Moral rights feature prominently and are relied on substantially in debates in bioethics. Conceptually, however, duties can perform the logical work of rights, but not vice versa, and reference to rights is therefore inessential. Normatively, rights, like duties, depend on more basic moral values or principles, and attempts to establish the logical priority of rights over duties or the reverse are misguided. In practical decision making, however, an analysis in terms of duties is more fruitful than one based on rights. (...) A right may function as a proxy term for a consequentialist rule, or for a deontological constraint, but does not thereby enrich these concepts. Rights may also help in a purely expressive sense and may assist an initial focusing on a moral conflict. However, their role in bioethics discourse is more one of convenience than of necessity. Moreover, unless rights are firmly founded on fundamental moral values, their use encourages rhetoric rather than argument. (shrink)

Outcome-adaptive randomization has been proposed as a corrective to certain ethical difficulties inherent in the traditional randomized clinical trial using fixed-ratio randomization. In particular, it has been suggested that OAR redresses the balance between individual and collective ethics in favour of the former. In this paper, I examine issues of welfare and autonomy arising in relation to OAR. A central issue in discussions of welfare in OAR is equipoise, and the moral status of OAR is crucially influenced by the way (...) in which this concept is construed. If OAR is based on a model of equipoise that demands strict indifference between competing interventions throughout the trial, such equipoise is disturbed by accruing data favouring one treatment over another; OAR seeks to redress this by weighting randomization to the seemingly superior treatment. However, this is a partial response, as patients continue to be allocated to the inferior therapy. Moreover, it rests upon considerations of aggregate harms and benefits, and does not therefore uphold individual ethics. Issues of fairness also arise, as early and late enrollees are randomized on a different basis. Fixed-ratio randomization represents a fuller and more consistent response to a loss of equipoise, as so construed. With regard to consent, the complexity of OAR poses challenges to adequate disclosure and comprehension. Additionally, OAR does not offer a remedy to the therapeutic misconception—participants’ tendency to attribute treatment allocation in an RCT to individual clinical judgments, rather than to scientific considerations—and, if anything, accentuates rather than alleviates this misconception. In relation to these issues, OAR fails to offer ethical advantages over fixed-ratio randomization. More broadly, the ethical basis of OAR can be seen to lie more in collective than in individual ethics, and overall it fares worse in this territory than fixed-ratio randomization. (shrink)

The text is extensively referenced, but practical in its approach, giving real life examples and cases based on therapeutic practice.

This paper explores the nature of rights, and their implications for the ethics of nursing. A right is seen as an entitlement which is justified on moral and/or legal grounds, and which may take the form of a right of action or a right of recipience, or both; in either case, correlative duties are generally imposed on others. Some of the conflicts which can occur among two or more conflicting rights are examined through three hypothetical scenarios, and approaches to their (...) resolution are suggested. The question of whether nurses, as nurses, possess rights is then considered, and it is suggested that they do not. In conclusion, it is argued that, if rights are to be a helpful concept, they must be carefully defined and analysed, and their relationship to one another, and to duties, must be clarified. Cet article étudie la nature des droits et leur implications pour l'éthique des soins infirmiers. Un droit reste sur des bases morales et légales et peut prendre la forme d'un droit d'action ou d'un droit de récipience ou des deux formes ensembles. En chaque instant, des devoirs corrélatifs sont normalement imposés à d'autres personnes. Quelques uns des conflits qui peuvent arriver entre deux (ou plusieurs) droits opposés sont considérés ici par trois possibilités hypothétiques et des possibilités de résoudre les problèmes sont proposées. Enfin, la question est considérée si les infirmiers/ères possèdent des droits en tels qu'infirmiers/ères, et il est proposé qu'ils/elles ne les possèdent pas. En conclusion, il est proposé que pour les droits d'être utiles, ils doivent être bien définis et analysés et les relations entre eux et envers les devoirs doivent être bien claires. Dieser Artikel erforscht des Wesen der Rechte und deren Auswirkungen in der Krankenpflegeethik. Ein Recht hat moralische oder legale Gründe und nimmt die Form entweder eines Rechtes der Aktion oder eines Rechtes des Empfanges, oder beider Arten. In allen Fällen sind entsprechende Pflichten anderen aufgelegt. Einige Konflikte, die unter zwei (oder mehreren) Rechten entstehen können, sind hier untersucht an Hilfe von drei hypothetischen Szenarien. Möglichkeiten für die Lösung der Probleme sind vorgeschlagen. Anschliessend wird die Frage, ob das Krankenpflegepersonal Rechte hat - als Personal - betrachtet, und es ist vorgeschlagen, dass solche Rechte nicht bestehen. Zum Abschluss wird vorgeschlagen dass Rechte hilfreich sind wenn sie sorgfältig analysiert und festgelegt sind und wenn deren Beziehung zu einander und zu Pflechten klar ist. (shrink)

This book is the outcome of a European Commission-funded project on resource allocation in health care. It is co-authored by a philosopher, an epidemiologist, a public health medicine specialist and a health economist. Its range is broad, covering the historical, economic, methodological and philosophical aspects of healthrelated quality of life and its measurement.