Kennedy Institute of Ethics journal
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Philosophers have mostly advocated that advance directives should bear the same authority, with regard to refusal of life-extending treatment, as a patient's contemporaneous consent or refusal. Such authors typically support this position through a theory of persistent personal identity. I agree that the loss of mental competence does not render someone a moral stranger to their prior goal but argue that equating advance direction with consent is to ignore the capacity of nonpersons to attribute and withhold moral value. A distinction should be drawn between advance directives that seek to pursue deeply held goals and those that express contempt for the mentally incompetent.
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Kennedy Inst Ethics J · Sep 2011
Biodefense research and the U.S. regulatory structure whither nonhuman primate moral standing?
Biodefense and emerging infectious disease animal research aims to avoid or ameliorate human disease and suffering arising from the natural outbreak or intentional deployment of some of the world's most dreaded pathogens. Research to develop medical countermeasures to these diseases faces a difficult challenge since the products usually cannot be tested for efficacy in human beings. The U. ⋯ S. regulations guiding animal research, the Animal Rule specifically and the regulations generally raise serious problems for the attribution of moral standing to nonhuman primates. We argue, however, that the burden of proof is on a position denying all moral standing to nonhuman primates and compare the implications of the U. S. regulatory structure in this regard with some recent developments in the European Union.
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The decision to terminate a clinical trial earlier than planned is often described as ethically problematic, but it is rarely systematically analyzed as an ethical issue in its own right. This paper provides an overview of the main ethical considerations at stake in such decisions and of the main tensions between these considerations. ⋯ Should the trial be stopped so that participants in the control group will not be allocated a seemingly inferior treatment, or should it continue in pursuit of evidence conclusive enough to improve the care of future patients? We scrutinize three ways to address this problem. Rather than dissolving the tension, they represent different trade-offs between the respective welfare interests of subjects and future patients.
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An ethics of enhancement should not rest on blanket judgments; it should ask us to distinguish between the kinds of activities we want to enhance. Both students and academics have turned to cognition-enhancing drugs in significant numbers--but is their enhancement a form of cheating? The answer should hinge on whether the activity subject to enhancement is zero-sum or non-zero-sum, and whether one is more concerned with excellence in process or excellence in outcome. Cognitive enhancement should be especially tolerated when the activities at stake are non-zero-sum and when the importance of process is outweighed by the importance of outcome. The use of cognition-enhancing drugs does not unnaturally cheapen accomplishments achieved under their influence; instead, cognitive enhancement is in line with well-established conceptions of collaborative authorship, which shift the locus of praise and blame from individual creators to the ultimate products of their efforts.
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The standard notion of autonomy in medical ethics does not require that autonomous choices not be irrational. The paper gives three examples of seemingly irrational patient choices and discusses how a rational autonomy analysis differs from the standard view. ⋯ Furthermore, respect for rational autonomy entails strong positive requirements of respect for the autonomy of the person as a rational decision maker. The rationality view of autonomy is conceptually stronger than the standard view, allows for a more nuanced understanding of the practical moral calculus involved in respecting patient autonomy, and promotes positive respect for patient autonomy.