This paper argues that the Quality Adjusted Life Year or QALY is fatally flawed as a way of priority setting in health care and of dealing with the problem of scarce resources. In addition to showing why this is so the paper sets out a view of the moral constraints that govern the allocation of health resources and suggests reasons for a new attitude to the health budget.

Is there such a thing as a social conception of disability? Recently two writers in this journal have suggested not only that there is a coherent social conception of disability but that all non-social conceptions, or “medical models” of disability are fatally flawed. One serious and worrying dimension of their claims is that once the social dimensions of disability have been resolved no seriously “disabling” features remain. This paper examines and rejects conceptions of disability based on social factors but notes (...) that physical and mental conditions which disadvantage the individual have social dimensions. (shrink)

The ethical implications of human clones have been much alluded to, but have seldom been examined with any rigour. This paper examines the possible uses and abuses of human cloning and draws out the principal ethical dimensions, both of what might be done and its meaning. The paper examines some of the major public and official responses to cloning by authorities such as President Clinton, the World Health Organisation, the European parliament, UNESCO, and others and reveals their inadequacies as foundations (...) for a coherent public policy on human cloning. The paper ends by defending a conception of reproductive rights of "procreative autonomy" which shows human cloning to be not inconsistent with human rights and dignity. (shrink)

Biomedical research is so important that there is a positive moral obligation to pursue it and to participate in itScience is under attack. In Europe, America, and Australasia in particular, scientists are objects of suspicion and are on the defensive.i“Frankenstein science”5–8 is a phrase never far from the lips of those who take exception to some aspect of science or indeed some supposed abuse by scientists. We should not, however, forget the powerful obligation there is to undertake, support, and participate (...) in scientific research, particularly biomedical research, and the powerful moral imperative that underpins these obligations. Now it is more imperative than ever to articulate and explain these obligations and to do so is the subject and the object of this paper.Let me present the question in its starkest form: is there a moral obligation to undertake, support and even to participate in serious scientific research? If there is, does that obligation require not only that beneficial research be undertaken but also that “we”, as individuals and “we” as societies be willing to support and even participate in research where necessary?Thus far the overwhelming answer given to this question has been “no”, and research has almost universally been treated with suspicion and even hostility by the vast majority of all those concerned with the ethics and regulation of research. The so called “precautionary approach”9 sums up this attitude, requiring dangers to be considered more likely and more serious than benefits, and assuming that no sane person would or should participate in research unless they had a pressing personal reason for so doing, or unless they were motivated by a totally impersonal altruism. International agreements and protocols—for example, the Declaration of Helsinki10 and the CIOMS Guidelines11—have been directed principally at …. (shrink)

Many people question whether God is the source of morality. Under divine command theory, God's will creates the moral order, and therefore ethical truths are true because of God's will. Under natural law, on the other hand, some ethical truths do not depend on God's will, and yet perhaps they depend on his reason or creation. Ethics and Religion develops strong, defensible, and original versions of both divine command theory and natural law. The book also discusses ethics and atheism: how (...) atheists object on ethical grounds to belief in God and how they view ethics. The book defends belief in God from criticisms and analyzes related concepts, such as practical reason, the golden rule, ethics and evolution, the problem of evil, and the fine-tuning argument. (shrink)

Abstract:Work on stakeholder theory has proceeded on a variety of fronts; as Donaldson and Preston (1995) have noted, such work can be parsed into descriptive, instrumental, and normative research streams. In a normative vein, Phillips (1997) has made an argument for a principle of fairness as a means of identifying and adjudicating among stakeholders. In this essay, I propose that a reconstructed principle of fairness can be combined with the idea of consent as outlined in integrative social contract theory (ISCT) (...) to bring about a more normative stakeholder theory that also has ramifications for corporate governance. (shrink)

Religion has been in general neglected or even seen as a taboo subject in organizational research and management practice. This is a glaring omission in the business and society and business ethics literatures. As a source of moral norms and beliefs, religion has historically played a significant role in the vast majority of societies and continues to remain relevant in almost every society. More broadly, expectations for responsible business behavior are informed by regional, national, or indigenous cultures, which in many (...) parts of the world are heavily influenced by religious belief systems and religious institutions. In this essay, we discuss examples of how religion has functioned as a macro social force affecting business and society, discuss some of the key questions and issues related to research in this domain, offer some observations about why religion may be problematic with regard to its effects on business, and conclude by summarizing the articles contained in the special issue. (shrink)

Frantz Fanon’s works have been invaluable in the analysis of colonies and the colonized subject’s mentality therein, but an analysis of the colonial power itself has been largely left to the wayside. The aim of this paper is to explicate a key element of Fanon’s theoretical framework, the metropolis/periphery dichotomy, then, using the writings of Huey P. Newton and Stokely Carmichael, among others, show its reversal within the colonial power. I will analyze this reversal in three ways: first, the reversal (...) of the relationship between, and the roles of, the metropolis and periphery; second, the role of police and the differences between the colonial police and the police within the colonial power; and third, the modified role of prisons within the colonial power. (shrink)

The 25th anniversary of R. Edward Freeman’s Strategic Management: A Stakeholder Approach provides an opportunity to consider where stakeholder theory has been, where it is going, and how it might influence the behavior of academics conducting stakeholder-oriented research. We propose that Freeman’s early work on the stakeholder concept supports the normative claim that a stakeholder’s contribution to value creation implies a right to stakeholder voice with regard to how a corporation makes decisions. Failure to account for stakeholder voice (especially for (...) non-shareholder stakeholders) works to the detriment of stakeholders. We further propose that business ethicists and stakeholder scholars have a role to play with regard to supporting the interests — including a right to voice — of non-shareholder stakeholders through advocacy, teaching, and scholarship. We use the example of industrial relations teaching and scholarship as a model for future business ethics teaching and scholarship. (shrink)

NICE must not say people are not worth treatingThe National Institute for Health and Clinical Excellence has proposed that drugs for the treatment of dementia be banned to National Health Service patients on the grounds that their cost is too high and “outside the range of cost effectiveness that might be considered appropriate for the NHS”i.1This is despite NICE’s admission that these drugs are effective in the treatment of Alzheimer’s disease and despite NICE having approved even more expensive treatments. The (...) effect is that thousands of Alzheimer’s patients will be denied the only treatment available. It is difficult to think of this as anything but wickedness or folly or more likely both. At the same time, and with no apparent sense of irony, NICE has launched a public consultation document3 on its guidelines on social value judgments. As we shall see these guidelines are ethically illiterate as well as socially divisive.Assuming permanently scarce resources it is clearly crucial that such healthcare resources as are available are not wasted. This point is often made in terms of cost effectiveness and it is argued, not implausibly, that to talk of cost effectiveness implies that we are able to measure just how cost effective each treatment is. To do so of course we need a standard of measurement. NICE has adopted the ubiquitous, but justly infamous QALY, the Quality Adjusted Life Year.The QALY combines life expectancy after treatment with measures of the expected quality of that life. There are two ways in which QALYS can be used. They might be used to determine which of rival therapies to give to a particular patient or which procedure to use to treat a particular condition, in short which of two different treatments is the more …. (shrink)

This one-volume encyclopedia of logic introduces the central concepts of the field in a series of brief, non-technical, cross-referenced dictionary entries. The 352 alphabetically arranged entries give a clear, basic introduction to a very broad range of logical topics.

This article states that drugs could be used to produce, if not more intelligent individuals, at least individuals with better cognitive functioning. Cognitive functioning is something that we might strive to produce through education, including of course the more general health education of the community. Enhancements are good if and only if they make people better at doing some of the things they want to do including experiencing the world through all of the senses, assimilating and processing what is experienced, (...) remembering and understanding things better, becoming more competent, and experiencing more. Beneficial neural changes have been reported for such familiar technologies as reading, education, physical exercise, and diet. Smart drugs create irresistible competitive pressures such that once they are used everyone is forced to follow in order to keep up, and this is coercive and corrosive. (shrink)

The bottom line is that Claxton and Culyer believe, and are on record as saying, that a therapy or procedure is not cost effective if “the health benefits that it is estimated could be gained from the technology are less than those estimated to be forgone by other patients as other procedures are necessarily curtailed or not undertaken. It is this comparison of health gained and health forgone that is at the heart of the rationale of cost-effectiveness analysis”. To estimate (...) whether the gains made …. (shrink)

This paper argues that Sulmasy and Sugarman have not succeeded in showing a moral difference between withholding and withdrawing treatment. In particular, they have misunderstood historical entitlement theory, which does not automatically prefer a first occupant by just acquisition.

There is a popular and widely accepted version of the precautionary principle which may be expressed thus: “If you are in a hole—stop digging!”. Tom Baldwin, as Deputy Chair of the Human Fertilisation and Embryology Authority , may be excused for rushing to the defence of the indefensible,1 the HFEA’s sex selection report,2 but not surely for recklessly abandoning so prudent a principle. Baldwin has many complaints about my misrepresenting the HFEA and about my supposed elitist contempt for public opinion; (...) readers of this exchange will decide for themselves.REDRAFTING THE REPORTBaldwin begins with a piece of wishful thinking:"Harris objects that in this recommendation “an absurdly high standard of caution is employed”, since a theoretical risk is associated with almost all medical procedures. This objection is misplaced: as paragraph 142 of the report indicates, the phrase “theoretical risk” is to be understood here in the light of the earlier discussion of the risks arising from the fact that flow cytometry exposes sperm to laser energy, a procedure which is known to be liable to damage DNA."Paragraph 142 does not make that clear. It does indeed refer back to a set of earlier paragraphs but these give, if anything, an upbeat assessment of the safety of flow cytometry. Paragraph 121 states: “However whilst potentially less intrusive, and with potentially lower risk to the health of patients, flow cytometry …” .2 But even if the overall burden of the report does indicate unresolved fears, the standard is still absurdly high. However, so far from endorsing the report’s judgement that flow cytometry has “potentially lower risk to the health of patients”, Baldwin now regards the risk of flow cytometry as “serious”1:"Since the application of flow cytometry to humans is a new procedure, the risk of … ". (shrink)

Wilkins and Wakefield's hypothesis that language is fundamentally a cognitive rather than cominunicational adaptation is reasonable, but there are flaws in their anatomical and fossil evidence. Their analysis of reorganization also needs clarification. Finally, the origin of language ability must have occurred with australopithecine rather than habiline adaptations on entry into the novel hominid adaptive zone.

It is commonly accepted that the golden rule—most often formulated as "do unto others as you would have them do unto you"—is a unifying element between many diverse religious traditions, both Eastern and Western. Its influence also extends beyond such traditions, since many non-religious individuals hold up the golden rule as central to their lives. Yet, while it is extraordinarily important and widespread, the golden rule is often dismissed by scholars as a vague proverb that quickly leads to absurdities when (...) one attempts to formulate it in clear terms. In this book, Harry J. Gensler defends the golden rule and addresses all of the major philosophic objections, pointing out several common misunderstanding and misapplications. Gensler first discusses golden-rule reasoning and how to avoid the main pitfalls. He then relates the golden rule to world religions and history, and to areas like moral education, egoism, evolution, society, racism, business, and medicine. The book ends with a discussion of theoretical issues . Ethics and the Golden Rule offers two introductory chapters, the first is simpler and the second more technical; a reader may start with either or both. One can then read any combination of further chapters, in any order, depending on one’s interests; but Chapters 13 and 14 are technical and assume one has read Chapter 2. This is "a golden-rule book for everyone," accessible to a wide readership. (shrink)

In this paper a plea is made for an unprincipled approach to biomedical ethics, unprincipled of course just in the sense that the four principles are neither the start nor the end of the process of ethical reflection. While the four principles constitute a useful “checklist” approach to bioethics for those new to the field, and possibly for ethics committees without substantial ethical expertise approaching new problems, it is an approach which if followed by the bioethics community as a whole (...) would, the author believes, lead to sterility and uniformity of approach of a quite mindbogglingly boring kind. Moreover, much of bioethics is not concerned with identifying the principles or values appropriate to a particular issue, but rather involves analysing the arguments that are so often already in play and which present themselves as offering solutions in one direction or another. Here, as I try to show in discussion of these four scenarios, the principles allow massive scope in interpretation and are, frankly, not wonderful as a means of detecting errors and inconsistencies in argument. (shrink)

This paper begins to explore how corporate social responsibility (CSR) has evolved in Mexico. It looks at Mexico's social and political history to see the values that shaped expectations about how Mexican firms should address the needs and desires of their stakeholders in various periods in the 20th century. Particular attention is given to firms in Monterrey because they pioneered a form of company paternalism that reflected early CSR initiatives. Finally the paper briefly examines some contemporary CSR practices by large (...) Mexican firms. The paper begins to fill a gap in the business-andsociety literature about CSR practices outside the U.S. and Western European countries, which have received most attention by business-and-society scholars. (shrink)

Do doctors and other medical staff have an obligation to treat those who need their help? This paper assumes no legal or contractual obligations but attempts to discover whether there is any general moral obligation to treat those in need. In particular the questions of whether or not the obligation that falls on medical staff is different from that of others and of whether doctors are more blameworthy than others if they fail to treat patients are examined. Finally we look (...) at the question of the burden of this obligation and at the responsibility of society to mitigate its hardships. (shrink)

This paper continues the debate between myself and Peter Singer et al started in the Journal of Medical Ethics volume 21, no 3 about the ethical respectability of the use of QALYs in health care allocation. It discusses the question of what, in the way of health care provision, would be chosen by rational egoists behind a Rawlsian "veil of ignorance", and takes forward the vexed question of what is to count as "doing good" and hence as "doing the most (...) good" in health care. Most importantly, this paper argues that it would be unfair to discriminate against people because they have been disadvantaged by their genetic condition. It notes that McKie et al in their reply to my first contribution to this debate continue to fail to distinguish between chance and probability and it is argued that this failure causes them to miss the whole point of the argument. (shrink)

This paper examines some of the arguments advanced and acted upon by doctors concerned in decisions about whether severely handicapped patients should live or die. It criticises the view that 'selective treatment' is morally preferable to infanticide and shows how the standard arguments advanced for this preference fail to sustain it. It argues that the self-deception, which is sometimes cited as a sign of humanity in these cases, and which is implicit in the term 'selective treatment' is more dangerous than (...) is the remote chance of brutalisation which is often cited as the danger of active euthanasia. (shrink)

In his invited essay for Business & Society’s 60th anniversary, Archie B. Carroll (2021, p. 16) refers to human rights as “a topic that holds considerable promise for CSR [corporate social responsibility] researchers in the future.” The objective of this article is to unpack this promise. We (a) discuss the momentum of business and human rights (BHR) in international policy, national regulation, and corporate practice, (b) review how and why BHR scholarship has been thriving, (c) provide a conceptual framework to (...) analyze how BHR and corporate social responsibility (CSR) relate to each other, and (d) provide a research agenda outlining how BHR can expand business and society scholarship in general and one of its foundational constructs, CSR, in particular, beyond the current confines of the business and society field. (shrink)

This paper discusses the provocative views of Skene and Parker as to the role of religious or other ideologically based interest groups in law and policy making. We draw distinctions between doctrine and prejudice and between argument and ideology which we trust take the debate further. Finally we recommend an ethereal, democratic, and populist partial solution.

Abstract:Boundaryless careers may be beneficial to people with rare and valuable skills, but might prove harmful to many others. The idea ofemployabilityas an ethical responsibility of employers to employees is introduced; it is argued that attention to employability in private practice and public policy partially resolves the ethical problems inherent to in boundaryless careers. Because employability programs are considered to be voluntary, some means of holding employers accountable for such responsibilities needs to be considered when discussing boundaryless careers. Implications for (...) practice and public policy are also discussed. (shrink)

A rupture has occurred–something is no longer quite as it was. Our current environmental crisis, climate catastrophe,has left us floundering without words for after three decades of popular ecological writing and decades more of scientificstudies nothing has yet been done to avert our path from its terminal arc. It is a weird occurrence for our words seeminsufficient, our categories incapacitated, and our understanding too flawed to comprehend it. Yet, it is a disasterwhich has already occurred–it is a disaster which we (...) live in the midst of and yet still lack the language with which tospeak. The greatest danger of such an epoch, according to Blanchot, is that, out of convenience, we use an outdatedand unsuitable language to attempt reconciliation. Rather than attempting to apply logical and nomical systems andconcepts to a catastrophe, which is catastrophic precisely because it obsolesces such ways of thinking, a new mode ofthought, of language, is required if climate catastrophe is to be properly understood and addressed. Utilizing the textsof Roland Barthes, Karen Barad, Maurice Blanchot and Timothy Morton, as well as the weird fiction of H.P.Lovecraft, I intend to demonstrate not only the pitfalls of our current agrilogistical approach to climate catastrophe,but also a potential eco-deconstructive alternative that would allow significant change to occur. (shrink)