The relevance of Rawls' principle of justice for research on cognitively impaired patients

An ethical conflict arises when we must performresearch in the interest of future patients,but that this may occasionally injure theinterests of today's patients.In the case of cognitively impaired persons, thequestion arises whether it is compatible withhumane healthcare not only to treat, but alsoto use these patients for research purposes.Some bioethicists and theologians haveformulated a general duty of solidarity, alsopertaining to cognitively impaired persons, as ajustification for research on these persons. Ifone examines this thesis from the theory ofjustice according to John Rawls, it is revealedthat such a duty of solidarity cannotnecessarily be extrapolated from Rawls'conception of justice. This is at least true ofRawls' difference principle, because accordingto the difference principle only those measuresare justifiable which serve the interest of therespective least well off. Those measures whichwould engender additional injury for the leastwell off could not be balanced by any utilityaccording to Rawls.However, John Rawls' difference principleis subordinate to the first principle,which is that each person has an equalright to the most extensive basic libertycompatible with the same liberty for others.These primary goods are determined by thefreedom and integrity of the person.This integrity of decisionally impaired personswould be in danger if one would abstain fromresearch and thus forego the increase inknowledge related to their disease. Thus onecould conclude, at least from Rawls' firstprinciple, that society must take on a duty toguarantee the degrees of freedom forcognitively impaired persons and thus alsosupport the efforts for their healing.     

Pessimism

The problem of pessimism is the secular analogue to the evidential problem of evil facing traditional theism. The traditional theist must argue two things: that the evidence shows that this is on balance a good world and that it is the best possible world. Though the secular optimist who advocates any form of secular moral theory need not argue that the current and future world will likely be the best possible world, she nonetheless must argue that were there a clean solution to the problem of current and future suffering in which all sentient life could be instantly and painlessly eliminated, we would have reasons not to employ the clean solution because the future promises to bring on balance a good world in which the evil of human and animal suffering is outweighed by whatever is good in the world. Pessimism is the view that the evidence argues against secular optimism. It is argued here that it is anything but clear that secular optimism is warranted when viewed from an impersonal point of view. The problem is then evaluated from the personal point of view in which a form of personal optimism is defended even in the face of impersonal pessimism.     

Caring,Social Policy,and Homelessness

Care theory offers a way to overcome a weaknessof liberalism – its reluctance to intervene inthe private lives of adults. In caring for thehomeless, we must sometimes use a limited formof coercion, but our intervention is alwaysinteractive, and the process of finding asolution is one of negotiation between theneeds expressed by the homeless and the needswe infer for them.     

What is analysis?

This paper attempts to discern a ground for doing depth psychological work in times of disappearance, loss and the absence of the gods. Through the poetry of Friedrich Hölderlin, and to a lesser extent, Rainer Maria Rilke, it seeks to discover the significance of fragmentation and conflagration in the manifestations of both psyche and the post-industrial landscape we inhabit. What does the ‘death of god’ mean for our notions of symbol and self and for the practice of psychotherapy and psychoanalysis? How do we understand our daily clinical work in the context of ruin, holocaust and despair?     

When religion may be an ethical issue

Though Americans are a religious people, there are times when religion or religious views may confound the ethical process. This article claims that religious values may be expressed as either principles or narratives, then seeks to establish a case for dealing with religious claims as principled narratives. Methods of evaluation are explored and then seven guidelines are offered for dealing with religion in ethics consultations.     

社会因素对剖宫产率的影响

近二三十年来,剖宫产率在世界范围内不断升高。究其原因,除了医学因素外,社会因素起着重要作用,从社会经济发展,社会科学文化水平、社会习俗观念、法律、医疗道德、国家计划生育政策、医学教育等多个角度分析了社会因素对剖宫产率的影响,并就如何发挥社会因素的积极作用,消除和避免其消极作用,使剖部率维持在合理的范围内进行了讨论。     

Nietzsche Contra “Self-Reformulation”

Not only do the writings of Nietzsche – early and late – fail to support the pedagogy of self-reformulation, this doctrine embodies what for him is worst in man and would destroy that which is higher. The pedagogy of self-reformulation is also incoherent. In contrast, Nietzsche offers a fruitful and comprehensive theory of education that, while non-democratic and contemptuous of egalitarian aspirations, emerges consistently from his metaphysics and philosophical anthropology. Whatever, then, we might think of his premises, Nietzsche’s philosophy of education represents an attractive model for those who would develop a meaningful, distinctive, and persuasive educational theory. It defines a domain of the possible and then straightforwardly states what is and is not to be done within it – and why.     

The immoral gene: Does it really exist?

Over the last years several European patents were opposed for protecting technology violating the morality requirement under Article 53(a) EPC. Attempts have been made by the Appeal Boards of the European Patent Office (EPO), as well as by amendments introduced into the Implementing Regulations of the European Patent Convention (EPC), to address this sensitive patentability requirement more precisely. The most recent hot topic coming up in this context is the patentability of stem cells. It is to be expected that this discussion will still go on in the field of biotechnological inventions for the next several years. An earlier version of this paper was presented at an international conference, “The Ethics of Intellectual Property Rights and Patents,” held in Warsaw, Poland on 23–24 April, 2004.     

The gap between law and ethics in human embryonic stem cell research: Overcoming the effect of U.S. Federal policy on research advances and public benefit

Key ethical issues arise in association with the conduct of stem cell research by research institutions in the United States. These ethical issues, summarized in detail, receive no adequate translation into federal laws or regulations, also described in this article. U.S. Federal policy takes a passive approach to these ethical issues, translating them simply into limitations on taxpayer funding, and foregoes scientific and ethical leadership while protecting intellectual property interests through a laissez faire approach to stem cell patents and licenses. Those patents and licenses, far from being scientifically and ethically neutral in effect, virtually prohibit commercially sponsored research that could otherwise be a realistic alternative to the federal funding gap. The lack of federal funding and related data-sharing principles, combined with the effect of U.S. patent policy, the lack of key agency guidance, and the proliferation of divergent state laws arising from the lack of Federal leadership, significantly impede ethical stem cell research in the United States, without coherently supporting any consensus ethical vision. Research institutions must themselves implement steps, described in the article, to integrate addressing ethical review with the many legal compliance issues U.S. federal and state laws create. The opinions expressed in this article are the author’s own, and are not necessarily the opinions of others, including Children’s Hospital Boston. Portions of earlier versions of this article were previously published by the American Bar Association and the New York State Bar Association.     

Introducing ethics across the curriculum at South Dakota school of mines and technology

This paper describes how the Electrical and Computer Engineering Department at South Dakota School of Mines and Technology has chosen to integrate ethics into their curriculum. All university freshmen engineering students are introduced to ethics through the presentation of ethical dilemmas. During this exercise, students are forced to argue both sides (‘for’ and ‘against’) of a hypothetical ethical engineering dilemma. It provides a setting for great discussion with the desired outcome that they learn to carefully analyze a situation before they draw conclusions. In the sophomore year, students are introduced to methods to use the fundamental principles, the fundamental canons, and the suggested guidelines for use with the fundamental canons of ethics when analyzing appropriate action to be taken when confronted with ethical dilemmas. We currently use the ‘sophomore’ method for seniors because the sequencing is just beginning. Next year the seniors will do more indepth analysis of ethical case studies. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.