Tom Beauchamp

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the “standard” Jehovah’s Witness case that having autonomously chosen the authority of his religious institution, a Jehovah’s Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author’s view of the child of a Jehovah’s Witness scenario is that it is morally required—not merely permitted—to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure

Western ethics and law have been slow to come to conclusions about the right to choose the time and manner of one's death. However, policies, practices, and legal precedents have evolved quickly in the last quarter of the twentieth century, from the forgoing of respirators to the use of Do Not Resuscitate (DNR) orders, to the forgoing of all medical technologies (including hydration and nutrition), and now, in one U.S. state, to legalized physician-assisted suicide. The sweep of history—from the Quinlan case in New Jersey to legislation in Oregon that allows physician-assisted suicide—has been as rapid as it has been revolutionary.

To address some questions in global biomedical ethics, three problems about cultural moral differences and alleged differences in Eastern and Western cultures are addressed: The first is whether the East has fundamentally different moral traditions from those in the West. Concentrating on Japan and the United States, it is argued that theses of profound and fundamental East-West differences are dubious because of many forms of shared morality. The second is whether human rights theory is a Western invention with no firm traditions in Eastern moral traditions. It is argued that this thesis is unsupported both historically and in contemporary bioethics. The third problem is whether multiculturalist theory casts doubt on claims of universal principles and rights. It is argued that the reverse is true: multiculturalism is a universalistic theory. The argument throughout supports common morality theory.

about Hume: David Hume 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 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, D. F. Norton, M. A. Stewart. 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 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.

Hume wrote about fundamental similarities and dissimilarities between human and nonhuman animals. His work was centered on the cognitive and emotional lives of animals, rather than their moral or legal standing, but his theories have implications for issues of moral standing. The historical background of these controversies reaches to ancient philosophy and to several prominent figures in early modern philosophy. Hume develops several of the themes in this literature. His underlying method is analogical arg ument and his conclusions are generally favorable regarding the abilities in animals. Hume does not attribute a moral sense or capacity of judgment to animals, but he does suggest that their actions exhibit moral qualities, such as other-regarding instincts. Hume allows in-kind differences in both demonstrative reason and moral judgment, but in the domains of both causal reason and moral agency he believes there are differences of degree rather than of kind. Hume's most significant philosophical contribution was to move as far as anyone before him to a naturalistic explanation of human and nonhuman minds that invited psychological and epistemological examination of minds by using the identical methods and categories for man and beast.

What is the organizational structure of Hume’s essay? The first three paragraphs are purely introductory and somewhat incidental. To someone untutored in Hume’s general religious skepticism, these opening remarks might appear to be the vain boasts of a philosopher in praise of philosophy. More plausibly, his opening remarks are stage-setting devices. They prepare the reader not for what Hume will argue but rather for how he will uncompromisingly challenge commonly held presuppositions about the sensitive issue of suicide. His comments are methodological or perhaps meta-philosophical in character. In more contemporary language, Hume is promoting the following two theses in these introductory paragraphs, each of which has to do with the inadequacy of non-philosophical foundations for reaching conclusions about the morality of suicide

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the classroom, during conferences, etc.

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 ..

“Applied ethics” has been the major growth area in North American philosophy in the last decade, yet a robust confidence and enthusiasm over its promise is far from universal in academic philosophy. It is considered nonphilosophical in West Germany, and has largely failed to penetrate British departments of philosophy. Whether it has any intellectually or pedagogically redeeming value is still widely debated in North America, where many who have tried to teach some area of applied ethics for the first time have seen their courses grind to a halt in unresolvable quandaries, practical exigencies, or unavailable technical information. Consequently, some departments are at war over whether to hire or confer tenure on those who teach these subjects. Many also remain unconvinced that philosophical generalizations or theories can play any significant role in applied contexts. They may even doubt both that applied ethics is really ethics and that philosophy should accomodate this creature in its curriculum.

: The belief persists in philosophy, religion, science, and popular culture that some special cognitive property of persons like self-consciousness confers a unique moral standing. However, no set of cognitive properties confers moral standing, and metaphysical personhood is not sufficient for either moral personhood or moral standing. Cognitive theories all fail to capture the depth of commitments embedded in using the language of "person." It is more assumed than demonstrated in these theories that nonhuman animals lack a relevant form of self-consciousness or its functional equivalent. Although nonhuman animals are not plausible candidates for moral personhood, humans too fail to qualify as moral persons if they lack one or more of the conditions of moral personhood. If moral personhood were the sole basis of moral rights, then these humans would lack rights--and precisely for the reasons that nonhuman animals would.

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...