Allen Buchanan

Next SectionBiodefence, broadly understood as efforts to prevent or mitigate the damage of a bioterrorist attack, raises a number of ethical issues, from the allocation of scarce biomedical research and public health funds, to the use of coercion in quarantine and other containment measures in the event of an outbreak. In response to the US bioterrorist attacks following September 11, significant US policy decisions were made to spur scientific enquiry in the name of biodefence. These decisions led to a number of critical institutional changes within the US federal government agencies governing scientific research. Subsequent science policy discussions have focused largely on ‘the dual use problem’: how to preserve the openness of scientific research while preventing research undertaken for the prevention or mitigation of biological threats from third parties. We join others in shifting the ethical debate over biodefence away from a simple framing of the problem as one of dual use, by demonstrating how a dual use framing distorts the debate about bioterrorism and truncates discussion of the moral issues. We offer an alternative framing rooted in social epistemology and institutional design theory, arguing that the ethical and policy debates regarding ‘dual use’ biomedical research ought to be reframed as a larger optimisation problem across a plurality of values including, among others: (1) the production of scientific knowledge; (2) the protection of human and animal subjects; (3) the promotion and protection of public health (national and global); (4) freedom of scientific enquiry; and (5) the constraint of government power

The idea of moral progress played a central role in liberal political thought from the Enlightenment through the nineteenth century but is rarely encountered in moral and political philosophical discourse today. One reason for this is that traditional liberal theorists of moral progress, like their conservative detractors, tended to rely on under-evidenced assumptions about human psychology and society. For the first time, we are developing robust scientific knowledge about human nature, especially through empirical psychological theories of morality and culture that are informed by evolutionary theory. On the surface, evolutionary accounts of morality paint a rather pessimistic picture of human moral nature, suggesting that certain types of moral progress are unrealistic or inappropriate for beings like us. Humans are said to be ‘hard-wired’ for tribalism. However, such a view overlooks the great plasticity of human morality as evidenced by our history of social and political moral achievements. To account for these changes while giving evolved moral psychology its due, we develop a dynamic, biocultural theory of moral progress that highlights the interaction between adaptive components of moral psychology and the cultural construction of moral norms and beliefs, and we explore how this interaction can advance, impede, and reverse moral progress.

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.

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.

ABSTRACT In this article, I argue that overly‐optimistic beliefs about how much progress toward justice has been made and overly‐pessimistic beliefs about what progress toward justice can be made can both help perpetuate injustices. Further, such beliefs can help perpetuate injustices even if those who hold them have a firm grasp of the correct principles of justice, a robust commitment to realize them, and the political influence to make their commitment effective. I also argue that when mistaken beliefs about justice of either sort are embedded in ideologies, they are an especially serious obstacle to moral progress. Finally, I conclude that ideologies can help perpetuate injustices even if they do not ‘mask’ them, if they include either overly‐optimistic or overly‐pessimistic beliefs about progress toward justice.

The distinctive aim of applied ethics is to provide guidance as to how we ought to act, as individuals and as shapers of social policies. In this essay, I argue that applied ethics as currently practiced is inadequate and ought to be transformed to incorporate what I shall call social moral epistemology. This is a branch of social epistemology, the study of the social practices and institutions that promote the formation, preservation, and transmission of true beliefs. For example, social epistemologists critically evaluate the comparative advantages of adversarial versus inquisitorial criminal proceedings as mechanisms for the discovery of truth.

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.

Commentators on The Evolution of Moral Progress: A Biocultural Theory raise a number of metaethical and moral concerns with our analysis, as well as some complaints regarding how we have interpreted and made use of the contemporary evolutionary and social sciences of morality. Some commentators assert that one must already presuppose a moral theory before one can even begin to theorize moral progress; others query whether the shift toward greater inclusion is really a case of moral progress, or whether our theory can be properly characterized as ‘naturalistic’. Other commentators worry that we have uncritically accepted the prevailing evolutionary explanation of morality, even though it gives short shrift to the role of women or presupposes an oversimplified view of the environment in which the core elements of human moral psychology are thought to have congealed. Another commentator laments that we did not make more extensive use of data from the social sciences. In this reply, we engage with all of these constructive criticisms and show that although some of them are well taken, none undermine the core thesis of our book.

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 (on grounds of choice, efficiency, and quality of care) 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 (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) 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 (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care.

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.

This volume examines comparatively the views and principles of seven prominent ethical traditions on one of the most pressing issues of modern politics - the making and unmaking of state and national boundaries. The traditions represented are Judaism, Christianity, Islam, natural law, Confucianism, liberalism and international law. Each contributor, an expert within one of these traditions, shows how that tradition can handle the five dominant methods of altering state and national boundaries: conquest, settlement, purchase, inheritance and secession. Written by a distinguished group of international specialists this volume is unique in providing both in-depth normative and comparative perspectives on a troubling question that will offer readers real insight into inter-tradition conflict. Those readers will range from upper-level undergraduates to scholars in such fields as philosophy, political science, international relations and comparative religion.

Appeals to the idea of human nature are frequent in the voluminous literature on the ethics of enhancing human beings through biotechnology. Two chief concerns about the impact of enhancements on human nature have been voiced. The first is that enhancement may alter or destroy human nature. The second is that if enhancement alters or destroys human nature, this will undercut our ability to ascertain the good because, for us, the good is determined by our nature. The first concern assumes that altering or destroying human nature is in itself a bad thing. The second concern assumes that human nature provides a standard without which we cannot make coherent, defensible judgments about what is good.I will argue (1) that there is nothing wrong, per se, with altering or destroying human nature, because, on a plausible understanding of what human nature is, it contains bad as well as good characteristics and there is no reason to believe that eliminating some of the bad would so imperil the good as to make the elimination of the bad impermissible, and (2) that altering or destroying human nature need not result in the loss of our ability to make judgments about the good, because we possess a conception of the good by which we can and do evaluate human nature. I will argue that appeals to human nature tend to obscure rather than illuminate the debate over the ethics of enhancement and can be eliminated in favor of more cogent considerations.