The physician and the pharmaceutical detail man: An ethical analysis

The relationship between the physician and the pharmaceutical detail man is discussed. Specific emphasis is given to an analysis of the ethical implications that this relationship has for patient care.     

The physician as fortune teller: a commentary on "The ethical justification for minimal paternalism

...I shall summarize my argument to this point. 1) A new technology -- medicalizing life choices -- introduces additional sources of uncertainty into the physician-patient relationship. The implications for the authority-autonomy tension of that relationship are not fully worked out, as is evidenced by differing views on professional obligations. 2) The warrants for paternalism are complex, ranging from a pragmatic response in the face of uncertainty to a proactive, highly directive determination of the patient's best interests. 3) Although some proponents of autonomy argue that it entails positive rights to intervention and information, the "strong sense" of autonomy is not the prevailing view. 4) The as yet unclear benefits of knowledge about one's genetic makeup are even less clear in the case of HD. Strong circumstantial evidence of risks of harm from disclosure of unfavorable test results have not been dispelled by early experience with use of the HD test. 5) A cautious approach in the use of HD test seems warranted, even at the cost of restricting autonomy. Legitimating that approach by reference to traditional ethical theory is a necessary element in the transfer of the new technology to the wider clinical setting. 6) While PMP [the principle of minimal paternalism] attempts to offer such an approach, some questions do not appear to have been resolved or fully addressed by this formulation.     

Sham surgery: an ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Intellectual property and pharmaceutical drugs: an ethical analysis

The pharmaceutical industry has in recent years come under attack from an ethical point of view concerning its patents and the non-accessibility of life-saving drugs for many of the poor in both less developed countries and in the United States. The industry has replied with economic and legal justifications for its actions. The result has been a communication gap between the industry on the one hand and poor nations and American critics on the other. This paper attempts to present and evaluate the arguments on all sides and suggests a possible way out of the current impasse. It attempts to determine the ethical responsibility of the drug industry in making drugs available to the needy, while at the same time developing the parallel responsibilities of individuals, governments, and NGOs. It concludes with the suggestion that the industry develop an international code for its self-regulation.     

Explicit ambiguity: the 1992 ethics code as an oxymoron

The author reviews the major themes emerging from commentators' reactions to the 1992 American Psychological Association ethics code and presents his own views as well. Commentators agreed that the 1992 code is improved by its increased breadth and specific attention to important issues not addressed in the previous code but criticized the code for its lack of clarity, its rampant qualifying language, and for seeming to protect the profession rather than the public. The author, finding the code overly long, detailed, and lawyered, recommends that those who revise the code in the 21st century adhere more closely to fundamental moral principles.     

Islam as an ethical tradition of international relations

This article explores the ethical traditions of Islam in order to examine its potential as a source that would help precipitate ethical and peaceful, as opposed to political and conflictual, relations between nations, faiths, and cultural groups. While using philosophical and ethical categories borrowed from the Western epistemes, this paper in a way reintroduces Islam as an ethical tradition. Given the significance that Islamic sentiments and Islamic symbolism have for a billion people and over fifty nation states, this paper recommends the inclusion of Islamic traditions in discourses whose concern is the proliferation of ethical consideration in international and intercultural relations. Having said that, the paper proceeds to elaborate foundations for an Islamic ethic of international relations.     

Involuntary sterilization of persons with mental retardation: an ethical analysis

Legitimate concerns on the part of parents and guardians may lead to requests for sterilization of a mentally retarded person in their care. At the same time, mentally retarded persons must be protected from actions that do not serve their best interests. This paper will review the history of involuntary sterilization in the United States and evaluate the ethical arguments that are relevant to decisions about involuntary sterilization. While other, less permanent forms of contraception might be acceptable, involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage. Mentally retarded persons who lack capacity in those three areas should be considered for involuntary sterilization only when the procedure is necessary, sterilization would serve the best interests of the mentally retarded person, less intrusive and temporary methods of contraception or control of menstruation are not acceptable alternatives, and procedural safeguards have been implemented to assure a fair decision-making process.     

The armchair and the trolley: an argument for experimental ethics

Ethical theory often starts with our intuitions about particular cases and tries to uncover the principles that are implicit in them; work on the ‘trolley problem’ is a paradigmatic example of this approach. But ethicists are no longer the only ones chasing trolleys. In recent years, psychologists and neuroscientists have also turned to study our moral intuitions and what underlies them. The relation between these two inquiries, which investigate similar examples and intuitions, and sometimes produce parallel results, is puzzling. Does it matter to ethics whether its armchair conclusions match the psychologists’ findings? I argue that reflection on this question exposes psychological presuppositions implicit in armchair ethical theorising. When these presuppositions are made explicit, it becomes clear that empirical evidence can (and should) play a positive role in ethical theorising. Unlike recent assaults on the armchair, the argument I develop is not driven by a naturalist agenda, or meant to cast doubt on the reliability of our moral intuitions; on the contrary, it is even compatible with non-naturalism, and takes the reliability of intuition as its premise. The argument is rather that if our moral intuitions are reliable, then psychological evidence should play a surprisingly significant role in the justification of moral principles.