Allen Buchanan

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.

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.

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.

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.

There is a puzzling disconnect between recent philosophical literature on equality and the modern theory and practice of human rights. This disconnect is puzzling because the modern human rights movement is arguably the most salient and powerful manifestation of the commitment to equality in our time. One likely source of this disconnect is the tendency of contributors to the philosophical literature on equality to focus on justice within the state, considered in isolation. This article begins the task of connection. Section II outlines a philosophical conception of human rights, the Modest Objectivist View, according to which the list of human rights is grounded in descriptive and normative egalitarian assumptions about what is required to help ensure that every individual has the opportunity for a minimally good or decent human life. Next, I explore the resources of the Modest Objectivist View for rationally reconstructing the conventional conception of human rights. Section III examines challenges to the Modest Objectivist View’s egalitarian assumptions. Section IV explores the question of whether the minimal egalitarianism of the Modest Objectivist View is compatible with the more robust egalitarianisms advanced in recent philosophical literature. I conclude that the minimalist egalitarianism of human rights is compatible with more robust egalitarian principles, once we understand the distinctive function of human rights as standards of transnational justice. Key Words: basic interests • decent human life • egalitarianism • equality • minimally good life • Modest Objectivist View • minimalism • opportunity for a decent life • transnational justice.

This book articulates a systematic vision of an international legal system grounded in the commitment to justice for all persons. It provides a probing exploration of the moral issues involved in disputes about secession, ethno-national conflict, "the right of self-determination of peoples," human rights, and the legitimacy of the international legal system itself. Buchanan advances vigorous criticisms of the central dogmas of international relations and international law, arguing that the international legal system should make justice, not simply peace among states, a primary goal, and rejecting the view that it is permissible for a state to conduct its foreign policies exclusively according to what is in the "national interest." He also shows that the only alternatives are not rigid adherence to existing international law or lawless chaos in which the world's one superpower pursues its own interests without constraints. This book not only criticizes the existing international legal order, but also offers morally defensible and practicable principles for reforming it. Justice, Legitimacy, and Self-Determination will find a broad readership in political science, international law, and political philosophy.

All theories of the right to secede either understand the right as a remedial right only or also recognize a primary right to secede. By a right in this context is meant a general, not a special, right (one generated through promising, contract, or some special relationship). Remedial Right Only Theories assert that a group has a general right to secede if and only if it has suffered certain injustices, for which secession is the appropriate remedy of last resort.1 Different Remedial Right Only Theories identify different injustices as warranting the remedy of secession.

The international legal order is beginning to take human rights seriously, yet sound justifications for claims about human rights are conspicuously absent. Philosophers have begun to respond to this “justification deficit” by developing theories of human rights. Although a philosophical conception of human rights is needed, it would not be sufficient. The justification of human rights is a dynamic process in which a provisional philosophical conception of human rights both guides and is fleshed out by public processes of practical reasoning structured by legal institutions. Whether the “justification deficit” can be remedied depends not only upon the content of human rights norms as set out in the major conventions and the arguments philosophers can marshal to justify them but also upon the epistemic virtues of the institutions through which the norms are specified, contested, and revised over time.

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge.