Tom Beauchamp

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research

L'actuel débat sur l'« égalité face aux soins » et le « droit aux soins » est la conséquence directe des progrès techniques réalisés dans le domaine de la santé, mais il reste encore à fonder rationnellement les politiques suivies en la matière et à formuler une théorie adéquate de la justice distributive. Le présent article analyse le rôle et le statut du droit aux soins, ainsi que les considérations tenant à la justice qui vont à rencontre de la rentabilité et de l'utilité sociales. Les choix de répartition budgétaire sont décisifs pour la formulation de revendications au nom de l'existence d'un droit positif aux soins, et il convient de se demander si un tel droit existe et quelles en sont les limites. Discussions today of « equal access » and « the right to health care » are the direct descendants of advances in the technology of health care, and we are still in search of a rationale for our policies and a theory of distributive justice adequate to the task. The role and status of rights to health care, together with considerations of justice in conflict with social efficiency and utility are discussed in this paper. It is argued that allocation decisions are central to claims on behalf of a positive right to health care, which forces questions both of whether there is such a right and of the limits to the right.

For forty years, successive editions of Ethical Theory and Business have helped to define the field of business ethics. The 10th edition reflects the current, multidisciplinary nature of the field by explicitly embracing a variety of perspectives on business ethics, including philosophy, management, and legal studies. Chapters integrate theoretical readings, case studies, and summaries of key legal cases to guide students to a rich understanding of business ethics, corporate responsibility, and sustainability. The 10th edition has been entirely updated, ensuring that students are exposed to key ethical questions in the current business environment. New chapters cover the ethics of IT, ethical markets, and ethical management and leadership. Coverage includes climate change, sustainability, international business ethics, sexual harassment, diversity, and LGBTQ discrimination. New case studies draw students directly into recent business ethics controversies, such as sexual harassment at Fox News, consumer fraud at Wells Fargo, and business practices at Uber.

David Hume (1711-1776) is one of the greatest of philosophers. Today he probably ranks highest of all British philosophers in terms of influence and philosophical standing. His philosophical work ranges across morals, the mind, metaphysics, epistemology, and aesthetics; he had broad interests not only in philosophy as it is now conceived but in history, politics, economics, religion, and the arts. He was a master of English prose. about the Clarendon Hume Edition: The Clarendon Hume will include all of his works except his History of England and minor historical writings; it will be the only thorough critical edition, and will provide a far more extensive scholarly treatment than any previous editions. This edition (which has been in preparation since the 1970s) offers authoritative annotation, bibliographical information, and indexes, and draws upon the major advances in textual scholarship that have been made since the publication of earlier editions--advances both in the understanding of editorial principle and practice and in knowledge of the history of Hume's own texts. General Editors: Professors T. L. Beauchamp (Georgetown University, USA), D. F. Norton (McGill University, Canada), M. A. Stewart (University of Lancaster, England). The Edition will comprise: Vols. 1 and 2: A Treatise of Human Nature, edited by D. F. Norton Vol. 3: An Enquiry concerning Human Understanding, edited by T. L. Beauchamp Vol. 4: An Enquiry concerning the Principles of Morals, edited by T. L. Beauchamp Vol. 5: The Natural History of Religion and the Dissertation on the Passions Vols. 6 and 7: Essays Vol. 8: Dialogues concerning Natural Religion and other posthumous publications, edited by M. A. Stewart

In lieu of an abstract, here is a brief excerpt of the content:The Mettle of Moral Fundamentalism: A Reply to Robert Baker*Tom L. Beauchamp (bio)AbstractThis article is a reply to Robert Baker’s attempt to rebut moral fundamentalism, while grounding international bioethics in a form of contractarianism. Baker is mistaken in several of his interpretations of the alleged moral fundamentalism and findings of the Advisory Committee on Human Radiation Experiments. He also misunderstands moral fundamentalism generally and wrongly categorizes it as morally bankrupt. His negotiated contract model is, in the final analysis, itself a form of the moral fundamentalism he declares bankrupt.Robert baker’s imaginative and incisive articles on international bioethics (Baker 1998a & b) are rich in history and philosophy, but they are as profoundly misguided as they are misdirected. In this comment, I will concentrate both on a pivotal interpretation and criticism that he offers of the Report of the Advisory Committee on Human Radiation Experiments (ACHRE 1996) and on his philosophical thesis that a moral fundamentalism of principles and rights is bankrupt. Baker seriously misinterprets the ACHRE report, distorts and fails to refute moral fundamentalism, and ultimately embraces a form of the very fundamentalism that he declares bankrupt. These three topics are connected in that Baker’s misconceptions of the ACHRE report launch his critique of moral fundamentalism and his mistaken understanding of moral fundamentalism drives his critique of the ACHRE report. 1 [End Page 389]Some Misunderstandings of the Human Radiation CommitteeBaker proclaims a conflict between ACHRE’s moral fundamentalism and multiculturalism. He presents this conflict as primarily a factual issue regarding whether different cultures and eras accept different moral principles—“the difference claim,” in his vernacular (Baker 1998a, pp. 208–9). This interpretation eventuates in a critique of the work of both ACHRE and Ruth Macklin:[W]hen Macklin and the Radiation Committee consider the challenge of multiculturalism, they construe this challenge, not as dispute about anthropological fact, but as a dispute about philosophical theory. More specifically, they treat any assertion of the difference claim as a form of “ethical relativism.”... They thus respond to the multiculturalist’s factual observations—even to factual observations by anthropologists—as if they were philosophical analyses.(Baker 1998a, p. 209)Baker thinks that a factual question has been fallaciously transformed into a philosophical one. However, this false dilemma is a figment of his fancy. He provides no citation to ACHRE to show that it holds this view, and for an understandable reason: This position is neither stated nor presumed in the Report. ACHRE is quite clear that relativism involves both an anthropological (I would prefer to say historical) dispute about fact and a philosophical dispute about value—and that they are not the same.The Committee and its staff proceeded as follows: They first collected a large body of historical documents and facts about the practices, policies, and values that prevailed during the period they were studying. Chapters 1 through 3 and 5 through 13, 12 of the Report’s 18 chapters, display the results of this empirical work. The Committee concluded, on this basis, that research investigators and government officials were aware of the obligations generated by universal principles. The ACHRE report specifically lists six “basic” moral principles and maintains that these principles were pervasively recognized at the time of the radiation experiments (ACHRE 1996, pp. 114ff, 124). ACHRE received testimony, conducted interviews, and compiled documents that indicated how deeply these principles were woven into the fabric of American culture at the time, so deeply that no responsible research investigator could have been unaware of them. ACHRE did not move beyond its list of six principles to a broader thesis about the (factual) universality of other principles and did not examine other cultures or periods of history; such work would [End Page 390] have exceeded ACHRE’s mandate and would have done more to obscure than to further its arguments.ACHRE also found that some government officials had attempted to hide their wrongdoing—a clear indication that these officials were aware of the relevant moral principles and knew that they should not have been treating persons as they did (ACHRE 1996, pp. 152–53; Chapman 1946). These factual findings were not armchair philosophy or empirical guesswork...

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.4 (2002) 389-390 [Access article in PDF] IOM Report on the System for Protecting Human Research Participants Tom L. Beauchamp* In response to society's concerns about the use of human subjects in research, the Department of Health and Human Services commissioned the Institute of Medicine to perform a comprehensive assessment of current systems of research participant protection in the U.S., including recommendations for reform (Committee 2002). Although the committee declared its frustration over the lack of data, it found ample evidence to indicate that there are pivotal weaknesses in the current system. First, it discovered dissatisfaction with the current system from virtually every quarter and at virtually every level. Second, it found evidence that IRBs are under severe strain and performing inadequately. Third, it found that the existing regulatory framework—the IRB system and the Common Rule—has not and probably now cannot react adequately to the constantly evolving research environment. Some of these problems might be handled through federal agencies, but the committee holds that the problems are more extensive and will require additional institutional support and professional attention.The committee found that federal protection requirements should be extended to every research project—private, public, or otherwise. Subjects should be, in this respect, equally protected in privately sponsored research.The committee found that the IRB system is in important respects a failure, especially when it alone is relied upon for ethics reviews in institutions. One set of problems concerns the proper education of IRB members. The committee recommends that all members henceforth be given a specialized knowledge of human research ethics. It finds that IRB deliberations commonly have been dominated by scientists, who often marginalize the perspectives of nonscientist members. It therefore recommends that unaffiliated members, nonscientists, local community representatives, and those representing the participant-perspective comprise at least 25 percent of the membership. It also recommends that no protocol be approved without three-quarters of the voting members concurring. [End Page 389]The committee recommends that institutions distinguish review aimed at (1) scientific merit, (2) conflict of interest, and (3) general Ethics Review. The distinction should more evenly distribute the work of institutional ethics review. The IRB should not conduct the initial scientific review nor should it be spending the bulk of its time purely in examining either scientific merit—as many IRBs now do—or conflict of interest. Instead, the conclusions of the scientific review should be submitted to the IRB for ethics-focused deliberations. Problems of both financial and nonfinancial conflicts of interest should be handled similarly, preferably by a committee properly distanced from the institution's interests.The committee underscores that consent must be understood on the model of an interactive dialogue between research staff and participants and not merely as a signed form or single-disclosure event. Conversations between the participant and the research staff should begin even prior to the point of enrollment and should be reinforced during each stage of the research. The committee finds that informed consent conversations and documents too often are being conceived as risk management tasks gauged to protect the institution from liability.The committee also believes that the system of protections established by a research program should be open to the public in order to foster and maintain the community's trust. Open communication should occur among all relevant stakeholders. The committee notes that currently no centralized system exists for the dissemination of information about clinical trials and other research activities.It urges reconsideration of present policies regarding compensation, finding that many research organizations provide at least short-term medical care for those who are injured, but that few organizations cover all potential risks and that many organizations have no effective policy of compensation. The report holds that providing reasonable compensation for bona fide instances of research harm is the only just system and is necessary to avoid diminished public trust.The committee holds that establishing the appropriate culture in research institutions will require sustained efforts to educate researchers, research administrators, IRB members, and...

This accessible overview of classical and modern moral theory with short readings provides comprehensive coverage of ethics and unique coverage of rights, justice, liberty and law. Real-life cases introduce each chapter. While the book's content is theoretical rather than applied ethics, Beauchamp consistently applies the theories to practical moral problems. Aristotle, Hume, Kant, and Mill are at the book;s core and they are placed in the context of moral philosophical controversies of the last 30 years. In this edition one-third of the reading selections are new and all the selections in chapter 8 on rights are new. Chapter 7 on Hume has been heavily reshaped. Chapter 1 has been reduced to get students past introductory material and into the philosophers.

The last twenty-five years of published literature and curriculum development in bioethics suggest that the field enjoys a successful and stable marriage to philosophical ethical theory. However, the next twenty-five years could be very different. I believe the marriage is troubled. Divorce is conceivable and perhaps likely. The most philosophical parts of bioethics may retreat to philosophy departments, while bioethics continues on its current course toward a more interdisciplinary and practical field.I make no presumption that bioethics is integrally linked to philosophical ethical theory. Indeed, I assume that the connection is contingent and fragile. Many individuals in law, theological ethics, political theory, the social and behavioral sciences, and the health professions carefully address mainstream issues of bioethics without finding ethical theory essential or breathtakingly attractive. This is not surprising. Moral philosophers have traditionally formulated theories of the right, the good, and the virtuous in the most general terms.

: The Advisory Committee on Human Radiation Experiments has correctly argued that persons and institutions can sometimes be held responsible for actions taken more than a half-century ago, when practices and policies on the use of research subjects were strikingly different. In reaching its conclusions, the Committee did not altogether adhere to the language and commitments of its own ethical framework. In its Final Report, the Committee emphasizes judgments of wrongdoing, to the relative neglect of culpability; it discusses mitigating conditions that are exculpatory, but does not provide a thoroughgoing assessment of either culpability or exculpation. However, the Committee's shortcomings are mild in comparison to the deficiencies in the "Report of the UCSF Ad Hoc Fact Finding Committee on World War II Human Radiation Experiments" of the University of California at San Francisco. The latter report reaches no significant judgments of either wrongdoing or culpability. The findings that should have been reached by both committees are discussed