In the relatively short time since 2006—when Theoretical Medicine and Bioethics published an issue on moral issues relevant to the use of nonhuman animals in research [1]—significant changes have occurred for nonhuman animals in many quarters. Public sentiment, new policy initiatives, and scientific studies of nonhuman animals’ capacities have all influenced the ways in which nonhuman animals are perceived and treated in research. Today, a large body of information is available for use in decision making about the acceptability of using (...) nonhuman animals in research. The articles in this issue assess how moral argument and empirical studies stand to guide animal research policies and practices in future years.Many in bioethics have come to regard issues of animal research as a subfield of research ethics, bringing it closer to human research ethics. Animal ethics, like public health ethics, has struggled for recognition in bioethics. As the contributions to this issue show, some in bioe. (shrink)

Abstract:Human and animal research both operate within established standards. In the United States, criticism of the human research environment and recorded abuses of human research subjects served as the impetus for the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and the resulting Belmont Report. The Belmont Report established key ethical principles to which human research should adhere: respect for autonomy, obligations to beneficence and justice, and special protections for vulnerable individuals and (...) populations. While current guidelines appropriately aim to protect the individual interests of human participants in research, no similar, comprehensive, and principled effort has addressed the use of (nonhuman) animals in research. Although published policies regarding animal research provide relevant regulatory guidance, the lack of a fundamental effort to explore the ethical issues and principles that should guide decisions about the potential use of animals in research has led to unclear and disparate policies. Here, we explore how the ethical principles outlined in the Belmont Report could be applied consistently to animals. We describe how concepts such as respect for autonomy and obligations to beneficence and justice could be applied to animals, as well as how animals are entitled to special protections as a result of their vulnerability. (shrink)

There is a long history of medical research that involves intentionally infecting healthy people in order to study diseases and their treatments. Such research—what might be called “human challenge studies”—are an important strand of much current research—for example, in the development of vaccinations. The many international and national guidelines about the proper conduct of medical research do not specifically address human challenge studies. In this paper we review the guidelines on the risk of harm that healthy volunteers may be exposed (...) to in the course of medical research. We examine the ethical arguments that are implicit or explicit in these guidelines. We then ask whether there is reason for limiting such studies on grounds independent of risk of harm. We conclude that the major ethical concern with challenge studies is that of risk of harm and that the fact that a study is a challenge study is not a wrong in itself. (shrink)

Issues in medical ethics are rarely out of the media and it is an area of ethics that has particular interest for the general public as well as the medical practitioner. This short and accessible introduction provides an invaluable tool with which to think about the ethical values that lie at the heart of medicine. Tony Hope deals with thorny moral questions, such as euthanasia and the morality of killing, and also explores political questions such as: how should health (...) care resources be distributed fairly? (shrink)

Important advances in biomedical and behavioral research ethics have occurred over the past few decades, many of them centered on identifying and eliminating significant harms to human subjects of research. Comprehensive attention has not been paid to the totality of harms experienced by animal subjects, although scientific and moral progress require explicit appraisal of these harms. Science is a public good and the prioritizing within, conduct of, generation of, and application of research must soundly address questions about which research is (...) morally defensible and valuable enough to support through funding, publication, tenure, and promotion. Likewise, educational pathways of re-imagined science are critical. (shrink)

New Zealand is a South Pacific nation with a history of British colonization since the 19th century. It has a population of over four million people and, like other indigenous societies such as in Australia and Canada, Māori are now a minority in their land, and their experience of colonization is that of being dominated by settlers to the detriment of their own systems of society.

Aristotle's Nicomachean Ethics is devoted to the topic of human happiness. Yet, although Aristotle's conception of happiness is central to his whole philosophical project, there is much controversy surrounding it. Hope May offers a new interpretation of Aristotle's account of happiness - one which incorporates Aristotle's views about the biological development of human beings. May argues that the relationship amongst the moral virtues, the intellectual virtues, and happiness, is best understood through the lens of developmentalism. On this view, happiness (...) emerges from the cultivation of a number of virtues that are developmentally related. May goes on to show how contemporary scholarship in psychology, ethical theory and legal philosophy signals a return to Aristotelian ethics. Specifically, May shows how a theory of motivation known as Self-Determination Theory and recent research on goal attainment have deep affinities to Aristotle's ethical theory. May argues that this recent work can ground a contemporary virtue theory that acknowledges the centrality of autonomy in a way that captures the fundamental tenets of Aristotle's ethics. (shrink)

Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the “rule of rescue” should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are rejected. (...) It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (shrink)

Both human research and animal research operate within established standards and procedures. Although the human research environment has been criticized for its sometimes inefficient and imperfect process, reported abuses of human subjects in research served as the impetus for the establishment of the Nuremberg Code, Declaration of Helsinki, and the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and the resulting Belmont Report. No similar, comprehensive and principled effort has addressed the use of animals in (...) research. Although published policies regarding animal research provide relevant regulatory guidance, these policies have not emerged from the process of specifying consistent and reasoned ethical principles. The lack of a fundamental effort to explore the ethical issues and principles regarding the use of animals in research has led to unclear and disparate policies. Recent studies have increased our understanding of animal cognition and emotion, suggesting that animals' potential for experiencing a wide variety of harms, such as pain and fear, is greater than has been previously appreciated. Furthermore, relationships between methods of captivity and certain laboratory procedures and the resulting adverse physical, social and psychological effects have been established. In light of this information, current protections may need to be reconsidered and modified. This paper explores the historical convergence and divergence in the creation of human and animal research guidelines, as well as opportunities to align ethical frameworks with new scientific discoveries. (shrink)

The “best interests” of the patient are widely seen as a cornerstone of medical practice. They are the explicit legal standard for medical care in the case of patients who lack capacity to consent to treatment.The best interests of the individual patient have, of course, long been compromised for the sake of other potential patients—in infectious disease control for example. The question of the ethics of such compromise became a hot issue, for UK doctors, about fifteen years ago in the (...) context of health care rationing. At that time the fact that there are insufficient resources to provide all patients, in all circumstances, with the best possible treatment became explicit. Faced with this uncomfortable truth, doctors tended to divide into two camps. Some wanted to play no role in decisions about resource allocation. They continued to be guided by the single ethic of each individual patient's best interests. However, “best interests” could be interpreted as “best” given the treatments that were made available by those who determined the allocation of resources. Others took the opposite approach: since choices had to be made as to the best use of available resources, doctors ought to be playing a significant role in making these choices.This polarisation has softened over time. Doctors have become more at ease with the idea that some treatments are not, given the overall resources, cost-effective, even if they are the best available. Clinical guidelines increasingly are influenced by cost-effectiveness. To provide the best health care overall, within the available resources, doctors aim to provide good care for each individual patient, but they do not always provide the best care. (shrink)

The Mental Capacity Act is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of Practice to (...) the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced with difficult decisions concerning best interests. This paper suggests ways in which the checklist can be developed and discusses cases that could be used in an updated Code of Practice. (shrink)

Kant’s ethics provides surprising resources for addressing duties with respect to climate change. First, I show how Kant’s moral metaphysics, according to which the self is a phenomenon, provides a distinctive ground to mitigate the harm of climate change for future generations. In short, the physical appearances of our actions are grounded in an atemporal existence from which our intrinsic moral value derives. As such, the a priori basis for addressing climate duties to the present is no different from that (...) of duties to address climate duties to the future, though we must consider present circumstances in order to act effectively. Second, I show that recent helpful contributions towards understanding the resources of Kantian ethics for addressing climate face the following prima facie dilemma: perfect duties to reduce emissions are overly demanding because it requires reduction below subsistence levels, while imperfect duties to reduce emissions are not demanding enough to address the climate crisis. Without ruling out the existence of perfect duties to address climate, I analyze the latter horn of the dilemma and show how imperfect duties can be more demanding than one might have thought, given that we are in a climate emergency. Recent work on the role of emergency in Kant’s ethics has shown that there are resources for making sense of the prioritization of some concerns as more pressing. Overall, the aim of this contribution is to highlight some of the prospects and problems that face Kantian approaches to climate ethics. (shrink)

Ethics, communication skills, and the law ('practice skills') are important in all aspects of modern health care. Doctors and nurses must be sensitive to the ethical aspects of their work and understand the legal framework within which clinical decisions are made. Well developed skills of communication, with patients, their relatives and other members of the clinical team, are a key feature of good clinical practice Until recently, the important of practice skills has been relatively neglected in health care education. This (...) situation is changing. The UK General Medical Council, for example, has recently identified three aspects as part of the core of the medical course, and the move to degree courses in nursing has led to an increasing focus of practice skills in nurse education. The Oxford Practice Skills Project (OPSP) team have developed a course, within the University of Oxford Clinical School, which covers the teaching of practice skills in an integrated manner. This course is widely recognized as one of the most systematic developments of education in these areas. This manual describes the OPSP course in detail and provides teaching materials. Although developed initially for medical students, it should be helpful to all those involved in teaching ethics, communication skills, and law in health care. Each Seminar is described in detail Tutors' guides are provided Student handouts are included Contains guidelines for introducing 'practice skills' into a busy clinical curriculum Includes over forty case histories for teaching and examination Gives details of many useful sources and resources Details a variety of teaching methods together with their advantages and disadvantages Provides an ethics teaching toolkit for clinical teachers new to this area Readers are welcome to photocopy any part of this manual for their own teaching. (shrink)

Aristotle's chief ethical work, the Nicomachean Ethics , has given rise to a number of lively scholarly debates. Chief among them, is the debate about Aristotle's conception of the human good or eudaimonia. Aristotle defines eudaimonia as activity of the soul in accordance with virtue . But several different kinds of psychic virtues are all discussed in the NE, viz., ethical virtue and sophia. Unfortunately, it is unclear whether Aristotle identifies eudaimonia with the combination of ethical virtue and sophia, or (...) whether he believes that eudaimonia consists in the activity of sophia alone. Inclusivists endorse the former alternative, whereas intellectualists endorse the latter. ;Aristotle's "function argument" ---the argument which leads Aristotle to conclude that eudaimonia is "activity of the soul in accordance with virtue"---has become the locus of the dispute between intellectualists and inclusivists. The present work focuses on this dispute. I argue that both intellectualist and inclusivist interpretations of Aristotle's conception of eudaimonia , are flawed. For both accounts ignore Aristotle's views about the biological development of human beings. As I will show, Aristotle's views about human development play a crucial role in the function argument. Once this fact is appreciated, we are able to see that ethical virtue is a developmental prerequisite for sophia, and hence that sophia cannot be actualized without ethical virtue. This conclusion challenges those intellectualists who claim that in some cases, ethical virtue and sophia can come into conflict with one another.1 These intellectualists conclude from this that eudaimonia consists in contemplative activity alone, and that ethical virtue is merely instrumentally valuable. On this view, ethical virtue is valuable only to the extent that it helps one to be a better contemplator. I reject this view and argue that ethical virtue is necessary for the development of sophia. Thus, eudaimonia is activity in accordance with ethical virtue and sophia, but these virtues are hierarchically related since ethical virtue is a developmental prerequisite of sophia. This is the primary conclusion of this work. ;1See Cooper , Kraut. (shrink)

Although the concept of food sovereignty is rooted in International Peasant Movements across the global south, activists have recently called for the adoption of this framework among low-income communities of color in the urban United States. This paper investigates on-the-ground processes through which food sovereignty articulates with the work of food justice and community food security activists in Oakland, California, and Seattle, Washington. In Oakland, we analyze a farmers market that seeks to connect black farmers to low-income consumers. In Seattle, (...) we attend to the experiences of displaced immigrant farmers from Latin America and their efforts to address their food needs following migration. In both cases, we find that US based projects were constrained by broader forces of neoliberalism that remained unrecognized by local activists. In Oakland, despite a desire to create a local food system led by marginalized African Americans, emphasis on providing green jobs in agriculture led activists to take a market-based approach that kept local food out of the economic grasp of food-insecure neighborhood residents. In Seattle, the marginalization of the immense agroecological knowledge of Latino/an immigrant farmers rendered local food projects less inclusive and capable of transformative change. Taken together, these very different cases suggest that a shift towards food sovereignty necessitates a broad acknowledgement of and resistance to neoliberalism. (shrink)

ABSTRACT When is it right to enforce medical treatment on a patient who is refusing that treatment? English law recognises two ethical principles as of paramount importance: the autonomy of the patient; and the consequences of not treating compared with treating. The law, by and large, operates these principles in succession. Thus, in the case of a patient refusing treatment, the law asks first, is the patient competent? Only if the answer is no, are the consequences considered. We criticise the (...) position taken by English law and argue, first, that competence is a graded and not a binary concept, and secondly, that the two ethical principles should be applied not sequentially but at the same time. These two ideas form what we have called the balance model. This model could be used for an empirical study of individuals’ ethical beliefs, and in particular to test the hypothesis that the ethical beliefs of most individuals conform to the balance model rather than to the position taken by English law. (shrink)

We describe the teaching programme in ethics, law and communication skills for clinical medical students which is being developed as part of the Oxford Practice Skills Project. These three elements of practice are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centred health care in guiding the teaching is described. Although the final aim of the teaching is to improve actual practice, we have found three 'sub-aims' helpful in (...) the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge. (shrink)

Some of the most important achievements in the field of empiricist ethics were made by the School of Moral Sentiment, comprising Francis Hutcheson, David Hume, and Adam Smith. This book throws new light on their consensus theory of virtue. Hope works some of their ideas into a merit theory of rights applicable to conventional rights, defends ethical cognitivism, and analyzes pleasure.

Decisions on which new health technologies to provide are controversial because of the scarcity of healthcare resources, the competing demands of payers, providers and patients and the uncertainty of the evidence base. Given this, additional information about new health technologies is often considered valuable. One response is to make access to a new health technology conditional on further research. Access can be restricted to patients who participate in a research study, such as a randomised controlled trial; alternatively, a new treatment (...) can be made generally available, but only on condition that further evidence is collected (eg, on long-term outcomes and adverse events, in patient registries). The National Institute for Health and Clinical Excellence (NICE), which provides guidance on which new health technologies to make available under the UK's NHS, for example, has made some research conditional recommendations, and the current interest in such options suggests that they are likely to become more prevalent in the future. This paper identifies and discusses the main ethical issues created by this distinctive range of recommendations. We argue that decisions to put research conditions on access to new technologies are compatible with widely accepted values, principles and practices relevant to resource allocation. However, there are important features of these distinctive judgements that must be taken into account by resource allocation decision-making bodies and research ethics committees, and that require new sorts of empirical data. (shrink)

Alternative proteins, including plant-based and cell-based meat and dairy analogues, are discursively positioned as a new form of meat and dairy and as a solution to the myriad of issues associated with conventional animal agriculture. Animal agricultural industries across various nations have resisted this positioning in regulatory spaces by advocating for laws that restrict the use of meat and dairy terms on the labels of alternative proteins products. Underlying this contestation are differing understandings of, and vested interests in, desirable futures (...) for animal agriculture. In Australia, this broader contestation led to a national-level inquiry by a Senate parliamentary committee entitled _Definitions of meat and other animal products_ (the Inquiry). This paper reports findings from a study of the problematizations developed through the Inquiry using a framework for policy discourse analysis referred to as Bacchi’s ‘What’s the Problem Represented to be’ methodology. It shows how the dominant discourse throughout the Inquiry moved away from the initial problematization of alternative proteins as a threat to animal agriculture. Instead, both industries were ultimately positioned as not in competition and only labelling laws were problematized with the solution being amendments to ensure ‘consumer clarity’. This outcome ignored a range of alternative problematizations related to the ethical, environmental, health, social and economic issues raised by animal agriculture and by alternative proteins. This lack of scrutiny benefits both industries, by closing off the policy discourse to consideration of a range of alternative interests, voices, and potential solutions, such as stricter health and welfare regulation. (shrink)

There are some ideas that at first seem simple, but which become more complex and profound the more they are explored. Great art, of course, is like that. When I first saw Vermeer's Girl with a Pearl Earring I was excited by its fresh simplicity. I thought, however, it a painting I would soon understand. I was wrong. It becomes increasingly mysterious with increasing familiarity. It has recently inspired a novel.1The distinction between acts and omissions is one of these simple, (...) complex, ideas. When I first studied philosophy I thought I would rapidly be able to decide once and for all whether the distinction is of moral importance or not. I did in fact come to a decision. The problem is that I have kept revising that decision ever since. The issues raised by the arguments over acts and omissions continue to inspire philosophical discussion. They also continue to haunt doctors and relatives at the bedsides of those near the end of their lives.Donna Dickenson, in this issue of the journal,2 reports the results of a survey of opinions from those taking part in an Open University course on death and dying. She believes that for many bioethicists the acts/omissions distinction has been shown to be wrong as a distinction of moral worth. Her survey suggests, however, that for many health professionals this distinction is seen as morally important. She asks whether the bioethical consensus, as she sees it, against the distinction is a result of clear thinking, or whether the views of practitioners result from their taking into account, in a way bioethicists do not, the richness of reality.There is I believe, less consensus amongst bioethicists than Dickenson suggests. In this issue of the journal, Marc Stauch3 argues in favour of the acts/omissions …. (shrink)

Entscheidungen der Therapiebegrenzung und in der Betreuung am Lebensende sind häufig komplex und von ethischen Problemen begleitet. Im Mittelpunkt der Untersuchung steht die entscheidende Frage, wie hilfreich existierende „Ethik-Richtlinien“, die eine ethische Orientierung bei solchen Entscheidungen geben sollen, in der klinischen Praxis tatsächlich sind. Die Frage, welchen Nutzen „Ethik-Richtlinien“ bei der Entscheidungsfindung haben oder haben können, wird hier exemplarisch an einem klinischen Fallbeispiel aus einer Ethik-Kooperationsstudie in der Intensivmedizin analysiert. Vergleichend werden hierzu „Ethik-Richtlinien“ aus Deutschland, der Schweiz und aus Großbritannien (...) herangezogen, die Gegenstand eines internationalen Projekts zur Analyse von Richtlinien waren. Die Möglichkeiten und Grenzen einer ethischen Orientierung an „Ethik-Richtlinien“ bei Entscheidungsproblemen der Therapiebegrenzung und in der Betreuung am Lebensende werden anhand der Fallstudie diskutiert und illustriert. Abschließend werden Schlussfolgerungen für die Entwicklung ethischer Richtlinien für die klinische Praxis formuliert. (shrink)

On December 15, 2011, a final report was issued by the Committee on the Use of Chimpanzees in Biomedical and Behavioral Research, which had been convened by the U. S. Institute of Medicine (IOM) in collaboration with National Research Council (NRC) of the National Academies. Within a month of its release, this report was designated by Wired Science one of the “top scientific discoveries of 2011” (Wired Science Staff 2011). The ad hoc Committee responsible for this report was formed at (...) the request of the National Institutes of Health (NIH) in response to congressional inquiry that had been prompted by expressions of public concern.1 The issues addressed in the report are profoundly ethical, despite NIH’s .. (shrink)

In this paper I assess the possibility of advancing a modern conception of social justice under neo-Aristotelian lights, focussing primarily on conceptions that assert a fundamental connection between social justice and eudaimonia. After some preliminary remarks on the extent to which a neo-Aristotelian account must stay close to Aristotle’s own, I focus on Martha Nussbaum’s sophisticated neo-Aristotelian approach, which I argue implausibly overworks the aspects of Aristotle’s thought it appeals to. I then outline the shape of a deeper and more (...) general, and as yet unanswered, problem facing neo-Aristotelian accounts: how to justify the claim that the point of a just society is to assist or enable its members to flourish. (shrink)

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate (...) these distinctions back to differing accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

Intensive care units are not always able to admit all patients who would benefit from intensive care. Pressure on ICU beds is likely to be particularly high during times of epidemics such as might arise in the case of swine influenza. In making choices as to which patients to admit, the key US guidelines state that significant priority should be given to the interests of patients who are already in the ICU over the interests of patients who would benefit from (...) intensive care but who have not been admitted. We examine four reasons that in principle might justify such a prioritization rule and conclude that none is convincing. We argue that the current location of patients should not, in principle, affect their priority for intensive care. We show, however, that under some but not all circumstances, maximizing lives saved by intensive care might require continuing to treat in the ICU a patient already admitted rather than transferring that patient out of the unit in order to admit a sicker patient who would also benefit more from intensive care. We conclude that further modelling is required in order to clarify what practical policies would maximize lives saved by intensive care. (shrink)

Alternative food movements work to create more environmentally and economically sustainable food systems, but vary widely in their advocacy for social, racial and environmental justice. However, even those food justice activists explicitly dedicated to equity must respond to the unintended consequences of their work. This paper analyzes the work of activists in Oakland, CA, who have increasingly realized that their gardens, health food stores and farm-to-table restaurants play a role in what scholars have called green gentrification, the upscaling of neighborhoods (...) through the creation of environmental amenities. Gentrification has had grave consequences for the low-income communities of color that food justice activists seek to serve. Activists are reflexive about this dynamic, and have developed strategies to push back against displacement. Most commonly, non-profit organizations and individual social entrepreneurs found businesses that seek to raise the profile of people of color in the trendy Oakland food scene while employing long-term residents in well-paying, green jobs. However, while these efforts are an essential component of a broader agenda to create both food justice and development without displacement, even these relatively high paying “good food jobs” cannot keep up with escalating rents. For this reason, we also highlight the direct action and policy-oriented strategies engaged by a smaller number of food justice activists, and argue that these are necessary compliments to a market-based approach. (shrink)

It is commonly claimed, in the global justice literature, that global injustices are best characterised in terms of the violation or unfulfilment of human rights. I suggest that global justice theorists are overconfident on this point. For decolonising peoples, contemporary global injustice is likely to be characterised in terms drawn from local histories of injustice and the constellations of thick ethical concepts they contain. To make the point I describe how the Māori of New Zealand, who do not reject human (...) rights, typically make no reference to human rights in political argument. I argue that the Māori are reasonable to consider human rights talk to be ‘one thought too many’, and the considerations that make this so typically apply in other postcolonial contexts of political activity. (shrink)

Most studies into the performance of socially responsible investment vehicles have focused on the performance of sustainable or socially responsible mutual funds. This research has been complemented recently by a number of studies that have examined the performance of sustainable investment indices. In both cases, the majority of studies have concluded that the returns of socially responsible investment vehicles have either underperformed, or failed to outperform, comparable market indices. Although the impact of sustainable indices to date has been limited, the (...) recent launch of sustainable indices by Dow Jones and FTSE suggests that more attention is being paid to the subject by financial markets, investors, and companies. This development raises a number of important issues which are reviewed in this article: (a) the performance of indices compared with their benchmark indices; (b) the methodologies employed in compiling the indices; and (c) the impact of the indices on companies and the investment community. The article concludes with a number of suggestions for areas that merit future research. (shrink)

To reduce the spread of the human immunodeficiency virus (HIV), Granich et al. 1 ( 2009 ) have proposed a new strategy for universal voluntary HIV testing immediately followed by antiretroviral therapy. Although this proposal is likely to benefit the partners of those affected and thus promote public health, it is by no means clear that it benefits the infected people themselves and indeed it may be harmful. Since the proposal involves an intervention that is not clinically indicated, it falls (...) foul of the normal ethical standards of clinical medicine, which is to act in the best interests of patients. Neither is it a measure that would be imposed under the protection of public health law on people who are seen as representing such danger to others that significant restrictions in liberty are appropriate. Thus, the proposal represents a third category of public health measure. We argue that a coherent ethical framework including a robust process is appropriate to proposals of this kind and that medical research offers a useful model since some research, like this proposal, is motivated not by the interests of the individual participants but by the common good. We outline some possible elements of such an ethical framework. (shrink)