The definition of adequate care in externally sponsored clinical trials: The terminological controversy about the concept “standard of care”

The treatment of the control group in externally sponsored clinical trials is the issue of one of the most heated debates in international research ethics. The paradigmatic cases are the mother-to-child HIV-transmission trials that took place in 16 developing countries in 1997, where the control group received a placebo while proven treatment was available in industrialized countries. From this circumstance results the controversy as to whether the sponsor and researchers of externally sponsored trials have to supply a treatment that is usually not available in the host country. From the beginning of the debate the controversial level of treatment has been called “standard of care”. However, besides the disagreement about the quality of the care that has to be supplied, there is as yet no widely accepted clear meaning of this concept. This article examines the fundamental ambiguity of the term and its formal function as an ethical criterion including suggestions on its further use. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

John Dewey on Educating the Moral Self

Despite the affirmation below from a chapter entitled “The Moral Self” in his Ethics (1932), Deweyseems not to have used the term “moralself” outside that context. Perhaps he didn’t think it that crucial in his overall philosophy. I argue, on the contrary, that the concept ofthe moralself is fundamental to Deweyan moral psychology and that it provides an illuminating lens through which to view his philosophy of education. This paper explicates Dewey’s perspective on moral education as education of the moral self.     

Ethics in an operations management course

Graduates of the management major at the University of Pittsburgh at Greensburg find employment in a variety of organizations. As future managers with employees from different professions, students expressed an interest in discussing ethics cases in the operations management class. The semester starts with students familiarizing themselves with various professional and corporate codes of ethics. Throughout the semester a number of short ethics’ cases in operations’ areas such as inventory management, scheduling, facility location, and product design are introduced to illustrate ethical issues that a manager and his/her employees might face. Students prepare individual responses before the in-class discussions. The semester ends with a long group ethics case discussion and formal case presentations. In the end-of-semester survey, students responded very favorably to an ethics component in the operations management class. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.     

Can drug patents be morally justified?

This paper offers a few elements of an answer to the question to what extent drug patents can be morally justified. Justifications based on natural rights, distributive justice and utilitarian arguments are discussed and criticized. The author recognizes the potential of the patents to benefit society but argues that the system is currently evolving in the wrong direction, particularly in the field of drugs. More than a third of the world’s population has no access to essential drugs. The working of the patent system is an important determinant of access to drugs. This paper argues that drug patents are not easily justified and that the ‘architecture’ of the patent system should be rethought in view of its mission of benefiting society. 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 author is a part-time Senior Research Fellow of the Fund for Scientific Research, Department of Philosophy and Moral Science, Ghent University (Belgium) and a part-time Professor, Department of General Economics, University of Antwerp (Belgium).     

Reasonable Partiality and Animal Ethics

Moral psychology is often ignored in ethical theory, making applied ethics difficult to achieve in practice. This is particularly true in the new field of animal ethics. One key feature of moral psychology is recognition of the moral primacy of those with whom we enjoy relationships of love and friendship – philia in Aristotles term. Although a radically new ethic for animal treatment is emerging in society, its full expression is severely limited by our exploitative uses of animals. At this historical moment, only the animals with whom we enjoy philia – companion animals – can be treated with unrestricted moral concern. This ought to be accomplished, both for its own sake and as an ideal model for the future evolution of animal ethics.     

Health Care Reform: What History Doesn’t Teach

The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician’s role in managed care take root in medicine’s past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical narratives can function as “master narratives” that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform.     

Organizing Muslim Virtue: Community Organizing,Comparative Religious Ethics,and the South African Muslim Struggle Against Apartheid

While offering valuable comparative insights into models of the self and ethical formation across religious traditions, studies of virtue ethics have been critiqued for putting forward accounts which are elite-focused. Some comparative ethicists have pointed to work in religious ethics and political theology on faith-based community organizing as offering compelling case studies of non-elite ethical formation. I seek to add to this literature by performing an analysis of the theories and practices of ethical formation in the South African Muslim anti-apartheid grassroots organization known as the “Call of Islam.” The “Call of Islam” emphasized a liberation-oriented praxis and active solidarity with non-Muslim organizations for the purposes of protesting apartheid and employed a range of social practices including study circles (halaqat) and political funeral processions to prepare and equip its members for such work. As such, it not only sheds light on non-elite ethical formation, but in its cultivation of the habits and dispositions of democratic solidarity, it also serves as an Islamic example of broad-based community organizing.     

A Virtue Approach Instead of a Kantian Approach as a Solution to Major Dilemmas in Meta-ethics? A Criticism of David Carr

This contribution is a criticism of some points David Carr brings forward both in his 1991 book (Educating the Virtues) but even more so in his 1996 article in this journal (After Kohlberg: Some Implications of an Ethics of Virtue for the Theory of Moral Education and Development). With the help of a virtue approach Carr tries to solve the moral objectivism-moral relativism dilemma and the deontologism-consequentialism dilemma in ethics. I will argue that his attempt, though very interesting, suffers from some serious flaws and that, either, Carr's position is much closer to a Kantian approach than Carr thinks, or Carr's position needs a good deal of clarification.