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.     

Hotep's Story: Exploring the Wounds of Health Vulnerability in the US

A wide variety of forms of domination hasresulted in a highly heterogeneous health riskcategory, ``the vulnerable.' The study of healthinequities sheds light on forces thatgenerate, sustain, and alter vulnerabilities toillness, injury, suffering and death. Thispaper analyzes the case of a high-risk teenfrom a Boston ghetto that illuminatesintersections between ``race' and class in theconstruction of vulnerability in the US.Exploration of his ``wounds' helps specify howlarge-scale social and cultural forces becomeembodied as individual experience of disparatehealth risk. The case demonstrates that healthinequities would not occur if resources –employment, income, wealth, education, housing,profiling in the legal system, and health care– were more justly managed in keeping withstandards outlined in the Universal Declarationof Human Rights. Professional responses to the``wounds of vulnerability' may reveal importantaspects of who we are and what our work asscholars, practitioners, and advocates mustbecome.     

Global Progress I: Empirical Evidence for ongoing Increase in Quality-of-life

This paper argues that both the relativist and the pessimist critiques of the idea of progress are inadequate. Progress is defined as increase in global quality of life (QOL). Such QOL is intrinsically subjective, but not relative. It can be reliably measured through life satisfaction-type questions. The World Database of Happiness provides extensive data on social, economic and psychological factors that correlate with overall QOL. They include wealth, health, security, knowledge, freedom and equality. Various statistical data suggest that all these QOL indicators have undergone significant improvements during the last half century, in most of the world. This gives strong support to the thesis that progress objectively occurs.     

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.     

Nanotechnology — A new field of ethical inquiry?

Parallel to the public discussion on the benefits and risks of nanotechnology, a debate on the ethics of nanotechnology has begun. It has been postulated that a new “nano-ethics” is necessary. In this debate, the — positive as well as negative — visionary and speculative innovations which are brought into connection with nanotechnology stand in the foreground. In this contribution, an attempt is made to discover new ethical aspects of nanotechnology in a more systematic manner than has been the case. It turns out that there are hardly any completely new ethical aspects raised by nanotechnology. It is much rather primarily a case of gradual shifts of emphasis and of relevance in questions which, in principle, are already known and which give reason for ethical discussions on nanotechnology. In a certain manner, structurally novel ethical aspects arise through the important role played by visions in the public discourse. New questions are also posed by the fact that previously separate lines of ethical reflection converge in the field of nanotechnology. The proposal of an independent “nano-ethics”, however, seems exaggerated.     

The Duty to Eradicate Global Poverty: Positive or Negative?

In World Poverty and Human Rights, Thomas Pogge argues that the global rich have a duty to eradicate severe poverty in the world. The novelty of Pogges approach is to present this demand as stemming from basic commands which are negative rather than positive in nature: the global rich have an obligation to eradicate the radical poverty of the global poor not because of a norm of beneficence asking them to help those in need when they can at little cost to themselves, but because of their having violated a principle of justice not to unduly harm others by imposing on them a coercive global order that makes their access to the objects of their human right to subsistence insecure. In this paper, I claim that although Pogge is right in arguing that negative duties are crucial in an account of global justice, he is wrong in saying that they are the only ones that are crucial. Harming the global poor by causing their poverty provides a sufficient but not a necessary condition for the global rich to have a duty of justice to assist them. After engaging in a critical analysis of Pogges argument, I conclude by suggesting the need for a robust conception of cosmopolitan solidarity that includes positive duties of assistance which are not mere duties of charity, but enforceable ones of justice.     

The Ethics of Type 1 Diabetes Prediction and Prevention Research

There are approximately one million cases oftype 1 diabetes in the US, and the incidenceis increasing worldwide. Given that two-thirdsof cases present in childhood, it is criticalthat prediction and prevention research involvechildren. In this article, I examine whethercurrent research methodologies conform to theethical guidelines enumerated by the NationalCommission for the Protection of Human Subjectsof Biomedical and Behavioral Research, andadopted into the federal regulations thatprotect research subjects. I then offer twopolicy recommendations to help researchersdesign studies that conform to these ethicalrequirements.     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

The ‘Medical Body’ As Philosophy's Arena

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: (i) as a salutary reminder of the extent to which thereality even of the human body is constructed; and (ii) as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy's traditional (and traditionally abstract) questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate.