Abstract: Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the “unethical” experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical research.
The Limits of Confidentiality
Introduction: Doctors, lawyers, and priests have traditionally recog nized the duty of professional secrecy regarding what individuals confide to them: personal matters such as alcoholism or depression, marital difficulties, corporate or political problems, and indeed most concerns that patients or clients want to share with someone, yet keep from all others.’ Accountants, bankers, social workers, and growing numbers of professionals now invoke a similar duty to guard confidences. As codes of ethics take form in old and new professions, the duty of confidentiality serves in part to reinforce their claim to professional status, and in part to strengthen their capacity to offer help to clients.
Mental disorder and the value(s) of ‘autonomy’
Summary (from Introduction of Autonomy and Mental Disorder, Radoilska ed.): In ‘Mental disorder and the value(s) of autonomy’, Jane Heal identifies and critically examines a form of thought which is implicit in discussions about what we, as a society, owe to people with mental disorder. This form of thought builds upon intuitions which link respect for a person with respect for a person’s autonomy. In light of these intuitions, the issue of how to treat a person with mental disorder may seem to revolve around the question whether or not this person has the capacity for autonomy. However, Heal argues, inquiries that share this logical form are methodologically inappropriate and potentially unhelpful in answering either of the questions they put together: what we owe to people with mental disorder and what is involved in autonomy as a capacity. The reason for this is twofold.
Firstly, the apparent consensus about autonomy as a capacity for self-determination that ought to be protected from interference by a corresponding right to self-determination is too shallow to ground a coherent course of action in terms of respect for autonomy. Even if we work with the assumption that autonomy is part of the Enlightenment project, we face an important dilemma since we have to choose between a Kantian or rationality oriented and a Millian or well-being oriented take on the nature and significance of autonomy. Secondly, even if we were to reach a substantive consensus on the concept of autonomy, it would arguably require an intricate array of mental capacities, outside the reach of at least some people with mental disorder. Getting clearer on what autonomy is will not help us find out what it means to treat these people respectfully.
When Caring Is Just and Justice is Caring: Justice and Mental Retardation
Summary: In this paper, Kittay advances a conception of justice that ‘begins with an acknowledgement of dependency and seeks to organise society so that our well-being is not inversely related to our need for care or to care’ (576). Her motivation for advancing this view is that ideals of citizenship in liberal society, including independence and productivity, perpetuate the victimisation, social exclusion, or stigmatisation of people with mental retardation and their carers. This is because liberal definitions of personhood do not provide resources for responding in a morally adequate way to the mutual dependence of people with mental retardation and their carers/advocates. People with mental retardation are inescapably dependent because of their central need for attentive care. And, carers’ work is so deeply other-directed that they also do not fit the liberal model of the rationally self-interested actor. Thus, both carers and their charges are vulnerable and need to be advocated for so that they can be seen as having important entitlements to public resources and claims to justice. To this end, Kittay proposes a conception of personhood that is based on relationships. Although those with mental retardation are inherently dependent, they still count as persons because they are able to participate in relationships. This makes them entitled to the satisfactions that make life worth living. To achieve the twin goal of achieving justice for familial or paid carers, Kittay advances a new principle of justice, doulia, which calls for larger society to support those who care for the inexorably dependent. Kittay takes her relational conception of personhood and her principle of doulia to ensure that appropriate forms of social organization exist to support all those who become dependent. She claims her view is needed because principles of charity and beneficence are not adequate since they are consistent with the continued stigmatization of mental retardation and care work, and ground only low-priority social obligations.
Autonomy and Trust in Bioethics
Publisher’s Note: Onora O’Neill suggests that the conceptions of individual autonomy (so widely relied on in bioethics) are philosophically and ethically inadequate; they undermine rather than support relationships based on trust. Her arguments are illustrated by issues raised by such practices as the use of genetic information by the police, research using human tissues, new reproductive technologies, and media practices for reporting on science, medicine, and technology. The study appeals to a wide range of readers in ethics, bioethics, and related disciplines.
Breastfeeding and defeasible duties to benefit
Abstract: For many women experiencing motherhood for the first time, the message they receive is clear: mothers who do not breastfeed ought to have good reasons not to; bottle feeding by choice is a failure of maternal duty. We argue that this pressure to breastfeed arises in part from two misconceptions about maternal duty: confusion about the scope of the duty to benefit and conflation between moral reasons and duties. While mothers have a general duty to benefit, we argue that this does not imply a duty to carry out any particular beneficent act. Therefore, the expectation that mothers should breastfeed unless they have sufficient countervailing reasons not to is morally unwarranted. Recognising the difference between reasons and duties can allow us to discuss the benefits of breastfeeding and the importance of supporting mothers who wish to breastfeed without subjecting mothers who bottle feed to guilt, blame and failure.
Empty Ethics: The Problem with Informed Consent
Abstract: Informed consent is increasingly heralded as an ethical panacea, a tool to counter autocratic and paternalistic medical practices. Debate about the implementation of informed consent is constricted and polarised, centring on the right of individuals to be fully informed and to freely choose versus an autocratic, paternalistic practice that negates individual choice. A bioethical framework, based on a principle-led form of reductive/deductive reasoning, dominates the current model of informed consent. Such a model tends to abstract the process of consent from its clinical and social setting. By fleshing out the social process involved when patients and healthy volunteer subjects consent to take part in clinical drug trials, this paper attempts to address the problem arising from the current ’empty ethics’ model. My arguments are substantiated by qualitative interview data drawn from a study I conducted on the process of consent as experienced by participants in clinical drug trials.
Medical and Scientific Uses of Human Tissue
Abstract: Inevitably a policy-oriented report on issues as complex and as rapidly changing as the medical and scientific uses of human tissue can achieve neither philosophical purity nor regulatory completeness. The council’s strategy has been to begin with robust ethical principles, for which sound philosophical arguments can be given, which will (it is hoped) command widespread support. The council went on to argue for guidelines of sufficient, but not vapid, generality which could be of practical use to the various medical intermediaries, professional and regulatory bodies and research ethics committees which will carry out the tasks of detailed regulation and of making decisions that affect uses of human tissue. The council’s hope is that the recommendations of the report can be absorbed into regulatory and professional practice, and where needed into government policy. If they can, the increasing diversity of uses of human tissues need lead neither to overt nor to covert ‘commercialisation of the human body’, but will also not put unnecessary restrictions on advances in research and medical practice.
Justification for Conscience Exemptions in Health Care
Abstract: Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed.
The Logical Case for “Wrongful Life”
Summary: In this article, Steinbock solves the logical problem with torts based on wrongful life. She argues that a wrongful life suit need not show that it would have been better for the infant to have never been born, but merely that the infant is impaired to such a degree that the infant has no capacity for fulfilling even very basic human interests. She claims that this criteria is capable of serving as the basis for a tort claim concerning the recovery of extraordinary medical care and specialized training.