Allen Buchanan

This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike.

When advocates of insurance‐privatization consider whether private insurance‐dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance‐dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance‐privatization at all plausible are inconsistent with the motivational assumptions needed to show that in practice a private insurance‐dominated system will achieve justice. A private insurance‐dominated system can be expected to satisfy the criteria for just healthcare only if there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions or contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care.

Many philosophers invoke the "wisdom of nature" in arguing for varying degrees of caution in the development and use of genetic enhancement technologies. Because they view natural selection as akin to a master engineer that creates functionally and morally optimal design, these authors tend to regard genetic intervention with suspicion. In Part II, we examine and ultimately reject the evolutionary assumptions that underlie the master engineer analogy (MEA). By highlighting the constraints on ordinary unassisted evolution, we show how intentional genetic modification can overcome many of the natural impediments to the human good. Our contention is that genetic engineering offers a solution that is more eff icient, reliable, versatile, and morally palatable than the lumbering juggernaut of Darwinian evolution. In Part III, we evaluate a recent attempt to ground precautionary enhancement heuristics in adaptive etiology. Our problem with this approach is two-fold: first, it is based on the same "strong adaptationist" interpretation of evolution that motivates the flawed MEA, and second, the etiological concept of function on which it relies provides indirect and potentially misleading information about the likely consequences of genetic intervention. We offer instead enhancement criteria based on causal relationships in ontogeny. We conclude that rather than grounding a presumption against deliberate genetic modification, the causal structure of the living world gives us good moral reason to pursue it

Among analytic philosophers in the past few years there has been a growing commitment to taking Marx seriously. Since the publication in 1971 of John Rawls’ book A Theory of Justice there has been a growing commitment to taking problems of Justice and rights seriously. These two developments intersect in mutual criticism: Marx's radical critique challenges the resources of recent theories of rights and Justice, while the sophistication of recent theories raises the possibility that they escape Marx's most basic criticism.

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.

There are several reasons for the current prominence of global health issues. Among the most important is the growing awareness that some risks to health are global in scope and can only be countered by global cooperation. In addition, human rights discourse and, more generally, the articulation of a coherent cosmopolitan ethical perspective that acknowledges the importance of all persons, regardless of where they live, provide a normative basis for taking global health seriously as a moral issue. In this paper we begin the task of translating the vague commitment to doing something to improve global health into a coherent set of more determinate obligations. One chief conclusion of our inquiry is that the responsibilities of states regarding global health are both more determinate and more extensive than is usually assumed. We also argue, however, that institutional innovation will be needed to achieve a more comprehensive, fair distribution of concrete responsibilities regarding global health and to provide effective mechanisms for holding various state and nonstate actors accountable for fulfilling them.

: The mandate of the U.S. Advisory Committee on Human Radiation Experiments required that the Committee take a position on the validity of retrospective moral judgments. However, throughout its period of operation, the Committee remained divided on the question of whether sound judgments of individual culpability and wrongdoing should be included in its Final Report. This essay examines the arguments that various committee members marshalled to support their opposing views on retrospective moral judgment and explains the significance of the controversy.

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.

Today we are witnessing two dramatic processes: the fragmentation of old states and empires, followed by the emergence of new states and new forms of political association; and the construction of new economies out of the ruins of state socialism. These two processes—the redrawing of political boundaries and the creation of economies—are not independent of one another. In some cases, the desire for a new, more productive economy supplements other motives for state-breaking and state-making. In others, even if the fragmentation of political union results from other factors, such as ethnic divisions or the resurgence of nationalism against a weakened imperial center, the fragments may sort themselves out into new states, federations, or commonwealths, according to what they believe to be maximally productive economic units.

From a moral standpoint, lethal drones are intrinsically no worse as a means of warfare than bombing or sending commandos to kill enemies. From the perspective of their users, they have six major advantages over more conventional weapons: they are often cheaper; their use can be more readily concealed; they allow for more precise targeting, with the potential for less “collateral damage”; their use can involve less serious infringements of sovereignty than invasion by troops; and they may be less likely to provoke widespread hostile reactions by the population of the country in which they are used than military operations involving troops on the ground. But these advantages generate three major risks: of violating sovereignty, of over-using the military option, and of making it more difficult to identify violations of constraints against targeting noncombatants. To deal with these risks, a Drone Accountability Regime is needed that imposes obligations on states, which in turn would be required to impose them on their agents. Since it would be infeasible to negotiate a treaty-based legal regime at present and for the foreseeable future, the Drone Accountability Regime should be informal and should involve transnational actors as well as states. Its key principle should be transparency, helping enable civil society to hold states accountable, and its central agent would be an Ombudsperson with broad authority to investigate situations and publicize her findings. No institution can ensure that states, or operators, are held fully accountable to appropriate standards of conduct, but such a regime could increase the degree of accountability for the use of lethal drones.

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.

For several decades the work of Joel Feinberg has been the most influential in legal, political and social philosophy in the English-speaking world. This 1994 volume honours that body of work by presenting fifteen essays, many of them by leading legal and political philosophers, that explore the problems that have engaged Feinberg over the years. Amongst the topics covered are issues of autonomy, responsibility and liability. It will be a collection of interest to anyone working in moral, legal or political philosophy.