Allen Buchanan

This essay demonstrates that the management and contestability of power is central to Dewey's understanding of democracy and provides a middle ground between two opposite poles within democratic theory: Either the masses become the genuine danger to democratic governance (à la Lippmann) or elites are described as bent on controlling the masses (à la Wolin). Yet, the answer to managing the relationship between them and the demos is never forthcoming. I argue that Dewey's response to Lippmann for how we ought to conceive of the relationship between citizens and elites if power is not to become arbitrary is located within a larger framework that avoids the problematic distinction Wolin draws between the demos and representative government. For Dewey, the legitimacy of decision-making, and, indeed, the security of freedom, is determined not merely by our actual involvement, but the extent to which non-participation does not preclude the future contestability of power.

This essay articulates a crucial and neglected element of a general theory of the ethics of bureaucratic organizations, both private andpublic. The key to the approach developed here is the thesis that the distinctive ethical principles applicable to bureaucratic organizations are responses to the distinctive agency-risks that arise from the nature of bureaucratic organizations as complex webs of principal/agent relationships. It is argued that the most important and distinctive ethical principles for bureaucratic organizations express commitments on the part of bureaucrats that function to reduce the agency risks that are inherent in such organizations. This approach to the ethics of bureaucratic organizations is shown to be more illuminating than those that concentrate exclusively or primarily on determining the conditions for corporate responsibility or on the idea that the ethical obligations distinctive of bureaucracies are role-derived.

This chapter first identifies what is extremely valuable and distinctive in the approach to Ethics Glover takes in Humanity. It then goes on to argue that Glover's approach is incomplete, because it is insufficiently empirical and, more importantly because it lacks a conceptual framework capable of identifying the full range of topics for empirically informed Ethics research. The needed conceptual framework must incorporate social moral epistemology, which focuses on the interaction between the moral‐epistemic virtues and vices of individuals and the moral‐epistemic functions of institutions. Through the use of historical examples of the sort Glover appeals to in Humanity, this chapter shows that work in Ethics must pay more attention to the ethics of believing and to the role that institutions play in the formation of systems of belief.

abstract Part 1 of this essay argues that one of the most important contributions of philosophers to sound public policy may be to combat the influence of bad Philosophy (which includes, but is not limited to, bad Philosophy produced by accredited academic philosophers). Part 2 argues that the conventional conception of Practical Ethics (CPE) that philosophers bring to issues of public policy is defective because it fails to take seriously the phenomenon of the subversion of morality, the role of false factual beliefs in this subversion, and the vulnerability to the exploitation of our moral powers that our social-epistemic dependency entails. Given the serious risks of the subversion of morality through the propagation of false factual beliefs, CPE's near exclusive emphasis on identifying sound moral principles greatly constrains its potential contribution to the Negative Task of Practical Ethics, the endeavour to reduce the incidence of the most grievously wrong behaviour. Practical ethicists should focus more on the ethics of believing, and develop a more sophisticated conception of the moral and epistemic virtues of individuals and of institutions, one that includes protective meta-virtues, whose function it is to guard us against the more frequent and predictable subversions of morality, including those subversions that are facilitated by the processes of belief-formation that our social institutions and practices foster.

Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and to professional organizations. The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies.

: Two basic criticisms of managed care are that it erodes patient trust in physicians and subjects physicians to incentives and pressures that compromise the physician's fiduciary obligation to the patient. In this article, I first distinguish between status trust and merit trust, and then argue (1) that the value of status trust in physicians is probably over-rated and certainly underdocumented; (2) that erosion of status trust may not be detrimental if accompanied by an increase in well-founded merit trust; and (3) that under conditions of managed care the physician's commitment to traditional medical ethics cannot serve as an adequate basis for merit trust. Next, drawing on an analogy between managed care organizations and polities, I argue that (4) the most appropriate basis for merit trust in managed care is a conception of organizational legitimacy that includes procedural justice, empowerment of constructive criticism within the organization, and organizational accommodation of the noninstrumental commitment to patient well-being that is distinctive of medical professionalism. I then explore the conditions necessary for robust competition for merit trust among managed care organizations and indicate the kinds of public policies needed to facilitate such competition. Finally, I show how the account of organization-based merit trust can accommodate the special fiduciary obligation of medical professionals, without indulging in the delusion that it is the physician's fiduciary obligation always to provide all care that is expected to be of any net benefit to the patient.

This book, written by four internationally renowned bioethicists and first published in 2000, was the first systematic treatment of the fundamental ethical issues underlying the application of genetic technologies to human beings. Probing the implications of the remarkable advances in genetics, the authors ask how should these affect our understanding of distributive justice, equality of opportunity, the rights and obligations as parents, the meaning of disability, and the role of the concept of human nature in ethical theory and practice. The book offers a historical context to contemporary debate over the use of these technologies by examining the eugenics movement of the late nineteenth and early twentieth centuries. The questions raised in this book will be of interest to any reflective reader concerned about science and society and the rapid development of biotechnology, as well as to professionals in such areas as philosophy, bioethics, medical ethics, health management, law, and political science.

What limitations on intervention in support of democratic revolutions does proper regard for the collective right of self-determination impose? Some have held that if intervention in support of democratic revolutions is justified, it must cease once the authoritarian regime has been deposed—that any effort by the intervener to use force to shape the new political order would violate the people’s right of self-determination. This essay argues that proper regard for self-determination is compatible with much more extensive interventions

Is it right to use biomedical technologies to make us better than well or even perhaps better than human? Should we view our biology as fixed or should we try to improve on it? College students are already taking cognitive enhancement drugs. The U.S. army is already working to develop drugs and technologies to produce "super soldiers." Scientists already know how to use genetic engineering techniques to enhance the strength and memories of mice and the application of such technologies to humans is on the horizon. In Better Than Human, philosopher-bioethicist Allen Buchanan grapples with the ethical dilemmas of the biomedical enhancement revolution. Biomedical enhancements can make us smarter, have better memories, be stronger, quicker, have more stamina, live much longer, avoid the frailties of aging, and enjoy richer emotional lives. In spite of the benefits that biomedical enhancements may bring, many people instinctively reject them. Some worry that we will lose something important-our appreciation for what we have or what makes human beings distinctively valuable. Others assume that biomedical enhancements will only be available to the rich, with the result that social inequalities will worsen. Buchanan shows that the debate over enhancement has been distorted by false assumptions and misleading rhetoric. To think clearly about enhancement, we have to acknowledge that human nature is a mixed bag and that our species has many "design flaws." We should be open be open to the possibility of becoming better than human, while never underestimating the risks that our attempts to improve may back-fire.