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"Luck egalitarianism"--the idea that justice requires correcting disadvantages resulting from brute luck--has gained ground in recent years and is now the main rival to John Rawls's theory of distributive justice. Health, Luck, and Justice is the first attempt to systematically apply luck egalitarianism to the just distribution of health and health care. Challenging Rawlsian approaches to health policy, Shlomi Segall develops an account of just health that is sensitive to considerations of luck and personal responsibility, arguing that people's health and the health care they receive are just only when society works to neutralize the effects of bad luck.
Combining philosophical analysis with a discussion of real-life public health issues, Health, Luck, and Justice addresses key questions: What is owed to patients who are in some way responsible for their own medical conditions? Could inequalities in health and life expectancy be just even when they are solely determined by the "natural lottery" of genes and other such factors? And is it just to allow political borders to affect the quality of health care and the distribution of health? Is it right, on the one hand, to break up national health care systems in multicultural societies? And, on the other hand, should our obligation to curb disparities in health extend beyond the nation-state?
By focusing on the ways health is affected by the moral arbitrariness of luck, Health, Luck, and Justice provides an important new perspective on the ethics of national and international health policy.
The Points of Conflict
Where should physicians get their ethics? Professional codes such as the Hippocratic Oath claim moral authority for those in a particular field, yet according to medical ethicist Robert Veatch, these codes have little or nothing to do with how members of a guild should understand morality or make ethical decisions. While the Hippocratic Oath continues to be cited by a wide array of professional associations, scholars, and medical students, Veatch contends that the pledge is such an offensive code of ethics that it should be summarily excised from the profession. What, then, should serve as a basis for medical morality?
Building on his recent contribution to the prestigious Gifford Lectures, Veatch challenges the presumption that professional groups have the authority to declare codes of ethics for their members. To the contrary, he contends that role-specific duties must be derived from ethical norms having their foundations outside the profession, in religious and secular convictions. Further, these ethical norms must be comprehensible to lay people and patients. Veatch argues that there are some moral norms shared by most human beings that reflect a common morality, and ultimately it is these generally agreed-upon religious and secular ways of knowing—thus far best exemplified by the 2005 Universal Declaration on Bioethics and Human Rights—that should underpin the morality of all patient-professional relations in the field of medicine.
Hippocratic, Religious, and Secular Medical Ethics is the magnum opus of one of the most distinguished medical ethicists of his generation.
Debates about Biotechnology and the Environment
Going back at least to the writings of John Stuart Mill and Jean-Jacques Rousseau, people have argued for and against maintaining a state of nature. Is there an inherent virtue in leaving alone a naturally occurring condition, or does the human species thrive when we find ways to improve our circumstances? This volume probes whether “nature” and “the natural” are capable of guiding moral deliberations in policy making. Drawing on philosophy, religion, and political science, this book examines three questions central to debates over the idea of “nature” in human action. Conceptually, it asks what the term means, how it should be considered, and if it is, even in part, a social construct. From a moral perspective, the contributors question if being “natural” is itself of value or if its worth is only as a means to advance other morally acceptable ends. Politically, essays discuss whether appeals to nature can and should affect public policy and, if so, whether they are moral trump cards or should instead be fitted alongside or weighed against other concerns. Achieving consensus on these questions has proven elusive and seems unattainable. This should not, however, be an obstacle to moving the debate forward. By bringing together disparate approaches to addressing these concepts, The Ideal of Nature suggests the possibility of intermediate positions that move beyond the usual full-throated defense and blanket dismissal found in much of the debate. Scholars of bioethics, environmental philosophy, religious studies, sociology, public policy, and political theory will find much merit in this book’s lively discussion.
Making Life and Death Decisions after Terri Schiavo
Every day, thousands of people quietly face decisions as agonizing as those made famous in the Terri Schiavo case. Throughout that controversy, all kinds of people--politicians, religious leaders, legal and medical experts--made emphatic statements about the facts and offered even more certain opinions about what should be done. To many, courts were either ordering Terri's death by starvation or vindicating her constitutional rights. Both sides called for simple answers. ###If That Ever Happens to Me# details why these simple answers were not right for Terri Schiavo and why they are not right for end-of-life decisions today.
Vol. 1 (2008) through current issue
IJFAB: International Journal of Feminist Approaches to Bioethics is committed to sustaining and expanding the network of scholars in feminist bioethics. The journal is:
The Development of Obstetric Ultrasound
To its proponents, the ultrasound scanner is a safe, reliable, and indispensable aid to diagnosis. Its detractors, on the other hand, argue that its development and use are driven by the technological enthusiasms of doctors and engineers (and the commercial interests of manufacturers) and not by concern to improve the clinical care of women. In some U.S. states, an ultrasound scan is now required by legislation before a woman can obtain an abortion, adding a new dimension to an already controversial practice. Imaging and Imagining the Fetus engages both the development of a modern medical technology and the concerted critique of that technology. Malcolm Nicolson and John Fleming relate the technical and social history of ultrasound imaging—from early experiments in Glasgow in 1956 through wide deployment in the British hospital system by 1975 to its ubiquitous use in maternity clinics throughout the developed world by the end of the twentieth century. Obstetrician Ian Donald and engineer Tom Brown created ultrasound technology in Glasgow, where their prototypes were based on the industrial flaw detector, an instrument readily available to them in the shipbuilding city. As a physician, Donald supported the use of ultrasound for clinical purposes, and as a devout High Anglican he imbued the images with moral significance. He opposed abortion—decisions about which were increasingly guided by the ultrasound technology he pioneered—and he occasionally used ultrasound images to convince pregnant women not to abort the fetuses they could now see. Imaging and Imagining the Fetus explores why earlier innovators failed where Donald and Brown succeeded. It also shows how ultrasound developed into a "black box" technology whose users can fully appreciate the images they produce but do not, and have no need to, understand the technology, any more than do users of computers. These "images of the fetus may be produced by machines," the authors write, "but they live vividly in the human imagination."
Ethical Issues and Challenges
This thought-provoking study examines the ethical, legal, and social problems that arise with cutting-edge medical technology. Using as examples four powerful and largely unregulated technologies—off-label use of drugs, innovative surgery, assisted reproduction, and neuroimaging—Margaret L. Eaton and Donald Kennedy illustrate the difficult challenges faced by clinicians, researchers, and policy makers who seek to advance the frontiers of medicine safely and responsibly. Supported by medical history and case studies and drawing on reports from dozens of experts, the authors address important practical, ethical, and policy issues. They consider topics such as the responsible introduction of new medical products and services, the importance of patient consent, the extent of the duty to mitigate harm, and the responsibility to facilitate access to new medical therapies. This work's insights into the nature and consequences of medical innovation contribute to the national debate on how best to protect patients while fostering innovation and securing benefits.
Vol. 1 (1991) through current issue
Now in its third decade of publication, the Kennedy Institute of Ethics Journal (KIEJ) is an interdisciplinary quarterly journal of the Joseph and Rose Kennedy Institute of Ethics at Georgetown University in Washington, D.C. It publishes philosophically rigorous and empirically informed articles in all areas of bioethics (broadly construed) and on related issues in practical ethics. The KIEJ has recently focused on publishing papers that explore ethical and social issues in science practice, as well as philosophical approaches to health, environmental, and science policy, especially those which situate philosophical and ethical issues in a global context.
Human Organs, Transplantation, and the Market
Over the past decade in the United States, nearly 6,000 people a year have died waiting for organ transplants. In 2003 alone, only 20,000 out of the 83,000 waiting for transplants received them--in anyone's eyes, a tragedy. Many of these deaths could have