Background: The advent of AIDS brought about a group of patients unwilling to accept crucial aspects of the methodological standards for clinical research investigating Phase 1 drugs, surgeries or devices. Their arguments against placebo controls in trials, which depended-at the time-on the terminal status of patient volunteers led to a renewed discussion of the ethics of denying patients with catastrophic illnesses access to last-chance experimental drugs, surgeries or devices. Sources of data: Existing ethics and health policy literature on the topic (...) of access to experimental drugs. Areas of agreement: The positions of those arguing for or against free access to experimental drugs for terminally ill patients are irreconcilable. Areas of controversy: At stake are questions about the kinds of personal sacrifices society can reasonably expect patients in clinical trials to make to ensure statistically predictive results. These would benefit by necessity a much larger number of current and future patients-the conflict is about individual versus public interests. It is also about the question of whether or not the state can legitimately prevent patients with terminal illnesses from unfettered access to experimental drugs, surgeries or devices in order to motivate them to participate in clinical trials. We review the ethical arguments for and against the provision of access to Phase 1 agents for terminally ill patients. Growing points: Finding a compromise between providing free or no access to Phase 1 drugs for terminally ill patients. Areas timely for developing research: We ought to investigate means to increase access to experimental drugs for terminally ill patients without sacrificing necessary clinical trials' sounds scientific methods. (shrink)

This paper examines two strategies aimed at demonstrating that moral obligations to improve global health exist. The ‘humanitarian model’ stresses that all human beings, regardless of affluence or global location, are fundamentally the same in terms of moral status. This model argues that affluent global citizens’ moral obligations to assist less fortunate ones follow from the desirability of reducing disease and suffering in the world. The ‘political model’ stresses that the lives of the world's rich and poor are inextricably linked (...) because of harmful state-to-state actions and because of the currently existing transnational institutions. These institutions’ design at once secures the high standard of living of the affluent and reinforces the continued foreseeable—and avoidable—deprivation of many of the global poor; and these give rise to compensatory health-related moral obligations beyond borders. This paper argues that political reasoning is unsuitable for the crucial task of determining priority in the receipt of health aid. We conclude that in the context of global health ethics, political reasoning must be supplemented with, if not replaced by, humanitarian reasoning. (shrink)

The essays in this book engage the original and controversial claims from Michael Boylan's A Just Society. Each essay discusses Boylan's claims from a particular chapter and offers a critical analysis of these claims. Boylan responds to the essays in his lengthy and philosophically rich reply.

Based on a close reading of the debate between Rawls and Sen on primary goods versus capabilities, I argue that liberal theory cannot adequately respond to Sen’s critique within a conventionally neutralist framework. In support of the capability approach, I explain why and how it defends a more robust conception of opportunity and freedom, along with public debate on substantive questions about well-being and the good life. My aims are: to show that Sen’s capability approach is at odds with Rawls’s (...) political liberal version of neutrality; to carve out a third space in the neutrality debate; and to begin to develop, from Sen’s approach, the idea of public value liberalism as a position that falls within that third space.En me basant sur une lecture attentive du débat entre Rawls et Sen sur les biens premiers versus les capabilités, je soutiendrai que la théorie libérale est incapable, dans un cadre neutraliste conventionnel, de répondre adéquatement à des injustices dans le domaine de la santé. À partir de l’approche des capabilités, j’explique pourquoi et comment cette approche permet de défendre une conception plus robuste de l’opportunité et de la liberté, de même qu’un débat public sur des questions substantielles concernant le bien-être et la vie bonne. Mes objectifs sont : de clarifier le rapport entre le neutralisme de Rawls et sa défense des biens premiers,, de démontrer les implications de la critique des capabilités de Sen, et, d’esquisser une troisième position dans le débat sur la neutralité versus le perfectionnisme – à savoir, celle d’un perfectionnisme motivé par des considérations de légitimité. (shrink)

This chapter contains sections titled: Introduction Doubts About Libertarianism Obligations Conclusions References Further reading.

In this review I argue that while Berger makes out a good argument that the language of civic engagement covers too much (and hence too little) and that education plays a vital role in developing civic-minded sensibilities, I am less sanguine that the strategies for the reform of our “attention deficit democracy” will achieve the desired effect in a political society dominated by the corrupting influence of corporations who actively seek to undermine just such sensibilities as anathema to their objectives. (...) As corporate objectives become more and more wedded to the state, so too reform becomes less and less likely to be successful. An excellent example of this is the power wielded by the current incarnation of the fossil fuel empire and it’s influence over law-making concerning hydraulic fracturing in Pennsylvania. While I applaud Berger’s objectives, I am no longer convinced that pragmatism and not a more revolutionary approach can fulfill Berger’s—and my own—democratic ideals. (shrink)

In this review I argue that while Berger makes out a good argument that the language of civic engagement covers too much (and hence too little) and that education plays a vital role in developing civic-minded sensibilities, I am less sanguine that the strategies for the reform of our “attention deficit democracy” will achieve the desired effect in a political society dominated by the corrupting influence of corporations who actively seek to undermine just such sensibilities as anathema to their objectives. (...) As corporate objectives become more and more wedded to the state, so too reform becomes less and less likely to be successful. An excellent example of this is the power wielded by the current incarnation of the fossil fuel empire and it’s influence over law-making concerning hydraulic fracturing in Pennsylvania. While I applaud Berger’s objectives, I am no longer convinced that pragmatism and not a more revolutionary approach can fulfill Berger’s—and my own—democratic ideals. (shrink)