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)

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.

No tragic poet uses the phrase μxs22EFνος πνxs22EFουσαν, except Aeschylus, who employs it in describing the Erinyes, not a Greek maiden. Similarly Homer of his ‘Mut-schnaubende’ heroes and of the savage steeds of Diomed. Hence, in the Sophoclean passage, some scribe may have mistaken the familiar ΜΕΝΟCΠΝΕΟΤCΑΝ for the more unusual ΜΕΝΕΙCΙCΤΝΟΤCΑΝ. Initial C attached itself to the preceding word, and ΤΝΟΤCΑΝ became ΠΝΟΤCΑΝ, which was promptly changed to πνxs22EFουσαν.

Harry Gensler engages the reader with the basics of logic through practical examples and important arguments in the history of philosophy and from contemporary philosophy.

Intuitionists and classical logicians use in common a large number of the logical axioms, even though they supposedly mean different things by the logical connectives and quantifiers — conquans for short. But Wittgenstein says The meaning of a word is its use in the language. We prove that in a definite sense the intuitionistic axioms do indeed characterize the logical conquans, both for the intuitionist and the classical logician.

"Introduces the issues and controversies of contemporary moral philosophy. It gets students to struggle with the big questions of morality while it also relates these questions to practical issues, especially racism, global warming, moral education, and abortion. Providing a practical method for thinking about moral issues--a method based largely on the golden rule--it is written simply and clearly throughout."--Provided by publisher.

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)

When philosophers put forward claims for or against 'property', it is often unclear whether they are talking about the same thing that lawyers mean by 'property'. Likewise, when lawyers appeal to 'justice' in interpreting or criticizing legal rules we do not know if they have in mind something that philosophers would recognize as 'justice'. J. W. Harris here examines the legal and philosophical underpinnings of the concept of property and offers a new analytical framework for understanding property and justice.

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)

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)

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)

I criticize various anti- and pro-abortion arguments. then, using the principle that a consistent person who thinks it permissible to do a to another will also consent to the idea of someone doing a to him in similar circumstances, i argue that most people could not consistently hold that abortion is normally permissible. i discuss possible objections and distinguish my view from hare's.

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)

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)

There are two well‐known ways of doing arithmetic with ordinal numbers: the “ordinary” addition, multiplication, and exponentiation, which are defined by transfinite iteration; and the “natural” (or “Hessenberg”) addition and multiplication (denoted ⊕ and ⊗), each satisfying its own set of algebraic laws. In 1909, Jacobsthal considered a third, intermediate way of multiplying ordinals (denoted × ), defined by transfinite iteration of natural addition, as well as the notion of exponentiation defined by transfinite iteration of his multiplication, which we denote. (...) (Jacobsthal's multiplication was later rediscovered by Conway.) Jacobsthal showed these operations too obeyed algebraic laws. In this paper, we pick up where Jacobsthal left off by considering the notion of exponentiation obtained by transfinitely iterating natural multiplication instead; we shall denote this. We show that and that ; note the use of Jacobsthal's multiplication in the latter. We also demonstrate the impossibility of defining a “natural exponentiation” satisfying reasonable algebraic laws. (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)

Correspondence to: John Harris The Centre for Social Ethics and Policy, Institute of Medicine Law and Bioethics, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 0JH, UK; [email protected] and Culyer1 have written an interesting and considered response, as people intimately connected to the National Institute for Health and Clinical Excellence , to the two editorials that I wrote on recent NICE decisions. Before commenting on their response, I would like to consider a point they made, which (...) echoes a point already made by Rawlins and Dillon,2 about the tone of my editorials. Claxton and Culyer accuse me of making “personally abusive charges”. In my original editorial, I criticised an institution, NICE, in robust terms, but in doing so I was continuing a long and respected tradition in English philosophy. Consider the following extract from Jeremy Bentham:" In English law, fiction is a syphilis, which runs in every vein, and carries into every part of the system the principle of rottenness...Fiction of use to justice? Exactly as swindling is to trade...It affords presumptive and conclusive evidence of moral turpitude in those by whom it was invented and first employed.3"My remarks were not an ad hominem criticism of anyone but directed at the published, but anonymous statements of an institution—a body corporate. In robustly criticising NICE, I no more attacked any individual associated with NICE than I attacked Tony Blair or the various ministers of state who are ultimately responsible for NICE. And, contra Claxton and Culyer’s claims, I have not denigrated the views of people who beg to differ from me.i If the apologists for NICE, whether they are Tony Culyer or Tony Blair, choose to identify themselves with criticism of NICE, that is entirely a matter for them. The only ad hominem remarks in this entire exchange have been made by Rawlins and Dillon, and Claxton and Culyer. The idea that criticism of the anonymously authored publications of …. (shrink)

_Ethics_ introduces the issues and controversies of contemporary moral philosophy to undergraduate students who have already done an introductory course in philosophy. It will help students to think more clearly about how to form their moral beliefs in the wisest and most rational way. The basic approaches to metaethics and normative ethics are related to specific issues, particularly those of racism, education, and abortion. Written in a clear and concise way by an experienced textbook author, _Ethics_ will also be of (...) interest to the general reader. Unique features of the textbook: * boxed key ideas * Glossary of philosophical terms * Chapter summaries and study questions * Annotated further reading and Internet Web resources There is an associated website for teachers and students at www.routledge.com/routledge/philosophy/cip/ethics.htm. (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)

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 the HFEA’s recent report on sex selection abdicates its responsibility to give its own authentic advice on the matters within its remit, that it accepts arguments and conclusions that are implausible on the face of it and where they depend on empirical claims, produces no empirical evidence whatsoever, but relies on reckless speculation as to what the “facts” are likely to be. Finally, having committed itself to what I call the “democratic presumption”, that human freedom will (...) not be constrained unless very good and powerful reasons can be produced to justify such infringement of liberty, the HFEA simply reformulates the democratic presumption as saying the opposite—namely that freedom may only be exercised if powerful justifications are produced for any exercise of liberty. (shrink)

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)

My paper has two parts. First, I talk about the golden rule. After introducing the rule and its global importance, I explain why many scholars dismiss it as a vague proverb that leads to absurdities when we try to formulate it clearly. I defend the golden rule against such objections. Second, I talk about the golden rule in Persia and Islam; I consider Persian sources and also non-Persian Muslim sources. I show that the golden rule is deeply rooted in Persia (...) and Islam. And I point out special ways that this tradition‘s understanding of the golden rule can contribute to those outside this tradition. (shrink)

Michael Rawlins and Andrew Dillon start their defence of Nice in fine polemical style, unfortunately polemics is all they have to offer. They totally fail to justify the Nice proposals on dementia treatments nor do they make any more plausible than formerly their use of the notorious QALY. They say:"Harris’s recent editorial, It’s not NICE to discriminate, is long on both polemic and invective – but short on scholarship. He offers nothing to illuminate the debate about allocating healthcare in circumstances (...) of finite resources; he has no understanding of the quality adjusted life year and its use in health economic evaluation; and he makes ill-researched, unsubstantiated and offensive charges against the Institute and its advisory bodies."Accusations are easy to make, difficult to substantiate. There are a number of claims here, only one of which is true. It is true that my editorial was robust, polemical if you like, but editorials are not the same as research papers and these are important issues which deeply affect real lives. Although Rawlins and Dillon affect to take the high ground their own article contains even more vigorous and much more personal invective than my editorial, I make no complaints. But as to the rest of what they say, well, let’s just see!They claim I offer nothing to illuminate resource allocation and that I have no understanding of the QALY. Both of these claims may well be true, but nothing they say goes any way to support these claims or even towards making them plausible. I have studied and written about the QALY for almost 20 years1,2,3,4,5,6,7,8,9,10,11,12,13,14,15 and Rawlins and Dillon show no evidence of any awareness or indeed any understanding of the issues, whether …. (shrink)

“Values and Cultures” argues against cultural relativism (which denies objective values and holds that good and bad are relative to culture) and argues for cultural objectivism (which holds that cultures tend to share a common core of objective values). I begin by trying to make a plausible case for cultural relativism; then I point out problems with this view. I argue for three objective values that are widely shared across cultures. Consistency claims that we ought to be consistent in thought (...) and action; this includes things like consistency in beliefs, ends and means, living in harmony with our moral beliefs, evaluating similar cases similarly, and treating others only as we’re willing to be treated in the same situation (the golden rule). Knowledge claims that we need to be informed and that false beliefs are to be avoided. Imagination claims that we need a vivid and accurate awareness of what it would be like to be in the place of those affected by our actions. Further sections deal with our evolutionary origins, various metaethical justifications, religion and ethics, and my experience of teaching ethics in the United States and China. (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.