Tom Beauchamp

This edition represents a thorough-going revision of what has become a classic text in biomedical ethics. Major structural changes mark the revision. The authors have added a new concluding chapter on methods that, along with its companion chapter on moral theory, emphasizes convergence across theories, coherence in moral justification, and the common morality. They have simplified the opening chapter on moral norms which introduces the framework of prima facie moral principles and ways to specify and balance them. Together with the shift of advanced material on theory to the back of the book, this heavily revised introductory chapter will make it easier for the wide range of students entering bioethics courses to use this text. Another important change is the increased emphasis on character and moral agency, drawing the distinction between agents and actions. The sections on truth telling, disclosure of bad news, privacy, conflicts of interest, and research on human subjects have also been throughly reworked. The four core chapters on principles (respect for autonomy, nonmaleficence, beneficence, and justice) and the chapter on professional-patient relationships retain their familiar structure, but the authors have completely updated their content to reflect developments in philosophical analysis as well as in research, medicine, and health care. Throughout, they have used a number of actual cases to illuminate and to test their theory, method, and framework of principles.

Animal research has long been a source of biomedical aspirations and moral concern. Examples of both hope and concern are abundant today. In recent months, as is common practice, monkeys have served as test subjects in promising preclinical trials for an Ebola vaccine or treatment 1, 2, 3 and in controversial maternal deprivation studies. 4 The unresolved tension between the noble aspirations of animal research and the ethical controversies it often generates motivates the present issue of the Cambridge Quarterly of Healthcare Ethics. As editors of this special section, we hope that these original and timely articles will push the professional discussion of animal research ethics in a positive direction that will benefi t research scientists and others interested in moral problems in animal research. We also look forward to a day when animal research will genuinely meet both appropriate scientifi c and appropriate ethical criteria—criteria that themselves can be improved by critical scrutiny. Animal research—that is, the use of live animals as experimental subjects in biomedical and behavioral fi elds of learning—has been deeply entrenched for well over half a century. One signal development was the enactment in the late 1930s of federal product safety legislation in the United States and other nations that required animal testing of food, drugs, and medical devices prior to use by human subjects or consumers. 5 Another development was the publication of codes of research ethics that called for animal research prior to human research. The Nuremberg Code, published by an American military tribunal in 1947–48 after scrutiny of Nazi medical atrocities, stated that experiments involving the use of human subjects should be " based on the results of animal experimentation. " 6 The Declaration of Helsinki, fi rst published in 1964, reaffi rmed this assumption and added, rather imprecisely, that " the welfare of animals used for research must be respected. " 7 Against the background of such statements, the institutionalization and widespread acceptance of animal research in the twentieth century rested on two basic assumptions, one factual and one moral. The factual assumption was that animal research is suffi ciently reliable as a basis for predicting the effects of drugs, products, and other materials on human beings that animal trials can be expected to yield signifi cant scientifi c conclusions and medical benefi ts to humanity.

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature.

In the third of his Essays on the Intellectual Powers of Man, Reid devotes the fourth chapter to the concept of‘identity’, and the sixth chapter to Locke’s theory of ‘personal identity’. This latter chapter is widely regarded as a definitive refutation of the thesis that personal identity is no more than memories of a certain sort. It is interesting that the terms ‘identity’ and ‘personal identity’ do not appear as chapter or section titles elsewhere in any of Reid’s works; and Hume is neither mentioned nor his theory of personal identity discussed in the two chapters specifically addressed to the matter. Moreover, while Locke, Reid, and Hume are often anthologized in works on personal identity, Reid is always presented as replying only to Locke.

In this essay, I describe Bob Veatch’s career from the perspective of a colleague and friend. Bob and I started our professional careers at the same time and quickly came into professional contact. With Bob’s move from the Hastings Center to the Kennedy Institute, we became colleagues and worked for almost a decade on our book on death and dying. He was an outstanding co-editor and author. I believe he knew more about the philosophically connected issues in this area of bioethics than anyone publishing in the area, and it was an area of intellectual interest that he pursued throughout his career. Beyond bioethics, Bob and I shared our shared love of contemporary bluegrass music, especially the songs of The Seldom Scene. Bob studied them much as he studied bioethics—with deep knowledge and seriousness. He was just a scholar by nature and with excellent training and experience. If we were to create a Hall of Fame for bioethics, Bob might be the first person elected.

This article presents an original interpretation of David Hume’s eighteenth-century writings in moral philosophy as universalistic and normative, and not as merely psychological, metaethical, empirical, and the like, which has been common in many interpretations of Hume. Whether his views should or should not be regarded as a type of general moral theory such as utilitarianism is not considered, although I argue that Hume is deeply committed to a form of virtue ethics. I also argue that Hume sees the fundamentals of morality as a human phenomenon that is universally applicable to, and universally shared across, cultures and geographical regions. In this way Hume relies heavily on his conception of a universally shared common morality, which he refers to as the morality present “in common life.” This morality is a major foundation of his moral philosophy.

After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems.

Der US-amerikanische Philosoph Tom Beauchamp lehrt an der Georgetown University in Washington D. C., USA, und ist außerdem seit Mitte der 1970er Jahre am dortigen Kennedy Institute of Ethics tätig. Beauchamp kann als einer der maßgeblichen Autoren der heutigen Medizinethik betrachtet werden. Mit seinem Kollegen James Childress publizierte er 1977 erstmals „Principles of Biomedical Ethics“, das heute als Standardwerk der Medizinethik gilt. Die darin entfalteten vier ethischen Prinzipien stellten in theoretischer, praktischer und methodischer Hinsicht eine Innovation dar.

This chapter seeks to provide an understanding of philosophical ethics sufficient for reading other chapters and for appreciating the relevance of philosophical investigations for epidemiologic ethics. Some central concepts and methods of biomedical ethics are explained. In the section on Social Morality and Professional Morality, several questions about the nature of morality and moral responsibility are discussed. In the Section on Problems and Methods in Moral Philosophy, several problems and methods in moral philosophy are discussed, and, in the final section, some ethical theories of importance for biomedical ethics are investigated.