enhancement need not be primarily a zero sum affair, that the social costs of forgoing enhancements may be great, and that the state may well take an interest in facilitating biomedical enhancements, just as it does in facilitating education and other productivity-increasing traditional enhancements. Appreciating the productivity-increasing potential of enhancements also makes it possible to view the enhancement debate in a new light, through the lens of the ethics of development. (shrink)

The book uses evolutionary principles to explain tribalism, a way of thinking and acting that divides the world into Us versus Them and achieves cooperation within a group at the expense of erecting insuperable obstacles to cooperation among groups. Tribalism represents political controversies as supreme emergencies in which ordinary moral constraints do not apply and as zero-sum, winner take all contests. Tribalism not only undermines democracy by ruling out compromise, bargaining, and respect for the Other; it also reverses one of (...) the most important milestones of progress in how we understand morality: the insight that morality is not a list of commands to be unthinkingly followed, but rather that morality centrally involves the giving and taking of reasons among equals. Tribalism rejects this insight by branding the Other as a being who is incapable of reasoning. (shrink)

Early liberal theories about the feasibility of moral progress were premised on empirically ungrounded assumptions about human psychology and society. In this article, we develop a richer naturalistic account of the conditions under which one important form of moral progress–the emergence of more “inclusive” moralities–is likely to arise and be sustained. Drawing upon work in evolutionary psychology and social moral epistemology, we argue that “exclusivist” morality is the result of an adaptively plastic response that is sensitive to cues of out-group (...) threat that are detected during development. We conclude with a blueprint for reinforcing and extending inclusivist progress. (shrink)

This important study, the first book-length treatment of an increasingly crucial topic, treats the moral issues of secession at two levels. At the practical level, Professor Buchanan develops a coherent theory of the conditions under which secession is morally justifiable. He then applies it to historical and contemporary examples, including the U.S. Civil War and more recent events in Bangladesh, Katanga, and Biafra, the Baltic states, South Africa, and Quebec. This is the first systematic account of the conditions and terms (...) that justify secession from a political union.But Buchanan also locates this account of the right to secede in the broader context of contemporary political thought, introducing readers to influential accounts of political society such as contractarianism and communitarianism, and showing how the possibility of secession fits into a more complete understanding of political community and political obligation.At both levels this is an important book. It will interest not just political and social theorists but any reader concerned with one of the most momentous issues of our day: the future of troubled political federations and other states under conditions of ethnic and cultural pluralism. (shrink)

This volume collects Allen Buchanan's previously published articles with a focus on ethics and international law, specifically with regard to human rights, the legitimacy of international institutions, and the ethics of force across borders. The work fits together tightly in its systematic interconnections, and collectively it makes the case for a holistic and systematic approach to issues that are at the forefront of current discussions in political and legal philosophy- issues that have traditionally been seen as separate.

Many philosophers invoke the "wisdom of nature" in arguing for varying degrees of caution in the development and use of genetic enhancement technologies. Because they view natural selection as akin to a master engineer that creates functionally and morally optimal design, these authors tend to regard genetic intervention with suspicion. In Part II, we examine and ultimately reject the evolutionary assumptions that underlie the master engineer analogy (MEA). By highlighting the constraints on ordinary unassisted evolution, we show how intentional genetic (...) modification can overcome many of the natural impediments to the human good. Our contention is that genetic engineering offers a solution that is more eff icient, reliable, versatile, and morally palatable than the lumbering juggernaut of Darwinian evolution. In Part III, we evaluate a recent attempt to ground precautionary enhancement heuristics in adaptive etiology. Our problem with this approach is two-fold: first, it is based on the same "strong adaptationist" interpretation of evolution that motivates the flawed MEA, and second, the etiological concept of function on which it relies provides indirect and potentially misleading information about the likely consequences of genetic intervention. We offer instead enhancement criteria based on causal relationships in ontogeny. We conclude that rather than grounding a presumption against deliberate genetic modification, the causal structure of the living world gives us good moral reason to pursue it. (shrink)

The distinctive aim of applied ethics is to provide guidance as to how we ought to act, as individuals and as shapers of social policies. In this essay, I argue that applied ethics as currently practiced is inadequate and ought to be transformed to incorporate what I shall call social moral epistemology. This is a branch of social epistemology, the study of the social practices and institutions that promote the formation, preservation, and transmission of true beliefs. For example, social epistemologists (...) critically evaluate the comparative advantages of adversarial versus inquisitorial criminal proceedings as mechanisms for the discovery of truth. (shrink)

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of (...) the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge. (shrink)

Institutionalizing the Just War provides a new approach to theorizing the morality of war and argues that sound moral principles regarding war-making must take into account the fact that the validity of moral principles can depend upon existing institutions and social practices.

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public (...) health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

Ethical problems in business include not only genuine moral dilemmas and compliance problems but also problems arising from the distinctive characteristics of imperfect duties. Collective action by business to perfect imperfect duties can yield significant benefits. Sucharrrangements can (1) reduce temptations to moral laxity, (2) achieve greater efficiency by eliminating redundancies and gaps that plague uncoordinated individual efforts, (3) reap economies of scale and achieve success where benefits can be provided only if a certain threshold of resources can be brought (...) to bear on a social problem; (4) solve assurance problems where voluntary compliance by some parties depends upon their perception that competitors are doing their fair share, and (5) produce higher levels of contribution than would occur through independent action in response to imperfect duties, stimulated by the perception that there is a fair distribution of burdens of contribution among all parties involved. (shrink)

What limitations on intervention in support of democratic revolutions does proper regard for the collective right of self-determination impose? Some have held that if intervention in support of democratic revolutions is justified, it must cease once the authoritarian regime has been deposed—that any effort by the intervener to use force to shape the new political order would violate the people’s right of self-determination. This essay argues that proper regard for self-determination is compatible with much more extensive interventions.

In the months preceding the writing of this review, bioethics has been in the news a great deal. In congressional and public policy debates surrounding stem cell research, human cloning, and the Human Genome Project, bioethics and bioethicists have gained national attention and been subject to public scrutiny. Commentators have asked who these self-appointed moral experts are to tell us what is right and wrong.

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of (...) the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge. (shrink)