Tom Beauchamp

On December 15, 2011, a final report was issued by the Committee on the Use of Chimpanzees in Biomedical and Behavioral Research, which had been convened by the U. S. Institute of Medicine (IOM) in collaboration with National Research Council (NRC) of the National Academies. Within a month of its release, this report was designated by Wired Science one of the “top scientific discoveries of 2011” (Wired Science Staff 2011). The ad hoc Committee responsible for this report was formed at the request of the National Institutes of Health (NIH) in response to congressional inquiry that had been prompted by expressions of public concern.1 The issues addressed in the report are profoundly ethical, despite NIH’s ..

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 lieu of an abstract, here is a brief excerpt of the content:36. A DISCUSSION ON PERSONAL IDENTITY Jane L. Mclntyre's original paper "Is Hume's Self Consistent?" was presented at the MoGiIl Hume Conference; it will be published in the forthcoming volume devoted to those preceedings. Tom Beauchamp" s paper is presented here as delivered. John Biro's paper has been revised since its original presentation. 37. SELF INCONSISTENCY OR MERE SELF PERPLEXITY? Professor Mclntyre's imaginative and constructive paper has three primary parts (despite its division into six sections). First, she offers an interpretation of Hume's view of the self in Book I of the Treatise. Second, she explains why his own reservations in the Appendix create problems not only for this theory of self identity but for other parts of his philosophy as well. Finally, she tries to ease him out of these difficulties with her overlap interpretation of the bundle theory. My comments follow exactly this outline, though my conclusions, for the most part, do not coincide with hers. My reservations do not derive from her attempt to render Hume consistent. Rather, I question the foundations of the entire enterprise in which she, Robison, Nathanson, et. al. are engaged. That is, I remain unconvinced that the alleged problem, as presently framed, is more than a pseudo-problem. I. Hume's Theory in Book I In Book I Hume offers a variety of arguments about the nature of the self, most of which rely on other theories, such as those of causation, the association of ideas, and substance. Whatever the exact arguments and positions he may be advancing, at least the following six propositions are integral to his theory of personal identity: 1)The self is entirely reducible to a collection of perceptions. 2)The self is not characterized by strict identity. 3)There is nothing simple in which the collection of perceptions inheres. 4)Both identity and simplicity are attributed to the self because of relations between perceptions--the relations of causation and resemblance. 5)The relations of resemblance and causation unite these perceptions. 38. 6) There are no real (non-associational) connections or relations among these perceptions which unite them. Half of these six claims are critical denials of other philosophical claims; the other half are constructive philosophical theories. Hume's entire philosophical program in Book I is tied up with these claims. The criticisms are directed at numerous metaphysical theories of mind, substance and causation; and the constructive account of personai identity requires his theories of perception and association of ideas. I mention these obvious points only because it is so important to note that if_ the interpretation is correct which Professor Mclntyre and others give to (roughly) five sentences in the Appendix, where Hume mentions a possible inconsistency, then Hume is not only questioning his theory of personal identity in Book I, he is calling Book I itself into question. To be convinced that this strikingly implausible turnabout occurs in five sentences of the Appendix, we must be given a most compelling argument—one which I doubt is forthcoming. II. Hume's Alleged Inconsistency The alleged problem of inconsistency arises because Hume says in the Appendix that he does not know how to render his own former opinions consistent (T633, 636). However, when he comes to a formal statement of the inconsistency, as everyone is agreed, the propositions said to be inconsistent are not inconsistent. In the attempt to grasp Hume's meaning, a general consensus has emerged in recent Hume scholarship, including Professor Mclntyre in its company, that we ought both to move backward and forward a sentence or two in Hume's text. Hume says in those passages that his hopes for his theory are diminished because he is unable to explain the principles, that unite our successive perceptions in our thought or consciousness (T636) ; and he then indicates that i_f perceptions could be shown to inhere in something simple or to be really connected, these prob- 39. lems would vanish. It is this textual setting which Robison, Nathanson, and Professor Mclntyre turn into the claim that "the concept of a self which is affected by experience, and therefore must persist through experience— is precisely the concept of the self that...

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.

Two positions that Rosamund Rhodes puts forward are the proper starting point for this commentary: 1. Medical ethics based on the common morality that uses a body of abstract principles or rules are not ‘an adequate and appropriate guide for physicians’ actions’. 2. We need, but do not have, a true professional medical ethics for physicians, which must be ‘distinctly different’ from ethics based on common morality. I will argue that both positions are mistaken. Rhodes does not analyse what she means by a professional ‘medical ethics’ and does not supply content for what she calls ‘medical professionalism’. ‘Common morality‘ is also not given a precise meaning. However, I set aside these problems of conceptual clarity and concentrate on a paradigm case of professional ethics for physicians in interactions with patients. My example is The Belmont Report. Belmont is almost certainly a document that, in the USA, has for four decades been highly influential on physicians, especially physicians engaged in clinical research. It is not merely research ethics. In full satisfaction of the American Board of Medical Specialties’ ‘definition of medical professionalism’, The Belmont Report puts forward a system of ethical principles showing that physicians and other health professionals must conduct research in the service of the public interest and the well-being of patient–subjects. The Belmont Report also satisfies the earlier delineated conditions of medical professionalism in the American Board of Internal Medicine’s ‘Physician Charter’, which are stated in terms of the ‘fundamental principles’ of the primacy of patient welfare, patient autonomy and social justice.1,1–3 Belmont more than satisfies these conditions of medical professionalism. Indeed Belmont may well be the source of the principles …

Tom Beauchamp presents a new edition, designed especially for the student reader, of An Enquiry concerning Human Understanding, the classic work in which David Hume gave a general exposition of his philosophy to a broad educated readership. An authoritative new version of the text is preceded by a substantial introduction explaining the historical and intellectual background to the work and surveying its main themes. The volume also includes detailed explanatory notes on the text, a glossary of terms, and a section of supplementary readings.

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement with our commentators and respond to their critical evaluations.

In recent years, the right of employees to know about health hazards in the workplace has emerged as a major issue in occupational health policy. A general consensus has gradually evolved that there is a right to know, and correlatively that there is a moral obligation to disclose relevant information to workers. For example, the National Institute for Occupational Safety and Health, and several other U.S. federal agencies, informed the U.S. Senate as early as July 1977 that ‘workers have the right to know whether or not they are exposed to hazardous chemical and physical agents regulated by the Federal Government.’ In 1980, the Occupational Safety and Health Adminstration promulgated regulations guaranteeing workers access to medical and exposure records.

In lieu of an abstract, here is a brief excerpt of the content:The Institute of Medicine’s Report on Non-Heart-Beating Organ TransplantationRoger Herdman (bio), Tom L. Beauchamp (bio), and John T. Potts Jr. (bio)In December 1997, the Institute of Medicine (IOM) released a report on medical and ethical issues in the procurement of non-heart-beating organ donors. This report had been requested in May 1997 by the Department of Health and Human Services (DHHS). We will here describe the genesis of the IOM report, the medical and moral concerns that led the DHHS to sponsor it, the process of producing it, and its conclusions. The analyses, findings, and recommendations of the report are also reviewed, in particular the central issues that led to suggestions for policy changes.Transplantation BackgroundAs a first step, some background in the relevant aspects of organ transplantation will prove useful. For the purposes of this analysis, “transplantation” involves the transfer of cells, tissues, or solid organs from one human to another to replace the structure or function of comparable body components that, through injury or disease, are defective or of inadequate function. The IOM report deals with solid organs, primarily kidneys and livers, whose blood supply is reconnected in the organ recipient, in contrast to cells, like bone marrow, and tissues, like corneas. A variety of donor types exists for organ transplantation, each with particular medical and scientific conditions.Living donors are healthy (and usually genetically related) individuals who volunteer to provide either a whole, paired organ such as a kidney or a section of an organ such as a liver. Cadaver donors are individuals who have died and from whom a full array of organs can be taken. “Heart-beating” cadaver donors are individuals who have suffered “brain death,” that is, irreversible cessation of function of the whole brain including the brain stem; and “non-heart-beating” donors (NHBDs) are individuals who are ill or injured, but not “brain dead,” and who have suffered cardiopulmonary death, that is, irreversible cessation of cardiac and respiratory function. NHBDs can be “controlled,” which means that [End Page 83] they can be sustained by artificial life support systems until a medical and family decision is made to terminate futile life support. This can be done at a scheduled time and in a controlled manner, and organs can then be recovered for transplantation. NHBDs can also be “uncontrolled,” which means that their hearts and breathing have stopped through disease or injury at an unexpected time or in an uncontrolled manner, and they cannot be resuscitated; the organs of some individuals of this description can be recovered for transplantation. The IOM report focused on both controlled and uncontrolled NHBDs and on problems specific to them.The questions that were asked and addressed in the IOM report became current and salient beginning in 1992 with the establishment of the University of Pittsburgh “Policy for the Management of Terminally Ill Patients Who May Become Organ Donors After Death.” This policy addressed controlled NHBDs and the ethical questions raised by their use; much of the discussion was reported in the June 1993 special issue of the Kennedy Institute of Ethics Journal. Public notice and anxiety about some of these concerns were sharpened and refocused by national and local media allegations of improper treatment of donors at the Cleveland Clinic in 1997, specifically premature—i.e., antemortem—recovery of organs and administration of drugs that allegedly might hasten donor death.The DHHS Request for StudyIt is not surprising that several federal actions would be taken in response to these events. Some, such as the results of a transplantation task force, remain largely internal to DHHS at this writing. Others are public, such as the IOM study of the NHBD situation. In May 1997, the DHHS initiated contacts with the IOM with the goal of exploring federal concerns about the medical and ethical treatment of NHBDs, in particular the allegations directed at the Cleveland Clinic.The DHHS response should be understood in at least three contexts. First, living donors and uncontrolled NHBDs were essentially the only donor types in the early days of transplantation in the United States. The technologies, ethics, and social acceptance of controlling and terminating life support for...