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Sept-oct 03 report.qxd

BIOCHEMICAL WEAPONS AND HUMAN SUBJECTS RESEARCH The threat of biological and chemical terrorism highlights a growing tension in research ethics between respecting the interests of individuals and safeguarding and protecting the common good. But what it actually means to protect the common good is rarely scrutinized. There are two conceptions of the common good that provide very different accounts of the limits of permissible medical research. Decisions about the limits of acceptable medical research in defense of the common good should be carried out only Chemical and biological weapons are rightly re- could also be surprisingly low-tech solutions to de- garded with a special sense of horror. Their livery and dispersal. All this makes chemical and bio- effects can be both devastating and indiscrim- logical weapons uniquely potent tools for insurgency inate, taking the harshest toll on the most vulnerable classes of noncombatants. A biological attack may Responding to the threat of chemical and biologi- not even be discovered until long after a disease has cal weapons raises complex but important ethical spread through a population. Moreover, chemical questions. In a very real sense, the bulwark of last de- and biological weapons are especially attractive alter- fense against such agents must be mounted, not atop natives for groups that lack the ability to construct a wall or in a distant trench, but within the very bod- nuclear weapons. The 1995 release of sarin gas into ies of military and civilian personnel. Questions the Tokyo subway by the Aum Shinri Kyo group sug- about the limits of what can be justified in the name gested that effective delivery devices may be harder to of defense were raised during the first Gulf War.2 The procure than the chemical agents themselves, but the controversy surrounded a waiver that the Depart- 2001 anthrax attack in the United States, which used ment of Defense sought from the Food and Drug the postal service as a delivery device, showed there Administration that would allow it to administerpyridostigmine and botulinum toxoid vaccine toU.S. military personnel without their consent. Theconsent waiver was granted, but the vaccine was Alex John London, “Threats to the Common Good: BiochemicalWeapons and Human Subjects Research,” made available only on a voluntary basis. As the pos- sibility materializes that chemical and biological it rarely receives critical scrutiny, sets tially in times of relative peace and se- specification of when this is the case.
ble medical research in times of crisis.
often muted by the exigencies of war.
tion” and the “generic interests view.” sent in a social climate that is increas- Normative claim: There are circum-
18 H A S T I N G S C E N T E R R E P O R T Triggering condition:
Practical constraint:
munity, conceived of as an entity that whole. Jonas’s strategy is to argue that ments do not deny that civil liberties are important. It claims only that we may To paraphrase Cicero, law is often muted by the exigencies of war. ishing in every way.”9 As he puts it, “a uals and violations of their civil liber- The normative claim draws a con- search, therefore, because it is the less likely to destabilize the commu- ed ‘national priorities’ as a rationale right and, potentially, patients’ civil strict position is easily associated with nient position,” which is easily associ- sus,” with the special epistemic, or at dissenters as rational or reasonable.
20 H A S T I N G S C E N T E R R E P O R T mate basic interests of all parties.
in being able to develop and exercise their basic intellectual and affective ca- pacities and to pursue significant rela- tionships with each other. The goal is individuals as a result of their particu- Although appeals to the common good are familiar, it is rarely clear just what “the common good” actually refers to.
cise of their basic capacities for agency individual’s pursuit of his or her par- It is crucially important, therefore, tinguishes all of an individual's inter- view of the basic capacities of H A S T I N G S C E N T E R R E P O R T 21 tion. Just as all citizens have an inter- Rawls's "justice as fairness," by con- threaten interests that citizens share in biases in the laws or their execution.
does not diminish the justification terests of current trial participants in a vance the generic interests of both.
role in ensuring that clinical trials re- The presumption should be that individuals decide for themselves tion on agents’ control over their eco- terest in having their lives go well—in sure that trials protect these interests.
it is possible to design a trial that fully be justified only if it is absolutely nec- clinically significant benefit or protec- public safety, such as police officers or 24 H A S T I N G S C E N T E R R E P O R T 7. J.D. Moreno, “Bioethics after the Ter- tive to questions concerning distribution of American Journal of Bioethics 2, no. 1 welfare between individuals. In principle, if persecuting a minority yields a higher aggre-gate utility than equal treatment, then the 8. H. Jonas, “Philosophical Reflections persecution is justifiable. As Rawls puts it, Daedalus 98, no. 2 (1969): 219-47, at 221.
classical utilitarianism treats the political community as a single entity, thereby focus- ing moral and political deliberation on how best to maximize the overall well-being of Human Subject Protections in U.S. Medical Justice, 22-33.). Thus it appears to target the Research,” JAMA 24 (1999):1947-1952.
corporate conception of the common good. limits such as those sketched above.
to avoid this pitfall. David Brink’s “objective utilitarianism” is intended to provide a con- cal theories. Here, I have been trying to trast with subjective theories that reduce show that while there can be disagreements human welfare to mental states such as plea- over strict and lenient interpretations of the sure. Brink proposes a non-reductive, natu- triggering condition and these positions can ralistic account of human welfare whose pri- easily be associated with different compre- hensive moral and political theories, both pursuit and realization by agents of reason- interpretations presume tacit acceptance of able life projects and the development of personal and social relationships of mutual 13. To his credit, Jonas raises this issue Moral Realism and the Foundations of Ethics (“Philosophical Reflections on Experiment- 1989), 230-45, 262-90). Brink argues that what I am calling the corporate conception.
his account is distribution-sensitive because It is therefore appropriate to read Jonas’s ar- basic goods such as health, nutrition, and gument as dialectical in nature. That is, he is education, are either necessary conditions claiming that even if we assume the corpo- for the existence of value, or they are all- can still provide a sturdy foundation for in- pursue a wide range of individual life plans Conflict Resolution 9, no. 2 (1965): 200- (272),and, claims Brink, this definition of welfare does not permit trade offs between 2. J.M. Schofer, “Violations of Informed 14. When goals or ends conflict, an inte- access to basic goods for increases in social grative solution is one that modifies those utility (D.O. Brink, “Mill’s Deliberative 1657; E.G. Howe and E.D. Martin, “Treat- goals and ends so as to satisfy the underlying legitimate interests that provide the ratio- fairs 21, no. 1 (1992): 67-103). This is a no. 2 (1991): 21-24; G.J. Annas and M.A.
generic interests conception of the common ends. See J.Z. Rubin, D.G. Pruitt, S.H.
good, in the sense that it defines the com- Report 21, no. 2 (1991): 24-27; R.J. Levine, Social Conflict: Escalation, Stalemate, mon good in terms of a set of interests that and Settlement, second edition (New York: 3. J. Dao and J. Miller, “Pentagon Shifts and with respect to every other member of sessions and Freedom, ed. A. Kontos (Toron- to: University of Toronto Press, 1979), 39- Office, “Smallpox Vaccination: Implemen- April2003). “Update: Adverse Events Fol- tional constraints, see E.J. Emanuel, D.
Democracy: A Sympathetic Comment,”Philosophy and Public Affairs 29, no. 4 Wendler, and C. Grady, “What Makes Clin- 21. E.S. Anderson, “What Is the Point of good may be overlooked or dismissed be-cause its formulations are easily confused 5. W.J. Broad and J. Miller, “Report Pro- 22. A. Pollack and W.J. Broad, “Anti-Ter- vides New Details of Soviet Smallpox Acci- utilitarianism resembles the corporate con-ception because it identifies the good with a subjective mental state, such as pleasure, 23. M.E. Frisina, “The Offensive-Defen- and then evaluates states of affairs in terms sive Distinction in Military Biological Re- of the social aggregate of that good. A basic objection to classical utilitarianism is that its focus on aggregate utility makes it insensi-


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