Better Never to Have Been argues for a number of related, highly provocative, views: (1) Coming into existence is always a serious harm. (2) It is always wrong to have children. (3) It is wrong not to abort fetuses at the earlier stages of gestation. (4) It would be better if, as a result of there being no new people, humanity became extinct. These views may sound unbelievable--but anyone who reads Benatar will be obliged to take them seriously.

Are our lives meaningless? Is death bad? Would immortality be better? Alternatively, should we hasten our deaths by acts of suicide? Many people are tempted to offer comforting optimistic answers to these big questions. The Human Predicament offers a less sanguine assessment, and defends a substantial, but not unmitigated, pessimism.

While procreation is ubiquitous, attention to the ethical issues involved in creating children is relatively rare. In Debating Procreation, David Benatar and David Wasserman take opposing views on this important question. David Benatar argues for the anti-natalist view that it is always wrong to bring new people into existence. He argues that coming into existence is always a serious harm and that even if it were not always so, the risk of serious harm is sufficiently great to make procreation wrong. (...) In addition to these "philanthropic" arguments, he advances the "misanthropic" one that because humans are so defective and cause vast amounts of harm, it is wrong to create more of them.David Wasserman defends procreation against the anti-natalist challenge. He outlines a variety of moderate pro-natalist positions, which all see procreation as often permissible but never required. After criticizing the main anti-natalist arguments, he reviews those pronatalist positions. He argues that constraints on procreation are best understood in terms of the role morality of prospective parents, considers different views of that role morality, and argues for one that imposes only limited constraints based on the well-being of the future child. He then argues that the expected good of a future child and of the parent-child relationship can provide a strong justification for procreation in the face of expected adversities without giving individuals any moral reason to procreate. (shrink)

In Better Never to Have Been: The Harm of Coming into Existence, I argued that coming into existence is always a harm and that procreation is wrong. In this paper, I respond to those of my critics to whom I have not previously responded. More specifically, I engage the objections of Tim Bayne, Ben Bradley, Campbell Brown, David DeGrazia, Elizabeth Harman, Chris Kaposy, Joseph Packer and Saul Smilansky.

Procreation and Parenthood offers new and original essays by leading philosophers on some of the main ethical issues raised by these activities.

Peter Singer has argued that the affluent have very extensive duties to the world’s poor. His argument has some important implications for procreation, most of which have not yet been acknowledged. These implications are explicated in this paper. First, the rich should desist from procreation and instead divert to the poor those resources that would have been used to rear the children that would otherwise have been produced. Second, the poor should desist from procreation because doing so can prevent the (...) very bad things that would otherwise have befallen the children they would have brought into existence. Third, the rich sometimes have a duty to prevent the poor from procreating. Fourth, the rich sometimes have a right to prevent the poor from reproducing. Although these implications may not amount to a categorical prohibition on all procreation, they do significantly restrict the permissibility of procreation. They are, in that sense, anti-natalist. (shrink)

Many people are resistant to the conclusions for which I argued in Better Never to Have Been. I have previously responded to most of the published criticisms of my arguments. Here I respond to a new batch of critics (and to some fellow anti-natalists) who gathered for a conference at the University of Johannesburg and whose papers are published in this special issue of the South African Journal of Philosophy. I am also taking the opportunity to respond to two other (...) critics whose articles have previously been published in South African philosophy journals. Clearly I cannot respond to all the arguments in each of these papers and thus I shall focus on what I take to be some of the central issues in each. None of the arguments to which I shall respond have caused me to revise my views. However, I am pleased to have the opportunity to show why this is the case. (shrink)

Machine generated contents note: Preface; Introduction; Part I. Global Health, Definitions and Descriptions: 1. What is global health? Solly Benatar and Ross Upshur; 2. The state of global health in a radically unequal world: patterns and prospects Ron Labonte and Ted Schrecker; 3. Addressing the societal determinants of health: the key global health ethics imperative of our times Anne-Emmanuelle Birn; 4. Gender and global health: inequality and differences Lesley Doyal and Sarah Payne; 5. Heath systems and health Martin McKee; Part (...) II. Global Health Ethics, Responsibilities and Justice: Some Central Issues: 6. Is there a need for global health ethics? For and against David Hunter and Angus Dawson; 7. Justice, infectious disease and globalisation Michael Selgelid; 8. International health inequalities and global justice: toward a middle ground Norman Daniels; 9. The human right to health Jonathan Wolff; 10. Responsibility for global health? Allen Buchanan and Matt DeCamp; 11. Global health ethics: the rationale for mutual caring Solly Benatar, Abdallah Daar and Peter Singer; Part III. Analyzing Some Reasons for Poor Health: 12. Trade and health: the ethics of global rights, regulation and redistribution Meri Koivusalo; 13. Debt, structural adjustment and health Jeff Rudin and David Sanders; 14. The international arms trade and global health Salahaddin Mahmudi-Azer; 15. Allocating resources in humanitarian medicine Samia Hurst, Nathalie Mezger and Alex Mauron; 16. International aid and global health Anthony Zwi; 17. Climate change and health: risks and inequities Sharon Friel, Colin Butler and Anthony McMichael; 18. Animals, the environment and global health David Benatar; 19. The global crisis and global health Stephen Gill and Isabella Bakker; Part IV. Shaping the Future: 20. Health impact fund: how to make new medicines accessible to all Thomas Pogge; 21. Biotechnology and global health Hassan Masun, Justin Chakma and Abdallah Daar; 22. Food security and global health Lynn McIntyre and Krista Rondeau; 23. International taxation Gillian Brock; 24. Global health research: changing the agenda Tikki Pang; 25. Justice and research in developing countries Alex John London; 26. Values in global health governance Kearsley Stewart, Gerald T. Keusch and Arthur Kleinman; 27. Poverty, distance and two dimensions of ethics Jonathan Glover; 28. Teaching global health ethics James Dwyer; 29. Towards a new common sense: the need for new paradigms of global health Isabella Bakker and Stephen Gill; Index. (shrink)

Opinion about neonatal male circumcision is deeply divided. Some take it to be a prophylactic measure with unequivocal and significant health benefits, while others consider it a form of child abuse. We argue against both these polar views. In doing so, we discuss whether circumcision constitutes bodily mutilation, whether the absence of the child's informed consent makes it wrong, the nature and strength of the evidence regarding medical harms and benefits, and what moral weight cultural considerations have. We conclude that (...) nontherapeutic circumcision of infant boys is a suitable matter for parental discretion. (shrink)

Following promulgation of the Nuremberg code in 1947, the ethics of research on human subjects has been a challenging and often contentious topic of debate. Escalation in the use of research participants in low-income countries over recent decades, has intensified the debate on the ethics of international research and led to increasing attention both to exploitation of vulnerable subjects and to considerations of how the 10:90 gap in health and medical research could be narrowed. In 2000, prompted by the discussions (...) over several years that led to the US NIH launching a capacity building programme on research ethics for members of research ethics committees in developing countries, we advanced a ‘new look’ for the ethics of international research.1 Since then progress has been made on several fronts.First, our ideas—considered somewhat radical and impractical at the time—have been provocatively addressed by scholars who have either contested them or advanced similar conceptions of what obligations international researchers have to research participants and communities in low income countries before, during and after clinical trials. Second, those researchers who have been sympathetic to our ideas have either endeavoured to put these into practice or have investigated the feasibility of doing so. Third, the intractability of the 10/90 gap and the escalation of interest in global health have sensitised many to the need to amplify the uptake of these ideas in practice.Here, we briefly review the conceptual and practical developments in international research ethics. While much conceptual progress has been made (and the concepts are now appearing …. (shrink)

Humour is worthy of serious ethical consideration. However, it is often taken far too seriously. In this paper, it is argued that while humour is sometimes unethical, it is wrong much less often than many people think. Non-contextual criticisms, which claim that certain kinds of humour are always wrong, are rejected. Contextual criticisms, which take issue with particular instances of humour rather than types of humour, are more promising. However, it is common to overstate the number of contexts in which (...) humour is wrong. Various mistakes of this kind are highlighted and cautioned against. (shrink)

It is argued that the strength or scope of the right to reproductive freedom currently recognized in liberal democracies needs to be reconsidered, such that it does not include a right to engage in very risky or harmful procreation. More specifically, it is argued that if there would be no right to impose risk X of harm Y to some other person in non‐reproductive contexts, then there should be no right to do so in reproductive contexts. Thus, some (but not (...) all) methods, including some coercive methods, of preventing or discouraging such reproduction are morally acceptable. Two arguments against this thesis are examined. The first is the ‘non‐identity’ argument that people cannot be harmed by being brought into existence. This is an argument against the possibility of wrongful life. The second argument is that, although the interests of future people are important, these are outweighed by their parents' right to reproductive freedom. After discerning different senses of a right to reproductive freedom, four arguments for the special importance of reproductive freedom are considered. It is argued that none of them is sufficient to undermine the thesis that there should be limits on the right to reproductive freedom. Because of the long history of bias and arbitrary discrimination in curtailments of reproductive freedom, some suggestions for avoiding bias are provided. (shrink)

_Does sexism against men exist? What it looks like and why we need to take it seriously_ This book draws attention to the "second sexism," where it exists, how it works and what it looks like, and responds to those who would deny that it exists. Challenging conventional ways of thinking, it examines controversial issues such as sex-based affirmative action, gender roles, and charges of anti-feminism. The book offers an academically rigorous argument in an accessible style, including the careful use (...) of empirical data, and includes examples and engages in a discussion of how sex discrimination against men and boys also undermines the cause for female equality. (shrink)

Rodger et al 1 argue that ‘ethically defensible xenotransplantation should entail the use of genetic disenhancement if it is demonstrated that’ the pain and suffering of donor pigs ‘cannot be eliminated by other means’. The phrase ‘genetic disenhancement’ refers to genetic manipulation that would produce an animal that is either less able or entirely unable to experience pain and suffering. (The phrase is euphemistic because, on one possible reading, it suggests the removal of an existing enhancement, rather than what it (...) actually is, namely a diminishment relative to the species norm.) The authors acknowledge that genetic ‘disenhancement’ is not a ‘morally ideal ‘solution’, but argue that ‘it is morally better to prevent unavoidable pain until a viable non-animal alternative becomes available’ (p. 1). In advancing this argument, they explicitly state that they make no assumption that xenotransplantation is, in principle, morally permissible. They take no stand on that issue, which is beyond the scope of their paper. They assume only that ‘ (1) xenotransplantation research will inevitably continue and (2) causing pain and suffering requires sufficient justification’ (p. 1). However, in the absence of an assumption that xenotransplantation is, in principle, morally permissible, the authors have not established their …. (shrink)

Many people think that promiscuity is morally acceptable, but rape and pedophilia are heinous. I argue, however, that the view of sexual ethics that underlies an acceptance of promiscuity is inconsistent with regarding (1) rape as worse than other forms of coercion or assault, or (2) (many) sex acts with willing children as wrong at all. And the view of sexual ethics that would fully explain the wrong of rape and pedophilia would also rule out promiscuity. I intend this argument (...) neither as a case against promiscuity nor as either a mitigation of rape or a partial defense of pedophilia. My purpose is to highlight an inconsistency in many people's judgements. Whether one avoids the inconsistency by extending or limiting the range of practices one condemns, will depend on which underlying view of the ethics of sex one accepts. (shrink)

This chapter advances a misanthropic moral argument for anti-natalism. According to this argument, we have a presumptive duty to desist from bringing into existence new members of species that cause vast amounts of harm. Extensive evidence is provided to show that human nature has a dark side that leads humans to cause vast amounts of pain, suffering, and death to other humans and to non-human animals. Some of this harm is mediated by destruction of the environment. The resultant presumptive duty (...) we have not to create new humans is very rarely if ever defeated. Not all misanthropy is about humans’ moral failings. The chapter is followed by an appendix, in which aesthetic considerations against procreating are advanced. (shrink)

In this paper it is argued that the overwhelming majority of gamete donors are amongst those who treat decisions about bringing children into existence too lightly. The argument proceeds through the following stages. 1) People have a presumptive responsibility for rearing children who result from their gametes. 2) The responsibility people have to rear their offspring is a responsibility not merely to provide a minimum of care, but also to attend to the details of nurturing children and fostering their flourishing. (...) 3) Gamete donors transfer their responsibilities for raising their genetic offspring to those who will raise it. 4) Responsibilities for rearing children are weighty ones. 5) Treating weighty responsibilities too lightly is morally wrong. 6) Gamete donors' decisions to transfer their responsibilities for rearing their offspring to others, almost always involves treating parental responsibilities too lightly. 7) Therefore, gamete donation is almost always morally wrong. (shrink)

Interviews with David Benatar and Thaddeus Metz about some core aspects of their views about meaning in life, including debate between them. Accessible to a generally educated audience. Edited by Mark Oppenheimer and Jason Werbeloff.

Clinical research has become a burgeoning activity in recent years, largely stimulated by the pharmaceutical industry's interest in new drugs with high marketing profiles. Several other forces fuel this thrust: the increasing dependence of academic medical institutions on research funding from industry; the need for large, efficient multicenter trials to obtain reliable and statistically significant results in the shortest possible time for drug registration purposes; and access to research subjects in countries. The intense interest in HIV/AIDS research and recent controversies (...) about revisions to the Helsinki Declaration, which have been seen by some to be motivated by the desire to facilitate exploitative research in countries, have stimulated renewed interest in the ethics of clinical research. (shrink)

The field of bioethics has evolved over the past half-century, incorporating new domains of inquiry that signal developments in health research, clinical practice, public health in its broadest sense and more recently sensitivity to the interdependence of global health and the environment. These extensions of the reach of bioethics are a welcome response to the growth of global health as a field of vital interest and activity. This paper provides a critical interpretive review of how the term “global health ethics” (...) has been used and defined in the literature to date to identify ethical issues that arise and need to be addressed when deliberating on and working to improve the discourse on ethical issues in health globally. Selected publications were analyzed by year of publication and geographical distribution, journal and field, level of engagement, and ethical framework. Of the literature selected, 151 articles were written by authors in high-income countries, as defined by the World Bank country classifications, 8 articles were written by authors in low- or middle-income countries, and 13 articles were collaborations between authors in HIC and LMIC. All of the articles selected except one from 1977 were published after 1998. Literature on global health ethics spiked considerably from the early 2000s, with the highest number in 2011. One hundred twenty-seven articles identified were published in academic journals, 1 document was an official training document, and 44 were chapters in published books. The dominant journals were the American Journal of Bioethics, Developing World Bioethics, and Bioethics. We coded the articles by level of engagement within the ethical domain at different levels: interpersonal, institutional, international, and structural. The ethical frameworks at use corresponded to four functional categories: those examining practical or narrowly applied ethical questions; those concerned with normative ethics; those examining an issue through a single philosophical tradition; and those comparing and contrasting insights from multiple ethical frameworks. This critical interpretive review is intended to delineate the current contours and revitalize the conversation around the future charge of global health ethics scholarship. (shrink)

Nick Zangwill has argued that we have a moral duty to eat meat. His argument applies to the flesh of those domesticated animals who (a) would not have existed had it not been for the practice of killing and eating them; and (b) have lives that contain more good than bad—and thus, on his view, have “lives worth living.” In my reply, I point to various features of his argument that are unclear. I seek to render explicit the various premises (...) and inferences of his argument. I argue that there are problems with at least some of the premises. I also argue that his argument as a whole is liable to a reductio ad absurdum, which he considers, but to which he responds inadequately. I conclude that we ought to reject his argument. (shrink)

Recent decades have seen the emergence of two new fields of inquiry into ethical issues in medicine. These are the fields of bioethics and of health and human rights. In this critical review of these fields, the author argues that bioethics, partly because it has been construed so broadly, suffers from quality control problems. The author also argues that the field of health and human rights is superfluous because it does nothing that cannot be done by either bioethics of the (...) law. (shrink)

Interest in the ethics of research on human subjects, stimulated by atrocious human experimentation during WWII and the resultant Nuremberg Code, has been sustained by examples of unethical research in many countries and by proliferation of codes and guidelines. Such interest has intensified in recent years in association with expanding international collaborative research endeavors. The ongoing controversy in international research ethics takes place at two levels. At the practical level it is about the competing concerns of those predominantly interested in (...) doing research to advance knowledge and those who, while supporting the need for research, are more acutely aware of the potential to exploit vulnerable participants, especially in developing countries. At the level of theory the controversy pits ethical universalism against moral relativism.In her recent review of agreements and controversies in international research ethics, Ruth Macklin has concluded that, despite seeming agreement on several issues, many different viewpoints persist. In her view it is unlikely that these will be resolved easily. (shrink)

Economic globalization has profound implications for health. The scale of injustice at a global level, reflected in inexorably widening disparities in wealth and health, also has critical implications for health related research – in particular when the opportunities for exploiting research subjects are carefully considered. The challenge of developing universal guidelines for international clinical research is addressed against the background of a polarizing, yet interdependent, world in which all are ultimately threatened by lack of social justice. It is proposed that (...) in such a world there is a need for new ways of thinking about research and its relevance to health at a global level. Responsibility to use knowledge and power wisely requires more radical changes to guidelines for research ethics than are currently under consideration. (shrink)

Offers theoretical and practical guidance for addressing global health, and a deeper understanding of the challenges humanity faces.

Do our lives have meaning? Should we create more people? Is death bad? Should we commit suicide? Would it be better to be immortal? Should we be optimistic or pessimistic? Since Life, Death, and Meaning: Key Philosophical Readings on the Big Questions first appeared, David Benatar’s distinctive anthology designed to introduce students to the key existential questions of philosophy has won a devoted following among users in a variety of upper-level and even introductory courses. While many philosophers in the "continental (...) tradition"—those known as "existentialists"—have engaged these issues at length and often with great popular appeal, English-speaking philosophers have had relatively little to say on these important questions. Yet, the methodology they bring to philosophical questions can, and occasionally has, been applied usefully to "existential" questions. This volume draws together a representative sample of primarily English-speaking philosophers' reflections on life's big questions, divided into six sections, covering (1) the meaning of life, (2) creating people, (3) death, (4) suicide, (5) immortality, and (6) optimism and pessimism. These key readings are supplemented with helpful introductions, study questions, and suggestions for further reading, making the material accessible and interesting for students. In short, the book provides a singular introduction to the way that philosophy has dealt with the big questions of life that we are all tempted to ask. (shrink)

Background Tuberculosis is a major cause of morbidity and mortality globally. Recent scholarly attention to public health ethics provides an opportunity to analyze several ethical issues raised by the global tuberculosis pandemic. Discussion Recently articulated frameworks for public health ethics emphasize the importance of effectiveness in the justification of public health action. This paper critically reviews the relationship between these frameworks and the published evidence of effectiveness of tuberculosis interventions, with a specific focus on the controversies engendered by the endorsement (...) of programs of service delivery that emphasize direct observation of therapy. The role of global economic inequities in perpetuating the tuberculosis pandemic is also discussed. Summary Tuberculosis is a complex but well understood disease that raises important ethical challenges for emerging frameworks in public health ethics. The exact role of effectiveness as a criterion for judging the ethics of interventions needs greater discussion and analysis. Emerging frameworks are silent about the economic conditions contributing to the global burden of illness associated with tuberculosis and this requires remediation. (shrink)

In a recent paper, Rob Lawlor argues that moral theories should not be taught in courses on applied ethics. The author contends that Dr Lawlor’s arguments overlook at least two important roles that some attention to ethical theories may play in practical ethics courses. The conclusion is not that moral theory must be taught, but rather that there is more to be said for it than Dr Lawlor’s arguments reveal.

A number of problems plague universal declarations. To the extent that those drafting and adopting the declaration represent a range of different views, consensus can only be obtained if the declaration makes minimalist claims that all can support, or makes claims that are vague enough that they can be interpreted to everybody's satisfaction. To the extent that a universal declaration avoids these problems, and takes an unequivocal and controversial stand, it does so by privileging the view that is hegemonic. After (...) discussing these problems I ask whether such declarations could nonetheless do any good. (shrink)

Widening disparities in health within and between nations reflect a trajectory of ‘progress’ that has ‘run its course’ and needs to be significantly modified if progress is to be sustainable. Values and a value system that have enabled progress are now being distorted to the point where they undermine the future of global health by generating multiple crises that perpetuate injustice. Reliance on philanthropy for rectification, while necessary in the short and medium terms, is insufficient to address the challenge of (...) economic and other systems spinning out of control. Innovative approaches are required and it is suggested that these could best emerge from in-depth multidisciplinary research supported by endeavours to promote a ‘global mind-set.’. (shrink)

Medical practitioners have traditionally seen themselves as part of an international community with shared and unifying scientific and ethical goals in the treatment of disease, the promotion of health, and the protection of life. This shared mission is underpinned by explicit acceptance of traditional concepts of medical morality, and by an implied link between individual human rights and the ethics of medical practice long enshrined in a range of World Medical Association (WMA) and other medical codes. These have been powerful (...) instruments exhorting individual practitioners to promote health and to defend universal principles in order to protect their patients and the physician-patient relationship even in the face of authoritarian state coercion and imposed national ideologies and policies. There has been widespread support for this approach and this should be intensified. (shrink)

Disturbing international inequalities in health abound. Life expectancy in Swaziland is half that in Japan. A child unfortunate enough to be born in Angola has 73 times as great a chance of dying before age 5 as a child born in Norway. A mother giving birth in southern sub-Saharan Africa has 100 times as great a chance of dying from her labor as one birthing in an industrialized country. For every mile one travels outward toward the Maryland suburbs from downtown (...) Washington, DC on its underground rail system, life expectancy rises by a year – reflecting the race and class inequities in American health. Are the glaring, even larger, international health inequalities also unjust? All of us no doubt think they are grossly unfortunate. Many of us think they are unfair or unjust. Why should some people be at such a health disadvantage through no fault of their own, losers in a natural and social lottery assigning them birth in an unhealthy place? Others of us are troubled by the absence of the kinds of human relationships that ordinarily give rise to the claims of egalitarian justice that we make on each other – for example, being fellow citizens or even interacting in a cooperative scheme. Who has obligations of justice to reduce these international inequalities? And do those obligations hold regardless of how the inequalities came about? What institutions are accountable for addressing them? (shrink)

The progress of history rests on the battle for supremacy of competing ideas.... The power and wealth of western countries give them a dominant role in shaping the international public discourse. This is a privileged position... [an] imbalance of voice in the international discourse [that] has built up a dangerous sense of resentment by the silent majority of the world’s people. The dominant bioethical paradigm that provides the context for research ethics discourse has evolved within western philosophy’s powerful normative framework (...) and is built on a relationship model that explains and underpins the obligations doctors have to their patients. In this one-to-one relationship, the doctor is... (shrink)

In this article, it is argued that in the actual world, even if not in all possible worlds, sentience is both a necessary and sufficient condition for having moral standing. In arguing for this conclusion, the concepts of sentience and moral standing are explained. Five kinds of interest are then differentiated—functional, biotic, sentient, sapient, and self-conscious. It is argued that having sentient interests, rather than merely any interests, is what grounds moral standing. However, determining who has moral standing is only (...) a beginning. Once we know whose interests we need to consider, we still need to know what interests need to be considered. We also need to know what considering those interests implies. Those questions are engaged in the remainder of this article. (shrink)

Are fetuses, at any stage of their development, capable of feeling pain? In his paper, ‘Locating the Beginnings of Pain’, Stuart Derbyshire argues that they are not. We argue that he reaches this conclusion by way of conceptual confusion, a misreading of the available scientific data and the inclusion of irrelevant data. Despite his assertion to the contrary, the work of most scientists in the area supports the conclusion that fetuses can feel pain. At the outset we examine the concept (...) of pain and distinguish it from the allied concept of nociception, with which it is sometimes confused. With the relevant conceptual framework in place, we elucidate the problem of determining when, in its development, a human becomes capable of feeling pain. We then examine the available data showing how, on balance, it tends more to support than undermine the claim that fetuses of around 28 to 30 weeks' gestation are capable of feeling pain. (shrink)

Conventional and well-established guidelines for the ethical conduct of clinical research are necessary but not sufficient for addressing research dilemmas related to public health research. There is a particular need for a public health ethics framework when, in the face of an epidemic, research is urgently needed to promote the common good. While there is limited experience in the use of a public health ethics framework, the value and potential of such an approach is increasingly being appreciated. Here we use (...) two examples of adolescent women as potential candidates for participation in microbicide trials to illustrate how ethical decisions for public health research can be enhanced by drawing on both traditional research ethics guidance, and the emerging framework for public health ethics. (shrink)

The Ebola epidemic in West Africa is not merely a biomedical problem that can be seen in isolation and dealt with only through emergency medical rescue processes. The ethical dilemmas surfaced by this epidemic are also not confined to the usual micro-ethical problems associated with medical care and medical research. The pandemic, as one of many manifestations of failed human and social development that has brought the world to dangerous ‘tipping points’, requires deep introspection and action to address upstream causal (...) processes. (shrink)

It is widely acknowledged that the HIV and AIDS pandemic is a global emergency and that cheap, effective treatment should be provided for as many people as possible worldwide. But there are many challenges to rolling out antiretroviral treatment in resource-poor settings. These include the cost of drugs, sustaining their supply and distribution, the complexity of treatment regimens, selection of patients for treatment, shortage of medical and nursing personnel, inadequacy of healthcare facilities, the need for uninterrupted, lifelong treatment, and monitoring (...) for drug resistance. Great efforts, nationally and internationally, are required to meet these challenges. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.