The modern history of experimentation with human beings is notable for its ethical lacunae. In 1865, in his great work, An Introduction to the Study of Experimental Medicine, Dr. Claude Bernard, the French physician who first established the use of the scientific method in medicine, echoed the earlier injunctions of physician-moralist Moses Maimonides in counseling his fellow physicians not to treat their patients solely as a means of advancing knowledge. Yet such cautions had no apparent effect on the physicians who, (...) at the end of the 19th century, studied the transmission of venereal diseases by intentionally infecting poor and institutionalized people without their knowledge, much less their consent. In response... (shrink)

Henry Knowles Beecher, an icon of human research ethics, and Timothy Francis Leary, a guru of the counterculture, are bound together in history by the synthetic hallucinogen lysergic acid diethylamide. Beecher was a U.S. Army Lieutenant Colonel who received five battle stars, was inducted into the Legion of Merit, held the first endowed chair in his discipline, wrote at least three path-breaking papers, and is honored by two prestigious ethics awards in his name. Leary was a (...) West Point dropout who was obliged to leave a research assistant professorship, was convicted of violating the Marihuana Tax Act, was sentenced to 20 years in prison and broke out with the... (shrink)

Five decades ago, Henry Knowles Beecher, a renowned professor of research anesthesiology, sought to solve a problem created by modern medicine. The solution proposed by Beecher and his colleagues on the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proved very influential.1 Indeed, other contemporaneous medical developments magnified its significance yet also made the solution it offered somewhat problematic. As we mark this fiftieth anniversary, at a time when concerns (...) about the conceptual model on which its recommendations rested are being voiced by critics from medicine as well as philosophy, it is worthwhile to view the committee's report in relation to the problem that prompted its existence as well as the one to which it was quickly applied. (shrink)

Prompted by a 2019 essay by Jonathan Moreno in the Hastings Center Report, the Center's board of directors undertook a careful examination of the name of its preeiminent award, the Henry Knowles Beecher Award, which has been given to twenty‐nine individuals who have made lifetime contributions to bioethics. citing new research that revealed that Beecher's earlier experimentation on drugs had involved nonconsenting adults, Moreno urged the Center to reevaluate honoring Beecher through this award. After reviewing (...) the relevant published evidence and holding extensive discussions, the board decided to rename the award. We also took the opportunity to reframe the award to emphasize quality of scholarship and impact on thinking, practice, and policy rather than lifetime achievement. The new name—the Founders’ Award of The Hastings Center—reflects our desire to honor not only the Center's cofounders, Daniel Callahan and Willard Gaylin, but also others who helped found the field of bioethics. With great pride, the Center has announced that Patricia King of the Georgetown University Law Center is the 2021 recipient of the Founders’ Award. A distinguished civil rights lawyer, King was instrumental in ensuring justice as one of the three principles of The Belmont Report. (shrink)

Fifty years ago, Henry Knowles Beecher published his essay on clinical research ethics in the New England Journal of Medicine. The culmination of more than a decade and a half’s rumination and reflection on the use of patients and “captive populations” in research, Beecher’s 1966 article understandably casts a large shadow in American bioethics. In 1976, the Institute of Society, Ethics and the Life Sciences established the Henry Knowles Beecher Award for Contributions to (...) Ethics and the Life Sciences and named the Harvard professor as the first recipient of the Award. “It is unusual for a researcher,” Daniel Callahan explained, on behalf of the Board of Directors of the... (shrink)

Henry K. Beecher’s famous 1966 article on ethically problematic medical research was a pivot point. It came at the end of two decades of soul-searching among researchers and philosophers. It ushered in an era of legislation and regulation to address the complex issues that had been extensively discussed by Beecher and others. That soul-searching began with the Nuremberg trials and the disturbing recognition of how far the Nazi doctors had strayed from professional ethical norms. It led, eventually, (...) to the creation of the system of oversight that we have today.During these years, there were heated arguments about what sort of research ought or ought not to be permitted and with what sort of oversight. Often... (shrink)

The doctrine of informed consent, borrowed from the law of torts, cannot be readily transplanted into therapeutic settings. The broader, as yet unrealized, idea of informed consent, which suggests that parties must make decisions jointly, should guide interactions between physicians and patients or investigators and subjects.

Henry Beecher was a distinguished professor of anesthesia and clinical investigator at Harvard Medical School. He became an iconic figure in bioethics, best known for his 1966 article describing 22 examples of unethical clinical research. This is one of the most frequently cited articles on ethics in the medical literature. Indeed, it may be seen as marking a watershed in the moral climate of medical research. In his history of bioethics, Albert Jonsen characterized Beecher as one of (...) the “stars in the bioethical firmament”. Daniel Callahan, founder of the Hastings Center, explained Beecher’s impact in a 1991 interview:“I think the role of Henry Beecher was very important in the mid 60s when he blew the... (shrink)

When I arrived at Harvard as an incoming graduate student in the fall of 1964, I soon received a telephone call from a gentleman who introduced himself as Henry Beecher. I was in the process of shifting my graduate studies from research neuropharmacology to the study of ethics. Robert Featherstone, the head of the Department of Pharmacology at the University of California Medical Center, San Francisco, where I had been studying, was a specialist in anesthesiology and knew (...) class='Hi'>Henry Beecher, who was also working in anesthesiology, well. He had contacted Beecher, alerting him to the fact that a new graduate student was arriving and that it appeared that the two of us had much in common. The phone call from Beecher... (shrink)

In 1962, Harvard professor of anesthesiology Henry Beecher wrote to Senator Estes Kefauver about certain additions to the federal Food and Drug Act then being considered. According to The Antibiotic Era, the Maryland congressman Samuel Friedel had introduced language that would require informed consent in clinical research. Beecher joined a number of other distinguished medical scientists warning that such a requirement would “cripple” American medical research. A year before, Beecher had protested the U.S. Army's inclusion of (...) the Nuremberg Code in its contracts. Beecher's commitment to a medical ethics of virtue rather than one of oversight suggests that he was a far more interesting person than the cardboard cutout so often vaguely referenced in bioethics as an icon of the rights of human subjects. His thinking about research ethics was rooted in his post‐World War II laboratory work with LSD. (shrink)

To be both a clinician and a scientist—what is usually called a clinician scientist or clinical investigator—is easy neither from an ethical nor from a methodological standpoint. On the one hand, it requires care, cure of the patients, and good ethical practice. On the other, excellent skills in experimental design and data analysis are necessary. In addition, the correct choice of a disease as a model to be studied is very often hampered by the obvious ethical constraints of working with (...) human beings, thus limiting the experimental armamentarium in the hands of the clinician scientist. Yet, Henry Beecher succeeded in both. He was an excellent clinician and scientist and put forward ideas and concepts that today... (shrink)

The article presents and analyzes different approaches of U.S. bioethicists in comprehending the Nazi medical crimes after 1945. The account is divided into two sections: one dealing with discussions on research ethics and the Nuremberg Code up until the 1970s and the other ranging from the 1970s to the present and highlighting bioethics' engagement with Nazi analogies. The portrayal of different bioethical scholars, institutions, and documents—most notably Henry K. Beecher, Jay Katz, the Belmont Report, the Hastings Center, Arthur (...) L. Caplan, and Robert M. Veatch—provides a nuanced interpretation of the motives that bioethicists held and the strategies that they applied to establish an understanding of the Nazi medical crimes and their relation to contemporary bioethical issues. In this, the different approaches shared a common goal: To integrate the Nazi medical crimes into an ethical framework by means of selective acknowledgments and representation of their history. (shrink)

The pain-assessment literature often claims that pain is subjective. However, the meaning and implications of this claim are left to the reader’s imagination. This paper attempts to make sense of the claim and its problems from the history and philosophy of science perspective. It examines the work of Henry Beecher, the first person to operationalize “pain” in terms of subjective measurements. First, I reconstruct Beecher’s operationalization of “pain.” Next, I argue this operationalization fails. Third, I salvage (...) class='Hi'>Beecher’s insights by repositioning them in an intersubjective account. Finally, I connect these insights to current pain-assessment approaches, showing that they enrich each other. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

On June 16, 1966, the New England Journal of Medicine published “Ethics and Clinical Research” by Henry K. Beecher. Beecher’s account of 22 examples of unethical contemporary clinical research shook up the medical profession and helped pave the way for U.S. federal regulation of research involving human subjects. Five decades later, in this issue of Perspectives in Biology and Medicine, we pay tribute to the lasting significance of this whistle-blowing article and to the remarkable contributions of (...) class='Hi'>Henry Beecher. Beecher was a pioneer in anesthesiology as an academic discipline and in research on pain and the placebo effect. He was an early and influential champion of randomized placebo-controlled... (shrink)

Dr. Henry Beecher, a renowned Harvard Medical School anesthesiologist, sent shock waves through the medical research community and the lay press when he described 22 examples of “unethical or questionably ethical studies” by reputable researchers at major institutions in his now well-known 1966 New England Journal of Medicine article. Beecher concluded this exposé by noting: “The ethical approach to experimentation in man has several components: two are more important than the others, the first being informed consent.... Secondly, (...) there is the more reliable safeguard provided by the presence of an intelligent, informed, conscientious, compassionate, responsible investigator”. Beecher’s... (shrink)

This book constitutes one of the most important contributions to recent Kant scholarship. In it, one of the pre-eminent interpreters of Kant, Henry Allison, offers a comprehensive, systematic, and philosophically astute account of all aspects of Kant's views on aesthetics. The first part of the book analyses Kant's conception of reflective judgment and its connections with both empirical knowledge and judgments of taste. The second and third parts treat two questions that Allison insists must be kept distinct: the normativity (...) of pure judgments of taste, and the moral and systematic significance of taste. The fourth part considers two important topics often neglected in the study of Kant's aesthetics: his conceptions of fine art, and the sublime. (shrink)

Henry Allison is one of the foremost interpreters of the philosophy of Kant. This new volume collects all his recent essays on Kant's theoretical and practical philosophy. All the essays postdate Allison's two major books on Kant, and together they constitute an attempt to respond to critics and to clarify, develop and apply some of the central theses of those books. Two are published here for the first time. Special features of the collection are: a detailed defence of the (...) author's interpretation of transcendental idealism; a consideration of the Transcendental Deduction and some other recent interpretations thereof; further elaborations of the tensions between various aspects of Kant's conception of freedom and of the complex role of this conception within Kant's moral philosophy. (shrink)

Henry E. Allison presents a comprehensive commentary on Kant's Groundwork for the Metaphysics of Morals. Allison pays special attention to the structure of the work and its historical and intellectual context. He argues that, despite its relative brevity, the Groundwork is the single most important work in modern moral philosophy.

At its inception, “brain death” was proposed not as a coherent concept but as a useful one. The 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death gave no reason that “irreversible coma” should be death itself, but simply asserted that the time had come for it to be declared so. Subsequent writings by chairman Henry Beecher made clear that, to him at least, death was essentially a social construct, and society (...) could define it however it pleased. The first widely endorsed attempt at a philosophical justification appeared thirteen years later, with a report from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and a seminal paper by James Bernat, Charles Culver, and Bernard Gert, which introduced the insightful tripartite scheme of concept, criterion, and tests for death. Their paper proposed that the correct concept of death is the “permanent cessation of functioning of the organism as a whole,” which tenuously remains the mainstream concept to this day. In this essay, I focus on this mainstream concept, arguing that equating brain death with death involves several levels of incoherence: between concept and criterion, between criterion and tests, between tests and concept, and between all of these and actual brain death praxis. (shrink)

The routine practice of clinical research involving patient-subjects without informed consent prior to 1966 unquestionably was unethical. Does it follow that all clinical research involving competent adult patient-subjects is unethical without informed consent?In his landmark 1966 paper, Henry Beecher noted that of the 50 example studies he had originally compiled in preparation for that paper, only two even mentioned consent, and he observed further that mention of consent is “meaningless unless one knows how fully the patient was informed”. (...) Some of the studies in Beecher’s paper, such as one comparing sulfadiazine with no treatment to assess the complications of streptococcal pharyngitis (when the... (shrink)

This volume presents seventeen essays by one of the world's leading scholars on Kant. Henry E. Allison explores the nature of transcendental idealism, freedom of the will, and the concept of the purposiveness of nature. He places Kant's views in their historical context and explores their contemporary relevance to present day philosophers.

Until recently, the medical community assumed that placebos required either concealment in randomized controlled trials or deception in clinical practice to elicit placebo effects. Henry Beecher emphasized this orthodoxy, when he stated that placebo pills only work "as long as it is not detected as a placebo by the subject or the observer" and therefore, patients "believe it [is a drug] and consequently the expected results occurs". The time was ripe for such ideas: Norman Vincent Peale's The Power (...) of Positive Thinking was already in its fourth year on the bestseller list when Beecher published his landmark paper. As time went on, the use of placebo pills became trapped in an... (shrink)

Henry E. Allison presents a comprehensive commentary on Kant's Groundwork for the Metaphysics of Morals . Allison pays special attention to the structure of the work and its historical and intellectual context. He argues that, despite its relative brevity, the Groundwork is the single most important work in modern moral philosophy.

Do children have a theory of mind? If they do, at what age is it acquired? What is the content of the theory, and how does it differ from that of adults? The Child's Theory of Mind integrates the diverse strands of this rapidly expanding field of study. It charts children's knowledge about a fundamental topic - the mind - and characterizes that developing knowledge as a coherent commonsense theory, strongly advancing the understanding of everyday theories as well as the (...) commonsense theory of mind. Wellman presents evidence that children as young as age three do possess a commonsense theory of mind - that they grasp the distinction between mental constructs and physical entities and that they have an understanding of the relationship between individuals' mental states and their overt actions. He delves in detail into questions about the nature of adults' commonsense theories of mind and about the nature of commonsense theories. Wellman then examines the content of the three-year-old's theory of mind, the nature of children's notions of mind before age three, the changes in the theory during subsequent development from ages three to six, and the young child's conception of mind in comparison with those of older children and adults. Henry M. Wellman is a Professor in the Department of Psychology and the Center for Human Growth and Development at the University of Michigan at Ann Arbor. (shrink)

When The Ad Hoc Committee of Harvard Medical School to Examine the Definition of Brain Death began meeting in 1967, I was a graduate student, with committee member Ralph Potter and committee chair Henry Beecher as my mentors. The question of when to stop life support on a severely compromised patient was not clearly differentiated from the question of when someone was dead. A serious clinical problem arose when physicians realized that a patient's condition was hopeless but life (...) support perpetuated body function. Thus, the committee stated that its first purpose was to deal with the burdens on patients and families as well as on hospitals and on patients needing hospital beds occupied by comatose patients. They intuited the strategy of “defining” these patients as dead, thus legitimating treatment stoppage. They noted that this would also serve a second purpose. Although the dead donor rule had not yet been clearly articulated, they claimed that defining patients as dead would also address controversy over obtaining organs for transplant.My mentors’ discussions related to my interest in the intersection between questions primarily of medical fact (When has a human brain irreversibly ceased functioning?) and nonmedical questions of social policy (Should we treat individuals with dead brains and beating hearts as dead humans?). It quickly became clear that most committee members did not appreciate the interplay of these questions. (shrink)

Mitigation—preventative actions to reduce the human forcing of climate change with the goal of keeping climate change within a range to which humans can adapt—must be prompt, rigorous, and focused on eliminating emissions of carbon dioxide, beginning with rapid cessation of the use of coal. Carbon dioxide is by far the most threatening greenhouse gas because it remains in the atmosphere for millennia longer than any other major greenhouse gas, and the heat retained on the planet by atmospheric carbon dioxide (...) will continue to emerge from its transitional storage in the deep oceans for millennia after the atmospheric carbon finally dissipates. Sustainable development can be increased and ocean acidification can be stopped only if the dominant fossil fuel regime is promptly replaced by an affordable and accessible alternative energy regime. Poorer countries cannot be reasonably expected to cooperate with vigorous mitigation unless they are assisted with necessary adaptation. (shrink)

Although a good deal has been written about Kant's conception of free will in recent years, there has been no serious attempt to examine in detail the development of his views on the topic. This book endeavours to remedy the situation by tracing Kant's thoughts on free will from his earliest discussions of it in the 1750s through to his last accounts in the 1790s. This developmental approach is of interest for at least two reasons. First, it shows that the (...) path that led Kant to view freedom as a transcendental power that is both radically distinct from and compatible with the causality of nature was a winding one. Second, it indicates that, despite the variety of views of free will that Kant held at various times, the concept occupied a central place in his thought, because it was the point of union between his theoretical and practical philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Research Ethics after World War II: The Insular Culture of BiomedicineAllan M. Brandt (bio) and Lara Freidenfelds (bio)Human subjects research in the United States has only recently emerged as an important area of historical investigation. Over the last quarter century, scholars have begun the process of grounding within an historical context both the complex relationship between researchers and subjects and the processes by which biomedical knowledge is produced. Their (...) studies examine topics ranging from the impact of the anti-vivisectionist movement on human experimentation in the early twentieth century (Lederer 1995) to the development of the discipline of bioethics in the 1960s and 1970s (Rothman 1991) and the emergence of the legal concept of informed consent for human research (Katz, Glass, and Capron 1972). Many of the discussions focus on isolated incidents of scandal, such as the Tuskegee Syphilis Study (Jones 1993; Brandt 1978) and the Willowbrook School hepatitis study (Rothman and Rothman 1984). In doing so, they attempt to explain how such clearly unethical research could have been initiated and what consequences have resulted from public knowledge of such research.Nonetheless, the broader historical contexts and implications of human subjects research have yet to be fully delineated. This project will be of crucial importance, not only for historians, but also for those concerned with research policy and medical ethics. The historical examination of human subjects research will provide further insight into the details of research methods, the construction of protocols, and the historically specific interest in certain diseases. In addition, scholars will better understand the relationships of power and authority between researcher and subject, as well as the social and scientific mechanisms for the production of new biomedical knowledge. The process of enlisting research subjects illuminates the significance of class, gender, ethnicity, and race in science, in biomedicine, and in society. The fact that, historically, much research has employed research subjects from vulnerable populations, who participated in coercive contexts, has exposed powerful social assumptions embedded in the research enterprise. [End Page 239]The revelation of new documents indicating past abuses has sparked much of the investigation into human subjects research and the recent investigation of human radiation experiments during the Cold War era. One of the most important achievements of the Advisory Committee on Human Radiation Experiments was the uncovering of thousands of documents, a remarkable mine of archival data, that had been previously inaccessible to researchers. Jonathan Moreno and Susan Lederer’s article on the history of Cold War research ethics in this issue of the Kennedy Institute ofEthics Journal represents the first attempt since the publication of the Committee’s Final Report to analyze the Committee’s findings in a serious historical context.Historical accounts of the emergence of bioethics traditionally have left a great void in their discussions of human experimentation, generally ignoring the period between the writing of the Nuremberg Code in 1947 and the publication of Henry Beecher’s 1966 New England Journal ofMedicine article condemning systematic, unethical practices in human experimentation (Rothman 1991). The period from 1946 to 1966, however, was a time of vigorous research characterized by a fragmented community of medical researchers who applied inconsistent ethical standards and employed highly variable research practices. Both military and civilian medical researchers were intensely interested in radiation and thus conducted human subjects research along those lines, including examinations of the effects of plutonium injections and of total body irradiation, the use of trace radioisotopes to study various body processes, and observations of the effects of radiation intentionally released into the environment. The U.S. Government sponsored several thousand such studies (ACHRE 1995 [GPO, pp. 227–31; Oxford, pp. 135–38]), some of which were conducted on hospital patients, institutionalized children, military personnel, and prisoners. The Cold War scientific culture that produced this research must be examined from an historical ethical perspective.A central aspect of the culture of biomedical science after World War II was its insularity. Increasingly high standards of admission and challenging training had come to ensure that only a select group of individuals was admitted to the professions of medicine and research science. In this culture of experts, trustworthiness and ethical judgment were considered to be dependent upon expertise... (shrink)

Some of our most fundamental moral rules are violated by the practices of torture and war. If one examines the concrete forms these practices take, can the exceptions to the rules necessary to either torture or war be justified? Fighting Hurt brings together key essays by Henry Shue on the issue of torture, and relatedly, the moral challenges surrounding the initiation and conduct of war, and features a new introduction outlining the argument of the essays, putting them into context, (...) and describing how and in what ways his position has modified over time. The first six chapters marshal arguments that have been refined over 35 years for the conclusion that torture can never be justified in any actual circumstances whatsoever. The practice of torture has nothing significant in common with the ticking bomb scenario often used in its defence, and weak U.S. statutes have loop-holes for psychological torture of the kind now favoured by CIA in the 'war against terrorism'. The other sixteen chapters maintain that for as long as wars are in fact fought, it is morally urgent to limit specific destructive practices that cannot be prohibited. Two possible exceptions to the UN Charter's prohibition on all but defensive wars, humanitarian military intervention and preventive war to eliminate WMD, are evaluated; and one possible exception to the principle of discrimination, Michael Walzer's 'supreme emergency', is sharply criticized. Two other fundamental issues about the rules for the conduct of war receive extensive controversial treatment. The first is the rules to limit the bombing of dual-use infrastructure, with a focus on alternative interpretations of the principle of proportionality that limits 'collateral damage'. The second is the moral status of the laws of war as embodied in International Humanitarian Law. It is argued that the current philosophical critique of IHL by Jeff McMahan focused on individual moral liability to attack is an intellectual dead-end and that the morally best rules are international laws that are the same for all fighters.Examining real cases, including U.S. bombing of Iraq in 1991, the Clinton Administration decision not to intervene in the 1994 Rwandan genocide, NATO bombing of Serbia in 1999, and CIA torture after 9/11 and its alternatives, this book is highly accessible to general readers who are interested in the ethical status of American political life, especially foreign policy. (shrink)

Many think that properties are powers. However, whilst some claim that properties are pure powers, others claim that properties are powerful qualities. In this paper, I argue that the canonical formulation of the powerful qualities view is no different from the pure powers view. Contrary to appearances, the two positions accept the same view of properties. Thus, the debate between them rests on an illusion. I draw out some consequences of this surprising result for issues over property individuation. Along the (...) way, I argue that all existing objections to the powerful qualities view fail. (shrink)

Hastings Center Report, Volume 52, Issue 5, Page 32-42, September–October 2022.