David DeGrazia

In the traditional fix-it model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patient's future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patient's preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.

This best-selling anthology of readings with case studies provides insightful and comprehensive treatment of ethical issues in medicine. Appropriate for courses taught in philosophy departments, bioethics programs, as well as schools of medicine and nursing, the collection covers such provocative topics as biomedical enhancement, clinical trials in developing countries, animal research, physician-assisted suicide, and health care reform. The text's effective pedagogical features include chapter introductions, argument sketches, explanations of medical terms, headnotes, and annotated bibliographies.

_ Source: _Page Count 21 Guns occupy a major—sometimes terrible—place in contemporary American life. Do Americans have not only a legal right, but also a moral right, to own handguns? After introducing the topic, this paper examines what a moral right to private handgun ownership would amount to. It then elucidates the logical structure of the strongest argument in favor of such a right, an argument that appeals to physical security, before assessing its cogency and identifying two questionable assumptions. In light of persisting reasonable disagreement about the argument’s soundness, the paper identifies two gun control measures—demonstrated need for a gun as a condition of eligibility and the requirement to pass a rigorous gun safety course—that reasonable disputants on both sides of the issue have principled reasons to accept. The paper also advances the thesis that, if anyone has an undefeated moral right to own handguns, it is precisely those individuals who have a special need and demonstrate the relevant safety-related competence

Many critics of American gun culture and policy argue that the public health benefits of stricter regulations compensate for the associated loss of freedom: a bit less freedom is an acceptable cost for the expected gains in public safety. By contrast, gun advocates sometimes claim that freedom to own guns underlies all other important freedoms and therefore deserves priority over considerations of public health. In this volume, philosopher Firmin DeBrabander takes a distinct critical approach, denying any significant loss of freedom associated with gun control. Widespread gun ownership in the context of lax regulation makes Americans—and anyone else similarly situated—less free. In developing his...

As one of the most important ethicists to emerge since the Second World War, Alan Gewirth continues to influence philosophical debates concerning morality. In this ground-breaking book, Gewirth's neo-Kantianism, and the communitarian problems discussed, form a dialogue on the foundation of moral theory. Themes of agent-centered constraints, the formal structure of theories, and the relationship between freedom and duty are examined along with such new perspectives as feminism, the Stoics, and Sartre. Gewirth offers a picture of the philosopher's theory and its applications, providing a richer, more complete critical assessement than any which has occurred to date

From the late 1970s through the mid-1980s, a number of philosophers carefully worked out theories of justice in health care. Most of those still working on these issues have turned to clinical applications of the philosophical frameworks developed earlier. Although theories have not received much recent attention in this debate, this paper will offer a new theoretical framework for approaching issues of justice in health care. There are two reasons for thinking that returning to theory would be worth- while. One concerns the fact that our society remains very far from realizing justice in health care. While there are several well-argued theories of just health care whose implementation would take us into the neighborhood of justice, it would also seem - in pluralistic spirit - that adding to the arsenal is helpful. The more good arguments there are for a given conclusion, the more likely it is to be correct and, ultimately, to persuade. It will be contended that a limited right to health care can be grounded in self-respect. The argument will exploit Rawls' key insight that self-respect is a primary social good and will depend on the assumption that, at least in moderately affluent nations, one has a right to the primary social goods. This assumption is not defended here. But it should be noted that a right to the primary social goods is not of interest only to Rawlsians and other liberal deontologists; an enlightened utilitarianism might also vindicate it. The second reason for advocating a return to theory is that self-respect is especially fruitful as a focal concept for addressing issues of justice in health care (and other issues).

We argue that the current ethical and regulatory framework for permissible risk levels in pediatric research can be helpfully understood in terms of children’s moral right to adequate protection from harm. Our analysis provides a rationale for what we propose as the highest level of permissible risk in pediatric research without the prospect of direct benefit: what we call “relatively minor” risk. We clarify the justification behind the usual standards of “minimal risk” and “a minor increase over minimal risk” and explain why it is permissible to impose any risks at all on child participants who do not stand to benefit directly from enrollment in research. Finally, we illuminate some aspects of the concept of “best interests.”

Rarely do everyday discussions of ethical issues invoke ethical theories. Even ethicists deploy ethical theories less frequently than one might expect. In my experience, the most powerful ethical arguments rarely appeal to an ethical theory. How is this possible? I contend that ethical argumentation can proceed successfully without invoking any ethical theory because the structure of good ethical argumentation involves leveraging a sturdy norm, where the norm is usually far more specific than a complete ethical theory. To illustrate this idea, I present the argumentative structure of five powerful articles in the ethics literature. I further argue that the present model of ethical argumentation is consistent with the coherence model of ethical justification, but the former need not--and usually should not--invoke the latter explicitly for various practical reasons.

This volume offers a carefully argued, compelling theory of bioethics while eliciting practical implications for a wide array of issues including medical assistance-in-dying, the right to health care, abortion, animal research, and the definition of death. The authors' dual-value theory features mid-level principles, a distinctive model of moral status, a subjective account of well-being, and a cosmopolitan view of global justice. In addition to ethical theory, the book investigates the nature of harm and autonomous action, personal identity theory, and the 'non-identity problem' associated with many procreative decisions. Readers new to particular topics will benefit from helpful introductions, specialists will appreciate in-depth theoretical explorations and a novel take on various practical issues, and all readers will benefit from the book's original synoptic vision of bioethics. This title is also available as Open Access on Cambridge Core.

In “Human‐Animal Chimeras: The Moral Insignificance of Uniquely Human Capacities,” Julian Koplin explores a promising way of thinking about moral status. Without attempting to develop a model in any detail, Koplin picks up Joshua Shepherd's interesting proposal that we think about moral status in terms of the value of different kinds of conscious experience. For example, a being with the most basic sort of consciousness and sentience would have interests that matter morally, while a being whose consciousness featured the riches of loving affection, say, might have greater moral status and therefore deserve some sort of priority if the interests of the two beings conflicted. This approach represents an improvement over the more common, transparently anthropocentric habits of thinking about moral status, whether in connection with evaluating human‐animal chimera research, deciding what one can ethically eat, or pursuing some other moral inquiry.

BackgroundThe use of great apes (GA) in invasive biomedical research is one of the most debated topics in animal ethics. GA are, thus far, the only animal group that has frequently been banned from invasive research; yet some believe that these bans could inaugurate a broader trend towards greater restrictions on the use of primates and other animals in research. Despite ongoing academic and policy debate on this issue, there is no comprehensive overview of the reasons advanced for or against restricting invasive research with GA. To address this gap, we conducted a systematic review of the reasons reported in the academic literature on this topic.MethodsSeven databases were searched for articles published in English. Two authors screened the titles, abstracts, and full texts of all articles. Two journals specialized in animal ethics, and the reference lists of included articles were subsequently also reviewed.ResultsWe included 60 articles, most of which were published between 2006 and 2016. Twenty-five articles argued for a total ban of GA research, 21 articles defended partial restrictions, and 14 articles argued against restrictions. Overall, we identified 110 reason types, 74 for, and 36 against, restricting GA research. Reasons were grouped into nine domains: moral standing, science, welfare, public and expert attitudes, retirement and conservation, respect and rights, financial costs, law and legal status, and longer-term consequences.ConclusionOur review generated five main findings. First, there is a trend in the academic debate in favor of restricting GA research that parallels worldwide policy changes in the same direction. Second, in several domains (e.g., moral standing, and respect and rights), the reasons were rather one-sided in favor of restrictions. Third, some prominent domains (e.g., science and welfare) featured considerable engagement between opposing positions. Fourth, there is low diversity and independence among authors, including frequent potential conflicts of interests in articles defending a strong position (i.e., favoring a total ban or arguing against restrictions). Fifth, scholarly discussion was not the norm, as reflected in a high proportion of non-peer-reviewed articles and authors affiliated to non-academic institutions.

It might be appropriate to begin my commentary by disclosing the fact that Brad Lewis and I are good friends. “Oh, no,” you might think, “this will be one of those cozy, mutual back-patting, insider sessions that so often take place in the American Philosophical Association group meetings.” But never fear. For one thing, I’m no insider to the intellectual circles represented in Dr. Lewis’ bibliog- raphy. Indeed, I’ve read only two of the 32 works listed there. (Depending on how you look at it, that may make me either completely unqualified to comment on this paper or exceptionally well-qualified for reasons of critical distance.) Also, friendship and constructive criticism are entirely compatible in my book. And, to paraphrase a philosopher of some importance, “Brad is dear, but the truth is dearer.” I will begin my commentary by identifying some of Brad’s theses that I find interesting, important, and well-supported. The second part of my commentary will elaborate my major concerns about the paper. This part will be longer, not because my overall reaction is more critical than favorable, but because exploring different viewpoints generally takes more space and time than noting points of agreement. In my conclusion, I will suggest that many of the paper’s insights are likely to sail better if some of the baggage from postmodernism and cultural studies is thrown overboard.

This is a lucid and lively account of how Darwinian biology undermines traditional ethical doctrines regarding the moral status of animals. Digestible by nonphilosophers, the book takes a critical, historical view of scientific culture, placing ethical theorizing and popular attitudes about animals into their actual context. Overall, Rachels has succeeded in the following: writing an illuminating story about Darwin and the culture in which he worked ; exposing the poverty of standard argumentation purporting to support the "humanist" view; and providing very reasonable suggestions concerning how animals should be regarded ethically.