There is nearly universal agreement that coercion is an evil. Even when it is necessary to avoid a greater evil or to attain some good, it is still a necessary evil. There is also nearly universal agreement that, other things being equal, one ought not to exercise coercion. Here the agreement ends. There is little agreement about just when coercion is justified. More surprisingly, there is little agreement about what coercion is. This latter controversy is more fundamental, and this paper (...) is an attempt to shed some light on it. (shrink)

Although physician‐assisted death can be a great benefit both to those who are terminally ill and those who are not, the risks for patients in these two categories are quite different. For now it is reasonable to make the benefit available only for those near death, and to await better evidence about the risks before making it more broadly available.

It is tempting to argue that Kantian moral philosophy justifies prohibiting both human germ-line genetic engineering and non-therapeutic genetic engineering because they fail to respect human dignity. There are, however, good reasons for resisting this temptation. In fact, Kant’s moral philosophy provides reasons that support genetic engineering—even germ-line and non-therapeutic. This is true of Kant’s imperfect duties to seek one’s own perfection and the happiness of others. It is also true of the categorical imperative. Kant’s moral philosophy does, however, provide (...) limits to justifiable genetic engineering. (shrink)

The human right to health is crucial in the fight against global poverty. Health and an adequate standard of living are intimately connected. Poor health can make it difficult to overcome poverty, and poverty can make it difficult to attain good health. For the human right to health to be effective, however, it must have sufficient content to do the important normative work of rights. In the first part of this paper I give plausible arguments against the very existence of (...) a human right to health based on its lack of content and extend this to other social rights such as the right to adequate income, housing and education. In the second part of the paper I provide a defense of human social rights, including the human right to health, by arguing that these human rights, though abstract, have enough content to function as rights. (shrink)

The debate over whether germ-line genetic engineering is justified on the basis of the consent or presumed consent of future generations is mired in philosophical confusion. Because of this, the principle of informed consent fails to provide a reason to restrict germ-line genetic engineering. Most recent bioethicists ground the consent requirement on individual autonomy. While conceptually coherent, the notion of individual autonomy also fails to provide a reason for prohibiting germ-line genetic engineering. Moreover, it offers little in the way of (...) useful guidance for regulating genetic engineering. I argue, however, that respect for autonomy in the sense of moral agency – the ability to reflect on moral considerations and conform one’s behavior to those reflections – provides a principle that can be used for a nuanced evaluation of proposals for genetic engineering. (shrink)

One of the most potent arguments against physician‐assisted death hinges on the worry that people with disabilities will be subtly coerced to accept death prematurely. The argument is flawed. There is nothing new in PAD: the risk of coercion is already present in current policies about end of life care. And to hold that any such risk is too much is tacitly to endorse vitalism and to deny that people with disabilities are capable of choosing authentically.

: The Centers for Disease Control and Prevention (CDC) has recommended that HIV testing be routinely offered to certain patients in hospitals with a high prevalence of HIV infection and on all pregnant women. The CDC does not, however, offer implementation level guidelines for obtaining informed consent. We provide a moral justification for requiring informed consent for HIV testing and propose guidelines for securing such consent. In particular we argue that genuine informed consent can be secured without elaborate counseling, such (...) as that currently used at Counseling and Testing Sites, provided that sufficient written notice is given to the patients before testing and that they are specifically asked for permission. (shrink)

We assume that a statute permitting physician assisted death has been passed. We note that the rationale for the passage of such a statute would be respect for individual autonomy, the avoidance of suffering and the possibility of death with dignity. We deal with two moral issues that will arise once such a law is passed. First, we argue that the rationale for passing an assistance in dying law in the first place provides a justification for assisting patients to die (...) who are motivated by altruistic reasons as well as patients who are motivated by reasons of self-interest. Second, we argue that the reasons for passing a physician assisted death law in the first place justify extending the law to cover some nonterminal patients as well as terminal patients. (shrink)

Many people believe that it is permissible for people who are suffering from terminal illnesses to commit suicide or even that such people have a right to commit suicide. Some have also argued that it follows that it is permissible for them, or that they have a right, to use the assistance of another person. First, I assume that it is permissible for a person to commit suicide and ask whether it follows that it is also permissible for the person (...) to employ an agent to assist in the death. Second, I assume that people have a right to commit suicide and ask whether it follows that the right holders have a right to employ an agent to assist with the death. I argue that the permissibility of suicide does not by itself entail the permissibility of employing someone to assist in the suicide. I also argue that the right to commit suicide does not by itself entail the right to assisted death. Instead, what follows is that there is a right not to have unreasonable restrictions placed on the means by which one can exercise one's right to commit suicide. Whether a restriction is reasonable depends on the conclusion reached when one has weighed a number of policy considerations. (shrink)

The human right to health is crucial in the fight against global poverty. Health and an adequate standard of living are intimately connected. Poor health can make it difficult to overcome poverty, and poverty can make it difficult to attain good health. For the human right to health to be effective, however, it must have sufficient content to do the important normative work of rights. In the first part of this paper I give plausible arguments against the very existence of (...) a human right to health based on its lack of content and extend this to other social rights such as the right to adequate income, housing and education. In the second part of the paper I provide a defense of human social rights, including the human right to health, by arguing that these human rights, though abstract, have enough content to function as rights. (shrink)

It is often claimed that managed care organizations involve physicians in conflicts of interest by creating financial incentives for physicians to refrain from ordering treatments or making referrals. Such incentives, the argument goes, force the physician to balance the patient's health interests against the MCO's interests and the physician's own financial interest. I assume, for the sake of argument, that such arrangements at least provide reason to believe that physicians in MCOs are involved in conflicts of interest. Two approaches have (...) evolved for dealing with these conflicts. On one approach, MCOs disclose the financial arrangements under which their physicians work so that patients can consent to the managed care plan and thereby to the plan's limitations. The chief proponent of this approach is Mark Hall, whose recent book Making Medical Spending Decisions applies prior consent to a variety of decisions regarding medical financing and allocation. The other approach is simply to forbid conflicts of interest through regulations. (shrink)

It is often claimed that managed care organizations involve physicians in conflicts of interest by creating financial incentives for physicians to refrain from ordering treatments or making referrals. Such incentives, the argument goes, force the physician to balance the patient's health interests against the MCO's interests and the physician's own financial interest. I assume, for the sake of argument, that such arrangements at least provide reason to believe that physicians in MCOs are involved in conflicts of interest. Two approaches have (...) evolved for dealing with these conflicts. On one approach, MCOs disclose the financial arrangements under which their physicians work so that patients can consent to the managed care plan and thereby to the plan's limitations. The chief proponent of this approach is Mark Hall, whose recent book Making Medical Spending Decisions applies prior consent to a variety of decisions regarding medical financing and allocation. The other approach is simply to forbid conflicts of interest through regulations. (shrink)

Genetic engineering for purposes of human enhancement poses risks that justify regulation. I argue, however, that it is inappropriate to use human rights treaties to prohibit germ-line genetic engineering whether therapeutic or for purposes of enhancement. The scope and weight of human rights make them poor tools for regulating a rapidly developing technology such as genetic engineering. On the other hand, international treaties are appropriate regulatory tools as long as prohibitions are not put in terms of human rights.

Democratic civility is a core civic virtue of persons engaged in democratic deliberation. It is a complex trait that includes tolerance of diverse political views, openness regarding civic matters to reasons offered by others, willingness to seek compromise in an effort to find workable political solutions, and willingness to limit one’s individual interests for the public good when there are adequate reasons for doing so. Various writers have noted a tension between rights and civility. Insofar as rights trump general considerations (...) of community welfare and entail claims that can be demanded, an emphasis on individual rights and standing on one’s rights can undermine the sort of civility required for political compromise. Similarly an emphasis on civility might require not standing on rights when doing so is at the expense of the welfare of the community. Notwithstanding this tension, I argue that human rights and democratic civility have a symbiotic relationship. In particular, I argue that democratic civility is important for determining the scope of human rights as they are implemented in institutional structures, and that human rights have an important role to play in shaping the virtue of democratic civility. (shrink)

Democratic civility is a core civic virtue of persons engaged in democratic deliberation. It is a complex trait that includes tolerance of diverse political views, openness regarding civic matters to reasons offered by others, willingness to seek compromise in an effort to find workable political solutions, and willingness to limit one’s individual interests for the public good when there are adequate reasons for doing so. Various writers have noted a tension between rights and civility. Insofar as rights trump general considerations (...) of community welfare and entail claims that can be demanded, an emphasis on individual rights and standing on one’s rights can undermine the sort of civility required for political compromise. Similarly an emphasis on civility might require not standing on rights when doing so is at the expense of the welfare of the community. Notwithstanding this tension, I argue that human rights and democratic civility have a symbiotic relationship. In particular, I argue that democratic civility is important for determining the scope of human rights as they are implemented in institutional structures, and that human rights have an important role to play in shaping the virtue of democratic civility. (shrink)

In the past decade several international declarations have called for banning reproductive non-therapeutic and germ-line engineering. Article 11 of UNESCO’s Universal Declaration on the Human Genome and Human Rights states that practices that are contrary to human dignity such as cloning of human beings should not be permitted. Article 12 of the same declaration restricts genetic applications to the relief from suffering and the improvement of health. The European Council has also taken a strong stand on germ-line genetic engineering in (...) general and cloning in particular. Article 13 of the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine simply forbidsgerm-line engineering except for diagnostic or therapeutic purposes. The convention along with its explanatory report make it clear that the rationale for the decision is based, in large part, on the need to protect the dignity of persons.Several notions of dignity have been advanced to support bans on non-therapeutic germ-line engineering. I argue that they fail to provide a rationale for such a ban. I consider both secular and religious views of human dignity. In addition, I argue that there are forms of germ-line and non-therapeutic engineering that are compatible with human rights. (shrink)

In the past decade several international declarations have called for banning reproductive non-therapeutic and germ-line engineering. Article 11 of UNESCO’s Universal Declaration on the Human Genome and Human Rights states that practices that are contrary to human dignity such as cloning of human beings should not be permitted. Article 12 of the same declaration restricts genetic applications to the relief from suffering and the improvement of health. The European Council has also taken a strong stand on germ-line genetic engineering in (...) general and cloning in particular. Article 13 of the Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine simply forbidsgerm-line engineering except for diagnostic or therapeutic purposes. The convention along with its explanatory report make it clear that the rationale for the decision is based, in large part, on the need to protect the dignity of persons.Several notions of dignity have been advanced to support bans on non-therapeutic germ-line engineering. I argue that they fail to provide a rationale for such a ban. I consider both secular and religious views of human dignity. In addition, I argue that there are forms of germ-line and non-therapeutic engineering that are compatible with human rights. (shrink)

Human rights are high priority norms that empower right holders to demand the benefits protected by their rights. This is no less true of socioeconomic human rights than civil and political human rights. I argue that realizing human socioeconomic rights requires that they be enacted into state law in such a way that individual right holders have the power to bring legal action in defense of their rights. Contrary to Thomas Pogge, it is not enough for states simply to provide (...) the benefits required by human rights. Unfortunately, limited resources mean that successful litigation by right holders threatens to disempower other right holders by distorting a fair distribution of limited resources, since those with the resources to litigate can command a disproportionate and unjust share of limited resources. Using the human right to health as an example, I argue that an important part of the solution requires specifying different aspects of the content of the right to health and adopting appropriately strong standards of judicial review. (shrink)

Many bioethicists are involved in political advocacy groups as well as scholarship, and this has led to controversy. The virtues that enable scholarship to flourish are in tension with those that are vital for effective participation in political advocacy groups. This produces conflicts for bioethicists that are as serious as financial conflicts of interest. These conflicts cannot simply be eliminated, however. Scholars are citizens who have reason to engage in political action in light of their scholarly conclusions, and bioethicists who (...) are political advocates are thoughtful persons who have reason to engage in scholarship. At best, the conflicts can be mitigated. (shrink)

We argue that after the passage of a physician assisted death law some inequities in the health care system which prevent people from getting the medical care they need will become reasons for choosing assisted death. This raises the issue of whether there is compelling moral reason to change those inequities after the passage of an assisted death law. We argue that the passage of an assisted death law will not create additional moral reasons for eliminating inequities simply because they (...) become motives for someone to opt for assisted death. We also argue that it is not feasible to eliminate these reasons for opting for assisted death by granting a right to health care because of an intractable scarcity of medical resources. (shrink)