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Contents

• Letter from the Editor Bo Peng
  
• Interview: Glenn McGee, PhD (Founder of the American Journal of Bioethics; Director of the Alden March Bioethics Institute)
  

Articles

• Liberal Answers to Callahan’s Communitarianism by Frances McCorkle, University of Virginia Read Abstract

  We live in an age in which medical science makes constant and dazzling advances, while scores of individuals find themselves without access to even basic care. Faced with this reality, many philosophers have determined that we simply cannot—and should not—meet all individual health needs. Daniel Callahan1 argues persuasively to this end. He concludes that since the frontier of medical progress is a movable “ragged edge” rather than a fixed boundary, and since we as individuals regularly capitulate to deep fears about disease and death, society unavoidably overspends on health care. The only way to deal with this problem is to set firm limits on health care spending based on certain sensible goals for medicine. Liberal theorists, says Callahan, are either unwilling or unable to say “No” in a coherent way to limitless health care; thus his version of communitarianism2 should be adopted. In this paper I aim to test whether individualistic theories of justice are really unequal to the task of rationing. First, I will give a brief synopsis of my understanding of Callahan’s argument, then I will evaluate the arguments of Ronald Dworkin and Norman Daniels to show that they are stronger than he claims. Finally, I will show that there are some notable commonalities between the theories of Callahan and Daniels with respect to age-based rationing, concluding that we can achieve a comprehensive rationing scheme without abandoning liberal theory in favor of a communitarian framework. ss) of a certain act.

• Public Access to Anatomical Knowledge - Intrinsic Value of the Cadaver and Plastination by Virginia Portmann, Trent University Read Abstract

  Artists have long been entrusted with elevating human dignity along with anatomists; their partnership with anatomists dates back to the Renaissance, enabling a transformation from the view of the body as a burden to the appreciation of its wondrous beauty and function. Artistic contributions by anatomists are not only responsible for enlightening humankind to understand concepts of self and life, but they have also improved medical knowledge of the body’s inner workings, which to a certain degree has been kept secret. For most people, the human body represents an “unknown frontier”, as knowledge thereof has been exclusive to medical professionals, previously unattainable because of the high level of academia required – until now.
  Plastination exhibitions have been fiercely criticized and conversely, applauded. Developed by Gunther von Hagens of Germany, plastination is a technique in which a cadaver’s fluids are replaced with resins and plastic such that the body retains ironically “lifelike qualities,” even after death, and is indefinitely preserved (Wetz, 2000, p.385). The applications of plastination were originally limited to medical institutions’ teaching purposes, but have more recently been made publicly available in the hugely successful Body Worlds exhibitions that have travelled the globe (Bleyl, 1999, p.309). Due to the paucity of published debates in English on plastination exhibitions, this paper translates the main arguments on human dignity issues in plastination by two German philosophers, Bleyl and Wetz, and examines the classic conflicts of duty that occur when using Kant to argue against plastination.

• Thoughts on the Recently FDA-Approved HPV Vaccine: An Ethical and Historical Perspective on Mass Vaccination Programs by Daniel Wasser, Cornell Univeristy Read Abstract

  On June 8th 2006, the Food and Drug Administration approved the first vaccine ever developed to prevent cervical cancer and precancerous genital lesions due to human papillomavirus (USFDA, 2006). Many in the media and scientific community have declared the new vaccine Gardasil a victory against sexually transmitted disease and even cervical cancer itself. Recognizing the potential health benefits of the vaccine, Texas Governor Rick Perry on February 2nd 2007 ordered through executive mandate that all girls entering the sixth grade in Texas be vaccinated against HPV starting in 2008. This is in accordance with FDA guidelines as it approved the vaccine for all females between the ages of nine and twenty-six who had not yet contracted the virus (USFDA, 2006). Nevertheless, the tragic history of recent mass vaccination failures, such as the 1976 National Influenza Immunization Program against swine flu and the 2003 Smallpox Vaccination Program, demonstrates the inherent danger of rapid vaccination programs undertaken without adequate clinical research. The medical community must balance its fundamental ethical principles of patient autonomy and non-maleficence against the potential health benefits of Gardasil in assessing the government’s efforts to vaccinate such a large, indiscriminate and vulnerable segment of the population.

• On TRIPS, Access to Drugs, and the Expectation of Profit by Alexander Starks, Northwestern University Read Abstract

  In 1994, the World Trade Organization (WTO) implemented the Trade-Related Aspects of Intellectual Property (TRIPS) Agreement, which established standards for the protection of patents worldwide. Citing a utilitarian justification, known as the “incentiveto- invent-and-innovate” argument, the pharmaceutical industry has supported the enforcement of TRIPS, maintaining that pharmaceutical profits should be protected in order to maximally benefit society. However, it is worried that the protection of drug patents will further limit access to essential medicines in the developing world. In this paper, I use Peter Singer’s moral directive—“if it is within our power to prevent something bad from happening, without thereby sacrificing anything of comparable moral importance, we ought, morally, to do it”—in an attempt to show that the utilitarian justification for TRIPS is unethical and inadequate when applied to the developing world. In fact, considering that an insignificant portion of the industry’s profits actually comes from the developing world, it seems that the loss of that portion of profits is exactly the sort of thing that—under Singer’s directive—should be sacrificed in order to prevent access to drugs from declining. Finally, if access to drugs in the developing world is ever going to be substantially improved, then society must move away from the expectation that business in the developing world must always be profitable.

• The Legal Duty to Warn and the Evolution of Tarasoff by Bianca Gonzalez, University of Pennsylvania Read Abstract

  Tarasoff v. The Regents of the University of California (1974) has established the legal duty of clinicians to warn foreseeable victims of potential violent acts that have been communicated by psychiatric patients. Tarasoff has been cited by many courts and legislatures that have either chosen to broaden its application or to criticize it for being too broad and ambiguous. Some who stand in extreme opposition have even deemed it unnecessary to legally impose the duty to warn. This paper will address these contradicting views on Tarasoff, examining how the duty to warn has evolved over time and discussing the future of this controversial case.

• Feminist Perspectives, Pornography: Women as Commodities? by Craig Iffland, University of Virginia Read Abstract

  Feminist debates on pornography highlight a lingering philosophical dilemma among feminist philosophersthat of how feminists should respond to the woman who “chooses” to be subordinated. Feminist authors condemning pornography must do so at the expense of a woman’s presumably autonomous choice, the very type of choice championed by feminists. How, then, would a feminist author articulate a claim against the merchandising of woman via pornography without undermining a woman’s autonomy to choose? Some feminists suggest that the “choice” is not really autonomous, but is a result of the overarching patriarchy of modern societies. Others claim that the female actor in pornography is harmed by her participation in pornography. Feminist legal scholars have argued that toleration of pornography justified by government on free-speech grounds protects sexual abuse as speech. Justifications like these differ greatly from other condemnations of pornography in that they introduce “non-moral” concerns. However, it remains unclear why feminists should hesitate or disguise their positions against pornography as “non-moral”. Whether or not it is right that women are abused, even if they autonomously accept this abuse, is a moral question. To say self-chosen abuse is not right is to infer that a person’s making a genuine autonomous choice to do something is not, in itself, a factor that validates the rightness (as opposed to wrongness) of a certain act. This essay proposes a line of the moral reasoning for the regulation of pornographic films that puts forth the proposal that pornography, as it is now, should be regulated precisely because it treats “persons” (in this case women) as commodities.

• Globalization and Public Health: The Case of Bhopal by Joshua Farhadian, University of Pennsylvania Read Abstract

  On December 3, 1984, forty tons if methyl isocyanate (MIC) gas leaked from the Union Carbide pesticide plant located in the city of Bhopal, in the Madhya Pradesh Indian state. With over 200,000 individuals exposed to the toxic gas, the ensuing death and disability were disastrous. On the day of the leak, Indian hospitals recorded 2,850 associated deaths, with hundreds of thousands of injuries. Union Carbide blames internal sabotage as being responsible for the MIC leak; however exploitation and blatant neglect for Indian life, as well as globalization, appear to be contributing factors. In 1989, Union Carbide paid $470 million in an out-of-court settlement, yet many view the American company as not having faced sufficient justice. Over twenty-two years after the disaster, victims of Bhopal still suffer economic loss, unpaid healthcare bills, social disruption, and long term disability. The following paper presents an examination of the causes of the Bhopal disaster and analyzes its social, economic, and legal implications.

• Health Outcomes in Cuba Following the Transition by Katie Tuider, University of Pennsylvania Read Abstract

  Rationale: Cuba is at the brink of a natural health experiment due to its imminent political transition and so it is necessary to assess what are the possible health outcomes that may result from this transition. Background: In order to assess the possibilities of health outcomes in Cuba’s near future, this study analyzes the health outcomes of other countries during periods of transition such as Russia and Eastern bloc countries in the early 1990s. Methods and Sources: Literature review of Pubmed, WHO website to gain background for health outcomes of Russia and Eastern bloc countries, as well as Cuba. After the political transition in Cuba, data will be collected from MINSAP and/or directly from hospitals and clinics in Cuba. This data will be compared to Cuba’s current health outcomes. Expected Findings: If Cuba does not have a smooth political and economic transition, the health outcomes may decline reflecting those of Russia, Hungaria and Bulgaria in the early 1990s. If Cuba does however have a smooth economic and political transition, the current positive health outcomes that exist in Cuba will remain the same or follow a similar pattern to such Eastern bloc countries as East Germany, Poland and the Czech Republic, whose life expectancies actually increased during the transition. Limitations of Study: This study is based upon the transition of power in Cuba that is about to occur and so it is difficult to determine the nature of the transition at this point and in what direction health outcomes will go as a result of the political transition. Also, some of the health statistics from Cuba may be biased as a form of propaganda for the Cuban government. Possible Implications: If Cuba does experience a transition similar to that of Russia in the early 1990s, it is imperative to understand what triggers caused the mortality crisis in order to prevent such an event from occurring in Cuba as well.

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