Despite clinical evidence of drug superiority, therapeutic modalities, like combination immunotherapy, are mostly considered cost-ineffective due to their high costs per life year(s) gained. This paper, taking an ethical stand, reevaluates the standard cost-effectiveness analysis with that of the more recent justice-enhanced methods and concludes by pointing out the shortcomings of the current methodologies.

The use of placebos in randomised controlled trials is a subject of considerable ethical debate. In this paper we present a set of considerations to evaluate the ethics of placebo controlled trials that includes: social value of the study; need for a randomised controlled trial and placebo; standards of care; risks of harm due to administration of placebo and the harm benefit balance; clinical equipoise; and double standards. We illustrate the application of these considerations using a case study of a (...) large ongoing multicentre, placebo-controlled, double-blinded, randomised trial to determine primaquine anti-relapse efficacy in vivax malaria. There is an urgent need for primaquine anti-relapse studies in order to rationalise the management of a potentially fatal disease. An ethical justification for the use of the placebo arm is provided on the grounds that the actual current applied standard of care in most endemic places does not include primaquine. It has also been argued that there is clinical equipoise among the primaquine study arms and that the risk of harms of being in the placebo arm is the risk of having relapse, which is no more than not being included in the trial, and that there are no double standards. Based on our set of considerations, we conclude that a placebo arm is not only justified but imperative in this study. We propose that similar considerations should be prospectively applied to other placebo controlled trials and observational control arms where no treatment is offered. (shrink)

The rest is commentary.--Faith and knowledge.--The dynamics of emancipation.

A sourcebook of post-biblical Jewish literature from the Second Commonwealth to modern times.

Elias wrote in both English and German, and in all his work runs to 14 books and around 90 other essays, along with poems and numerous interviews. The 18 volumes of the collected works contain many writings not previously published in English, and a small number never published before. All of the texts have thoroughly checked and revised, by editors who have a deep knowledge of Elia's thinking; they have inserted many clarifications, cross-references and explanatory notes.

This is a new release of the original 1949 edition.

In diesem Beitrag diskutieren drei interdisziplinär ausgebildete Akademiker, die als klinisch tätige Ethiker auch viele Jahre Erfahrungen mit Gesundheitssystemen in verschiedenen Ländern haben, die Frage nach dem Kern klinisch-ethischer Expertise: der niederländische Mediziner und Philosoph Henk ten Have, Direktor des Center for Healthcare Ethics in Pittsburgh, USA, der deutsche Theologe und Philosoph Norbert Steinkamp, Professor für theologisch-ethische Grundlagen sozialprofessionellen Handelns an der katholischen Hochschule für Sozialwesen in Berlin, der 12 Jahre die klinische Ethik der Universitätsklinik Nijmegen, Niederlande, geleitet hat, (...) sowie der niederländische Philosoph und Historiker Bert Gordijn, Direktor des Institute of Ethics der Dublin City University, Irland, Präsident der International Association of Education in Ethics und u. a. Herausgeber von Medicine, Health Care and Philosophy. (shrink)

As this book reveals, his vision was much more complex and interesting. He hoped that machines would release people from relentless and repetitive drudgery in order to achieve more creative pursuits.

The objective of this article is to analyse and compare four methods of ethical case deliberation. These include Clinical Pragmatism, The Nijmegen Method of ethical case deliberation, Hermeneutic dialogue, and Socratic dialogue. The origin of each method will be briefly sketched. Furthermore, the methods as well as the related protocols will be presented. Each method will then be evaluated against the background of those situations in which it is being used. The article aims to show that there is not one (...) ideal method of ethical case deliberation, which fits to all possible kinds of moral problems. Rather, as each of the methods highlights a limited number of morally relevant aspects, each method has its strengths and weaknesses as well. These strengths and weaknesses should be evaluated in relation to different types of situations, for instance moral problems in treatment decisions, moral uneasiness and residue, and the like. The suggestion arrived at on the basis of the findings of this paper is a reasonable methodological plurality. This means that a method can be chosen depending on the type of moral problem to be deliberated upon. At the same time it means, that by means of a method, deliberation should be facilitated. (shrink)

This paper explores the relevance of the debate about ethical expertise for the practice of clinical ethics. We present definitions, explain three theories of ethical expertise, and identify arguments that have been brought up to either support the concept of ethical expertise or call it into question. Finally, we discuss four theses: the debate is relevant for the practice of clinical ethics in that it (1) improves and specifies clinical ethicists' perception of their expertise; (2) contributes to improving the perception (...) of moral competence of non-ethicists; (3) gives insight into complementary styles of argumentation of ethicists and non-ethicists; and (4) contributes to the awareness of the problem of profession-building of (clinical) ethicists. (shrink)

What is Sociology? presents in concise and provocative form the major ideas of a seminal thinker whose work--spanning more than four decades--is only now gaining the recognition here it has long had in Germany and France. Unlike other post-war sociologists, Norbert Elias has always held the concept of historical development among his central concerns; his dynamic theories of the evolution of modern man have remedied the historical and epistemological shortcomings of structualism and ethno-methodology. What is Sociology? refines the arguments (...) that were first found in Elias' massive work on the civilizing process, in which he formulated his major assertions about the interdependence of the making of modern man and modern society. It is Elias' contention that changes in personality structure--embodied in phenomena ranging from table manners and hygiene habits to rites of punishment and courtly love--inevitably reflect and mould patterns of control generated by new political and social instututions. Elias' rejection of a dichotomy between individual and society, and his use of psychoanalysis, political theory, and social history, help restore a fullness of resource to sociology. (shrink)

In this article, the question is discussed if and how Healthcare Ethics Committees (HECs) should be regulated. The paper consists of two parts. First, authors from eight EC member countries describe the status quo in their respective countries, and give reasons as to the form of regulation they consider most adequate. In the second part, the country reports are analysed. It is suggested that regulation of HECs should be central and weak. Central regulation is argued to be apt to improve (...) HECs’ accountability, relevance and comparability. To facilitate biomedical citizenship and ethical reflection, regulation should at the same time be weak rather than strict. Independence of HECs to deliberate about ethical questions, and to give solicited and unsolicited advice, should be supported and only interfered with by way of exception. One exception is when circumstances become temporary adversarial to ethical deliberation in healthcare institutions. In view of European unification, steps should be taken to develop consistent policies for both Eastern and Western European countries. (shrink)

The moral psychologist Joshua Greene has proposed a number of arguments for the normative significance of empirical research and for the unreliability of deontological intuitions. For these arguments, much hinges on the combination of various components of Greene's research – namely the dual-process theory of moral judgement, ‘personalness’ as a factor in moral decision-making, and his functional understanding of deontology and consequentialism. Incorporating these components, I reconstruct three distinct arguments and show that the Personalness Argument for the claim that empirical (...) research can advance normative ethics and the Combined Argument against deontology are both sound and interesting in themselves. They do not, however, cast doubt on traditional deontology or reserve a specific role for neuroscience. The Indirect Route argument overcomes some of the other arguments’ limitations. It is, however, invalid. I conclude by pointing out the broader philosophical relevance of Greene's arguments as shedding light on second-order morality. (shrink)

Norbert Trenkle tackles fundamental questions posed by the critique of value. How does it differ from other Marxisms? What are the consequences of the critique of value for the category of labor and for the labor theory of value? What is its relationship to socialism as an economic project? What is the relationship between the value-form and capitalist crisis? Can the critique of capitalism still be undertaken from the standpoint of labor?

In this book, Norbert Wiley offers a new interpretation of the nature of the self in society.

Carey's book on conceptual change and the accompanying argument that children's biology initially is organized in terms of naïve psychology has sparked a great detail of research and debate. This body of research on children's biology has, however, been almost exclusively been based on urban, majority culture children in the US or in other industrialized nations. The development of folkbiological knowledge may depend on cultural and experiential background. If this is the case, then urban majority culture children may prove to (...) be the exception rather than the rule, because plants and animals do not play a significant role in their everyday life. Urban majority culture children, rural majority culture children, and rural Native American children were given a property projection task based on Carey's original paradigm. Each group produced a unique profile of development. Only urban children showed evidence for early anthropocentrism, suggesting that the co-mingling of psychology and biology may be a product of an impoverished experience with nature. In comparison to urban majority culture children even the youngest rural children generalized in terms of biological affinity. In addition, all ages of Native American children and the older rural majority culture children gave clear evidence of ecological reasoning. These results show that both culture and expertise play a role in the development of folkbiological thought. (shrink)

Over 90% of the organs transplanted in China before 2010 were procured from prisoners. Although Chinese officials announced in December 2014 that the country would completely cease using organs harvested from prisoners, no regulatory adjustments or changes in China’s organ donation laws followed. As a result, the use of prisoner organs remains legal in China if consent is obtained. We have collected and analysed available evidence on human rights violations in the organ procurement practice in China. We demonstrate that the (...) practice not only violates international ethics standards, it is also associated with a large scale neglect of fundamental human rights. This includes organ procurement without consent from prisoners or their families as well as procurement of organs from incompletely executed, still-living prisoners. The human rights critique of these practices will also address the specific situatedness of prisoners, often conditioned and traumatized by a cascade of human rights abuses in judicial structures. To end the unethical practice and the abuse associated with it, we suggest to inextricably bind the use of human organs procured in the Chinese transplant system to enacting Chinese legislation prohibiting the use of organs from executed prisoners and making explicit rules for law enforcement. Other than that, the international community must cease to abet the continuation of the present system by demanding an authoritative ban on the use of organs from executed Chinese prisoners. (shrink)

Many contemporary ethicists use case-based reasoning to reach consistent beliefs about ethical matters. The idea is that particular cases elicit moral intuitions, which provide defeasible reasons to believe in their content. However, most proponents of case-based moral reasoning are not very explicit about how they resolve inconsistencies and how they abstract principles from judgments about particular cases. The aim of this article is to outline a methodology—called Consistency Reasoning Casuistry—for case-based reasoning in ethics. This methodology draws on Richmond Campbell and (...) Victor Kumar’s naturalistic model for the resolution of inconsistencies between the content of intuitions about particular cases. I argue that reasons similar to those that motivate their model also support a more abstract form of moral reasoning that goes beyond mere resolutions of inconsistencies between case judgments and demands the formulation of more abstract moral norms. Consistency Reasoning Casuistry, it is argued, is a good candidate for a methodology for case-based moral reasoning that is in harmony with paradigms of contemporary moral psychology and that can accommodate the methodology implicit in the work of many contemporary ethicists. (shrink)

Reflective equilibrium has been criticized for various reasons ever since the publication of Rawls’ A Theory of Justice. Recent empirical research into moral decision-making poses new challenges to RE because it questions the reliability of moral intuitions. This research might discredit moral intuitionism in general and RE in particular insofar as it ascribes epistemic value to moral intuitions. These findings suggest, for instance, that moral intuitions vary with cultural background, gender or framing. If it could be shown that all or (...) certain kinds of moral intuitions are unreliable, this would diminish the plausibility of the claim that they provide good reasons to believe in the truth of their content, especially given the growing evidence that professional philosophers are just as biased and susceptible to distorting factors as lay people. In this paper I critically discuss three recent defenses of RE against this unreliable intuitions objection. Two of these defenses argue that the UIO misses its target, because RE does not depend on intuitions, or because the relevant considered judgments in RE are not intuitions. The third defense grants that RE depends on intuitions and that some Rawlsian considered judgments are intuitions. But it argues that the notion of considered judgments can be revised, and that wide reflective equilibrium has the means to adopt the criticism because it can use information about unreliable intuitions and exclude those from further consideration. I argue that the first two defenses do not succeed. The third defense is the most promising one. However, I argue that this defense also fails. In this defense, RE is not a distinctive moral epistemic theory: different versions of RE would be conceivable, all of which are deeply problematic. I conclude with a discussion of the broader philosophical implications of the UIO, specifically whether or not accepting the UIO would warrant skepticism regarding moral knowledge. (shrink)

This article challenges E.P. Thompson's definition of ‘moral economy’ as a traditional consensus of crowd rights that were swept away by market forces. Instead, it suggests that the concept has the potential of improving the understanding of modern civil society. Moral economy was a term invented in the eighteenth century to describe many things. Thompson's approach reflects only a minor part of this conceptual history. His understanding of moral economy is conditioned by a dichotomous view of history and by the (...) acceptance of a model according to which modern economy is not subject to moral concerns. It is on principle problematic to confine a term conjoining two concepts as general as ‘moral’ and ‘economy’ to a specific historical and social setting. Recent approaches that frame moral economy as an emotively defined order of morals are also misleading since they do not address economic issues in the way they are commonly understood. The most promising current approaches appear to be those that consider t.. (shrink)